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Outcome of psychotherapy among early adolescents after trauma
Abstract
OBJECTIVE: The authors evaluated the effectiveness of brief trauma/grief-focused psychotherapy among early adolescents exposed to the 1988 earthquake in Armenia. METHOD: Posttraumatic stress and depressive reactions among treated and not treated subjects were evaluated pre- and postintervention, at 1 1/2 and 3 years after the earthquake, respectively. RESULTS: Severity of posttraumatic stress symptoms significantly decreased among the subjects given psychotherapy, while severity of these symptoms increased significantly among the subjects not treated with psychotherapy. The improvement in posttraumatic stress symptoms was attributable to improvement in all three symptom categories (intrusion, avoidance, and arousal) of posttraumatic stress disorder (PTSD). There was no change in severity of depressive symptoms among subjects given psychotherapy. However, depressive symptoms among subjects not treated with psychotherapy significantly worsened over time. The changes in severity of posttraumatic stress and depressive symptoms were positively correlated within both groups. CONCLUSIONS: The findings demonstrate the efficacy of trauma/grief-focused brief psychotherapy in alleviating PTSD symptoms and preventing the worsening of comorbid depression among early adolescents after a catastrophic disaster. The results support the broad use of such school-based interventions after major disasters and demonstrate the cross-cultural applicability of Western psychotherapeutic approaches.
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“Goenjian and colleagues69 assessed a classroom-based trauma and grief component therapy in adolescents 1.5 years after the 1988 earthquake in Armenia and reported that the intervention improved PTSD and maintained depression symptoms (both increased in the control group).”
From Mental health and psychosocial support in humanitarian settings: linking practice and research (2011) · cites this paper as [69]
In the citing paper
“The findings of a study on the effectiveness of brief trauma/grief-focused psychotherapy that has been carried out after an earthquake in Armenia [13] suggest that CBT-like methods can also be promising interventions in the context of mass disasters.”
From Treating children traumatized by war and tsunami: a comparison between exposure therapy and meditation-relaxation in north-east Sri Lanka (2009) · cites this paper as [13]
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Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., Friedman, M., Gersons, B. P. R., de Jong, J. T. V. M., Layne, C. M., et al. (2021) · Psychiatry · doi:10.1080/00332747.2021.2005387 · Cited by 66
“For instance, Basoglu and colleagues (2005), in an attempt to develop a brief treatment for disaster survivors, found that a single session of modified behavioral treatment in earthquake–related PTSD produced significant treatment effects on all measures at post–treatment.”
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“For instance, research has suggested that group-based treatments, which by their nature provide a source of peer support, can be effective in reducing distress in children exposed to extreme stressors (Goenjian et al., 1997; Paardekooper, 2002).”
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“Three studies [Goenjian et al., 1997; Layne et al., 2001; Saltzman et al., 2001] used the same treatment: trauma/grief-focused group psychotherapy.”
BackgroundMethodPractice Parameter on Disaster Preparedness
Pfefferbaum, B. J., & Shaw, J. A. (2013) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2013.08.014 · Cited by 56
When the Levee Breaks: Treating Adolescents and Families in the Aftermath of Hurricane Katrina
Rowe, C. L., & Liddle, H. A. (2008) · Journal of Marital and Family Therapy · doi:10.1111/j.1752-0606.2008.00060.x · Cited by 53
“Three years following a major earthquake in Italy, untreated youth had actually increased PTSD symptom scores and depressive symptoms, with a striking 69% still experiencing PTSD (Goenjian et al., 1997).”
