Trajectories of quality of life among disaster victims: A national longitudinal study.

AIM: This study categorized quality-of-life trajectories among disaster victims in South Korea and identified the characteristics and predictors of each trajectory. BACKGROUND: Disaster victims experience tremendous physical and mental distress, which has a long-term impact on their quality of life. METHODS: We conducted a cross-sectional study using data obtained from the fourth Long-term Survey on the Change of Life of Disaster Victims conducted from 2017 to 2019. The study included 257 participants who experienced a typhoon, earthquake, or fire and completed the three-year follow-up. Latent transition analysis was used to identify the potential class of quality-of-life trajectories among disaster victims. Independent t tests, χ2 tests, and logistic regression were used to identify the predictors of quality-of-life trajectories. RESULTS: Two latent quality-of-life classes were identified: persistent low-level and persistent high-level. Factors associated with the persistent high-level trajectory included higher education level, no injury/disease from the disaster, better subjective health status, higher social support, and lower social maladjustment. DISCUSSION: Quality of life early after a disaster is maintained throughout subsequent years; early and active support following disasters is essential to promote its rapid improvement. CONCLUSION: Targeted educational programs in disaster-prone areas are recommended to bolster resilience among individuals with lower education. Moreover, governmental and institutional efforts are needed to support victims who lack resources for disaster recovery. IMPLICATIONS FOR NURSING AND HEALTH POLICY: There is a need to establish community-based social support systems and enhance nurses' disaster response capabilities to support vulnerable groups, with such interventions tailored to reflect disaster-affected victims' unique characteristics and needs, along with ongoing research and evaluation for continuous improvements to nursing practice and disaster response.

Investigating perceived core disaster competencies of nurses in Iran: A case study of northwest hospitals.

AIM: This study was carried out to investigate the perception of the main competencies of disaster management in Iranian emergency department nurses in 2023 in hospitals affiliated with Kermanshah University of Medical Sciences. The present study was conducted to explore the perceived core disaster competencies in nurses of hospitals affiliated with Kermanshah University of Medical Sciences in 2023. BACKGROUND: Due to the rise in natural disasters, their escalating severity and associated regulatory response necessitate a closer look at the preparedness and core competencies of nursing personnel. The main competencies of nurses are necessary to deal with disasters in unexpected events, and they are expected to use their professional expertise to provide the required nursing services to reduce the risks caused by disasters. METHODOLOGY: This descriptive-analytical study was conducted cross-sectionally between May and September 2023. In the study, a sample of 384 nurses working in the departments of four hospitals affiliated with Kermanshah University of Medical Sciences was selected through a random stratification. The data collection instrument was a 45-item scale of nurses' perceived core competencies (NPDCC) in handling disasters. The data were analyzed using the Mann-Whitney U-test, Kruskal-Wallis test, and independent samples t-test. The significance level was set at 5%. RESULTS: The mean total score of perceived core disaster competencies was 139.11 ± 37.65. The technical skills subscale got the highest score (51.81 ± 11.28) and critical thinking skills received the lowest (9.74 ± 3.92). Also, "technical skills" had the highest average and "critical thinking skills" had the lowest average in all three age groups. The results found a significant difference between the scores of nurses in perceived core disaster competencies in age groups, work environments, education degrees, marital statuses, and experiences of attending disaster workshops (p ≤ 0.05). CONCLUSIONS: The results showed that nurses had different levels of core disaster competencies in the department. There are gaps in the core disaster nursing competencies that need to be filled. Nursing managers should consistently evaluate the core nursing competencies to achieve efficacious disaster preparedness. To this aim, it is recommended that authorities implement training courses and programs to enhance the preparedness of nurses in responding to disasters.

Global trend and epidemiological profiles of climate-related disasters from 2000 to 2021.

