Adolescents' Tsunami Exposure and Mental Health Consequences: Protective Role of Cultural Coping Strategies.

There is a knowledge gap regarding the link between disaster exposure and adolescent mental health problems in developing countries. This study examines the case of Sri Lanka to investigate (a) the immediate and long-term mental health impact of the 2004 tsunami disaster on adolescents and (b) the potential moderating effects of unique cultural and family practices that prevail in Sri Lanka. This study used a random sample of 160 adolescents (ages 12-19) and their mothers who were exposed to the tsunami disaster while living in a southern Sri Lankan village and provided prospective data immediately after the disaster (2005) and three years later (2008). A cross-culturally validated instrument assessed adolescent-mother dyads' tsunami exposure, stressful loss, family cultural rituals and familism, and adolescent mental health. Structural equation modeling analysis showed that exposure and perceptions of tsunami-induced stressful experiences were associated with early and later mental health problems in adolescents. In addition, this study found that unique cultural practices and familism moderated the link between adolescent tsunami exposure, stressful experiences, and levels of PTSD and depressive symptoms. The findings of this study could be utilized to develop prevention and intervention programs that are contextually and culturally valid and empirically supported, which would be more effective for trauma-exposed adolescents in developing countries.

Adverse Childhood Experiences and Intimate Partner Violence Among Recent Adults: Mental Health and Race.

Previous research has linked childhood exposure to family dysfunction and violence with long-term health outcomes, including mental health and later exposure to violence. However, fewer studies have modeled depressive symptoms (stemming from childhood adversity) as a key linking variable with later intimate partner violence (IPV) - particularly among diverse youth. The present study investigated (a) the direct effect of adverse childhood events (ACEs) on intimate partner violence, (b) the indirect effect of ACEs on intimate partner violence through depressive symptoms, and (c) the moderation of these associations by race. Method: Data were drawn from 702 participants (80% female) 18 years of age from panel data collected in 2019 from the 18 & Life Project. Participants self-reported adverse childhood experiences, intimate partner violence, and depressive symptoms using multiple items for each measure. Additional demographic variables assessed included gender, race, and sexual orientation. Structural equation modeling using Mplus Version 8 software was used to test hypothesized associations. Results: While results indicate a direct association between ACEs and IPV. Evidence for an indirect link through depressive symptoms was only found for White youth. The findings of this study provide evidence for the persistent long-term influence of ACEs on mental health and relationship experiences in later life. Conclusions: Our results suggest a need for early family and community-level interventions to protect children from exposure to early adverse experiences in order to protect their mental health and ensure successful relationship experiences.

Adolescent chronic pain links parental rejection to young adult biopsychosocial problems.

Little is known about the mediating role of adolescent chronic pain in the connection between adolescent parental rejection and psychosocial and physical health (i.e., disease risk) outcomes in young adulthood (YA). To address this gap, the present study tested a model of a successively contingent developmental process that integrates neurophysiological research and the life course developmental perspective. The model included parental rejection and chronic pain in adolescence and depressive symptoms, low education attainment, economic hardship and allostatic load in YA. The study utilized 13 years of prospective data from a nationally representative sample of 11,030 US adolescents. The findings largely supported the hypothesized model. Adolescent chronic pain, as influenced by parental rejection, was associated with depressive symptoms and economic hardship in YA. In addition, parental rejection directly influenced depressive symptoms, education level and economic hardship, all of which, in turn, contributed to greater physical health risk (i.e., allostatic load) in YA. These associations persisted even after controlling for adolescent illness, depressive symptoms, age, sex and race/ethnicity. Multi-group analysis showed that female participants were more vulnerable to stressful parental rejection and socioeconomic difficulties in YA. The theoretical and practical implications of these findings are discussed.

Early socioeconomic adversity and young adult diabetic risk: an investigation of genetically informed biopsychosocial processes over the life course.

The present study investigated a comprehensive model that integrates contributions of early socioeconomic adversity (ESA) and multiple polygenic scores (PGSs) through different mechanisms leading to diabetic risk in early adulthood. The study used prospective, longitudinal data from the National Longitudinal Study of Adolescent and Adult Health (Add Health) with a sample of 5,728 youth of European ancestry. The results showed that both ESA and PGSs were involved in different mechanisms. ESA contributed additively to educational failures, BMI, depressive symptoms, and diabetes risk over the life course (an additive process). Also, ESA launched a cascading process that connected these outcomes in a successively contingent manner. In addition to ESA, youths' multiple PGSs directly contributed to educational, psychological, and BMI outcomes. Multiple PGSs for education, BMI, and type 2 diabetes influenced not only youth outcomes that they were supposed to predict directly but also additional youth outcomes showing biological pleiotropy. The findings highlight the value of incorporating molecular genetic information into longitudinal developmental life course research and provide insight into malleable characteristics and appropriate timing for interventions addressing youth developmental and health outcomes.

