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Post-traumatic Stress Reactions in Children After the 1988 Armenian Earthquake

Published online by Cambridge University Press:  02 January 2018

Robert S. Pynoos
UCLA Program in Trauma, Violence and Sudden Bereavement, Department of Psychiatry and Biobehavioral Sciences, University of California School of Medicine, Los Angeles
Armen Goenjian
Psychiatric Outreach Program of the Armenian Relief Society of the Western United States and Medical Director, Alondra Crest Hospital, Belflower, California
Madeline Tashjian
Psychiatric Outreach Program of the Armenian Relief Society of the Western United States
Meline Karakashian
Psychiatric Outreach Program of the Armenian Relief Society of the Western United States
Raffi Manjikian
Psychiatric Outreach Program of the Armenian Relief Society of the Western United States
Gagik Manoukian
Psychiatric Outreach Program of the Armenian Relief Society of the Western United States
Alan M. Steinberg
Department of Developmental and Cell Biology, University of California, Irvine
Lynn A. Fairbanks
Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles


One and a half years after the devastating earthquake in Armenia in 1988, 231 children from three cities at increasing distances from the epicentre were randomly screened in their schools to determine the frequency and severity of post-traumatic stress reactions, using the Children's Post-traumatic Stress Disorder Reaction Index (CPTSD-RI). A systematic clinical assessment of PTSD based on DSM-III-R criteria was also conducted on approximately half of this sample. A high CPTSD-RI score was strongly correlated with a clinical diagnosis of PTSD. A strong positive correlation was found between proximity to the epicentre and overall severity of post-traumatic stress reaction, as well as severity of core component symptoms of PTSD. High rates of chronic, severe post-traumatic stress reactions were found among children in the two most damaged cities, Spitak and Gumri. Analyses controlling for exposure revealed that girls reported more persistent fears than boys. These findings indicate that after catastrophic natural disaster, post-traumatic reactions in children may reach epidemic proportions, remain high for a prolonged period, and jeopardise the well-being of the child population of a large region. Systematic screening of children for PTSD can provide critical information for a rational public mental health programme after such a disaster.

Research Article
Copyright © Royal College of Psychiatrists, 1993 

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American Psychiatric Association (1987) Diagnostic and Statistical Manual of Mental Disorders (3rd edn, revised) (DSM-III-R). Washington, DC: APA.Google ScholarPubMed
Andreasen, N. (1985) Posttraumatic stress disorder. In Comprehensive Textbook of Psychiatry, (4th edn, vol. 1) (eds Kaplan, H. I. et al). Baltimore: Williams & Wilkins.Google Scholar
Armenian Relief Society of the Western United States (1989a) The Emotional State of Children after a Quake and Ways to Help Them. 517 West Glenoaks Blvd, Glendale, CA, 91202, USA.Google Scholar
Armenian Relief Society of the Western United States (1989b) Yogi Bear's Help After the Earthquake. 517 West Glenoaks Blvd, Glendale, CA 91202, USA.Google Scholar
Artiss, K. L. (1963) Human behavior under stress: from combat to social psychiatry. Military Medicine, 128, 10111015.Google ScholarPubMed
Barten, H., (ed.) (1971) Brief Therapies. New York: Behavioral Publications.Google Scholar
Berren, M. R., Bergel, A. & Ghertner, S. A. (1980) A typology for the classification of disasters: implications for intervention. Community Mental Health Journal, 16, 103111.CrossRefGoogle Scholar