BackgroundSaxe, G., Ellis, B. H., Fogler, J., Hansen, S. E., & Sorkin, B. (2005) · Psychiatric Annals · doi:10.3928/00485713-20050501-10 · Cited by 51
Interventions for post-traumatic stress disorder in children and adolescents
Carr, A. (2004) · Developmental Neurorehabilitation · doi:10.1080/13638490410001727464 · Cited by 50
“Participants in the other studies were earthquake survivors in Armenia and Italy [56, 57]; survivors of the sinking of the ship Jupiter in Greece [25]; hurricane survivors in the US [58] and survivors of single incident stressors in the US such as road traffic accidents, gunshot injury, fires, severe storms, severe il…”
BackgroundYe, Y., Fan, F., Li, L., & Han, Q. (2014) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-0821-4 · Cited by 50
“For example, 6–20 weeks after Turkey’s 7.4 magnitude quake, 31 % of children had depression [8]; 15 months after the 2008 Sichuan earthquake in China, 13.9 % children developed depression [9] and one and a half years after the Armenia earthquake, Goenjian [10] reported the rates of depression among early adolescents w…”
BackgroundInfluentialLopes, A. P., Macedo, T. F., Coutinho, E. S. F., Figueira, I., & Ventura, P. R. (2014) · PLoS ONE · doi:10.1371/journal.pone.0109013 · Cited by 49
“The only two studies with adolescents [15,16] used techniques encompassing reconstruction and reprocessing the traumatic experience, identification of traumatic memories and building up tolerance to related reactions, development of acceptance and adaptation to earthquake-related changes, mental reconstruction of dece…”
BackgroundMethodInfluentialA Cognitive Developmental Approach to Understanding How Children Cope With Disasters
Deering, C. G. (2000) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/j.1744-6171.2000.tb00070.x · Cited by 49
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Group Psychotherapy for Adolescent Survivors of Homicide Victims: A Pilot Study
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“On the Child PTSD Reaction Index, higher scores indicate more severe symptoms and scores of 40 or greater have been found to correlate with clinical diagnoses of PTSD (Goenjian et al., 1997).”
BackgroundCognitive Behavioral Therapy for Symptoms of Trauma and Traumatic Grief in Refugee Youth
Murray, L. K., Cohen, J. A., Ellis, B. H., & Mannarino, A. (2008) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/j.chc.2008.02.003 · Cited by 47
“Savjak, and colleagues, unpublished manual, 2001) are covered in another article in this issue [51,52].”
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“PTSD and depressive symptoms have been reported by many western studies to occur more frequently among children exposed to disasters (Goenjian, 2005; Goenjian et al., 1997, 2001, Roussos et al., 2005; Papageorgiou et al., 2000; Shaw, Applegate, & Schorr, 1996).”
BackgroundResultThe Prevalence of Childhood Traumatic Grief—A Comparison of Violent/Sudden and Expected Loss
McClatchey, I. S., Vonk, M. E., & Palardy, G. J. (2009) · OMEGA - Journal of Death and Dying · doi:10.2190/om.59.4.b · Cited by 46
“Contrary to previous studies that have reported higher levels of PTSD among females (Dyregrov et al., 1996; Goenjian et al., 1997; Pynoos et al., 1993; Winje & Ulvik, 1998), no gender differences were found in this study.”
ResultSequelae of Sarin Toxicity at One and Three Years After Exposure in Matsumoto, Japan
Nakajima, T., Ohta, S., Fukushima, Y., & Yanagisawa, N. (1999) · Journal of Epidemiology · doi:10.2188/jea.9.337 · Cited by 46
The Cost-Effectiveness of Psychotherapy for the Major Psychiatric Diagnoses
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“Psychotherapy for PTSD includes a number of effective specialized approaches including psychodynamic, cognitive, and desensitization treatments (Brom, Kleber, & Defares, 1989; Foa, 1997; Foa, Rothbaum, Riggs, & Murdock, 1991; Frueh, Turner, Beidel, Mirabella, & Jones, 1996; Goenjian et al., 1997; Lubin, Loris, Burt, &…”
Validation of the UCLA Child Post traumatic stress disorder-reaction index in Zambia
Murray, L. K., Bass, J., Chomba, E., Imasiku, M. L., Thea, D. M., Semrau, K. E. A., Cohen, J. A., Lam, C., & Bolton, P. A. (2011) · International Journal of Mental Health Systems · doi:10.1186/1752-4458-5-24 · Cited by 45
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“However, recent research focusing on the interaction between trauma and grief symptoms (e.g., Eth & Pynoos, 1994; Goenjian et al., 1997; Nader, Pynoos, Fairbanks, & Frederick, 1990; Pynoos, 1992; Pynoos et al., 1993; Saltzman, Steinberg, Layne, Aisenberg, & Pynoos, 2001) Authors’ Note: Correspondence concerning this a…”
BackgroundInfluentialFive Essential Elements of Immediate and Mid-Term Mass Trauma Intervention: Empirical Evidence
Hobfoll, S. E., Watson, P., Bell, C. C., Bryant, R. A., Brymer, M. J., Friedman, M. J., Friedman, M., Gersons, B. P. R., de Jong, J. T. V. M., Layne, C. M., et al. (2009) · FOCUS The Journal of Lifelong Learning in Psychiatry · doi:10.1176/foc.7.2.foc221 · Cited by 48
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“follow rather than precede a disaster (Chemtob et al. 2002; Giannopoulou et al. 2006; Goenjian et al. 1997; Hock et al. 2004; LaGreca et al. 1996; Ronan 1997a; Ronan and Johnston 1999, 2005; Shooshtary et al. 2008; Vernberg et al. 1996; Weems et al. 2007).”
