Environmental Semeiotics (2010) 3(4), 42-56

DOI 10.3383/es.3.4.1

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Emergencies and Disasters: Childrens Vulnerability

and Psychosocial Resilience.
LARCAN R., CUZZOCREA F.
Pedagogic and Psychological Sciences Department, University of Messina, Messina (Italy)
Email corresponding author: larcan@unime.it

Abstract: The main aim of this paper is to summarize the most significant factors that
can influence the impact of a natural disaster on children and adolescents. First, the
principal psychological approaches are synthesized. Literature offers four models to
explain the impact of a natural disaster on individual functioning: (1) homeostatic model;
(2) transactional model; (3) motivational perspective; (4) socio-cognitive theories. These
models must be analysed together to better explain the effect of a natural disaster on the
individual, family and social context. Starting with a definition of stress, we focused on
the psychological processes involved and the specific effects on children's development.
Several studies have found that unexpected and uncontrollable events can cause various
physical and psychological problems in children and adolescents. We examined the
relationship between the parents reactions and their children's well being. In general, the
family can represent a functional protector system, but it is necessity to provide
psychological support to help individuals cope with the distress caused by unpredictable
natural disasters. Specific social support must be provided to promote both individual and
family resilience.
Keywords: Emergency, disaster, stress, vulnerability, psychosocial resilience

1. INTRODUCTION
A high percentage of people involved in emergencies experience
health problems after their exposure to these traumatic events. A highly
probable event that can be predicted is concurrent with a low stress
perception. Unpredictability and uncontrollability (e.g. natural disaster,
earthquakes, etc.) produce a high level of stress.
Predicting a natural disaster such as an earthquake is very difficult.
The occurrence of a natural disaster in a community is a large-scale
environmental stressor and exposure to earthquakes will result in many

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43

psychological reactions. People have to adapt quickly to new

circumstances, often facing the loss of friends, family and possessions.
The effect of trauma on children and adolescents has been studied in
a wide range of situations (Ursano, Bell, Eth et al., 2004). The conceptual
model for understanding the development and maintenance of
psychological effects include characteristics of the stressors, pre-existing
child characteristics, and the post-disaster environment.
A traumatic event may affect an individuals ability to regulate,
identify and express emotions as well as his/her later development (Tural
et al., 2004).
Literature presents some psychological approaches that investigate
the nature and characteristics of stress from different points of view.
The homeostatic model, for example, focuses on the fact that if a
particular event influences the psychophysical state of the subject it is
necessary to implement a series of processes of re-equilibration.
Researches have shown that stress occurs during these processes of reequilibrium. This stress however is caused not by the environmental
changes the subject has to cope with, but by the processes themselves.
Unlike claims made by authors such as Lazarus and Folkman (1984),
according to whom only clearly negative events can lead to stress, the
prospect of change argues that stress is a condition that accompanies any
change, regardless of the connotation (positive or negative) given to the
event.
The transactional model focuses mainly on the function of cognitive
and emotional processes. It states, for example, how the evaluation of an
event is strongly influenced not only by the characteristics themselves,
either positive or negative, but also by the characteristics of the subject, its
objectives, its values and its level of vulnerability.
Very close or similar to this theory is the motivational perspective,
with particular emphasis on the relationship between the level of
motivation, the level of vulnerability of the subject and the event
characteristics. Skinner and Welborn (1994) consider stressful only those
events that affect autonomy, competence and relationships of the subjects.
On the other hand, socio-cognitive theories have focused research on
styles of attribution and locus of control of individuals, highlighting the
influence these have on the interpretation of events and the behaviour that
follows. In fact, if the individual is not sufficiently "equipped" on a
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cognitive and emotional level, that is, not able to produce and implement
useful strategies, over time the consequences could become serious,
especially with the biological onset of illnesses which are often
psychosomatic (Cuzzocrea, 2002).
To better understand the impact of a natural disaster on individual
functioning, all these theories and models must be organized together. It
might therefore be useful to consider: (1) the psychophysical state of the
subject (homeostatic model); (2) the function of cognitive and emotional
processes (transactional model); (3) the motivation and the vulnerability of
individuals (motivational perspective); (4) the styles of attribution and
locus of control of subjects (socio-cognitive theories).
The principal aim of this paper is to summarize the main factors that
can influence the impact of a natural disaster on children. In these
situations, the child must cope with distress that causes an unbalanced
homeostatic system, perhaps without adequate cognitive and emotional
competences that influence their style of attribution and locus of control.
This internal condition exposes the child to a high risk of vulnerability.
The social context (e.g. family, community and society) plays an
important role of protection.
In this paper, we start by defining stress and the psychological processed
involved, with the objective of highlighting the difficulty in generalizing
results for all those affected. Individual competences, the learning process,
social contexts make it impossible to provide a general hypothesis about
the psychological effects on all subjects. However, researches have
produced some important informations about how to support people who
have been exposed to a natural disaster in order to prevent future
physiological disorders.
Particular attention was given to the effect of natural disasters on
children and how they cope with this kind of distress. Another important
aim in this paper was to analyse the relationship between parents' reactions
and children's well being. Literature shows the significant psychological
effect that natural disasters have on parents and, with a high probability,
on their children. Generally speaking, the family can represent a functional
protector system, but, faced with a natural disaster, if the parents are not
properly supported, they can become involuntarily a factor of risk.
In the final part of this paper, we point out the necessity of providing
psychological support to individuals in order to help them cope with the
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distress caused by unpredictable natural disasters. This support must focus