OBJECTIVE: The objective of this study is to analyse the epidemiological profile of global climate-related disasters in terms of morbidity and mortality, as well as to examine their temporal trends. METHOD: This cross-sectional study analysed climate-related global disasters from 2000 to 2021, utilising definitions and criteria from the United Nations Strategy for Disaster Reduction and the Centre for Research on the Epidemiology of Disasters. Data were sourced from the EM-DAT database. The study assessed trends over the entire period and compared them with previous years (1978-2000). RESULTS: A total of 7398 climate-related disasters were recorded, with hydrological disasters being the most frequent, followed by meteorological and climatological disasters. Statistically significant differences were noted in the average rates of affected individuals and injuries per million inhabitants. No significant trends were found in mortality rates, but the frequency trends for the entire period (1978-2021) and the subperiod (1978-2000) were increasing and statistically significant. However, the trend from 2000 onwards showed a non-significant decrease, potentially reflecting better disaster preparedness and response strategies under the Hyogo and Sendai Framework. CONCLUSION: The study highlights hydrological disasters as the most frequent and deadliest climate-related events, with climatological disasters affecting and injuring the most people. The lack of standardised criteria for disaster inclusion in databases presents a significant challenge in comparing results and analysing trends. Establishing uniform inclusion criteria is crucial for effective data analysis and disaster management.

Improving the non-structural preparedness of the selected hospital based on the FOCUS-PDCA1 model: action research.

INTRODUCTION: With the intensification of the country's development process, the expansion of cities and population, and the inclusion of Iran in the accident-prone category, reducing the vulnerability of non-structures has received more attention from the organizations involved. In addition to damage to communities and infrastructure, accidents can affect hospitals and their non-organizational components. Hospitals, as the front line of providing medical services after accidents, must maintain their stability, ensure the safety of their patients and employees, and continue to operate without interruption as in normal conditions. Therefore, it is necessary to evaluate the non-structural safety and their preparedness to ensure they can perform acceptable in critical conditions. METHODS: This applied research was conducted in 2023 (September to December) using the participatory action research method in all selected hospital departments. The level of non-structural preparedness of the hospital was checked using the valid "Hospital Safety Index" questionnaire and the non-structural weaknesses of the hospital were identified. Then, in action research using the FOCUS-PDCA model, a program was implemented to improve the non-structural preparedness of different departments of hospitals in the face of accidents and disasters. The non-structural readiness level of the hospital was compared before and after the implementation of the change. RESULTS: Based on the evaluation conducted in the present study, the lowest level of safety was observed in the water supply system, office furniture and appliances, and fuel storage. The waste management systems, the fire protection system, and the long-distance communication systems were at a desirable performance level. Although in the evaluation before the change, the overall score of the hospital was 71.01%, and it had a desirable performance level in non-structural factors, in all the involved parts of the hospital, the sensitive, critical, and practical parts in the operation of the hospital had an average and sometimes low safety level. According to the obtained safety score, the safety level of the selected hospital before the change was 7 out of 10 (level seven of safety evaluation = medium). After the change and corrective measures, the non-structural safety assessment score was 76.93, and the hospital's safety level was raised by one step to 8 out of 10 (8th level of safety assessment = relatively favorable). CONCLUSION: The present study showed that the application of Total Quality Management (TQM), primarily its application tool FOCUS-PDCA, is efficient and helpful in improving the non-structural preparedness of hospitals. Using action research in the health field in accidents and disasters can open blind knots in different dimensions of preparedness (structural, non-structural, and functional).

Comprehensive risk assessment for identifying suitable residential zones in Manavgat, Mediterranean Region.

The absence of comprehensive risk analysis in residential development within certain regions often leads to substantial human and material losses during natural disasters. The Mediterranean region, particularly susceptible to the impacts of climate change, is projected to witness an upsurge in the frequency of natural calamities like floods, landslides, and forest fires. Consequently, meticulous risk assessment during the selection of residential areas becomes paramount in this context. This study is dedicated to the evaluation of suitable residential zones in Manavgat, a pivotal location in the Mediterranean region with a progressively growing population. The findings indicate that approximately 4.26 % of the research area is deemed appropriate for residential establishment. The identification of these locations is crucial for ensuring human and material safety, as well as enhancing overall biocomfort. Moreover, this study provides a foundation for long-term planning initiatives within the region and makes a significant contribution to the international evaluation literature by demonstrating the application of integrated risk assessment methodologies in urban planning.

Considerations for Psychological Debriefing in the Context of Prolonged Disaster Response.

First responders face greater exposure to potentially traumatic events compared with the general public, which can lead to an increased likelihood of developing mental health concerns. The challenges of disaster relief take a physical and mental toll on first responders. Critical incident stress debriefing (CISD), the widely accepted gold-standard treatment for psychological debriefing, is often applied to offset this toll among first responders. CISD is a manualized seven-stage group intervention that was developed to provide support and aid in coping and to allow individuals who respond to emergencies and disasters to continue working. Substantial evidence has been found for its effectiveness. However, there is a general dearth of evidence about the field of prolonged disaster response, and research is hampered by the difficulties of executing a controlled study in the context of an emergency scenario.