The stigma of widowhood in war and disaster affected communities of Sri Lanka: Contextual paths between trauma exposure and mental health distress.

To add to the dialogue regarding the long-term recovery and wellbeing of war and tsunami-affected women in Sri Lanka, we utilised the Conservation of Resources Theory (COR, Hobfoll, 2009) to inform an investigation of direct and indirect effects. The study was specifically designed to assess how traumatic exposure may represent a form of loss which may associate with related losses in the form of external and internal stigma which may then associate with poor mental health outcomes. The data for this study were collected in 2016 from a sample of 379 widowed women in Eastern Sri Lanka; participant spouses died in the civil war, in the tsunami, or from health or other problems. Our analyses yielded a model suggesting associations between remembered trauma event exposure from war and disaster, external stigma, internalised stigma and mental health symptom distress. Results further yielded direct and indirect effects suggesting that trauma may represent a form of loss, and potentially lead to distress through the weight and challenges of stigma.

Stressful work conditions, positive affect, and physical health of middle-aged couples: A dyadic analysis.

This study investigated actor and partner effects involving middle-aged husbands' and wives' stressful work conditions (SWCs), positive affect (PA), and health outcomes in a dyadic trajectory context in three steps. First, examination of husbands' and wives' individual trajectories showed significant interindividual variations in SWCs and PA over time. Second, a dyadic growth curve model incorporating both husbands' and wives' growth curves of SWCs and PA showed that husbands' and wives' trajectories of SWCs over their early middle years (1991-1994) were negatively associated with their own parallel trajectories of PA independent of depressive symptoms trajectories. Finally, most of the growth factors of PA trajectories of husbands and wives (1991-1994) predicted their own residual changes in physical illness and overall physical health in 2001. In dyadic models, although contemporaneous correlations between most of the study constructs between husbands and wives were significant, all partner effects involving growth parameters of SWCs, PA, and health outcomes were not significant. Most of the indirect effects from SWCs growth factors to health outcomes through PA were significant. The findings suggested that PA was an important health resource for middle-aged husbands and wives that mediates the influence of one's SWCs on own physical health outcomes.

War and disaster in Sri Lanka: Implications for widows' family adjustment and perception of self-efficacy in caring for one's family.

The data for this study were collected in 2014 from widows in Eastern Sri Lanka whose spouses died in the civil war, tsunami, or from health-related problems. Conservation of resources (COR) theory was used as a lens to examine the extent to which war and tsunami-related damages and family problems predict variation in social support, family adjustment and a perception of self-efficacy in caring for one's family as reported by widowed women. We also investigated whether social support from the community and social support from family and friends mediated those relationships. Results of a path model fit to the data suggested variation in family adjustment to be negatively predicted by war-related family problems and positively predicted by the social support of friends and family. Additionally, a sense of self-efficacy in caring for one's family was found to be inversely predicted by war-related family problems and tsunami damages. Clinical, social and theoretical implications are discussed as well as directions for further research.

Subjective reactions to international research participation: An illustration of ethical considerations with women heading households in Sri Lanka.

There are unique ethical considerations in conducting international research with war and disaster-affected populations that are important for ensuring adequate protection of participants. Of particular importance is the distress that participants may experience as a result of being asked about traumatic stressors, psychological symptoms, and life problems. In this study, trauma-affected Tamil women in Eastern Sri Lanka were asked to report on their research-participation experience after taking part in a larger study on risk and resiliency. Results indicated that most participants experienced emotional upset as a result of taking part in the study. However, the degree of distress was generally not more than they anticipated, and most participants reported they would have participated had they known in advance how they would feel. Most participants perceived some benefit as a result of participating and agreed that items were personally relevant. Emotional distress from participation positively correlated with culturally specific symptoms of anxiety and depression. Contextual stressors and social support were not associated with participation-related distress. We discuss these findings as well as general issues that might arise in international research with trauma-affected populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Toward understanding posttraumatic stress and depression among trauma-affected widows in Sri Lanka.

OBJECTIVE: In this study, we applied conservation of resources theory (Hobfoll, 1989) to explain high rates of depression and posttraumatic stress symptoms (PTSS) among war- and disaster-affected Tamil widows in the Eastern Province of Sri Lanka. We hypothesized exposure to potentially traumatic events and severity of current contextual problems would influence PTSS and depressive symptoms directly and indirectly through loss of psychological (view of self), environmental (sense of community), and energy (physical health) resources. METHOD: Trained research assistants interviewed a convenience sample (N = 381) of women, using established measures of the constructs of interest. Data were analyzed using path analysis in MPlus. The significance of the indirect effects was tested using bootstrapping. RESULTS: The model had an acceptable fit (χ2 = 4.06, df = 1, p < .05; Log Likelihood = -3344.26*; AIC = 6760.59; BIC = 6894.64; RMSEA = 0.09; CFI = .99; TLI = .91; SRMR = .02) and explained approximately 38% of the variance in both PTSS and depression. Contextual problems were significantly associated with PTSS and depression both directly and indirectly through deleterious effects on view of self, health status, and sense of community. Degree of trauma exposure was directly associated with indicators of distress. CONCLUSION: Results support the utility of COR theory in this context and hold implications for research and program development. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

PTSD symptoms among tsunami exposed mothers in Sri Lanka: the role of disaster exposure, culturally specific coping strategies, and recovery efforts.

