Depremi direk olarak yaşayan ve okulları yıkılan çocuklarda görülen travma sonrası stres tepkilerinin ve alt boyutlarının üç yıllık boylamsal incelenmesi

Bu çalışmanın amacı depremden sonra öğrencilerin gösterdikleri travma sonrası stres bozukluğu (TSSB) ve bu bozukluğun alt boyutları olan yeniden yaşama, kaçınma ve uyarılma tepkilerinin yaygınlığı ve şiddetini yıllara göre incelemektir. Öğrencilerin TSSB tepkileri ve alt boyutları yıllara göre değerlendirilmiş, yaygınlık oranları ve şiddet dereceleri frekans analizi yapılarak genel örnekleri için ve kız ve erkek öğrenciler için ayrı ayrı hesaplanmıştır. TSSB'nun yaygınlık oranı yıllara göre % 68, % 48 ve % 39 olarak bulunmuştur. Bu oran yıllara göre erkekler için % 67, % 47 ve % 44; kızlar için ise % 69, % 49 ve % 29 olarak hesaplanmıştır. Yeniden yaşama ve kaçınma puanları azalma eğilimi gösterirken, bu azalma büyük oranda birinci yılda olmuştur. Erkek öğrencilerin yeniden yaşama puanları 2. yılda azalırken, 3. yılda tekrar artma eğilimine girmiştir. Uyarılma semptomları ise 1. yılda fazla, 2 ve 3. yıllarda ise az miktarlarda olmak üzere cinsiyet farkı göstermeksizin tüm gruplarda azalmıştır. TSSB tepkileri ve yaygınlık oranları 2. yılda düşme yönünde değişim göstermiş ve bu düşme hızı kızlar için 3. yılda da hızlı bir şekilde devam etmiştir. Erkek öğrencilerin yaygınlık oranındaki azalma 2. ve 3. yıllar arasında oldukça az düzeyde gözlenmiştir. Genel eğilim grubun tümünde ve kız ve erkek öğrenciler için ayrı ayrı bakıldığında travma ve alt semptom boyutlarında puanların giderek azalması yönündedir. Ancak bu genel bir kural değildir. Kronikleşme gösteren ya da geç başlangıçlı TSSB olan öğrenci sayısı da oldukça fazladır. Çalışma boylamsal olduğu için literatürde daha önce bildirilmemiş olan "inişli-çıkışlı" semptom belirtileri de görülmüştür.

Anahtar Kelimeler:

okul çocukları

Children's posttraumatic stress reactions and sub-symptoms: Three years of a longitudinal investigation study after a direct exposure to the earthquake and school's collapse

The purpose of this research was to investigate the long term effects of earthquakes on children's PTSD and reexperiencing, avoidance and hyperarousal subsymptoms and their severity and prevalence rates in a longitudinal design. Survivors' children were given a PTSD scale in April of 2004, 2005, and 2006. The prevalence rates and severity of PTSD were calculated with descriptive statistics. One hundred and forty-five students were compared via repeated measure of ANOVA's in total PTSD scores, and intrusions, avoidance and hyperarousal sub-symptoms in three point of time. Eta squares was also calculated to see the effect sizes. Polynomial contrast tests were utilized to investigate the trend of longitudinal course of traumatic symptoms. The possible prevalence rates for whole sample were found to be 68 %, 48 %, and 39 %, respectively. According to the years, the prevalence rates for boys were 67%, 47% and 44% and for girls were 69 %, 49 %, and 29 %. Findings revealed a difference among the years. Follow-up polynominal contrast showed a significant linear effect. Pairwaise comparisons were used to detect which means of the year differs from each other. It was observed that there was a significant difference between 1st and 2nd year. Additionally there was a decrease between 1st and 3rd year and between 2nd and 3rd year. Results indicate that PTSD symptoms tend to follow a linear trend and drop off gradually. Although other studies reported similar results, sub-symptoms tend to increase in the 3rd year for boys' intrusion. Additionally, avoidance symptoms were also more resistant in boys than girls.

