25-year follow-up of treated and not-treated adolescents after the Spitak earthquake: course and predictors of PTSD and depression

Background There is a paucity of long-term prospective disaster studies of the psychological sequelae among survivors. Methods At 11/2 and 25 years after the Spitak earthquake, 142 early adolescents from two cities were assessed: Gumri (moderate-severe exposure) and Spitak (very severe exposure). The Gumri group included treated and not-treated subjects, while the Spitak group included not-treated subjects. Instruments included: DSM-III-R PTSD-Reaction Index (PTSD-RI); DSM-5 PTSD-Checklist (PCL); Depression Self-Rating Scale (DSRS); and Center for Epidemiological Studies-Depression Scale (CES-D). Results (1) Between 11/2 and 25 years, PTSD rates and mean scores decreased significantly in the three groups (over 50%). However, at 25 years 9.1-22.4% met DSM-5 PTSD criteria. (2) At 11/2 years, the Spitak group had higher PTSD-RI (p < 0.001) and DSRS scores (p < 0.001) compared to the Gumri-not-treated group. At 25 years, the Spitak group that had experienced fewer post-earthquake adversities (p < 0.03), had a greater decrease in PTSD-RI scores (p < 0.02), and lower CES-D scores (p < 0.01). (3) Before treatment, PTSD-RI and DSRS scores did not differ between the Gumri-treated and not-treated groups. At 25-years, the Gumri-treated group showed a greater decrease in PTSD-RI scores (p < 0.03), and lower mean PTSD-RI (p < 0.02), PCL (p < 0.02), and CES-D (p < 0.01) scores. (4) Predictors of PTSD symptom severity at 25-years included: home destruction, treatment, social support, post-earthquake adversities, and chronic medical illnesses. Conclusion Post-disaster PTSD and depressive symptoms can persist for decades. Trauma-focused treatment, alleviation of post-disaster adversities, improving the social ecology, and monitoring for chronic medical illnesses are essential components of recovery programs.

Automated summary

Long-term prospective disaster studies have shown that PTSD rates and mean scores decreased significantly over 25 years, with 9.1-22.4% still meeting DSM-5 criteria. Factors such as post-disaster adversities, social support, and chronic medical illnesses were found to be predictors of PTSD symptom severity at 25 years. Treatment and improvement of social ecology are crucial for recovery programs.