Bloch, D., Silber, E. & Perry, S. (1956) Some factors in the emotional reactions of children to disaster. American Journal of Psychiatry, 113, 416422.CrossRefGoogle Scholar
Bolin, R. (1982) Long Term Family Recovery from Disaster. Institute of Behavioral Science. Boulder: University of Colorado.Google Scholar
Boyd, S. T. (1981) Psychological reaction of disaster victims. South African Medical Journal, 60, 744748.Google Scholar
Bradshaw, J. (1988) Bradshaw on: The Family and Revolutionary Way of Self-Discovery. Deerfield Beach, Florida: Health Communications.Google Scholar
Brand, D. & Blakeman, A. (1988) When the earth shook. Time, 19 December, pp. 3439.Google Scholar
Brislin, R. W. (1976) Translation research and its applications: an introduction. In Translations: Applications and Research (ed. Brislin, R.). New York: Wiley/Halsted.Google Scholar
Brislin, R. W., Lonner, W. J. & Thorndike, R. M. (1973) Cross-Cultural Research Methods. New York: Wiley.Google Scholar
Buck, J. M. (1966) The House Tree Person Technique Revised Manual. Beverly Hills: Western Psychological Services.Google Scholar
Catalano, R. & Dooley, C. D. (1977) Economic predictors of depressed mood and stressful life events in a metropolitan community. Journal of Health and Social Behavior, 18, 292307.CrossRefGoogle Scholar
Clines, F. X. (1991) Soviet plans for armenia quake recovery stall. New York Times, 3 March.Google Scholar
Deitz, J. (1986) Time-limited psychotherapy for posttraumatic stress disorder: the traumatized ego and its self reparative function. American Journal of Psychotherapy, 40, 290299.Google ScholarPubMed
Earls, F., Smith, E., Reich, W., et al (1988) Investigating psychopathological consequences of a disaster in children: a pilot study incorporating a structured diagnostic interview. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 9095.CrossRefGoogle ScholarPubMed
Edgar, P. N., Meyers, A. L., O'Brien, C. P., et al (1977) Depression in veterans: two years after Vietnam. American Journal of Psychiatry, 134, 167170.Google Scholar
Engelbrecht, H. (1989) Armenie un an apres. Geo, December, pp. 2046.Google Scholar
Erickson, K. T. (1976) Everything in its Path: Destruction of Community in the Buffalo Creek Flood. New York: Simon and Schuster.Google Scholar
Fairbank, J. A., Gross, R. T., Keane, T. M., et al (1983) Treatment of posttraumatic stress disorder: evaluation of outcome with a behavioral code. Behavior Modification, 7, 557568.CrossRefGoogle Scholar
Friel, J. & Friel, L. (1988) Adult Children - The Secrets of Dysfunctional Families. Deerfield Beach, Florida: Health Communications.Google Scholar
Galante, M. A. & Foa, D. (1986) An epidemiological study of psychic trauma and treatment effectiveness for children after a natural disaster. Journal of the American Academy of Child Psychiatry, 25, 357363.CrossRefGoogle Scholar
Gleser, G. C., Green, B. L. & Winger, C. (1981) Prolonged Psychosocial Effects of Disaster: A Study of Buffalo Creek. New York: Academic Press.Google Scholar
Goldsteen, R. & Schorr, J. K. (1982) The long term impact of man made disaster: an examination of a small town in the aftermath of the Three Mile Island nuclear reactor accident. Disaster, 6, 1019.CrossRefGoogle Scholar
Green, B. L., Lindy, J. D. & Grace, M. C. (1990) Buffalo Creek survivors in the second decade: stability of stress symptoms. American Journal of Orthopsychiatry, 60, 4354.CrossRefGoogle ScholarPubMed
Green, B. L., Korol, M., Grace, M. C., et al (1991) Children and disaster: age, gender, and parental effects on PTSD symptoms. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 945951.CrossRefGoogle ScholarPubMed
Haas, J. E., Kates, R. W. & Bowden, M. J., (eds) (1977) Reconstruction Following Disaster. Cambridge, Mass: MIT Press.Google Scholar