not on parents and children separately, but on the family as a system.
2.WHAT IS STRESS? WHICH PSYCHOLOGICAL PROCESSES ARE INVOLVED?
Selye (1950) is the father of the concept of stress, although he
used the term to indicate stimulus that triggered responses. Hence, we
must distinguish between stimulus (stressor), responses and process.
The expression "Im stressed" is quite commonly used in daily life,
but it is difficult for people to distinguish "eustress" from "distress"
(Selye, 1974). In psychology, this distinction is very important because
stress is not necessarily a negative factor. In many situations, the organism
activation triggered by an unexpected event represents a protection factor.
For example, while we are driving a car and a person crosses the street,
this input immediately activates our brain, and we can stop the car.
Moreover, while we are waiting for an important exam, eustress
guarantees the right state of activation. However, if a stressor has
continued for a long time, if it is unexpected, or too intense, we may have
great difficulty in re-establishing the homeostatic system. In these
situations negative stress occurs.
Although stress response is an individual process, researchers are
trying to find some constants. The way an individual processes information
and chooses the best response (in terms of the best adaptation) depends on
biological factors. The mind and body are programmed to respond and to
perceive danger. The amygdala and sympathetic nervous system are
stimulated, while the parasympathetic nervous system and, consequently,
the vegetative functions are inhibited. The release of cortisol and
noradrenaline guarantee an automatic response capable of coping with
stress. For these reasons, the response to stress stimuli is a non-specific
alarm response that elicits a general increase in wakefulness (arousal).
However, individual characteristics, previous learning and contextual
factors can influence the identification of a stimulus as "stressor" and how
to cope with stress. An event is considered a stressor when it causes a
discrepancy between the usual situation and what is taking place (Ursin,
Eriksen, 2004).
Figure 1 represents the four aspects of the process to guarantee the
correct balance of the homeostatic system. Stress is defined by these four
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components: stimuli input ("stressors"), experience,

("activation") and "feedback" (Levine, Ursin, 1991).

Stimuli
input

Individual
evaluation

Social and
family support

stressors
or
neutral stimuli

Individual
evaluation

Experience

Individual
evaluation

Contextual factors
Cognitive processing
Individual
Feedback

response

Individual
evaluation

Response
Activation

Figure 1: Graphic representation of the processes involved in the evaluation of stimulus

that could be considered a stressor.

An input can be considered a source of stress if evaluated as too

frequent, intense and long lasting. Same stimuli would be regarded as
negative in most or all situations, but others can be perceived differently.
For example, an earthquake is commonly considered a traumatic event;
however, the impact is different on different people depending on the
situational setting and previous learning. The impact of an earthquake can
cause loss of friends, family, and possessions (situational setting). The
degree of damage is correlated with a high probability of observing other
psychological consequences.
Most of the time, an event is considered a stressor in relation to its
consequences. Stimuli are evaluated by the brain and learning process
allows us to categorize a particular stimulus or set of stimuli as threatening
or negative. Concerns and beliefs about possible health consequences of
the state seem to play an important role.
The way individuals evaluate stimuli, feedback, past experience,
cognitive resources influences the degree of homeostatic imbalance and
alarm occurs only when there is a significant discrepancy between what
should be and what is.
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Ursin and Eriksen (2004) present the "Cognitive Activation Theory

