Research reportPosttraumatic stress disorder symptom trajectories in Hurricane Katrina affected youth
Introduction
An estimated 14% of American youth experience a disaster during their childhood (Becker-Blease et al., 2010). Disaster-exposed youth are at risk for developing symptoms of posttraumatic stress disorder (PTSD), (Norris et al., 2002, Osofsky et al., 2009, Yelland et al., 2010). Research on the longitudinal course of youth PTSD following disasters indicate that the majority of symptoms remit in the months and years following the event (Kronenberg et al., 2010); however, persistence or worsening of symptoms also has been documented (e.g., Bokszczanin, 2007, Goenjian et al., 2005, John et al., 2007, Lai et al., In Press).
Hurricane Katrina was one of the worst natural disasters in U.S. history in terms of death, destruction, and delayed recovery (Knabb et al., 2006). Researchers studying youth who experienced Katrina have found variability in post-trauma symptoms. For instance, Marsee (2008) found that 63% of youth reported symptoms of PTSD 15–18 months post-Katrina, while 27% reported no symptoms. In comparison, Kronenberg et al. (2010) found that 45% of youth did not meet the clinical cutoff for symptoms at either a two or three year post-Katrina assessment time point, and 27% who initially met the clinical cutoff at year two, were recovered one year later. However, there were some youth who exhibited more chronic pattern trajectories, with 23% of youth demonstrating no reductions in symptoms over time, and 4% had an increase in symptoms. These findings are commensurate with how (Bonanno and Mancini, 2008) conceptualize post-disaster adult recovery patterns, in terms of resilience (absence of elevated PTSD symptoms), recovery (initially elevated PTSD symptoms that decline to adaptive functioning levels), chronic dysfunction (elevated PTSD symptoms that do not abate with time), and delayed trauma (PTSD symptoms increase over time to elevated levels).
To date, published research examining post-disaster outcomes in youth over time has relied on analytic strategies that permit assessment of mean-level changes in PTSD symptoms. This approach does not allow characterization of differing trajectories of more chronic and less symptomatic children. Growth mixture modeling is an analytic approach that allows for explication of differing trajectories (Curran and Hussong, 2003, Muthén and Asparouhov, 2008), as well as factors associated with each trajectory. This approach has been increasingly utilized in the adult trauma and PTSD symptom literature (e.g., Dickstein et al., 2010, Elliott et al., 2005, Galatzer-Levy et al., 2011, Orcutt et al., 2004), with results indicating significant heterogeneity in trajectories of PTSD symptoms over time.
Although growth mixture modeling has not yet been applied to studying youth after natural disasters, a few emerging studies have used these techniques with youth exposed to other types of trauma (e.g., Amstadter et al., 2009; Le Brocque et al., 2010, Nugent et al., 2009). For example, Nugent and colleagues (2009) examined latent class trajectories of PTSD symptoms in youth ages 7 to 18 years who had been exposed to family violence. Results indicated a resilient trajectory group and a persistent symptom trajectory group. Similarly, Le Brocque et al., 2010 used this approach to examine the course of PTSD symptoms for youth following an accidental injury. Three trajectories emerged, including youth who were resilient following the accident, those who initially experienced high levels of stress but recovered quickly, and, lastly, those with chronic stress patterns. Collectively, these studies support the notion that youth response to trauma is not homogenous, and that the distinct PTSD trajectory paths emerge.
Patterns of post-disaster recovery in youth are impacted by multiple factors that can serve to enhance the risk of negative trajectories or promote resilience (Weems and Overstreet, 2008), and such factors can be important in distinguishing PTSD trajectories. Similar to prior research examining youth outcomes post-disaster (e.g., La Greca et al., 1998; La Greca et al., 2010; Vernberg et al., 1996, Russoniello et al., 2002, Neuner et al., 2006), emerging research evaluating Katrina-affected youth indicate differential outcomes based on individual-level and microsystem-level (i.e., family and other systems in the child’s immediate environment, Brofenbrenner, 1979) risk and protective factors. For instance, several studies have indicated that individual-level factors, such as Hurricane loss and life disruption following Katrina, are associated with youth-reported posttraumatic stress symptoms (Kelley et al., 2010, Rowe et al., 2010). Furthermore, Weems et al. (2007) found that youth pre-disaster anxiety and negative affect significantly influenced Katrina-related posttraumatic stress symptoms. In regard to microsystem-level factors, (Kronenberg et al., 2010) found that life stressors, including school and family problems, increased risk for poor long-term outcomes post-Katrina, while Kelley and colleagues (2010) found that violence exposure and parent behavior significantly impacted youth PTSD symptoms.
