Full and partial PTSD among young adult survivors 10 months after the L'Aquila 2009 earthquake: Gender differences

Abstract

Background

Earthquakes are one of the most frequently occurring natural disasters and extensive research has been conducted on mental disorders on exposed populations, particularly on post-traumatic stress disorder (PTSD). On April 6th 2009, the town of L'Aquila (Abruzzo), in central Italy, was struck by an earthquake with a strength of 5.9 on the Richter scale. In the town of L'Aquila many buildings collapsed and large parts of the town were destroyed. Overall, 309 people were killed, 1600 injured among which 200 severely injured and hospitalized, more than 65,000 people were displaced.

Methods

The aim of the present study was to investigate prevalence rates of PTSD, either full-blown or partial PTSD, among 512 students attending the last year of high school in L'Aquila about 10 months after the earthquake. According to the literature, partial PTSD was defined as the presence of symptoms in the DSM-IV Criterion B and C or D for PTSD diagnosis. Gender differences in the symptoms reported were investigated. Assessments included the Trauma and Loss Spectrum-Self Report (TALS-SR) and the Impact of Event Scale (IES).

Results

The results of the present study showed the presence of a diagnosis of PTSD in 192 (37.5%) of the students examined, with significantly (p = .000) higher rates in women than men (N = 120, 51.7% and N = 72, 25.7%, respectively). Moreover, 153 (29.9%) students reported partial PTSD (75, 32.3% women and 78, 27.9% men respectively). Significantly higher PTSD symptoms were reported by women with respect to men.

Limitations

The lack of information on the impact of the earthquake on subjects and on the presence of Axis I psychiatric comorbidities are two major limitations besides the use of self-report instruments.

Conclusions

Our results show high rates of full or partial PTSD in adolescents who survived the April 2009 L'Aquila earthquake, with women being the most affected. Thus, these results highlight the need to carefully explore these conditions.

Introduction

Post-traumatic stress disorder (PTSD) has been frequently investigated following natural disasters, particularly after the occurrence of earthquakes. These represent one of the most frequent natural disasters throughout the world affecting numbers of people, often striking unexpectedly, threatening lives and leading to large scale destruction (Armenian et al., 2000, Bödvarsdottir and Elklit, 2004, Lai et al., 2004, Bland et al., 2005, Chang et al., 2005, Önder et al., 2006, Priebe et al., 2010). Extensive research has been conducted on mental disorders following earthquakes as the mental distress associated with these experiences poses relevant challenges to mental health services (Armenian et al., 2002, Goenjian et al., 2005, Kun et al., 2009, Hussain et al., 2010). Prevalence rates of PTSD ranging from 10.3% to 49.6% (Armenian et al., 2000, Bödvarsdottir and Elklit, 2004, Kun et al., 2009, Wang et al., 2009, Cairo et al., 2010) have been found among earthquakes survivors. Even though the amount of studies on PTSD has increased over the past 20 years, the majority of the trauma studies continue to focus on adult trauma survivors (Yule, 2001, Norris et al., 2002). Nevertheless, increasing evidence suggests that exposure to high magnitude natural disasters, such as earthquakes, reliably predicts PTSD in children and adolescents at different levels (Gordon and Wraith, 1993, Amaya-Jackson and March, 1995, Dilsaver et al., 2007, Goenjian et al., 2009, Priebe et al., 2009).

Research findings on the role of gender in the prediction of PTSD symptoms following earthquakes in adult populations show higher vulnerability in women (Priebe et al., 2009, Wang et al., 2009, Wang et al., 2010), consistently with data in children and adolescents (Bal and Jensen, 2007, Goenjian et al., 2009). There is evidence, in fact, that women report PTSD more frequently than men after the exposure to a traumatic event. Priebe et al. (2009), in a sample of 1680 individuals who survived the Molise (Italy) 2002 earthquake, found female gender, besides age over 55 years and lower school education, to predict higher rates of PTSD. Some studies showed gender differences also in the frequency of PTSD symptoms following an earthquake exposure with women reporting more symptoms than men (Karanci and Rustemli, 1995, Carr et al., 1997, Bal and Jensen, 2007), while other studies found no such differences (Nolen-Hoeksema and Morrow, 1991, Goenjan et al., 1994). However, across studies, different assessment instruments to measure PTSD symptoms and different time frames between the assessment and the actual earthquake were evaluated (Bland et al., 2005, Bödvarsdottir and Elklit, 2004). Thus, it remains unclear to what extent the inconsistencies between studies reflect true differences between the samples studied or are due to the different methodologies utilized. In any case, more systematic data are required to understand gender differences in PTSD following earthquakes.

Recent efforts have been oriented to explore the prevalence rates and impact of not only Axis I (DSM-IV-TR, 2000) PTSD in individuals exposed to a traumatic event but also of partial or subthreshold forms. In particular, the concept of partial PTSD was introduced for those subjects who did not fulfill all the criteria (B, C and D) of the DSM-IV for PTSD, but only a subset of them (Weiss et al., 1992, Stein et al., 1997, Marshall et al., 2001, Breslau et al., 2004, Mylle and Maes, 2004, Hepp et al., 2005). More recently, dimensional approaches to PTSD have also been developed (Moreau and Zisook, 2002, Dell'Osso et al., 2008, Dell'Osso et al., 2009) that conceptualize post-traumatic stress reactions as consisting of three main dimensions: the nature of the stressor, the possible responses to trauma and the symptom severity.

Italy is one of the most seismically active countries in Europe and despite minor tremors which are common, it is unusual for the country to experience deadly earthquakes. On April 6th 2009, at 3:32 a.m., an earthquake (Richter Magnitude 6.3) struck L'Aquila, Italy, a town with a population of 72,000 residents and a health district of 105,000 residents. The L'Aquila earthquake caused the deaths of 309 people, with more than 1600 individuals injured among which 200 were severely injured and hospitalized, and 66,000 displaced. In the town of L'Aquila many buildings collapsed and large parts of the town were destroyed. This disaster provided the opportunity to explore the onset of PTSD after the earthquake in a population of young adults.

The aim of the present study was to investigate prevalence rates of full and partial PTSD in a population of young adults who survived to the L'Aquila 2009 earthquake. Further, aim of the present study was to explore gender differences in these prevalence rates and in the post-traumatic spectrum symptoms reported.