Keywords:

school children,

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Alyanak, B., Ekşi, A., Toparlak, D., Peykerli, G. ve Saydam, R. (2000). Depremden sonraki 2-6 aylık sürede travma sonrası stres bozukluğunun ergenlerde araştırılması. Çocuk ve Gençlik Ruh Sağlığı Dergisi, 7(2), 71-80.
American Academy of Child and Adolescent Psychiatry, (1998). Practice parameters of the assessment and treatment of post traumatic stress disorder in children and adolescents. Journal of American Child and Adolescents Psychiatry, 37(1), 4-26.
American Psychiatric Association, (2000). Diagnostic and statistical manual of mental disorders (4. baskı). Washington, DC.
Asarnow, J. R., Glynn, S., Pynoos, R., Mahum, J., Guthrie, D., Cantwell, D. P. ve ark. (1999). When the earth stops shaking: Earthquake sequelae among children diagnosed for pre-earthquake psychopathology. Journal of American Academy of Child and Adolescent Psychology, 38, 1016- 1023.
Bromet, E., Hough, L. ve Connell, M. (1984). Mental health of children near the Three Mile Island reactor. Journal of Preventive Psychiatry, 2,275-301.
Bradburn, I. S. (1991). After the earth shook: Children's Stres symptoms 6-8 months after a disaster. Advanced Behavior Research and Therapy, 13, 173-179.
Bulut, S. (2003). Underlying dimensions and prevalence of post traumatic Stres disorder among 4th and 5th grade children who experienced the 1999 Turkish earthquakes. Yayınlanmamış doktora tezi, Oklahoma State University, Stilwater, OK, USA.
Bulut, S., Bulut, S. ve Taylı, A. (2005). The dose of exposure and prevalence rates of post-traumatic stres disorder in a sample of Turkish children eleven months after the 1999 Marmara earthquakes. School Psychology International, 26(1), 55-70.
Bulut. S. (2006). Comparing the earthquake exposed and non- exposed Turkish children's post traumatic stress reactions. Anales de Psicologia, 22(1), 29.-36.
Bulut, S. (2009). Depremden sonra çocuklarda görülen travma sonrası stres tepkilerinin yaş ve cinsiyetler açısından karşılaştırılması. Türk Psikolojik Danışma ve Rehberlik Dergisi, 4(31), 43-51.
Carlier, I. V. E. ve Gersons, B. P. R. (1995). Partial posttrau¬matic stress disorder (PTSD): The issues of psychological scars and the occurrences of PTSD symptoms. Journal of Nervous and Mental Disease, 183, 107-109.
Cohen, A., Bernet, W. ve Dunner, J. E. (1998). Practice parameters for the assessment and treatment of children and adolescents with posttraumatic stres disorder. Journal of American Academy of Child and Adolescent Psychiatry, 37(10), 4-25.
Erden, G„ Kılıç, E. Z., Uslu, R. İ. ve Kerimoğlu, E. (1999). Çocuklar için travma sonrası sress tepki ölçeği: Türkçe geçerlilik, güvenilirlik ön çalışması. Çocuk ve Gençlik Ruh Sağlığı Dergisi, 6(3), 143-149.
Famularo, R., Fenton, T., Augustinian, M. ve Zuckerman, B. (1996). Persistence of pediatric posttraumatic stress disorder after 2 years. Child Abuse and Neglect, 20, 1245- 1248.
Freedy, J. R„ Saladin, M. E., Kilpatrick, D. G„ Resnick, H. S. ve Saunders, B. E. (1994). Understanding acute psychological distress following natural disaster. Journal of Traumatic Stres, 7(2), 257-273.
Fetter, J. C. (2005). Psychological response to mass casualty terrorism: Guidelines for physicians, prime care companion. Journal of Clinical Psychiatry, 7, 49-52.
Galante, R. ve Foa, D. (1986). An epidemiological study of psychic travma and treatment effectiveness for children after a natural disaster. Journal of American Academy of Child Psychiatry, 25, 357-363.
Garrison, C. Z., Bryant, E., Addy, C. L., Spurrier, P. G., Freedy, J. R. ve Kilpatrick, D. (1995). Posttraumatic stress disorder in adolescents after Hurricane Andrew. Journal of American Child and Adolescent Psychiatry, 34, 1193- 1201.
