A Longitudinal Examination of Interpersonal Violence Exposure, Concern for Loved Ones During a Disaster, and Web-Based Intervention Effects on Posttraumatic Stress Disorder Among Adolescent Victims of the Spring 2011 Tornadoes
Open accessAbstract
Natural disasters are common and devastating, and can affect the mental health of adolescents. It is also common for adolescents to have histories of interpersonal violence (IPV). The current study was a secondary data analysis of a larger randomized clinical trial and examined the moderating effect of IPV history and concern for loved ones during a disaster on treatment condition effects on posttraumatic stress disorder (PTSD) symptoms over time among disaster-exposed adolescents. Participants ( n = 979) were recruited postdisaster to participate in a randomized clinical trial examining the efficacy of a web-based intervention, Bounce Back Now (BBN), on mental health symptoms at 4 and 12 months postintervention. It was found that adolescents with an IPV history and who had caregivers that were concerned for loved ones during a disaster had more PTSD symptoms at baseline than those without such histories. Furthermore, caregiver concern for loved ones during a disaster moderated the effect of BBN on PTSD symptoms over time. Specifically, the BBN condition was most effective for adolescents who had caregivers who were concerned for loved ones during the disaster in reductions of PTSD symptoms over time. The current study provides further evidence for the use of technology-based interventions for individuals as a means to address mental health symptoms after a traumatic event, especially among those with more severe traumatic experiences.
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Cites
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Claims the paper makes
0 of 23 cited sources checked · 0 supported · 0 flagged
- Findingown data
There was no significant interaction between IPV history, BBN condition, and PTSD symptoms over time.
“There was no significant interaction between IPV, BBN, and PTSD symptoms over time.”
Quote in the paperNot a substantial claim - Findingown data
Female adolescents had more PTSD symptoms at baseline than male adolescents.
“This suggests that females and adolescents with an IPV history in addition to their experience with a natural disaster had more PTSD symptoms at baseline.”
Quote in the paperNot a substantial claim - Findingown data
Among adolescents with caregivers who did not report concern for loved ones during the disaster, neither the BBN group nor the control group showed a significant change in PTSD symptoms over time.
“among those who were not concerned for loved ones during the disaster, there was no main effect of change over time for adolescents in the BBN condition or the control condition, control: b = −0.03, p = .338, odds ratio (OR) = 0.97; BBN: b = −0.02, p = .120, OR = 1.02.”
Quote in the paperSubstantial claim - Findingown data
The BBN group showed a non-significant trend toward fewer PTSD symptoms than the control group.
“There was a trend for both time and BBN condition on PTSD symptoms suggesting that PTSD symptoms lowered over time, and those in the BBN condition had lower PTSD symptoms than those in the control condition, but these effects did not reach significance.”
Quote in the paperNot a substantial claim - Findingown data
Among disaster-exposed adolescents, having a history of interpersonal violence was associated with a greater number of PTSD symptoms at baseline.
“The main effects model revealed a significant association between IPV exposure and PTSD symptoms and an association between gender and PTSD at baseline”
- Also stated in: § Discussion · plain
“The main effects models revealed that an IPV history was significantly associated with more PTSD symptoms among disaster-exposed adolescents.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · plain
- Findingown data
For adolescents with caregivers who were concerned about loved ones during the disaster, the BBN group showed a significant decrease in PTSD symptoms over time.
“Those in the BBN condition experienced a significant decline in PTSD symptoms over time (b = −0.02, p = .041, OR = 0.98)”
Quote in the paperSubstantial claim - Findingown data
The analysis showed a significant three-way interaction of time, treatment group, and caregiver concern for loved ones on PTSD symptoms.
“A significant interaction was found between time, treatment condition (BBN vs. control), and concern for loved ones on PTSD symptoms (see Table 2).”
Quote in the paperSubstantial claim - Findingown data
Concern for loved ones during the disaster was not significantly associated with PTSD symptoms at baseline.
“There were no significant associations between age and PTSD symptoms or concern for loved ones and PTSD symptoms.”
Quote in the paperNot a substantial claim - Findingown data
There was a non-significant trend for PTSD symptoms to decrease over time.
“There was a trend for both time and BBN condition on PTSD symptoms suggesting that PTSD symptoms lowered over time, and those in the BBN condition had lower PTSD symptoms than those in the control condition, but these effects did not reach significance.”