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“…young people who had PTSD as a result of exposure to a disaster includes that by Chemtob, Nakashima, and Carlson (2002) examining adolescents with PTSD 2–3 years following exposure to a disaster, and that by Goenjian et al. (1997) in which CBT for PTSD began 1.5 years after exposure to a disaster.”
BackgroundInfluentialFacing Fears and Sadness: Cognitive‐Behavioral Therapy for Childhood Traumatic Grief
Brown, E., Pearlman, M., & Goodman, R. F. (2004) · Harvard Review of Psychiatry · doi:10.1080/10673220490509516 · Cited by 51
Positive Psychology and Disaster Mental Health: Strategies for Working with Children and Adolescents
Vernberg, E. M., Hambrick, E. P., Cho, B., & Hendrickson, M. L. (2016) · Journal of Clinical Psychology · doi:10.1002/jclp.22289 · Cited by 44
Depression in children and adolescents
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“…individual psychological treatment for PTSD has been the primary empirically tested treatment among young people (Deblinger, McLeer, & Henry, 1990; Goenjian et al., 1997; March, Amaya-Jackson, Murray, & Schulte, 1998; Saigh, 1986, 1987a, 1987b) However, new arrivals to our psychologically…”
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Structured group therapy for posttraumatic stress disorder in incarcerated male juveniles.
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Group Therapy for Children After Homicide and Violence: A Pilot Study
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“Goenjian et al. (1997) evaluated the effectiveness of a school-based trauma and grief psychotherapy protocol with sixth and seventh graders provided in Armenia about a year and a half after the 1988 Armenian earthquake.”
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Hill, R. M., Oosterhoff, B. J., Layne, C. M., Rooney, E. E., Yudovich, S., Pynoos, R. S., & Kaplow, J. B. (2019) · Journal of Child and Family Studies · doi:10.1007/s10826-019-01481-x · Cited by 41
“TGCTA has been implemented and evaluated in multiple settings, including in schools following a 1988 earthquake in Armenia (Goenjian et al. 1997), underserved inner-city youth exposed to high rates of community violence (Saltzman et al. 2001), and following the 1992-1995 Bosnian civil war (Layne et al. 2008).”
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Child Disaster Mental Health Interventions: Therapy Components
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“For example, a number of group interventions used pull-out sessions in which the child was seen individually.(25,29,39,40) In their”
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“Studies have shown that mental health interventions can have a contributory influence after disasters and that programs developed for Western countries can be adapted cross culturally [3,4].”
BackgroundPredictors of posttraumatic stress in children and adolescents
Hizli, F. G., Taşkıntuna, N., Ișıklı, S., Kılıç, C., & Zileli, L. (2008) · Children and Youth Services Review · doi:10.1016/j.childyouth.2008.08.008 · Cited by 30
Children, Adolescents, and Families Exposed to Torture and Related Trauma
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Prevention and treatment of posttraumatic stress disorder in the school setting
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Internalizing problem behavior and family environment of children with burns: A Dutch pilot study
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“[31] described treatment interventions for PTSD after a single-incident stressor [32], or caused by unpredictable catastrophic environmental events [33,34].”
BackgroundPost-traumatic stress disorders
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“While PTSD reactions and anxiety are likely to occur early in the post-disaster course and to continue if untreated, depression may have later onset and may persist.(34) The course of symptom development and recovery may affect the response to interventions.”
BackgroundMethodRoux, I. H. L., & Cobham, V. E. (2021) · Clinical Child and Family Psychology Review · doi:10.1007/s10567-021-00373-1 · Cited by 32
“, (2005) was a followup of participants from another included study (Goenjian et al., 1997) where it is clearly noted that criteria for a probable PTSD diagnosis were met.”