Goenjian, A., Karayan, I., Pynoss, R., Minassian, D., Najarian, L., Steinberg, A. ve ark. (1997). Outcome of psychotherapy among early adolescents after trauma. American Journal of Psychiatry, 144, 536-542.
Gökler, I. (2001). The predictor variables of post-traumatic stress symptoms in children and adolescents following 1999 Marmara earthquake: Exposure to traumatic experiences and coping. Yayınlanmamış Yüksek lisans tezi, Orta Doğu Teknik Üniversitesi, Ankara.
Green, B. L., Grace, C. M., Vary, G. M., Kramer, T. L., Glesser, G. C. ve Leonard, A. C. (1994). Children of disaster in the second decade: A 17-year follow-up of Buffalo Creek Survivors. Journal of American Academy of Child Psychiatry, 33, 71-79.
Green, B. L., Lindy, J. D., Grace, M. C., Gleser, G. C., Leonard, A. C., Korol, M. ve ark. (1990). Buffalo Creek survivors in the second decade: Stability of stress symptoms. American Journal of Orthopsychiatry, 60, 43-54.
Hickling, E. J. ve Blanchard, E. B. (1992). Post traumatic Stres disorder and motor vehicle accidents. Journal of Anxiety Disorders, 6, 283-304.
Hondius, A. J. K., van Willingen, L. H. M., Kleijn, W. C. ve van deer Pole, H. M. (2000). Health problems among Latin-American and Middle Eastern refugees in the Netherlands; Relations with violence exposure and ongoing sociopsychological strain. Journal of Traumatic Stress, 13, 619-634.
Howard, S. J. ve Gordon, N. S. (1972). Children and the San Fernando earthquake. San Fernando, CA: San Fernando Valley Child Guidance Clinic.
Jones, L. (2008). Responding to the needs of children in crisis. International Review of Psychiatry, 20, 291-303.
Kar, N. (2009). Psychological impact of disaster on children: review of assessment and interventions. World Journal of Pediatri, 5( 1), 5-11.
Karabekiroğlu, K., Akbaş, S., Taşdemir, G. N. ve Karakurt, M. N. (2008). Post-traumatic stress symptoms in adolescents after two murders in a school: A controlled followed- up study. International Journal of Psychiatry Medicine, 38(4), 407-424.
Karakaya, I., Ağaoğlu, B., Coşkun, A. ve Şişmanlar, Ş.G. (2004). Marmara depreminden üç buçuk yıl sonra ergenlerde TSSB, depresyon ve anksiyete belirtileri. Türk Psikiyatri Dergisi, 15(4), 257-263.
Krause, N. (1987). Exploring the impact of a natural disaster on the health and psychological well-being of older adults. Journal of Human Stress, 61-69.
Kim, B. N., Kim, J.W., Kim, H. W., Shin, M. S., Cho, N. H., Ahn, H. ve ark. (2009). A 6-month follow-up study of posttramatic stres and anxiety/depressive sympthoms in Korean childfren after direct or indirect exposure to a single incident of trauma. Journal of Clinical Psychiatry, 70(80),1148-1154.
Kinzie, J. D„ Sack, W., Angell, R., Clarke, G. ve Ben, R. (1989. A three year follow-up of Cambodian young people traumatized as children. Journal of the American Acad¬emy of Child and Adolescent Psychiatry, 28, 501-504.
Klingman, A. (1993). School based intervention following a di¬saster. C. F. Saylor, (Ed.), Children and disasters içinde (187-210). New York: Plenum Press.
La Greca, A. M., Silverman, Vernberg, E. M., W. K. ve Prin- stein, M. J. (1996). Symptoms of posttraumatic stress in children after Hurricane Andrew: A prospective study. Journal of Consulting and Clinical Psychology, 64, 712- 723.
Laufer, A. ve Solomon, Z. (2008). Gender differences in PTSD in israil youth exposed to terror attacks. Journal of Interpersonal Violence, 24(6), 959-976.
Math, S. B., Tandon, S., Girimaji, S. C., Benegal, V., Kumar, U., Hamza, A. ve ark. (2008). Psychological impact of the tsunami on children and adolescents from the Andaman and Nicobar Islands, prime care companion. Journal of Clinical Psychiahtry, 10, 31-37.
McFarlane, A. C. (1987). Posttraumatic phenomena in a longitudinal study of children following a natural disaster. Journal of the American Academy of Child and Adolescent Psychiatry, 26, 764-769.
