Posttraumatic stress and depressive reactions among Nicaraguan adolescentsafter hurricane mitch

Objective: This study determined the severity of posttraumatic stress and d epressive reactions among Nicaraguan adolescents after Hurricane Mitch and the relationship of these reactions to objective and subjective features of hurricane exposure, death of a family member, forced relocation, and thoug hts of revenge. Method: Six months after the hurricane, 158 adolescents from three differen tially exposed cities were evaluated by using a hurricane exposure question naire, the Child Posttraumatic Stress Disorder Reaction Index, and the Depr ession Self-Rating Scale. Results: Severe levels of posttraumatic stress and depressive reactions wer e found among adolescents in the two most heavily affected cities. Severity of posttraumatic stress and depressive reactions and features of objective hurricane-related experiences followed a "dose-of-exposure" pattern that w as congruent with the rates of death and destruction across cities. Level o f impact (city), objective and subjective features, and thoughts of revenge accounted for 68% of the variance in severity of posttraumatic stress reac tion. Severity of posttraumatic stress re action, death of a family member, and sex accounted for 59% of the variance in severity of depression. Conclusions: After a category 5 hurricane, adolescents in heavily affected areas with extreme objective and subjective hurricane-related traumatic fea tures of exposure experience severe and chronic posttraumatic stress and co morbid depressive reactions. The recovery of the severely affected Nicaragu an adolescents is vital to the social and economic recovery of a country ra vaged by years of political violence and poverty. These findings strongly i ndicate the need to incorporate public mental health approaches, including systematic screening and trauma/ grief-focused interventions, within a comp rehensive disaster recovery program.