The aim of the current study was to identify trajectories of youth’s PTSD symptoms following Hurricane Katrina, as well as risk and protective factors associated with each trajectory. In terms of risk, youth-reported disaster loss and disruption, as well as youth exposure to other traumatic events, specifically, home and community violence, were examined. Parental and peer social support, which researchers have found to be associated with positive youth post-disaster outcomes (Khoury et al., 1997, La Greca et al., 1996), were examined as potential protective factors. Latent Class Growth Analysis, a subset of growth mixture modeling, was employed to identify youth’s varying PTSD symptom trajectories. Based on prior research, we hypothesized that distinct PTSD symptom trajectories would emerge among Hurricane Katrina-exposed youth, and that youth who reported higher levels of Hurricane loss/disruption and violence exposure, as well as lower levels of social support, would be at greatest risk for a chronic and persistent PTSD symptom trajectory.
Section snippets
Participants
Participants were 426 children living in New Orleans and the surrounding area when Hurricane Katrina made landfall. The majority were displaced from their home as a result of the Hurricane (75%). Children (51% female) ranged in age from 8 to 16 years old (M=11.63 years; SD=2.26) and were in grades 4–8 at Time 1. Children were primarily African American (68%), with 25% identifying as Caucasian, and 7% as other ethnicities. Median income prior to Hurricane Katrina was below $25,000; 56% of
Preliminary analyses
Mean-level analysis of PTSD symptoms for all participants in this study showed a decline in severity across all time points. The average score at Time 1 (M=18.13, SD=14.57) fell within the mild range, according to published cutoff scores. Time 2 (M=14.41, SD=12.96) and Time 3 (M=12.53, SD=12.66) scores also fell within the mild range; however, by Time 4, scores had decreased to 10.57 (SD=11.18) which falls within the doubtful range. This pattern is similar to other studies showing a decline in
Discussion
This study explored PTSD symptom trajectories over a two-year period for youth who were exposed to Hurricane Katrina. In contrast to other published research evaluating youth post-disaster, this study employed latent class growth analysis, a subset of growth mixture modeling techniques, which allowed for the examination of distinct PTSD symptom trajectories following a significant traumatic event, as well as risk and protective factors associated with PTSD symptom trajectories. Results
Disclaimer
The views and conclusions contained in this document are those of the authors and should not be interpreted as necessarily representing the official policies, either expressed or implied, of the US Department of Homeland Security.
Role of funding source
This material is based upon work supported by the US Department of Homeland Security under Award Number: 2008-ST-061-ND 0001 and a research grant from the National Institute of Mental Health (RMH-078148A).
Conflict of interest
All other authors declare no conflicts of interest for this project.
Contributors
Author Kelley designed the overall study from which the data were collected. Author Self-Brown designed the study questions for the current study, as well as wrote the introduction and discussion. Author Lai completed the analyses and results section. Author McGill completed lit searches, contributed to the editing of the document, and completed the references. Author Thompson wrote the methods section of the paper. All authors contributed to and have approved the final manuscript.
Acknowledgement
This material is based upon work supported by the US Department of Homeland Security under Award Number: 2008-ST-061-ND 0001 and a research grant from the National Institute of Mental Health (RMH-078148A).
References (50)
Diagnostic and Statistical Manual of Mental Disorders
(2000)- et al.
Longitudinal trajectories of cigarette smoking following rape
Journal of Traumatic Stress
(2009) - et al.
Disasters, victimization, and children’s mental health
Child Development
(2010) PTSD symptoms in children and adolescents 28 months after a flood: age and gender differences
Journal of Traumatic Stress
(2007)- et al.