Evaluation of an On-Site Disaster Medical Management Course in Nepal.

The great 2015 Nepal earthquake of magnitude 7.6 killed about 9000 people. To better ensure a more coordinated disaster response, a Basic On-Site Disaster Medical Support (BOS-DMS) course was designed in 2017. This study evaluates the effectiveness of the BOS-DM course. The course was conducted twice and attended by 135 participants, of whom 113 (83.7%) answered pre-test and post-test based multiple-choice questions. Qualitative and quantitative feedback was provided by 94 participants (69.6%). Mean test scores for the participants increased from 4.24 ± 1.42 to 6.55 ± 2.16 (p-value < 0.0001; paired t-test). More than 92.0% of participants felt that the course prepared healthcare workers to manage acute medical situations at a disaster site. Subject knowledge scores increased from 34.8% to 90.2%. A three-day BOS_DMS course has the potential to improve on-site disaster management knowledge. Our study noted that precise scheduling, making attendance compulsory, translating course materials into the local language, inclusion of disaster exercises and training local master trainers can enhance course effectiveness.

Disaster preparedness among Asian, Pacific Islander, and Desi American communities.

Disaster experiences and explorations of preparedness among Asian, Pacific Islander, and Desi Americans (APIDA) in the United States are often overlooked owing to their relatively smaller population share. APIDA are not homogenous, and their disaster experiences warrant further examination. This paper does so by investigating disaster preparedness using disaggregated information about APIDA. The study utilises nationally representative data from the 2017 American Housing Survey, analysing sociodemographic covariates. The disaster preparedness score among APIDA communities was approximately 4.81 on a zero to nine scale. APIDA renters and non-US citizens were less prepared than homeowners and US citizens. Among subgroups, Korean, Chinese, and Vietnamese respondents who were non-US citizens were less prepared than those who were US citizens. Marital status was significantly and positively associated with preparedness among Indians, Japanese, Vietnamese, and multiracial respondents. The findings underscore the importance of data disaggregation and tailored preparedness information and resources to address specific challenges APIDA communities face instead of a one-size-fits-all approach.

Aral Sea environmental disasters area population's physical activity level assessment - the first step for targeted health promotion.

OBJECTIVE: Aim: We aimed to assess the physical activity and sedentary behavior of the population living in the Aral Sea area using the Global Physical Activity Questionnaire. PATIENTS AND METHODS: Materials: Data was collected from seven out-patient settings involving 445 participants (47.6% females, 52.4% males). The age of 33.6% of respondents was over 65. RESULTS: Results: Nearly a quarter (23.5%) of the participants did not meet World Health Organization physical activity recommendations. The Median Time spent on physical activity in recreation in all dispensaries among males (Md=34.29, IQR=66.43) was signif i cantly higher (Z=-4.78, p<0.001) than females (Md=12.86, IQR=51.43). A signif i cant association was observed between transport-related physical activity and gender (χ2= 5.60, p=0.018). The average percentage that comes from recreation-related activities among males (M=43.69, SD=26.90) was more signif i cant (MD=6.27, 95% CI: 0.46, 12.07) as compared to that of females (M=37.43, SD=31.66). A signif i cant association was observed between engagement in vigorous activity and gender (χ2= 30.77, p<0.001). CONCLUSION: Conclusions: Environmental, economic, demographic, and cultural peculiarities of the Aral Sea area should be considered in elaborating specif i c health promotion programs to shift health-harming ambient into health-improving environment.

Unveiling the heart of disaster nursing: A qualitative study on motivations, challenges, and lessons from the devastating 2023 Turkey earthquakes.

