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A 30-Month Prospective Follow-up Study of Psychological Symptoms, Psychiatric Diagnoses, and Their Effects on Quality of Life in Children Witnessing a Single Incident of Death at School

Sook-Hyung Song, MD; Bung-Nyun Kim, MD, PhD; Nam-Hee Choi, PhD; Jeong Ryu, PhD; Brett McDermott, MD; Vanessa Cobham, PhD; Subin Park, MD; Jae-Won Kim, MD, PhD; Soon-Beom Hong, MD; Min-Sup Shin, PhD; Hee-Jeong Yoo, MD, PhD; and Soo-Churl Cho, MD, PhD

Published: May 15, 2012

Article Abstract

Objective: We explored the course of trauma-related psychological symptoms and psychiatric diagnoses in 167 children who, as fourth graders, witnessed death at school and assessed the long-term effects of their symptoms on quality of life and their parents’ rearing stress.

Method: 167 children were evaluated using diverse self-rating symptom scales at 2 days (T1: May 19, 2007), 2 months (T2: July 16, 2007), 6 months (T3: November 12 – 17, 2007), and 30 months (T4: November 16 – 21, 2009) after the accident. All children were interviewed with the Diagnostic Interview Schedule for Children-Version IV (DISC-IV) at T1. High-risk children were assessed with the DISC-IV at T3 and T4. Children’s quality of life and parental stress were assessed in all children and parents using the Parenting Stress Index and the Child Health and Illness Profile at T4.

Results: The mean scores and prevalence of severe posttraumatic stress disorder (PTSD) and anxiety symptoms decreased significantly over time (P < .001), but depressive symptoms did not. Although the prevalence of DISC-IV-based diverse anxiety disorders decreased significantly over time, 45% of high-risk subjects evaluated with the DISC-IV met criteria for an anxiety or depressive disorder at T4. Linear and logistic regression analyses showed that depressive symptoms at 6 months predicted more severe parental stress (β = 0.51; odds ratio [OR] = 2.88), less satisfaction (β = −0.25; OR = 2.66), and lower achievement (β = −0.41; OR = 1.50) at 30 months. PTSD symptoms were not associated with parental stress or quality of life at T4.

Conclusions: This study provides new evidence regarding the long-term course of trauma-related symptoms and diagnostic changes in children exposed to a single trauma. Children’s depressive symptoms predicted lower children’s quality of life and higher parental rearing stress after 2 years. Careful assessment and management of depressive symptoms can potentially reduce parental stress and improve quality of life of children.

J Clin Psychiatry 2012;73(5):e594-e600

Submitted: August 22, 2011; accepted November 29, 2011 (doi:10.4088/JCP.11m07348).

Corresponding author: Bung-Nyun Kim, MD, PhD, Division of Child and Adolescent Psychiatry, Department of Psychiatry, Seoul National University, College of Medicine, 101 Daehakro, Chongro-Gu, Seoul, South Korea ( or

Volume: 73

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