What is PTSD?

PTSD is a complex disorder that is characterised by negative responses to traumatic

experience such as anhedonia-like and externalising symptoms. According to DSM-5, the

diagnostic criteria includes:

1. Exposure to actual or perceived threat to life especially death, severe physical

injury or sexual violence.

2. Four symptom clusters - Recurrent, involuntary and distressing memories or

dreams of the traumatic event, Persistent avoidance of the stimuli of the traumatic

event, negative alterations in cognition and mood, marked alterations in arousal

and reactivity.

3. Experiencing the above symptoms for more than a month.

When compared to adults (such as war veterans), prevalence of PTSD in children and

adolescent following a traumatic events is low. This could be because diagnostic criteria

of previous DSM was not comprehensive. It didn’t consider symptoms from the

perspective of developmental psychology.

Literature-Review Method
 An electronic literature search was conducted using Google Scholar to access

tandfonline, PubMed, Sagejournal, elsevier, Psycnet, Springerjournal, MDPI databases.

Search terms and keywords were generated based on the relevant search terms such as

“PTSD in children”,”Risk factors for PTSD in children”, “Predictors of PTSD in

children”. The initial search was exhaustive as papers relevant to PTSD in children are

limited. The search was then limited to year 2014 onwards to include only papers that

considered DSM-5 diagnostic criteria.

I have included papers in this review if they are:

1. Specific to children and adolescents.

2. Included adults but adolescent population is clearly delineated.

3. Assessing risk factor or protective factors of PTSD in children

4. Available in English Language.

Result

Yingqi Xiaoa, Donglin Liub, Kun Liua, Xiaolian Jianga

Post-traumatic stress disorder and its risk factors in bereaved Tibetan adolescents 3 years after

the 2010 Yushu earthquake, a cross-sectional study in China, 2014.

This study is about effects of Earthquake on Tibetian adolescents in Yushu County, China.

Yushu County experienced a magnitude 7.0 earthquake in the year 2010. The casualty included
2698 deaths, 12,135 injured, 270 missing and 200,000 displaced. This was one of the severe

earthquake that happened in China at a high altitude in the past 50 years. The Tibetin adolescents

experienced bereavement but its effect on them have not been documented and studied by

researchers.

The aim of this study was to identify the symptoms of PTSD in Tibetian adolescents 3 years after

the earthquake and also to identify various risk factors. They evaluated PTSD using

self-reporting instrument PCL-C. They also evaluated coping strategies using the Coping Style

Scale (CSS). They also evaluated the trauma exposure using a measuring instrument developed

by Tian et al. (Tian, Wong, Li, & Jiang, 2014).

This study highlighted that the incidence rate of PTSD in Tibetian adolescents was high (24.4% )

compared to other demography who have experienced earthquake and was decreasing more

slowly. It also attribute this to poor cognitive and poor adaptability of the adolescents, small

family units, Buddhism philosophy and geographical demographics. It was also highlighted that

unlike in other studies, they did not find gender sensitivity in PTSD. They didn’t find any

significant difference in PTSD symptoms between male and female.

This study added evidence of psychological distress to natural calamities such as earthquake. It

also highlighted the need for more research among sensitive population.
Bihan Tang, Qiangyu Deng, Deborah Glik, Junqiang Dong and Lulu Zhang,

A Meta-Analysis of Risk Factors for Post-Traumatic Stress Disorder (PTSD) in Adults and

Children after Earthquakes, 2017

This study highlights the need for meta-analysis of risk-factors for PTSD in population who have

experienced earthquakes. The study states that previous research done for PTSD in Earthquake

population focused only on few risk factors and that there is a need to consolidate all the risk

factors. This study uses observational studies on risk factors for PTSD among earthquake

survivors published from 1980 to 2016. It also categorises 19 risk factors under 3 broad

categories specifically for Earthquake affected populations - Basic characteristics, Trauma

exposure characteristics and Post trauma characteristics. Out of the 19 risk factors, it also studied

14 risk factors in depth. The study also highlight the common risk factors/predictors that have

bee studied in previously - gender sensitivity, older age, high education level, trauma

characteristics- witnessing or experience of being trapped, fear, injury, and bereavement,

post-trauma characteristic - loss of property.

