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ORIGINAL ARTICLE |
From the Department of Child and Adolescent Psychiatry, Necker-Enfants-Malades Hospital, Paris, France.
Address reprint requests to: Dr. Gilbert Vila, Service de Pédopsychiatrie, CHU Necker-Enfants-Malades, 149 rue de Sèvres, 75015 Paris, France.
OBJECTIVE: The objective of our investigation was to study the course of direct and indirect posttraumatic disorders over 18 months in children after they were taken hostage in their school.
METHODS: Twenty-six young hostages were evaluated by using standardized clinical interviews and self-administered questionnaires (State and Trait Anxiety Inventory for Children [STAIC]and Revised Impact of Event Scale [IES]) 2, 4, 7, and 18 months after the event. They were compared with 21 children from the same school who were not taken hostage (indirect exposure).
RESULTS: Symptoms of acute stress were observed in 25 (96%) of the children who were directly involved in the traumatic event. After 2 months, 18 children had developed disorders according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, including 7 cases of full posttraumatic stress disorder (PTSD), 11 cases of subclinical PTSD, 3 cases of separation anxiety, 1 case of specific phobia, and 2 cases of major depressive disorder. Anxiety scores (STAIC) decreased between 2 and 4 months and then stabilized, whereas symptoms of avoidance (IES-avoidance) decreased gradually throughout the follow-up period, and symptoms of repetition (IES-intrusion) decreased less markedly. Children who were indirectly exposed to the trauma also manifested protracted posttraumatic symptomatology (two full cases of PTSD and six cases of subclinical PTSD), but their IES-intrusion scores were significantly lower at 7 months than those of children who were directly exposed, and the severity of their symptoms diminished over time. Girls tended to show a higher level of anxiety and more features of intrusion than boys. Psychological debriefing did not prevent occurrence of the disorders, but children who were not debriefed had the worst outcomes.
CONCLUSIONS: Even after a short event and even if they are not directly exposed, children under the age of 9 years can develop high rates of posttraumatic disorders that follow a protracted course despite early intervention and careful monitoring.
Key Words: children • indirect exposure • debriefing • posttraumaticstress disorder • treatment
Abbreviations: DSM-IV = Diagnostic and Statistical Manual of MentalDisorders, fourth edition; IES = Revised Impact of EventScale; Kiddie-SADS-L = Kiddie-Schedule for Affective Disorders andSchizophrenia for School Age Children, Lifetime Version; MDD =major depressive disorder; PTSD = posttraumatic stress disorder; STAIC = State and Trait Anxiety Inventory for Children.
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