Quote in the paperNot a substantial claim - Findingown data
For adolescents with caregivers who were concerned about loved ones during the disaster, the control group did not show a significant decrease in PTSD symptoms over time.
“whereas those in the control condition did not (b = 0.02, p = .255, OR = 1.02; see Table 4).”
Quote in the paperSubstantial claim - Findingown data
Age was not significantly associated with PTSD symptoms.
“There were no significant associations between age and PTSD symptoms or concern for loved ones and PTSD symptoms.”
Quote in the paperNot a substantial claim - Premisecitation
The BBN program is able to lower mental health symptoms in adolescents exposed to disasters.
“A web-based intervention, Bounce Back Now (BBN), can reduce mental health symptoms among disaster-exposed adolescents (Ruggiero et al., 2015).”
- Also stated in: § BBN: A Web-Based Intervention · plain
“BBN is a web-based intervention that is efficacious at reducing mental health symptoms among disaster-exposed adolescents (Ruggiero et al., 2015).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Ruggiero et al., 2015
Not checked in the free run.
- Also stated in: § BBN: A Web-Based Intervention · plain
- Interpretationreasoning
Interpersonal relationships during a disaster might raise the likelihood of PTSD symptoms.
“Although disasters are not typically categorized as interpersonal traumas, the role of interpersonal relationships within the context of disasters may increase the risk of PTSD symptoms.”
Quote in the paperSubstantial claim - Premisecitation
A history of IPV carries greater risk for symptoms such as PTSD than a history of other trauma types.
“IPV confers higher risk of symptomatology, including PTSD, more so than history of other event types (Breslau et al., 1998; Briere & Elliott, 2000; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; Kilpatrick et al., 2013; Resnick, Kilpatrick, Dansky, Saunders, & Best, 1993).”
Quote in the paperSubstantial claim0 of 3 sources checked- cites Breslau et al., 1998
Not checked in the free run.
- cites Briere & Elliott, 2000
Not checked in the free run.
- cites Kessler et al., 1995
Not checked in the free run.
- Interpretationreasoning
Taken together, earlier IPV may increase vulnerability to mental health problems after later trauma exposure.
“Collectively, these findings highlight the relative importance of IPV history, suggesting that prior experience of IPV may confer heightened risk of mental health problems following exposure to additional traumatic events.”
Quote in the paperSubstantial claim - Interpretationown data
The BBN intervention produced the greatest benefit among adolescents with caregivers who worried about loved ones' safety during the disaster.
“These findings suggest that BBN was most effective for those who had caregivers who were concerned about the safety of loved ones during the disaster.”
- Also stated in: § Abstract · plain
“Specifically, the BBN condition was most effective for adolescents who had caregivers who were concerned for loved ones during the disaster in reductions of PTSD symptoms over time.”
Quote in the paperSubstantial claim - Also stated in: § Abstract · plain
- Study design and conductown data
The study used a randomized clinical trial design.
“Strengths of the current study include the large population, the randomized clinical trial design, and the examination of PTSD among disaster-exposed adolescents.”
Quote in the paperSubstantial claim - Premisecitation
Adolescents with multiple forms of victimization face an even higher risk of mental health symptoms.
“risk of these symptoms increases further for adolescents who have experienced polyvictimization, or multiple forms of victimization (Finkelhor, Ormrod, & Turner, 2007; Ford, Elhai, Connor, & Frueh, 2010).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Finkelhor, Ormrod, & Turner, 2007
Not checked in the free run.
- cites Ford, Elhai, Connor, & Frueh, 2010
Not checked in the free run.
- Premisecitation
Some aspects of IPV might add unique risk for psychopathology after accounting for other trauma, disaster experiences, and demographics.
“Certain features of IPV may uniquely contribute to higher risk of psychopathology, beyond other traumatic event history, experiences during the disaster, and demographic variables (Resnick et al., 2017).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Resnick et al., 2017
Not checked in the free run.
- Study design and conductown data
The count outcome of PTSD symptoms was best modeled with a negative binomial distribution.
“A negative binomial distribution best represented the distribution of the outcome variables, which were counts of PTSD symptoms.”
Quote in the paperSubstantial claim - Interpretationreasoning
People with more severe trauma histories may engage more with intervention content because it feels more relevant to them.
“It also provides further evidence that technology-based interventions are most effective for individuals with more severe trauma histories, suggesting that these individuals are more likely to attend to the content due to it being more salient for that population.”