BACKGROUND: Turkey has faced a notable escalation in earthquake disasters in the last two decades. Despite initiating a health and disaster management system, nurses' pivotal roles and experiences in handling such crises have been disregarded. AIM: This qualitative study analyzed nurses' experiences before, during, and after deployment in response to the 2023 Turkey earthquakes to enhance disaster-response efforts. METHODS: This descriptive qualitative study was conducted between March and May 2023 using semistructured interviews with 15 nurses purposively  sampled among those who volunteered to work in the earthquake zone. The MIRACLE and COREQ guidelines were followed for reporting qualitative research. FINDINGS: The analysis exposed five main themes for pre-tasking: moral obligation, motivation, insufficient experience, balancing responsibilities, and preparation challenges. The peri-task themes include responsibilities, skills, bravery and characteristics, workload management, teamwork, and outcomes. Post-tasking has three themes: competence assessment, career goals and aspirations, and support. Training and coping with anxiety and stress are common themes for all phases. CONCLUSIONS: Disaster relief requires a comprehensive and coordinated response from healthcare organizations, government agencies, and support systems. Providing adequate training, ensuring safety protocols, offering mental health support, and fostering a fair and supportive work environment are crucial steps in mitigating the adverse effects on nurses and, by extension, the patient care process in earthquake-affected areas. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Nurse training in disaster preparedness should cover various response methods and involve multiple disciplines. Managers can help by arranging drills, simulations, online courses, and workshops and promoting partnerships for improved collaboration. Psychological support should be included to address emotional challenges. Regularly updating response policies based on past experiences is crucial for preparedness and efficiency.

Health consequences of disasters: Advancing disaster data science.

Understanding the health effects of disasters is critical for effective preparedness, response, recovery, and mitigation. However, research is negatively impacted by both the limited availability of disaster data and the difficulty of identifying and utilizing disaster-specific and health data sources relevant to disaster research and management. In response to numerous requests from disaster researchers, emergency managers, and operational response organizations, 73 distinct data sources at the intersection of disasters and health were compiled and categorized. These data sources generally cover the entire United States, address both disasters and health, and are available to researchers at little or no cost. Data sources are described and characterized to support improved research and guide evidence-based decision making. Current gaps and potential solutions are presented to improve disaster data collection, utilization, and dissemination.

Abstruse Side of Climate Change, Impact on Malaria: A Systematic Evidence Review Comparing Iran versus Globally.

Background: Infectious outbreaks due to disrupted social and environmental conditions after climate change-induced events complicate disasters. This research aimed to determine the contentions of bioclimatic variables and extreme events on the prevalence of the most common Climate-Sensitive Infectious Disease (CSID); Malaria in Iran. Methods: The present narrative systematic review study was conducted on the bioclimatic variable impact on the prevalence of malaria, as a common CSID. The search was conducted in 3 sections: global climate change-related studies, disaster related, and studies that were conducted in Iran. The literature search was focused on papers published in English and Persian from Mar 2000 to Dec 2021, using electronic databases; Scopus, Web of Science, PubMed, Google Scholar, SID, Magiran, and IranDoc. Results: Overall, 41 studies met the inclusion criteria. The various types of climatic variables including; Temperature, rainfall, relative humidity, and hydrological events including; flood, drought, and cyclones has been reported as a predictor of malaria. The results of studies, inappropriately and often were inconsistent in both Iran and other parts of the world. Conclusion: Identifying malaria outbreak risks is essential to assess vulnerability, and a starting point to identify where the health system is required to reduce the vulnerability and exposure of the population. The finding of most related studies is not congruent to achieve reliable information, more extensive studies in all climates and regions of the country, by climatic models and high accuracy risk map, using the long period of bioclimatic variables and malaria trend is recommended.

Digital Terror: Its Striking Impact on Public Mental Health.

Digital terror refers to the use of digital technology to disseminate graphic images of acts of violence to frighten the public. On October 7, 2023, militants of the Palestinian organization Hamas launched a brutal attack on Israel and used digital terror to magnify their acts. Although the purposeful spreading of terror via digital means is not new, the Hamas attack was significant for the scope, immediacy, and widespread dissemination of its digital content. This column aims to describe and analyze the psychological significance of this new form of terror, the public mental health challenges raised, and the interventions needed to assist those exposed to digital terror.

Assessment of psychiatrists' preparedness in managing disaster-related psychiatric disorders: a survey in Taiwan from post-graduate medical education perspective.