The study added evidence to the need to address the psychological distress among the earthquake

survivors - both adults and children. By consolidating and categorising the risk factors it intends

to help psychiatrist and clinicians to identify and intervene the vulnerable population of

survivors. The study also highlights how PTSD persists among the survivor if not treated and the

need to for suitable preventive interventions at community health care level.

MM, and Shi Wu Wen, MD

Prevalence of Posttraumatic Stress Disorder among Children and Adolescents following Road

Traffic Accidents: A Meta-Analysis, 2018

This study highlights the need to identify the pooled prevalence of PTSD in children and

adolescents following Road Traffic accidents(RTAs) through meta-analysis. It states that no

researcher has made an attempt to do this so far.

The study found that one-fifth of children and adolescents developed PTSD following exposure

to RTAs. Also on comparison with similar pooled prevalence studies of other traumatic events, it

was was found that the pooled prevalence of PTSD was 19.96% which was lower than

earthquake survivors but higher than flood and stroke survivors. The study suggested that the

high pooled prevalence of PTSD among children and adolescents underscores the need for

psychological interventions in addition to physical treatment post RTAs.

The study also indicated that pooled prevalence of PTSD differed according to study location

and gender. Hence suggested that the psychological interventions resources shoul d be allocated

based on the prevalence. It also suggested that girl population will need special attention.
Fan Wu, Wei-Yang Meng, Chi-Zi Hao, Lie-Lie Zhu, Da-Qing Chen, Lu-Yang Lin & Hao Wen

Analysis of posttraumatic stress disorder in children with road traffic injury in Wenzhou, China,

2015

This study is about studying the incidence of PTSD in children with Road traffic injury in the

city of Wenzhou, China. It states that a total 7,122 road traffic accidents happened between 2011

and 2012 in a population of 9.1 million people.

The study aimed to identify risk factors of PTSD in children with Road traffic Injury(RTI). A

retrospective study was conducted on RTI pediatric patients in the age group of 1-13 years. The

findings showed PTSD incidence of 24.77% in children with an RTI which is quite high.

The study also revealed that the PTSD incidence in children younger than 6 years old with RTI

was 30.20% and higher than that of older children. The study also found that there was gender

difference. The study also highlights the risk factors of PTSD - personality features, education

level, family support.

The study also revealed that PTSD incidence in children with brain injury was higher than

children without brain-injuries. It also stated that children from families of migrant workers tend

to develop PTSD more easily after an RTI as compared to children from sufficient family

support.
Summary

This review examines the need to study the various risk factors for PTSD in children based on

the specific traumatic events. The further study and categorisation of risk factors will help

clinicians and psychiatrist to formulate psychological and social intervention strategies.

References

Dai, W., Liu, A., Kaminga, A. C., Deng, J., Lai, Z., & Wen, S. W. (2018). Prevalence of

Posttraumatic Stress Disorder among Children and Adolescents following Road Traffic

Accidents: A Meta-Analysis. ​The Canadian Journal of Psychiatry,​ ​63(​ 12), 798-808.

doi:10.1177/0706743718792194

Tang, B., Deng, Q., Glik, D., Dong, J., & Zhang, L. (2017). A Meta-Analysis of Risk Factors for

Post-Traumatic Stress Disorder (PTSD) in Adults and Children after Earthquakes.

International Journal of Environmental Research and Public Health,​ ​14(​ 12), 1537.

doi:10.3390/ijerph14121537

Tian, Y., Wong, T. K., Li, J., & Jiang, X. (2014). Posttraumatic stress disorder and its risk factors

among adolescent survivors three years after an 8.0 magnitude earthquake in China. ​BMC

Public Health,​ ​14​(1). doi:10.1186/1471-2458-14-1073

Wu, F., Meng, W., Hao, C., Zhu, L., Chen, D., Lin, L., & Wen, H. (2015). Analysis of

posttraumatic stress disorder in children with road traffic injury in Wenzhou, China.

Traffic Injury Prevention,​ ​17(​ 2), 159-163. doi:10.1080/15389588.2015.1050719

Xiao, Y., Liu, D., Liu, K., & Jiang, X. (2019). Post-traumatic stress disorder and its risk factors

in bereaved Tibetan adolescents 3 years after the 2010 Yushu earthquake, a cross-sectional
study in China. ​Archives of Psychiatric Nursing,​ ​33​(2), 149-154.

doi:10.1016/j.apnu.2018.11.010