BackgroundIdentifying and Helping Long Term Child and Adolescent Disaster Victims
Drumm, L., & Stretch, J. J. (2003) · Journal of Social Service Research · doi:10.1300/j079v30n02_06 · Cited by 26
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Trauma-Informed Care and Posttraumatic Growth Among Bereaved Youth: A Pilot Study
McClatchey, I. S. (2018) · OMEGA - Journal of Death and Dying · doi:10.1177/0030222818804629 · Cited by 24
Schoenwald, S. K., & Rowland, M. D. (2002) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195134575.003.0005 · Cited by 24
Graham, R. A., Osofsky, J. D., Osofsky, H. J., & Hansel, T. C. (2017) · Advances in School Mental Health Promotion · doi:10.1080/1754730x.2017.1311798 · Cited by 23
“Overall preliminary evidence suggests CBT as an effective method of treating children and adolescents post disaster (Ferdos & Seyed-Hossein, 2007; Giannopoulou, Dikaiakou, & Yule, 2006; Goenjian et al., 1997, 2005; Shooshtary, Panaghi, & Moghadam, 2008).”
Pediatric Posttraumatic Stress Disorder
Sharma-Patel, K., Filton, B., Brown, E. J., Zlotnik, D. M., Campbell, C., & Yedlin, J. (2011) · Springer eBooks · doi:10.1007/978-1-4419-7784-7_21 · Cited by 24
Children and disasters: public mental health approaches
Pynoos, R. S., Steinberg, A. M., & Brymer, M. J. (2007) · Cambridge University Press eBooks · doi:10.1017/cbo9780511544415.004 · Cited by 23
Self-citationIreys, H. T., DeVet, K. A., & Sakwa, D. (2002) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195134575.003.0008 · Cited by 21
Evans, M. E., & Armstrong, M. I. (2002) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195134575.003.0003 · Cited by 22
Caring for Children Affected by Disaster
Pfefferbaum, B. J. (1998) · Child and Adolescent Psychiatric Clinics of North America · doi:10.1016/s1056-4993(18)30230-x · Cited by 22
Earthquake effects on youth: understanding psychological challenges and support needs
ŞAM, M., Sever, G., Yüksel, H., & Aliyev, R. (2025) · BMC Psychology · doi:10.1186/s40359-025-02373-0 · Cited by 29
“…programs are effective in relieving symptoms of PTSD and depression, as well as providing improvements in the resilience levels of adolescents [25–27] Additionally, it was shown that online and face-to-face clinic-based group studies with earthquake-affected people in Turkey contributed to…”
Adolescents' experiences of psychosocial support after traumatisation in a school shooting
Murtonen, K., Suomalainen, L., Haravuori, H., & MARTTUNEN, M. J. (2011) · Child and Adolescent Mental Health · doi:10.1111/j.1475-3588.2011.00612.x · Cited by 21
Post-Disaster Social Justice Group Work and Group Supervision
Bemak, F., & Chung, R. C. (2011) · The Journal for Specialists in Group Work · doi:10.1080/01933922.2010.537737 · Cited by 21
“…single sessions, have been found to be highly beneficial in post-disaster work (Basoglu, Salcioglu, Livanou, Kalender, & Acar, 2005; de Jong, 2002; Goenjian et al., 1997; Hobfoll et al., 2007), despite the lack of uniformity of evidence-based best practices research (Gersons & Olff, 2005).”
BackgroundThe Telemedicine and Teleconsultation System Application in Clinical Medicine
Chang, T.-C., Lee, J. D., & Wu, S. (2004) · Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC) · doi:10.1109/iembs.2004.1403953 · Cited by 21
Adolescent Depression: Challenges and Opportunities
Jackson, B., & Lurie, S. (2006) · Advances in Pediatrics · doi:10.1016/j.yapd.2006.04.008 · Cited by 21
Delany‐Brumsey, A., Joseph, N. T., Myers, H. F., Ullman, J. B., & Wyatt, G. E. (2011) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0022381 · Cited by 20
Traumatic and Complicated Grief Among Children: One or Two Constructs?
McClatchey, I. S., Vonk, M. E., Lee, J., & Bride, B. E. (2013) · Death Studies · doi:10.1080/07481187.2012.725571 · Cited by 20
Cultural Factors in Traumatic Stress
Yeomans, P. D., & Forman, E. M. (2009) · doi:10.1002/9781444305807.ch11 · Cited by 20
“Goenjian et al. (1997) using a grief-focused psychotherapy significantly reduced PTSD symptoms among post-earthquake (1988) Armenian youth compared to a wait-list control.”
MethodLiu, Q., Jiang, M., Yang, Y., Zhou, H., Zhou, Y., Yang, M., Xu, H., & Ji, Y. (2019) · Disaster Medicine and Public Health Preparedness · doi:10.1017/dmp.2018.76 · Cited by 20
“5 years after the Spitak earthquake among untreated early adolescents.(9) Chronic PTSD symptoms are likely to have future detrimental effects on these adolescents, including on the state of their conscience, their academic achievement, physical health, and the stability of their family and community life.”