Background: Disaster-related psychiatric disorders (DRPD) present a significant challenge to mental health professionals, yet there is a notable lack of emphasis on the preparedness of psychiatrists in managing these conditions within post-graduate medical education. Methods: This study utilized a questionnaire to collect data from psychiatrists, focusing on their prior involvement in managing DRPD, perceived competence, medication preferences, and factors influencing their experiences in handling such disorders. Analysis included distribution and ranking of variables, alongside cross-analysis examining associations between demographic factors (age, gender, hospital levels, years of practice, board certification) and treatment experiences, as well as readiness for in-hospital or outside-hospital mobilization in DRPD management. Results: One hundred and three Taiwanese psychiatrists participated in the study, with the majority reporting involvement in managing DRPD (71.8%), particularly in post-traumatic stress disorder (PTSD) and depression. Antidepressants, specifically serotonin selective reuptake inhibitors, were commonly preferred for DRPD treatment, including PTSD and depression. Psychiatrists aged over 40, with more than 10 years of practice, and hold the board-certified status, showed greater experiences for outside- or inside- the hospital mobilization in DRPD management. Conclusion: Findings suggest that within post-graduate medical education, Taiwanese psychiatrists demonstrate significant experience, willingness, and capacity to effectively manage DRPD. However, there is a need to integrate comprehensive training on disaster psychiatry into post-graduate psychiatric education programs to further enhance preparedness and optimize outcomes in managing these challenging conditions.

Searching for a sustainable solution to increasing chemical pollution.

The growing world population and the development of civilization put pressure on the environment. Irreversible climate changes, biodiversity loss, ocean acidification, land and water degradation, and food scarcity took place. Climate changes affect human health through extreme atmospheric phenomena or indirect effects of ecosystem disruption. The intensification of natural disasters increases the risk of technical failures, and the growing production and release of larger quantities and more new chemical compounds, with different hazard potentials, exceeds the environment's adaptability and societies' ability to monitor changes and conduct safety assessments. The article reviews the knowledge and approach to the possibility of reducing the risks and effects of events resulting from chemical pollution. As stated, prevention of further environmental degradation and increased preparedness for natural disasters caused by climate change is critical to public safety and requires contingency plans to continuously adapt to the changing frequency, intensity, and scale of natural disasters.

The role of social capital in the impact of multiple shocks on households' coping strategies in underdeveloped rural areas.

Social capital has long been recognized as a facilitator of socio-economic development. However, the role of social capital in enhancing resilience to multiple shocks in rural China remains insufficiently explored. This study focus on the resilience of households that have recently get rid of poverty and reside in underdeveloped rural areas of China. Unlike previous studies, the article incorporates multiple shocks, social capital, and households' coping strategies into a research framework at the micro level. This study systematically analyses the multiple shocks experienced by households, their coping strategies, and further explores the mediating role of social capital. Utilizing two waves of a rural household panel survey data collected in six underdeveloped counties in 2015 and 2018 in China, we present four key findings. Currently, households primarily contend with drought, illness of family members, and the high costs of agricultural inputs as the main shocks. Their predominant coping strategy is reducing consumption. Importantly, social capital exhibits a mediating effect, accounting for 9.8% of the impact of multiple shocks on households' coping strategies. Notably, natural disasters significantly diminish the informal functions of social capital. While social capital exerts a full mediating effect in non-agricultural households, this effect is not observed among others. This study contributes to a better understanding of the dynamics and specificities of social capital in vulnerable rural areas. Additionally, the findings provide policymakers with practical insights regarding differentiated and preemptive risk governance approaches.

Nursing students' willingness to respond in disasters: a cross sectional study of facilitators and barriers.

INTRODUCTION: The preparedness of the healthcare system to address emergency situations is contingent on the inclination of healthcare personnel. Nursing students can serve as valuable resources to supplement the workforce during major incidents and disasters. This study investigated the facilitators and barriers of nursing students' willingness to respond to disasters at the Alborz University of Medical Sciences in 2022. METHODS: In this cross-sectional descriptive study, 234 nursing students were recruited using convenience sampling. A deductive-inductive questionnaire was developed and distributed through an online self-administered survey comprising demographic information and questions on barriers, facilitators, various disaster scenarios, preferred activities, and reasons for pursuing a nursing career. RESULTS: The mean willingness scores of nursing students in response to various disasters were as follows: 3.15 for natural disasters, 2.60 for man-made disasters, 2.94 for pandemics, and 3.32 overall. Among the disaster scenarios, the earthquake response obtained the highest willingness score, while infectious disease epidemics received the lowest score. The most and least willingness to perform activities during disaster response were related to bedside care and participation in patients' personal hygiene, respectively. Key determinants of participation included the possibility of immunization and concerns for family safety. CONCLUSION: The findings indicated that nursing students are generally willing to assist as members of the healthcare team during disasters. However, the willingness to respond to infectious disease epidemics and man-made disasters was below the norm. Concerns about family health and the risk of disease transmission were identified as primary barriers. Addressing these concerns is crucial to enhance nursing students' participation in disaster response.

