The main objective of the present study is to expand the knowledge about the factors that contribute to the development of and recovery from posttraumatic stress reactions following a single traumatic event from a child and family perspective. The results are based on quantitative information from interviews with Norwegian children (6 to 17 years of age) conducted 10 months and 2 ½ years post-tsunami and questionnaires completed by adults six months and two years after the tsunami. The thesis includes three longitudinal and two crosssectional studies.
Most of the children and adults who participated in the study had been exposed to a potentially traumatizing event. However, Paper I found that the children in the current sample had low levels of posttraumatic stress reactions 10 months after the tsunami compared to the children in studies of tsunami victims living in the disaster area. There was a significant decrease in the level of reactions at 2 ½ years. Thus, most children who experienced a single natural disaster and were protected against many secondary adversities did not have serious longitudinal stress reactions related to the traumatic event.
Levels of posttraumatic stress reactions at 10 months after the tsunami were related to the trauma experiences, whereas the levels of reactions at 2 ½ years post-tsunami were related to gender, the receipt of professional help for mental health problems before the tsunami, tsunami-related parental sick leave, and the death of family members (Paper I). Thus, factors related to levels of posttraumatic stress reactions seemed to shift over time from tsunamirelated features to features related to general mental health.
The findings indicate that family members may influence each other in the aftermath of a natural disaster. However, it is probable that adults and children are influenced differently, with adults in a family having a greater tendency for convergence in their definitions of the events and in their posttraumatic stress reactions than siblings do. Thus, the results indicate that treatments for adults with posttraumatic stress reactions should incorporate a family perspective. However, the results also indicate that children’s need for help may vary considerably within the family. While it is often important to incorporate parents in the treatment of children, the current study offers little evidence in support of including siblings in the treatment of an individual child.
There is an ongoing discussion of the definition of PTSD in the upcoming Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). The last paper (Paper V) of the present thesis contributes to knowledge of two themes: how the symptom criteria should be grouped and the potential overlap between posttraumatic stress reactions and other mental ailments. A four-factor model using the symptoms of intrusion, avoidance, numbing, and arousal was found to describe children’s posttraumatic stress reactions better than the present three-factor model specified in the current diagnostic manual, DSM-IV-TR. This study also found a significant overlap between general mental health problems and posttraumatic stress reactions, especially for mental health problems that were associated with arousal symptoms.
The participants had very different experiences compared to disaster victims who were not protected against common secondary adversities and compared to people who experience interpersonal violence or longitudinal exposure to traumatic events. Thus, care should be taken when generalizing from the present study to other groups of children and families who experience potentially traumatic events