BackgroundCognitive-Behavioral Psychology: Implications for Disaster and Terrorism Response
Ruzek, J., Walser, R. D., Naugle, A. E., Litz, B., Mennin, D., Polusny, M. A., Ronell, D. M., Ruggiero, K., Yehuda, R., & Scotti, J. R. (2008) · Prehospital and Disaster Medicine · doi:10.1017/s1049023x00006130 · Cited by 21
“Goenjian et al examined a school-based, brief trauma/grief-focused therapy for early adolescents who had been exposed to the 1988 Armenia earthquake.(35) Eighteen months following the event, 64 adolescents (on average, 13 years old) from four severely damaged elementary schools participated in the program.”
BackgroundTwenty-year follow-up of adults traumatized during childhood in Armenia
Najarian, L. M., Sunday, S. R., Labruna, V., & Barry, I. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2011.06.038 · Cited by 19
“A follow-up study of adolescents whowere treatedwith brief trauma/grieffocused psychotherapy, and evaluated 1 1/2 and 3 years postintervention, indicated significant improvement in PTSD but no change in severity of depressive symptoms in the treated group (Goenjian et al., 1997).”
BackgroundSelf-citationPharmacologic Treatment of Traumatized Children
Cohen, J. (2001) · Trauma Violence & Abuse · doi:10.1177/1524838001002002004 · Cited by 20
Acute Stress Disorder Symptoms in Gunshot‐Injured Youth
Hamrin, V., Jonker, B. W., & Scahill, L. D. (2004) · Journal of Child and Adolescent Psychiatric Nursing · doi:10.1111/j.1744-6171.2004.tb00013.x · Cited by 18
Endo, T., Shioiri, T., Toyabe, S., Akazawa, K., & Someya, T. (2007) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2006.09.006 · Cited by 18
In the face of tragedy: Placing children's reactions to trauma in a new context
Gurwitch, R. H., Kees, M. R., & Becker, S. M. (2002) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(02)80022-0 · Cited by 17
Reasons for Hope for Children and Families: A Perspective and Overview
Burns, B. J. (2002) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780195134575.003.0001 · Cited by 17
Medved, S., Imširagić, A. S., Salopek, I., Puljić, D., Handl, H., Kovač, M., Peleš, A. M., Štimac, D., Romančuk, L., Mužić, R., et al. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.795661 · Cited by 16
“After the 1988 Armenian earthquake, a psychiatric outreach program with trauma/grief-focused brief psychotherapy to adolescents was implemented, which was associated with a reduction of risk of developing PTSD and prevented the exacerbation of depressive symptoms (40, 41).”
Background
Metadata
- Authors
- Goenjian, A. K., Karayan, I., Pynoos, R. S., Minassian, D., Najarian, L. M., Steinberg, A. M., & Fairbanks, L. A.
- Affiliations
- University of California, Los Angeles (US)
- Venue
- American Journal of Psychiatry
- Published
- 1997-04-01
- Volume
- 154
- Issue
- 4
- Pages
- 536-542
- ISSN
- 0002-953X (ISSN-L)
- 1535-7228
- OpenAlex
- W2188464625
- Cited by
- 381
- References
- 29
- Citations by year
- 2026: 1 · 2025: 4 · 2024: 1 · 2023: 2 · 2022: 5 · 2021: 9 · 2020: 4 · 2019: 6 · 2018: 11 · 2017: 37 · 2016: 10 · 2015: 5 · 2014: 15 · 2013: 10 · 2012: 9
- FWCI
- 15.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Psychology › Clinical Psychology › Child Therapy and Development
- Keywords
- trauma-focused psychotherapy, post-traumatic stress disorder, depression, early adolescents, 1988 Armenia earthquake, disaster mental health, school-based intervention, PTSD symptom clusters, cross-cultural applicability
- MeSH terms
- Adolescent, Age Factors, Armenia, Cross-Cultural Comparison, Depressive Disorder, Disasters, Female, Follow-Up Studies, Humans, Male, Personality Inventory, Psychiatric Status Rating Scales, Psychotherapy, Psychotherapy, Brief, Psychotherapy, Group, Severity of Illness Index, Stress Disorders, Post-Traumatic, Students, Comorbidity, Treatment Outcome
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