Child Trajectories of Posttraumatic Stress after Natural Disasters

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Project Summary/Abstract Natural disasters, including hurricanes, floods, earthquakes, tornadoes, and wildfires, present a significant threat to the health and wellbeing of children. Disaster management experts advocate that stepped care models of intervention are needed to address children’s mental health needs after disasters. The goal of stepped care models is to triage children so that those at highest risk for persistent distress (e.g., clinically elevated posttraumatic stress symptoms, PTSS, that endure beyond 3 – 6 months postdisaster) receive the most intense levels of intervention. However, a critical barrier to implementing stepped care models is that there is a paucity of information on how and why children differ in the PTSS patterns (i.e., trajectories) after disasters. Thus, it is not clear how to stratify children based on their risk for persistent PTSS. This proposal will utilize a novel methodological approach, Integrative Data Analysis (IDA), to overcome the limitations of drawing conclusions from the myriad of individual studies focused on children’s mental health outcomes after disasters. Individual studies, while valuable in informing future directions for research, are limited in terms of sample size, period of child development examined, postdisaster assessment time frame, frequency of assessments, risk factors studied, and sample diversity. IDA methods integrate individual level data from multiple studies, creating a pooled source of data that is more powerful and diverse than any individual study. The proposed study will integrate data from landmark studies of children’s reactions to four of the most costly disasters in U.S. history (Hurricanes Andrew, Charley, Katrina, and Ike), using 3,245 observations of 1,653 children aged 6 to 16 years, assessed from 3 to 25 months postdisaster. The objective of this proposal is to use IDA to build an empirical knowledge base of data to understand which factors characterize varying trajectories of PTSS. The Specific Aims include Aim 1: Develop an IDA methods framework to synthesize data across four studies of children’s mental health outcomes after devastating hurricanes; and Aim 2: Determine trajectories and associated risk factors of PTSS following the hurricanes. The long-term goal of this study is to develop risk models to more effectively use scarce postdisaster resources in stepped care models. Results will be directly applicable to clinical practice by providing guidance for early identification of children at higher risk of persistent PTSS.