Quote in the paperNot a substantial claim - Study design and conductown data
On average, the intervention began about nine months after the tornado.
“although the intervention was conducted as soon as possible postdisaster, on average, it was approximately 9 months after the disaster.”
Quote in the paperSubstantial claim - Study design and conductreasoning
The inclusion of IPV interaction terms in the models means that the IPV main effects are not interpretable.
“Interaction terms involving IPV history were included in the interaction models; therefore, main effects of IPV cannot be interpreted.”
Quote in the paperNot a substantial claim - Study design and conductown data
The data violated assumptions for Poisson and zero-inflated regression models.
“The distributions did not fully meet the assumptions of other distributions including a Poisson regression (there was evidence of overdispersion) and zero-inflated regressions (there was no evidence of overinflated 0s).”
Quote in the paperSubstantial claim - Premisecitation
A prior randomized trial tested BBN, BBN with a parent self-help component, and assessment-only control on PTSD and depression.
“A randomized controlled trial compared BBN, BBN + adult self-help (ASH) for parents, and assessment-only control condition on PTSD and depression (Ruggiero et al., 2015).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Ruggiero et al., 2015
Not checked in the free run.
- Interpretationown data
This study adds evidence supporting technology-delivered interventions for mental health symptoms following trauma.
“The current study provides further evidence for the use of technology-based interventions for individuals as a means to address mental health symptoms after a traumatic event.”
Quote in the paperSubstantial claim - Premisecitation
An online program reduced alcohol use and sexual assault risk more strongly in people with greater sexual assault histories.
“a web-based intervention was more effective at reducing alcohol use and sexual assault risk among individuals with more severe sexual assault histories (Gilmore, Lewis, & George, 2015).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Gilmore, Lewis, & George, 2015
Not checked in the free run.
- Premisecitation
A recent study reported that having an IPV history and disaster-related experiences such as worrying about loved ones' safety raised the odds of PTSD in adolescents.
“a recent study found that both an IPV history and experiences during a disaster, including concern about the safety of loved ones increased the likelihood of adolescent PTSD (Resnick et al., 2017).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Resnick et al., 2017
Not checked in the free run.
- Premisecitation
Adolescents who reported IPV had about three times as many current PTSD symptoms as those who did not.
“Results from this study indicated that prior, pretornado IPV was robustly associated with PTSD symptoms assessed 8 months posttornado, finding that adolescents endorsing IPV history experienced 3 times the number of current symptoms as those without an IPV history.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Resnick et al., 2017
Not checked in the free run.
- Premisecitation
Prior work indicates that technology-delivered interventions for trauma survivors work best for those with more severe symptoms.
“Previous research has found that in technology-based interventions for trauma-exposed individuals, the intervention is most effective for individuals with more severe symptoms.”
Quote in the paperSubstantial claim - Interpretationown data
Contrary to the hypothesis, BBN did not show its greatest benefit among adolescents who had both an IPV history and a caregiver who was concerned for loved ones during the disaster.
“However, the BBN condition was not most effective for adolescents with both IPV histories and concern for loved ones during the disaster on PTSD symptoms as hypothesized.”
Quote in the paperSubstantial claim - Premisecitation
Active intervention groups outperformed the assessment-only control in lowering PTSD and depression.
“It was found that the intervention conditions were more effective than the assessment-only control condition on reducing PTSD and depression.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Ruggiero et al., 2015
Not checked in the free run.
- Interpretationreasoning
Technology-delivered interventions tend to work best for people with greater trauma histories.
“It also provides further evidence that technology-based interventions are most effective for individuals with more severe trauma histories, suggesting that these individuals are more likely to attend to the content due to it being more salient for that population.”
Quote in the paperSubstantial claim - Premisecitation
IPV occurring before the tornado was strongly linked to PTSD symptoms measured eight months later.
“Results from this study indicated that prior, pretornado IPV was robustly associated with PTSD symptoms assessed 8 months posttornado, finding that adolescents endorsing IPV history experienced 3 times the number of current symptoms as those without an IPV history.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Resnick et al., 2017
Not checked in the free run.
- Premisecitation
A meta-analysis reported that girls exposed to interpersonal trauma had the greatest PTSD risk relative to boys and to other trauma types.
“one meta-analysis found that adolescent girls who experienced interpersonal trauma were at highest risk of developing PTSD compared with boys and other types of traumatic experiences (Alisic et al., 2014).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Alisic et al., 2014
Not checked in the free run.