Maternal experiences of pregnant women affected by natural disasters: A modified grounded theory approach.

Pregnant women experience medical and psychological difficulties in their daily lives during disasters. Since the care provided to them in disaster situations is unclear, it is necessary to better understand their experiences. This study aims to identify the maternal experiences of pregnant women during natural disasters. This research employed a modified grounded theory approach. Twenty-three pregnant women, living in disaster-affected areas, were interviewed. The research methods were utilized and interpretive analysis was conducted, resulting in a diagram and storyline to describe the process. The characteristics of the maternal experiences fluctuated between "being unable to face pregnancy because of the disaster response" and "facing the fact of being pregnant." To maintain a fluctuation between their affected life and their pregnant life, it was necessary to control the weighting between "securing a safe and secure place," "encountering support based on pregnancy," and "signs from the fetus." Clarifying the maternal experiences of pregnant women living in disaster areas revealed a multilayered structure of categories and relationships. This study suggests that understanding the structure of fluctuations and control is critical for the nursing practice.

Building a National Standard for Outreach and Assistance to At-Risk Patients During Large-Scale Disasters.

Health care institutions play an essential role in community resilience. As one of the largest health care systems in the United States, the Veterans Health Administration (VHA) plays a critical role in supporting medically vulnerable Veterans during disasters. Disasters require large-scale outreach to individuals in affected areas, including the capability to identify patients, establish contact, determine needs, and deliver required services. Here we describe the development and implementation of VHA's Vulnerable Patient Care, Access, and Response in Emergencies (VP CARE) program, a data-driven system of outreach to preidentified medically vulnerable patients, which seeks to streamline this process. VP CARE was inspired by the VHA's Home-Based Primary Care (HBPC) program and the US Department of Health and Human Services' emPOWER program. It seeks to enhance Veteran patients' well-being and continuity of care during disasters using 3 components: (1) improving the readiness and resilience of vulnerable patients and their caregivers; (2) establishing an organization, policies, procedures, and competency-based training exercises to guide outreach and assistance; and (3) creating and implementing standardized 1- and 2-way outreach technology and reporting. Using Geographic Information Systems embedded in VP CARE, VHA can generate a list of high-risk patients and deploy a 2-way texting capability to contact and receive responses from them. VP CARE automatically tracks patient contact and responses, reducing duplication of effort and freeing up VA staff to focus on patients with immediate needs. Patients and their caregivers benefit from the reassurance of knowing that VHA is focused on their well-being and available to support them. The technologies deployed in VP CARE improve the efficiency of outreach efforts and reduce the risk of life-threatening harm, while reducing the cost and demands on VA staff. This article concludes with lessons learned that may be instructive for other health care systems seeking to establish similar outreach capabilities.

Adolescents' Tsunami Exposure and Mental Health Consequences: Protective Role of Cultural Coping Strategies.

There is a knowledge gap regarding the link between disaster exposure and adolescent mental health problems in developing countries. This study examines the case of Sri Lanka to investigate (a) the immediate and long-term mental health impact of the 2004 tsunami disaster on adolescents and (b) the potential moderating effects of unique cultural and family practices that prevail in Sri Lanka. This study used a random sample of 160 adolescents (ages 12-19) and their mothers who were exposed to the tsunami disaster while living in a southern Sri Lankan village and provided prospective data immediately after the disaster (2005) and three years later (2008). A cross-culturally validated instrument assessed adolescent-mother dyads' tsunami exposure, stressful loss, family cultural rituals and familism, and adolescent mental health. Structural equation modeling analysis showed that exposure and perceptions of tsunami-induced stressful experiences were associated with early and later mental health problems in adolescents. In addition, this study found that unique cultural practices and familism moderated the link between adolescent tsunami exposure, stressful experiences, and levels of PTSD and depressive symptoms. The findings of this study could be utilized to develop prevention and intervention programs that are contextually and culturally valid and empirically supported, which would be more effective for trauma-exposed adolescents in developing countries.