Natural Disasters, War, and Children’s Mental Health

The role of prenatal maternal stress (PNMS) from a natural disaster on cognitive and language development of mothers' offspring has been reported.¹ In 1998, an ice storm in Quebec resulted in power outages lasting up to 6 weeks and affecting more than 3 million people. Approximately 6 months after the storm, 89 women who were pregnant during the natural disaster completed questionnaires related to specific events regarding the storm (“objective stress” ) and stress related to the storm events (“subjective stress”). Objective stress included items such as number of days without electricity, number of relocations, severity of damage to residences, and changes in daily activities. Subjective stress included symptoms such as intrusive thoughts, hyperarousal, and avoidance.

To assess any long-term effects of PNMS, the children of these mothers were evaluated when they were 5 1/2 years old. The Wechsler Preschool and Primary Scale of Intelligence-Revised was administered to the children to assess intellectual functioning. Language abilities were assessed using the Peabody Picture Vocabulary Test-Revised. Children who were exposed in utero to high levels of objective PNMS had lower language abilities and lower full-scale IQs and verbal IQs than children who were exposed in utero to low levels of objective stress. The amount of subjective stress experienced by the pregnant women had no association on the children’s cognitive and language abilities. The authors concluded that events that befall pregnant women have more impact on the developing fetus than does the subjective distress associated with those events.

The effects of natural disasters, war, and family violence on the mental health of 296 children and adolescents in Sri Lanka were studied.² These children and adolescents (9 to 15 years old), who were exposed to civil war and the Asian Tsunami, completed a survey regarding war-related events, tsunami exposure, and family violence. Of those surveyed, 82% had experienced at least 1 war-related event in their lifetimes. The most common events were seeing a dead or mutilated body (44%), being close to a combat situation (40%), and witnessing gunfire or shelling (33%). Seventy-one percent of the children were directly affected by the tsunami; more than half had seen the wave close by; almost all had to flee; and about a quarter had been caught by the wave.

Nearly all of these children (96%) reported experiencing or witnessing some type of domestic violence event. The psychiatric status of the children was evaluated by a diagnostic interview, and 30% met the criteria for posttraumatic stress disorder (PTSD). There was a relationship between cumulative stress (war, tsunami, and family violence) and the severity of PTSD. Twenty percent of the children met the criteria for major depressive disorder, and 17% had current suicidal ideation.

The Sri Lankan study illustrates the effects of war, violence, and natural disasters on the mental health of children. There is a pressing need to identify effective treatments for youths who have been exposed to these adverse conditions. Recently, the results from 3 studies using school-based interventions to treat youths who have been exposed to war were reported.

In one study, participants comprised 127 youths who were exposed to war in Central Bosnia and who had symptoms of PTSD, depression, or maladaptive grief and impairment in relationships and school.³ These youths (mean age, 16 years) were randomized to classroom-based psychoeducation and skills intervention (problem solving, coping, and social support) or the school-based treatment condition and a trauma- and grief-focused group therapy treatment. Both treatment groups showed significant reduction in PTSD and depressive symptoms.

In another study, the efficacy of school-based intervention was assessed in a sample of 403 children (mean age, 10 years) who had been exposed to armed conflict in Central Sulawesi, Indonesia.⁴ These children had symptoms of PTSD and anxiety. They were randomized to a 15-session, school-based intervention or a wait-list control group. The intervention included cognitive-behavioral techniques, cooperative play, and creative-expressive elements (eg, drama, dance, music).

Those in the school-based group had significantly more improvement in PTSD symptoms and increased hope than did those in the wait-list control group. However, stress-related physical symptoms, depressive symptoms, anxiety, and functioning did not differ between the treatment and wait-list control groups. The authors speculated that psychosocial intervention alone was not sufficient to counter the chronic poverty and political instability in the region. They suggested that poverty reduction and conflict resolution in addition to psychosocial intervention may be necessary to improve the mental health functioning of these children.

The efficacy of a mind-body skills group was assessed for 28 adolescents with PTSD in postwar Kosovo.⁵ The youths were randomized to 12 weeks of a mind-body skills group program or to a wait-list control group. The mind-body techniques included relaxation, guided imagery, meditation, biofeedback, and breathing. It also included self-expression (eg, drawings, written exercises, dancing) to decrease tension and increase self-expression. Adolescents in the mind-body skills group had significantly reduced PTSD symptoms compared with the wait-list control group. The improvement in PTSD symptoms was maintained at 3 months following the intervention. Those in the wait-list control group also showed a significant decrease in PTSD symptoms after they received the mind-body skills group intervention.

References:

References

1. Laplante DP, Brunet A, Schmitz N, et al. Project Ice Storm: prenatal maternal stress affects cognitive and linguistic functioning in 5 1/2-year-old children. J Am Acad Child Adolesc Psychiatry. 2008;47:1063-1072.

2. Catani C, Jacob N, Schauer E, et al. Family violence, war, and natural disasters: a study of the effect of extreme stress on children’s mental health in Sri Lanka. BMC Psychiatry. 2008;8:33.

3. Layne CM, Saltzman WR, Poppleton L, et al. Effectiveness of a school-based group psychotherapy program for war-exposed adolescents: a randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2008;47:1048-1062.

4. Tol WA, Komproe IH, Susanty D, et al. School-based mental health intervention for children affected by political violence in Indonesia: a cluster randomized trial. JAMA. 2008;300:655-662.

5. Gordon JS, Staples JK, Blyta A, et al. Treatment of posttraumatic stress disorder in postwar Kosovar adolescents using mind-body skills groups: a randomized controlled trial. J Clin Psychiatry. 2008;69:1469-1476.