- May combine two claims. 5
- Classified as probably not a substantial claim. 9
May combine two claims.
Study design and conductown dataTreatment and control groups did not differ significantly at baseline in caregiver concern for loved ones or IPV history.
“There were no significant differences between treatment condition and control on concern for loved ones during the disaster (χ2 = 0.32, p = .57) or on IPV history (χ2 = .01, p = .92).”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataBoth models adjusted for age and gender as covariates.
“Age and gender were included as control variables in both the main effects and interaction model.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe intervention did not deeply address interpersonal trauma content.
“Finally, the content of the intervention did not target interpersonal traumas in great depth.”
Quote in the paperNot a substantial claimMay combine two claims.
Interpretationown dataBoth an IPV history and caregiver concern for loved ones during a disaster are interpersonal trauma-related experiences that can influence symptoms after a disaster.
“Taken together, these findings suggest that two interpersonal experiences related to trauma, IPV trauma history and concern for loved ones during a disaster, can affect postdisaster symptomology.”
Quote in the paperSubstantial claimMay combine two claims.
Interpretationown dataBBN produced its largest effects among adolescents with greater trauma exposure, including having a caregiver who worried about loved ones' safety.
“Partially consistent with the hypotheses, the BBN condition was most effective for adolescents with more severe trauma exposure, such as caregiver’s concern for the safety of loved ones.”
Quote in the paperSubstantial claimClassified as probably not a substantial claim.
PremisecitationHaving multiple victimization experiences predicts worse mental health outcomes than having only one.
“Previous literature suggests that polyvictimization is associated with more negative mental health outcomes than single victimization alone (Finkelhor et al., 2007; Ford et al., 2010);”
Quote in the paperSubstantial claim0 of 2 sources checked- cites Finkelhor et al., 2007
Not checked in the free run.
- cites Ford et al., 2010
Not checked in the free run.
Classified as probably not a substantial claim.
PremisecitationA video intervention delivered during a post-sexual-assault forensic exam helped women most when they had prior sexual assault histories.
“a video-based intervention conducted during a post–sexual assault medical forensic exam found that the intervention was most effective for women with prior sexual assault histories (Resnick et al., 2007).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Resnick et al., 2007
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationIPV is widespread among adolescents.
“Interpersonal violence (IPV) is widespread among adolescents, with 8.5 million women and 1.5 million men experiencing rape before the age of 18 years (Smith et al., 2017), 3.5 million women and nearly 1 million men experiencing stalking before the age of 18 years (Smith et al., 2017), and 21% of female and 10% of male high school students who date experiencing dating violence (Centers for Disease”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites Smith et al., 2017
Not checked in the free run.
- cites CDC, 2016
Not checked in the free run.
Classified as probably not a substantial claim.
Study design and conductown dataRandom assignment placed participants into control, BBN, or BBN with adult self-help groups.
“Participants were randomly assigned to a control condition, BBN, or BBN + ASH”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenCaregiver concern for loved ones during the disaster was measured with one dichotomous item.
“First, concern for loved ones during the disaster was a single-item assessment and it was dichotomous.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductcitationThe National Survey of Adolescents PTSD module was used to measure PTSD symptoms and has demonstrated good reliability and concurrent validity.
“assessed using the National Survey of Adolescents PTSD module, which yields strong reliability and concurrent validity (Kilpatrick et al., 2003).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Kilpatrick et al., 2003
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationChildhood and adolescent trauma, including disaster exposure, is linked to various mental health symptoms, and PTSD symptoms are among the most frequent.
“Trauma exposure in childhood and adolescence, including exposure to natural disasters, is associated with a range of mental health symptoms with posttraumatic stress disorder (PTSD) symptoms being among the most common (e.g., Kilpatrick et al., 2000; Kilpatrick et al., 2003; Waldrop et al., 2007)”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites Kilpatrick et al., 2000
Not checked in the free run.
- cites Kilpatrick et al., 2003
Not checked in the free run.
- cites Waldrop et al., 2007
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductnone givenThe study had a large population.
“Strengths of the current study include the large population, the randomized clinical trial design, and the examination of PTSD among disaster-exposed adolescents.”
Quote in the paperNot a substantial claim
The paper relies on this without support.
Whether other victimization histories affect treatment outcomes was previously unexamined.
“However, the role of other victimization history in treatment outcomes has not yet been examined.”
The paper relies on this without support.