BACKGROUND AND OBJECTIVES: Women in Sri Lanka have been uniquely exposed to a complex and protracted set of stressors stemming from a civil war conflict spanning over 25 years and the tsunami which struck Southeast Asia in 2004. This study investigates coping strategies and their association with trauma-related symptoms of tsunami-exposed mothers in Sri Lanka at two time points. DESIGN: Data for this study come from surveys administered in two waves of data collection to investigate both mothers' and adolescent children's post-tsunami mental health in early 2005, three months after the tsunami struck, and again in 2008, three years later. METHODS: Latent-variable structural equation modeling was used to test the study hypotheses among 160 tsunami-affected mothers in the Polhena village, Matara district, Sri Lanka. RESULTS: Among the various coping strategies examined, the use of cultural rituals as well as inner psychological strength was associated with lower levels of posttraumatic stress symptoms. In contrast, passive religious beliefs were associated with greater posttraumatic stress levels. CONCLUSIONS: The results of this study reveal the differential associations of various coping strategies including rituals used by mothers exposed to the tsunami in Sri Lanka and their posttraumatic stress symptom levels.

War and disaster in Sri Lanka: Depression, family adjustment and health among women heading households.

BACKGROUND: The civil war, lasting from 1983 to 2009, and the tsunami that struck Southeastern Asia in 2004 were major stressors that changed the demographic landscape of the northern province of Sri Lanka. The composition of families changed dramatically, with an increase in female-headed households, largely due to casualties. The conservation of resources (COR) model was applied in this study to examine relationships between risk and resiliency factors among women heading households, including women widowed by war or disaster. AIMS: This study represents an investigation of the association between predictive risk and resiliency factors (i.e. war damage and loss, social support, economic status, religious participation and discrimination) and outcomes representing well-being (depressive symptoms, family adjustment and a rating of physical health). METHODS: Data from 514 women heading households living in the Kilinochchi district of Sri Lanka were collected through face-to-face interviews in 2013, and associations among the data were estimated using path analysis. RESULTS: Results suggest that resiliency factors that are representative of greater resources generally predicted lower levels of distress and vice versa. CONCLUSION: Further study informing intervention development with women heading households in Sri Lanka is warranted to better understand which individual, family and community resources are most important to mobilize for sustainable recovery efforts to be successful in the decades following war and natural disaster.

The role of natural disaster in individual and relational adjustment in Sri Lankan mothers following the 2004 tsunami.

The purpose of this study is to examine the associations between maternal mental health distress symptoms, including depression and post-traumatic stress disorder, the extent to which the presence of a child's disaster-related physical health problem(s) have interfered with daily functioning, and family cohesion over time among Sri Lankan mothers who survived the tsunami on 26 December 2004. Study variables were measured using a self-report questionnaire administered approximately four months after the event and three years later in summer 2008. Univariate, bivariate, and multivariate analyses were conducted. Path analysis was employed to assess the relationships between the key variables over time and the correlations in the study variables at each time point. Among other findings, the results of the path analysis indicated that post-traumatic stress symptom distress four months after the disaster significantly predicted variance in family cohesion three years later. Clinical and empirical research implications are presented and discussed.

Early socioeconomic adversity, youth positive development, and young adults' cardio-metabolic disease risk.

OBJECTIVE: Recent research suggests that psychosocial resources, including self-esteem, personality, and educational attainment, may be mechanisms explaining the socioeconomic variation in health risks. However, less research has examined this possibility over the early life course. METHOD: A nationally representative sample of 12,424 respondents with data collected over a 13-year period from National Longitudinal Study of Adolescent to Adult Health (Add Health) was examined. This study utilized a cumulative measure of early socioeconomic adversity capturing multiple dimensions of adversity to test resource focused models in a structural equation framework estimating the influence of early adversity on young adults' (ages 25-34) risk for cardio-metabolic disease, as measured by metabolic and cardiovascular bio-markers, through psychosocial resources (i.e., self-esteem, personality, and educational attainment). Lastly, potential model differences by sex and race/ethnicity were examined. RESULTS: The findings showed that early adversity contributed to young adults' cardio-metabolic disease risk directly. Additionally, early adversity increased young adults' cardio-metabolic disease risk indirectly through its' negative influence on the development of youths' psychosocial resources: self-esteem, positive personality, and educational attainment. The association between psychosocial resources and young adults' cardio-metabolic disease risk differed for men and women and across racial/ethnic groups. CONCLUSIONS: These findings contribute valuable knowledge to existing research by elucidating how early adversity exerts an enduring long-term influence on young adults' cardio-metabolic disease risk directly and indirectly through psychosocial resources. Furthermore, this information suggests that effective intervention and prevention programs should focus on early adversity and the development of youths' psychosocial resources.

