Original article Post-traumatic stress reactions of children and adolescents exposed to the Athens 1999 earthquake Ioanna Giannopoulou a, *, Marios Strouthos b , Patrick Smith c , Anastasia Dikaiakou a , Vasiliki Galanopoulou a , William Yule c a NHS Community Mental Health Centre of Peristeri, Ploutonos and Ifaistou, 121 35 Athens, Greece b NHS Community Mental Health Centre of Halandri, Zalongou 6, 153 43 Athens, Greece c Department of Psychology, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London SE5 8AF, UK Received 25 May 2005; accepted 13 September 2005 Available online 10 March 2006 Abstract This study was undertaken 6–7 months after the 1999 Athens earthquake with the aim of exploring the differences in post-traumatic stress disorder (PTSD), anxiety and depression symptoms between a group of children exposed to earthquake with a group of children not exposed to it, but with both groups potentially exposed to the same levels of post-earthquake adversities. The study included 2037 children, aged 9–17 years, who were assessed with self-completed questionnaires. The directly exposed group (N = 1752) had significantly higher anxiety and PTSD scores than the indirectly exposed group (N = 284), but no significant group differences were found in depression scores. Girls in both groups reported significantly more PTSD, anxiety and depressive symptoms than boys. Younger children reported significantly more PTSD and anxiety symptoms than the older ones. No significant interactions were found between direct exposure to earthquake, age group and gender. The severity of PTSD symptoms was most strongly predicted by greater perceived threat during the earthquake, whereas depression was most strongly predicted by the level of post-earthquake adversity. The severity of anxiety symptoms was most strongly predicted by female gender. These findings are discussed in relation to the need for screening and intervention following earthquake events. © 2005 Elsevier SAS. All rights reserved. Keywords: PTSD; Children; Adolescents; Anxiety; Depression; Earthquake 1. Introduction Recent studies suggest that children and adolescents may develop posttraumatic stress symptoms after exposure to earthquake. The reported rates range from 21% to 70% [9,13]. This great variability in prevalence of PTSD symptoms may be attributable to differences in magnitude of the quake, the extent of devastation, casualties and differences in research methodology. Previous child post-earthquake studies have involved a comparison between children exposed to the event at various distances from the epicentre with non-exposed chil- dren. A common finding has been that proximity to the epi- centre and the magnitude of disaster-related experiences are the most powerful predictors of children’s PTSD [3,6,7]. Post- earthquake adversities (e.g. damage to home, displacement, disruption in social network, financial loss) have been impli- cated in explaining the severe and chronic nature of post- traumatic stress reactions [1,15]. Although the exposure effect has been clearly established, recent studies of disaster vic- tims have highlighted that the increased risk for PTSD is asso- ciated with how the child experiences and interprets the trau- matic event [21]. Perceived stress during earthquake has been found to be a significant predictor of PTSD symptoms [1]. Some studies investigating the effect of age on PTSD in school-age children found that younger children display more PTSD symptoms after exposure to a natural disaster [11] whereas others found no significant relationship between chil- dren’s age and PTSD [15]. Elevated PTSD levels have been reported by children, who had experienced indirect traumas, for example, either have witnessed another person being assaulted or were a relative of a victim [16,23]. There have * Corresponding author. E-mail address: ioannag@mycosmos.gr (I. Giannopoulou). European Psychiatry 21 (2006) 160–166 http://france.elsevier.com/direct/EURPSY/ 0924-9338/$ - see front matter © 2005 Elsevier SAS. All rights reserved. doi:10.1016/j.eurpsy.2005.09.005