Hammer, E. F. (1958) Classical Application of Projective Drawings. Springfield, Illinois: Thomas.Google Scholar
Handford, H. A., Mayes, S. D., Mattison, R. E., et al (1986) Child and parent reaction to the Three Mile Island nuclear accident. Journal of the American Academy of Child and Adolescent Psychiatry, 25, 346356.CrossRefGoogle Scholar
Hartsough, D. M. & Myers, D. G. (1985) Disaster Work and Mental Health: Prevention and Control of Stress Among Workers. Bethesda, Maryland: NIMH.Google Scholar
Hill, R. & Hansen, D. A. (1962) Families in disaster. In Man and Society in Disaster (eds Baker, G. W. et al). New York: Basic Books.Google Scholar
Hocking, F. (1965) Human reactions to extreme environmental stress. Medical Journal of Australia, ii, 477483.Google Scholar
Hoffman, M. L. (1979) Development of moral thought, feeling and behavior. American Psychologist, 34, 958966.CrossRefGoogle Scholar
Horowitz, J. M. (1986) Stress-response syndromes: a review of posttraumatic and adjustment disorders. Hospital and Community Psychiatry, 37, 241249.Google ScholarPubMed
Karno, M., Burnam, A., Escobar, J. I., et al (1983) Development of the Spanish-language version of the National Institute of Mental Health Diagnostic Interview Schedule. Archives of General Psychiatry, 40, 11831188.CrossRefGoogle ScholarPubMed
Kinzie, J. D., Sack, W. H., Angell, R. H., et al (1986) The psychiatric effects of massive trauma on Cambodian children: I. The children. Journal of the American Academy of Child Psychiatry, 25, 370376.CrossRefGoogle Scholar
Kohan, J. (1990) Soviet republics: almost civil war. Time, 29 January, pp. 3033.Google Scholar
Kulka, R. A., Schlenger, W. E., Fairbank, J. A., et al (1990) Trauma and the Vietnam War Generation: Report of Findings from the National Vietnam Veterans Readjustment Study. New York: Brunner/Mazel.Google Scholar
Lacey, G. N. (1972) Observations on Aberfan. Journal of Psychoanalytic Research, 16, 257260.CrossRefGoogle ScholarPubMed
Libaridian, G. J. (1989) Armenian earthquakes and Soviet tremors. Transaction Social Science and Modem Society, 26, 5963.Google Scholar
Lifton, R. J. (1967) Death in Life: Survivors of Hiroshima. New York: Random House.Google ScholarPubMed
Lifton, R. J. & Olson, E. (1976) The human meaning of total disaster: The Buffalo Creek experience. Psychiatry, 39, 118.CrossRefGoogle ScholarPubMed
Lonnigan, C. J., Shannon, M. P., Finch, A. J., et al (1991) Children's reactions to a natural disaster: symptom severity and degree of exposure. Advances in Behavior Research and Therapy, 13, 135154.CrossRefGoogle Scholar
Maddison, D. & Viola, A. (1968) The health of widows in the year following bereavement. Journal of Psychosomatic Research, 12, 297306.CrossRefGoogle Scholar
McFarlane, A. C., Policansky, S. K. & Irwin, C. (1987) A longitudinal study of the psychological morbidity in children due to natural disaster. Psychological Medicine, 17, 727738.CrossRefGoogle ScholarPubMed
Miller, J. A., Turner, J. G. & Kimball, E. (1981) Big Thompson flood victims: one year later. Family Relations, 30, 111116.CrossRefGoogle Scholar
Nader, K., Pynoos, R. S., Fairbanks, L., et al (1990) Children's PTSD reactions one year after a sniper attack at their school. American Journal of Psychiatry, 147, 15261530.Google ScholarPubMed
Nader, K., Pynoos, R. S., (1991) Play and drawing techniques as tools for interviewing traumatized children. In Play, Diagnosis and Assessment (ed. Schaeffer, C. et al). New York: Wiley.Google Scholar
Newman, C. J. (1976) Children of disaster: clinical observations at Buffalo Creek. American Journal of Psychiatry, 133, 306312.CrossRefGoogle Scholar
Parnes, H. S. & King, R. (1977) Middle aged job losers. Industrial Gerontology, Spring, 7995.Google Scholar