Early socioeconomic disadvantage and young adult sexual health.

OBJECTIVE: To test a longitudinal and multilevel model predicting young adult risky sexual behaviors and sexually transmitted infections. METHODS: Data from 14,058 participants in 3 waves were used to link community and family disadvantage, adolescent adjustment problems, and risky sexual behaviors with STIs. RESULTS: Community-level disadvantage, being African American, and being female remained predictors of sexual behaviors and STIs whereas adolescent adjustment mediated the effect of several family characteristics. CONCLUSIONS: This study demonstrates how individual-, family-, and community-level characteristics and vulnerabilities contribute to young adult sexual risk and STI prevalence. Findings indicate specific individual characteristics and childhood experiences that should be specific targets of STI prevention efforts.

Change in the health of tsunami-exposed mothers three years after the natural disaster.

BACKGROUND: Women's experiences with secondary stressors resulting from natural disasters, such as increased economic insecurity, expanded caregiving responsibilities and disrupted family life, may contribute to women's mental and physical health problems. AIMS: The present study investigates change and stability in post-tsunami depressive symptoms and perceived physical health of tsunami-exposed mothers over three and a half years. METHODS: Using data from 160 tsunami-affected mothers, the present study uses structural equation modelling to investigate (1) change, stability, cross-lagged reciprocal influences of mental and physical health and (2) the meditation effect of negative life events on the relationship between tsunami exposure and post-tsunami depressive symptoms and perceived physical health of tsunami-exposed mothers from 2005 to 2008. RESULTS: Tsunami exposure contributed to depressive symptoms among mothers independently of pre-tsunami family adversities. Average depressive symptoms showed a decline whereas poor physical health showed an increase over this period. The results also revealed an interrelated health process between depression and physical health over time. Continuity of health problems were mediated by secondary stressors that also exerted an additive effect on later health problems. CONCLUSIONS: Post-disaster intervention and recovery programmes should focus not only on mothers' exposure to natural disasters, but also their pre- and post-natural disaster adversities. They should reach disaster-exposed mothers directly and have an integrated health approach to disrupt continuities of health problems.

Heterogeneity in adolescent depressive symptom trajectories: implications for young adults' risky lifestyle.

OBJECTIVES: The first objective of this study was to empirically identify adolescent depressive symptoms trajectory among classes. The second objective was to investigate the implications of adolescent depressive symptom trajectories for their lifestyle factors in young adulthood. METHODS: Data came from the National Longitudinal Study of Adolescent Health (Addhealth). The analysis included the identification of depressive symptom trajectory groups using Latent Class Analyses. The identified trajectory groups were then compared with regard to risky lifestyle factors in young adulthood. RESULTS: Youth in the chronically high, increasing, and decreasing depressive symptoms groups showed significantly higher prevalence rates in most risky lifestyle factors compared with the consistently low trajectory group, after controlling for lagged measures, adolescent delinquency, family characteristics, and race/ethnicity. The risky lifestyle factors included: having multiple sex partners, having been arrested/committed crime, being an excessive drinker, being a smoker, and being unmarried. CONCLUSIONS: The associations of adolescent depressive symptom trajectory groups with young adult risky lifestyle factors provide evidence for the psychosocial processes through which experiences with depressive symptoms influence young adult lifestyle.

Heterogeneity in youth depressive symptom trajectories: social stratification and implications for young adult physical health.

PURPOSE: The first objective of this study was to investigate young adult physical health implications of adolescent depressive symptom trajectories. The second objective was to investigate the social stratification of adolescent depressive symptom trajectories. METHODS: Data came from the National Longitudinal Study of Adolescent Health. The analysis included the identification of depressive symptom trajectory groups. These four groups were then compared in terms of socioeconomic characteristics and change in physical health problems, from adolescence to young adulthood. RESULTS: Youth in the chronically high, increasing, and decreasing depressive symptoms groups showed significantly higher increases in physical health problems and poorer socioeconomic characteristics than did the consistently low group. CONCLUSIONS: The associations of adolescent depressive symptom trajectory groups with changes in physical health provide evidence for the etiological processes through which depression influences physical health. Differing socioeconomic characteristics of depressive symptom trajectory groups suggest social stratification of trajectories.