Weighing the costs of disaster: consequences, risks, and resilience in individuals, families, and communities
Psychological Science in the Public Interest
(2010) - et al.
Psychological resilience after disaster
Psychological Science
(2006) - et al.
The human capacity to thrive in the face of potential trauma
Pediatrics
(2008) - et al.
Is youth victimization related to trauma symptoms and depression after controlling for prior symptoms and family relationships? A longitudinal, prospective study
Journal of Consulting and Clinical Psychology
(1996) The Ecology of Human Development: Experiments by Nature and Design
(1979)- et al.
The use of latent trajectory models in psychopathology research
Journal of Abnormal Psychology
(2003)
Heterogeneity in the course of posttraumatic stress disorder: trajectories of symptomatology
Journal of Traumatic Stress
Patterns of treatment response in chronic posttraumatic stress disorder: an application of latent growth mixture modeling
Journal of Traumatic Stress
Development of a screening instrument for exposure to violence in children: the KID-SAVE
Journal of Psychopathology and Behavioral Assessment
Peritraumatic and trait dissociation differentiate police officers with resilient versus symptomatic trajectories of posttraumatic stress symptoms
Journal of Traumatic Stress
A prospective study of posttraumatic stress and depressive reactions among treated and untreated adolescents 5 years after a catastrophic disaster
American Journal of Psychiatry
Manual for the Social Support Scale for Children
Development and validation of the screen for adolescent violence exposure (SAVE)
Journal of Abnormal Child Psychology
The prevalence of posttraumatic stress disorder among children and adolescents affected by tsunami disaster in Tamil Nadu
Disaster Management and Response
An introduction to latent class growth analysis and growth mixture modeling
Social and Personality Psychology Compass
Predicting posttraumatic stress symptoms in children following Hurricane Katrina: a prospective analysis of the effect of parental distress and parenting practices
Journal of Traumatic Stress
The impact of Hurricane Andrew on deviant behavior among a multi-racial/ethnic sample of adolescents in Dade County, Florida: a longitudinal analysis
Journal of Traumatic Stress.
Children of Katrina: lessons learned about postdisaster symptoms and recovery patterns
Child Development
Hurricane-related exposure experiences and stressors, other life events, and social support: concurrent and prospective impact on children’s persistent posttraumatic stress symptoms
Journal of Consulting and Clinical Psychology
Symptoms of posttraumatic stress in children after Hurricane Andrew: a prospective study
Journal of Consulting and Clinical Psychology
Cited by (72)
Climate change impacts on the mental health and wellbeing of young people: A scoping review of risk and protective factors
2022, Social Science and MedicineCitation Excerpt :One study found that, after hurricane Katrina, children and adolescents living in communities with more evidence of law-breaking behaviours, such as graffiti, were more likely to experience emotional disturbance (Abramson et al., 2010) and depression (Salloum et al., 2011). Two longitudinal studies found that instead of recovering from internalising disorders over time, children and adolescents exposed to more community violence were more likely to have persistent high levels of distress two years after the hurricane (Lai et al., 2015; Self-Brown et al., 2013). Only three studies explored risk and protective factors in the marco-system level, and all of them examined cultural identity related factors.
Genome-wide Signatures of Early-Life Stress: Influence of Sex
2022, Biological PsychiatryAnxiety and resilience in the face of natural disasters associated with climate change: A review and methodological critique
2020, Journal of Anxiety DisordersCitation Excerpt :Studies have also linked specific stressors to anxiety and related outcomes. Initial loss and disruption, as well as community violence, were shown to predict chronically distressed over resilient trajectories of PTS in Hurricane Katrina affected youth (Self-Brown, Lai, Thompson, McGill, & Kelley, 2013). Perception of risk and perceived life threat have been linked to post-disaster PTSD among children and adolescents (McDermott, Lee, Judd, & Gibbon, 2005; Yelland et al., 2010), and a greater likelihood of developing generalized anxiety disorder among adults (Moosavi et al., 2019).
Trauma and Turnout: The Political Consequences of Traumatic Events
2023, American Political Science ReviewScoping review on trauma and recovery in youth after natural disasters: what Europe can learn from natural disasters around the world
2024, European Child and Adolescent Psychiatry