Poghosyan, H. (1989) The earthquake and its consequences. International Bulletin for the Reconstruction and Development of Armenia, 1, 110.Google Scholar
Poghosyan, H. (1990) The process of construction and reconstruction in the disaster zone. International Bulletin for the Reconstruction and Development of Armenia, 2, 13.Google Scholar
Popovic, M. & Perovic, D. (1964) After the earthquake. Lancet, ii, 11691171.CrossRefGoogle Scholar
Pynoos, R. S. & Eth, S. (1986) Witness to violence: the child interview. Journal of the American Academy of Child Psychiatry, 25, 306319.CrossRefGoogle Scholar
Pynoos, R. S., Frederick, C., Nader, K., et al (1987) Life threat and posttraumatic stress in school age children. Archives of General Psychiatry, 44, 10571063.CrossRefGoogle ScholarPubMed
Pynoos, R. S. & Nader, K. (1988a) Psychological first-aid and treatment approach to children exposed to violence: research implications. Journal of Traumatic Stress, 1, 445473.CrossRefGoogle Scholar
Pynoos, R. S. & Nader, K. (1988b) Children who witness the sexual assaults of their mothers. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 567572.CrossRefGoogle ScholarPubMed
Pynoos, R. S. & Nader, K. (1989) Prevention of psychiatric morbidity in children after disaster. In OSAP Prevention Monograph - 2, Prevention of Mental Disorders, Alcohol and Other Drug Use in Children and Adolescents (eds Shaffer, D. et al), Publication No. (ADM) 89-1646. Washington, DC: US Government Printing Office.Google Scholar
Quarantelli, E. L. (1982) Sheltering and Housing After Major Community Disasters: Case Studies and General Observations. Columbus: The Ohio State University Research Foundation.Google Scholar
Raphael, B. (1986) When Disaster Strikes, How Individuals and Communities Cope with Catastrophe. New York: Basic Books Inc.Google Scholar
Ryan, B. (1988) Ma vérite sur les secours. Armenie, Diaspora Communication, Avril, pp. 3857.Google Scholar
Saigh, P. A. (1986) In vitro flooding in the treatment of a 6 year old boy's post-traumatic stress disorder. Behavior Research and Therapy, 24, 685688.CrossRefGoogle Scholar
Shore, J. H., Tatum, E. L. & Vollmer, V. M. (1986) Psychiatric reactions to disaster: The Mount St. Helens experience. American Journal of Psychiatry, 143, 590595.Google ScholarPubMed
Terr, L. C. (1981) Psychic trauma in children: observations following the Chowchilla school-bus kidnapping. American Journal of Psychiatry, 138, 1419.Google ScholarPubMed
Terr, L. C. (1983) Chowchilla revisited: the effects of psychic trauma four years after a school-bus kidnapping. American Journal of Psychiatry, 140, 15431550.Google ScholarPubMed
Walk, J. I. & Cavener, J. O. (1982) Vietnam veterans: their problems continue. Journal of Nervous and Mental Disease, 170, 174180.CrossRefGoogle Scholar
Watts, J. (1989) Armenia speaks. Observer Magazine, November, 4858.Google Scholar
Western, J. S. & Milne, G. (1979) Some social effects of a natural hazard: Darwin residents and cyclone Tracy. In Natural Hazards in Australia (eds Heatcote, R. L. et al). Canberra: Australian Academy of Science.Google Scholar
Wise, M. (1983) Post traumatic stress disorder, the human reaction to catastrophe. Drug Therapy, 8, 6269.Google Scholar
Wisocki, B. A. & Whitney, E. (1965) Body image of crippled children as seen in draw a person. Perceptual and Motor Skills, 21, 499504.CrossRefGoogle Scholar
Wolff, R. (1987) Systemic desensitization and negative practice to alter the after effects of a rape attempt. Journal of Behavioral Therapy and Experimental Psychiatry, 8, 423425.CrossRefGoogle Scholar
Yule, W. & Williams, R. M. (1990) Post-traumatic stress reactions in children. Journal of Traumatic Stress, 3, 279295.CrossRefGoogle Scholar
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