Prevalence and risk factors of chronic Post-Traumatic Stress Disorder in children and adolescents after the 2012 earthquake affecting the Modena province: preliminary results of a cross-sectional study

Background Post-traumatic stress disorder (PTSD) is the most frequent psychological disorder occurring after natural disasters (with a prevalence ranging from 5 to 60% in the first 1-2 years after the event). Many cases remit within 12 months, but nearly one-third have a chronic, unremitting course determining long term negative health impacts and relevant social costs. On May 2012, two earthquakes of high Richter magnitude hit the province of Modena, causing 27 deaths, several hundred of injured citizen and more than 15000 homeless. The aim of this study was to investigate the prevalence of chronic PTSD in children and adolescents, two particularly sensitive subpopulations, and to identify PTSD potentially related individual and social risks and protective factors to be addressed in future effective preventive interventions. Methods A cross-sectional study approved by the local Ethical Committee was conducted between May 2013 and May 2014. Subjects aged 9- 14 were recruited from Primary and Secondary schools of Modena District, which were randomly selected after being assigned to two areas: earthquake area (19 municipalities most affected by the earthquake; EA) and extra-earthquake area (EEA). The two areas had similar demographic and geographic characteristics. Only subjects providing written informed consent from parents were included in the study. The Italian version of the UCLA PTSD Index for DSM-IV (UPID) was used to assess PTSD in students from primary (face to face interviews) and secondary school (self-reported), while risk/protective factors for the development and persistence of PTSD were investigated using the traumatic exposure checklist on objective/subjective experiences during the earthquake and the Strengths and Difficulties Questionnaire (SDQ). This instrument was also administered to subjects’ parents along with the Symptom Checklist-90-R (SCL-90), which aimed to investigate parental psychopathology. Findings We included in our study 682 subjects (male: 349, 51%; mean age: 11,2 ±1,4; 1,8% of the total residents of the same age in the two areas). The prevalence of people hit by the earthquake (damages to properties or people) and forced to leave their homes was significantly higher in the EA than in the EEA (78% vs 14%; 54% vs 2%: p<0.001). Overall, 9 subjects (1,3 %) reported symptoms of chronic PTSD. Most (8) were living in the EA. In this area the prevalence of chronic PTSD was equal to 1,9% and appeared particularly high in girls (2,4%) and in secondary school’s subjects (2,2%). Discussion A higher prevalence of chronic PTSD in children and adolescents living in the most affected area by the earthquake was observed. PTSD prevalence in our study however appeared lower than those observed in similar investigations: specific protective factors related to the social context together with differences in the time elapsed between the traumatic event and PTSD evaluation could partially explain these findings. Further analyses aimed at pointing out potentially protective individual, familiar and social factors will be sooner performed. We believe that any potential significant finding will give an effective contribution in the planning of future preventive and protective interventions in similar distressing situations.