McFarlane, A. Ç., Policansky, S. ve Irwin, C. (1987). A longitudinal study of the psychological morbidity in children due to a natural disaster. Psychological Medicine, 17, 727-738.
Mehlum, L. ve Weisaeth, L. (2002). Predictors of posttraumatic stress reactions in Norwegian UN peacekeepers 7 years after service. Journal of Traumatic Stress, 75(1), 17-26.
Milliyet Gazetesi, (2 Mayıs 2003). http:milliyet.com/2003/05 /02guncel/agun.html
Miral, S., Özcan, Ö., Baykara, A., Yemez, B. ve Tayyar, C. (1998). Dinar depremi sonrası çocuklarda kaygı ve depresyon. Çocuk ve Gençlik Ruh Sağlığı Dergisi, 5(1), 16- 22.
Nwe, Y. Y. (2005). Children and tsunami, a year on: A draft UNICEF summary of what worked. http://www.unıcef. org/emerg/disasterinasia/files/whatworked.pdf.
Oğuz, T. F. ve Kılıç, E. Z. (1999). Çocuk ve ergenlerde travma sonrası stres bozukluğu. Çocuk ve Gençlik Ruh Sağlığı Dergisi, 6(3), 172-181.
Pynoos, R. S., ve Eth, S. (1985). Post-traumatic stress disorder in children: The progress in psychiatry series. Washington, DC: American Psychiatric Press, Inc.
Pynoos, R. S., Frederick, C., Nader, K., Arroyo, W., Steinberg, S., Eth, S. ve ark. (1987). Life threat and post-traumatic stress in school-age children. Archives of General Psychiatry, 44, 1057-1063.
Pynoos, R. S., Goenjian, K., Tashjian, M., Karakashian, M., Manjikian, R., Manoukian, G. ve ark. (1993). Posttraumatic stress reactions in children after the 1988 Armenian Earthquake. British Journal of Psychiatry, 163,239- 247.
Rubonis, A. V. ve Bickman, L. (1991). Psychological impairment in the wake of disaster: The disaster-psychopathology relationship. Psychological Bulletin, 109(3), 384-399.
Silva, R. R., Cloitre, M., Davis, L., Levitt, J., Gomez, S., Ngai, I. ve ark. (2003). Early intervention with traumatized children. Psychiatry Quarterly, 74,333-341.
Shannon, M. P., Christopher, P. D., Lonigan, J., Finch, A. J. Jr. ve Taylor, C. M. (1994). Children exposed to disaster: Epidemiology of post-traumatic symptoms and symptom profile. Journal of American Child and Adolescent Psychiatry, 33, 80-93.
Shooshtary, M. H., Panaghi, L. ve Moghadam, J. A. (2008). Outcome of cognitive behavioral therapy in adolescents after natural disaster. Journal of Adolescents Health, 42, 466-472.
Southwick, S. M., Krystal, J. H., Morgan, C. A., Johnson, D. ve Naggy, L. M. N. A. (1993). Abnormal noradrenergic function in posttraumatic stress. Archives of General Psychiatry, 50, 226-274.
Sullivan, A. M., Saylor, F. C. ve Foster, K. Y. (1991). Post-hurricane adjustment of preschoolers and their families. Advance Behavioral Research and Therapy, 13, 163-171.
Steinglass, P., ve Gerrity, E. (1990). Natural disaster and posttraumatic stress disorder: Short-term versus long-term recovery in two disaster-affected communities. Journal of Applied Social Psychiatry, 20, 1746-1765.
Terr, L. C. (1983). Psychic trauma in children: Observation following the Chowchilla school-bus kidnapping. American Journal of Psychiatry, 138, 14-19.
Terranova, A. M., Boxer, P. ve Shefield-Morris, A.(2009). Factors influencing the course of posttraumatic stres following a natural disaster: Children's reactions to Hurricane Katrina. Journal of Applied Developmental Psychology, 30, 344-355.
Tuicomepee, A. ve Romano, J. L. (2008). Thai adolecent survivors 1 year after the 2004 tsunami: A mixed methods study. Journal of Counseling Psychology, 55(3), 308- 318.
Vernberg, E. M., La Greca, A. M., Silverman, W. K. ve Prinstein, M. J. (1996). Predication of post-traumatic stress symptoms in children after Hurricane Andrew. Journal of Abnormal Psychology, 105, 237-248.
Yehuda, R. ve McFarlane, A. C. (1995). Conflict between current knowledge about posttraumatic stress disorder and its original conceptual basis. American Journal of Psychiatry, 152, 1705-1713.