How IPV history and disaster-related concern for loved ones influence response to an online postdisaster PTSD intervention was not known.
“However, it is unclear how IPV history and concern for loved ones during a disaster are associated with treatment response for a web-based intervention targeting postdisaster PTSD among adolescents.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A pre-post-test study with N = 979 US adolescents affected by tornadoes in Missouri and Alabama in 2011 revealed a significant decline in PTSD symptoms in the BBN condition at 4- and 12-month follow-up compared to the control condition.
“A pre–post-test study with N = 979 US adolescents affected by tornadoes in Missouri and Alabama in 2011 [25] revealed a significant decline in PTSD symptoms in the BBN condition at 4- and 12-month follow-up compared to the control condition”
From Promoting Recovery from Disasters, Pandemics, and Trauma: A Systematic Review of Brief Psychological Interventions to Reduce Distress in Adults, Children, and Adolescents (2023) · cites this paper as [25]
The Participants and Procedure sections support the sample of 979 adolescents affected by the 2011 Missouri and Alabama tornadoes and the 4- and 12-month follow-ups. The Results report a significant decline in PTSD symptoms in the BBN condition only among adolescents whose caregivers were concerned for loved ones during the disaster; the overall BBN effect did not reach significance. The paper also reports change over time, not a separate significant BBN-versus-control difference at each follow-up. (LLM, conf=0.91)
Experimental — accuracy not yet measuredA controlled pre-post study found a significant decline in PTSD symptoms in adolescents and their parents at follow-up measurements after the application of BBN.
“One article reported on a controlled pre–post study that found a significant decline in PTSD symptoms in adolescents and their parents at follow-up measurements after the application of BBN [25]”
From Promoting Recovery from Disasters, Pandemics, and Trauma: A Systematic Review of Brief Psychological Interventions to Reduce Distress in Adults, Children, and Adolescents (2023) · cites this paper as [25]
The Results (page unavailable) report a significant decline in PTSD symptoms over time only among BBN-treated adolescents whose caregivers were concerned for loved ones during the disaster; the overall time and BBN effects were not significant. The Methods > Measures section (page unavailable) assesses adolescents’ PTSD symptoms at baseline and follow-up, not parents’ PTSD symptoms. The claim therefore overgeneralizes the adolescent finding and adds an unsupported parent outcome. (LLM, conf=0.90)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Abstract overstates the baseline finding for caregiver concern
MinorThe abstract presents caregiver concern as a finding associated with more baseline PTSD symptoms, but the Results state that its association with PTSD symptoms was not significant.
“It was found that adolescents with an IPV history and who had caregivers that were concerned for loved ones during a disaster had more PTSD symptoms at baseline than those without such histories.”
“There were no significant associations between age and PTSD symptoms or concern for loved ones and PTSD symptoms.”
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“(2021) [25] Bounce Back Now (BBN) [24] Controlled pre–post study N = 979 Tornadoes Improvement in post-disaster mental health.”
BackgroundMethodInfluential
- Authors
- Gilmore, A. K., Price, M., Bountress, K. E., Zuromski, K. L., Ruggiero, K., & Resnick, H.
- Affiliations
- Medical University of South Carolina (US)
- University of Vermont (US)
- Virginia Commonwealth University (US)
- Harvard University (US)
- Corresponding author
- Gilmore, Amanda K.
- Venue
- Journal of Interpersonal Violence
- Publisher
- SAGE Publications
- Published
- 2018-08-23
- Volume
- 36
- Issue
- 9-10
- Pages
- NP4611-NP4625
- ISSN
- 0886-2605 (ISSN-L)
- 1552-6518
- PMC
- PMC6387649
- OpenAlex
- W2888695879
- Cited by
- 8
- References
- 23
- Citations by year
- 2026: 2 · 2023: 2 · 2022: 1 · 2021: 1 · 2020: 1 · 2019: 1
- FWCI
- 0.88
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Interpersonal Violence (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (K23DA042935; PI: Gilmore)
- National Institute of Mental Health (R01MH107641-02S1; PIs: Ruggiero/Galea)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- post-traumatic stress disorder, adolescents, tornadoes, natural disasters, online intervention, moderating effect, disaster mental health, technology-based interventions
- MeSH terms
- Exposure to Violence, Internet-Based Intervention, Adolescent, Disasters, Humans, Stress Disorders, Post-Traumatic, Tornadoes
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-09-28.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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