Sixteen-year follow-up of childhood avalanche survivors

Background: Every year a substantial number of children are affected by natural disasters worldwide. However, data are scarce on long-term psychological impact of natural disasters on children's health. Identifying risk factors and outcomes associated with the long-term sequelae of posttraumatic stress disorder (PTSD) can provide a gateway to recovery as well as enhancement of preventive measures. Objective: Among childhood avalanche survivors, we aimed to investigate risk factors for PTSD symptoms and the relationship between socioeconomic status (SES) and PTSD symptoms in adulthood. Methods: Childhood survivors (aged 2-19 at the time of exposure) of two avalanches were identified through nationwide registers 16 years later. The Posttraumatic Diagnostic Scale was used to assess current PTSD symptoms. One-way ANOVA was used to explore PTSD symptoms by background and trauma-specific factors, as well as associations with current SES. Predictors of PTSD symptoms were examined by multivariable regression analysis. Results: Response rate was 66% (108/163). Results from univariate ANOVA analysis revealed that female sex was associated with PTSD symptoms (F = 5.96, p < 0.05). When adjusted for age and sex, PTSD symptoms were associated with lower education (F = 7.62, p < 0.001), poor financial status (F = 12.21, p < 0.001), and unemployment and/or disability (F = 3.04, p < 0.05). In a multivariable regression model, when adjusting for age and sex, lack of social support (t = 4.22, p < 0.001) and traumatic reactions of caregivers (t = 2.49, p < 0.05) in the aftermath of the disaster independently predicted PTSD 16 years post-trauma. Conclusions: Lingering PTSD symptoms after childhood exposure to a disaster may negatively influence socioeconomic development in adulthood. Strengthening children's support systems post-disaster may prevent the long-term sequelae of symptoms.