of Stress" (CATS), considering that the stress response depends on
acquired expectancies of the outcomes of stimuli and available responses.
The CATS model analyzed the relationship between learning, activation
and the relationship between stress and health, emphasizing the
difference between responses and expectancies.
Individuals repertories of coping resources vary greatly, with some
coping methods more likely to buffer against stress than others. How do
the children and adolescent survivors cope with the altered environment?
This question is of great interest to researchers, because the process of
coping is central to understanding the relationship between stressful life
events and psychiatric disorders (Spurrell, McFarlane, 1993). The CATS
model highlights the mechanism of reinforcement contingencies for the
development of coping. By analyzing feedback, the individual can verify
whether the strategy used was successful. If the response was efficient, it
will probably be used again in similar situations. However, if the
individual choices were not functional to find an escape or solution to the
problem, it will probably not be used again. In both situations, the
individual responses will be generalized. The individual learns what the
best solution for a specific situation is. Throughout a lifetime, many
associations between responses and consequences occur and this
knowledge contributes towards defining an individual's coping style.
This learning does not develop the same way for all individuals. However,
the preference for particular coping styles seems to be relatively stable and
it is considered a characteristic of personality (Folkman, Lazarus, 1990).
The complexity involved in processing stressful events makes it
impossible to reach a clear and certain generalization about possible
psychological consequences of exposure to traumatic events. However,
researches can provide some indication about the factors that, in particular
circumstances, may represent a risk for the health and psychological wellbeing of individuals of different ages. It is possible to identify elements
that can be considered protective or resilience factors.
3. HOW CHILDREN REACT TO NATURAL DISASTER
Many studies have shown that the personal skills needed to manage a
stressful event are subject to constant changes and developments. The age
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or, more correctly, the level of cognitive development achieved by the

individual, is therefore an important variable in predicting the type of
psychological reactions that the child might have during its development
(Cuzzocrea, 2002).
A childs perception of an event is influenced by age (more
specifically the development stage), by the consequences which surround it
and by following events. When faced by a natural disaster, young children
may be unable to process this event cognitively, which makes a child
particularly vulnerable.
If a child does not develop adequate individual coping strategies, the
impact of an event such as a natural disaster or earthquakes can be
traumatic. These inadequate individual competences, associated with a
negative evaluation of a natural disaster, expose the child to an elevated
risk of distress.
Figure 2 shows how different the level of stress can be. It is
influenced by the interaction between the type of perception and evaluation
of the situation the subject has to deal with (more or less dangerous) and
his/her capacity and ability (sufficient or insufficient) to cope successfully.

Sufficient
Individual coping
No

Medium
No
distress

Positive evaluation
of a stimulus

Unperceived
distress

Medium
distress

Maximum
distress

Negative evaluation
of a stimulus

Maximun

Low
Insufficient
Individual coping

Figure 2: Graphic representation of the levels of distress in relation to the perception of

the event and available individual resources.

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The four areas represent the different levels of distress. We observe

that if the individual resources are adequate it can be easier to control and
reduce the effects of the stressful event, (area shaded in grey). On the
contrary, if an individual is in a highly stressful situation - but not
perceived as capable of solving it - the level of distress would significantly
increase (area highlighted in black).
If an event is not considered a stressor, children will not
experience any distress and they will probable not come up with any
behaviour to cope with it (white zone). However, if the childs evaluation
is not adequate to the real situation (underestimated stimulus or
overestimated capacity), the insufficient coping strategies available will not
be helpful (dotted area). In this case, the child might experience illness and
unperceived distress.
Children who experience earthquakes show significant psychological and
physical changes. Several studies have found that being exposed to
unexpected and uncontrollable events can cause various physical and
psychological problems (Kilic, Ulusoy, 2003), such as post-traumatic
stress disorder (Chen, Lin, Tseng, Wu, 2002; Hsu, Chong, Yang, Yen,
2002), depression (Basoglu, Kilic, Salcioglu, Livanau, 2004; Hizli et al.,
2009), separation anxiety (Goenjian et al., 1995), generalized anxiety
disorder, panic attacks, borderline personality disorder, etc. (Goenjian et
al., 1997). This is especially true for children and adolescents (Goenjian et
al., 2001).
A significant correlation between exposure to a traumatic event and
sleep disorders, nightmares, anger, separation anxiety, memory and
distraction, survivors guilt, changes in perception of the world have been
found (Yule, 2001).
Unfortunately, studies on this topic have some significant limitations.
In many researches, the sample size is relatively low and not large enough
to analyse interaction effects. Most researches use questionnaires and
retrospective childrens self-reports or parents reports. Childrens
reactions are probably influenced by what they remember about their
emotional reactions during a traumatic event. A child attributes subjective
distress based on an elementary cognitive re-elaboration of information it
receives from its parents and the social context. Some researches suggest
using play and drawing to help younger children to express their
cognitions and emotional status. Interviews are not always helpful. On the
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other hand, parents are often unable to evaluate their childrens experience
and difficulties and bias can occur in parental observations. Parents'
reports of their childrens behaviour might be influenced by their own
mental health status.
Another limit regards time-sheet observations. Generally, children
are not interviewed during the early phases following a disaster or before
the catastrophe. The questionnaires are completed many months after the
natural disaster and it is extremely difficult to follow up on the children for
a long period of time.
In fact, from a clinical perspective, it is not very important to
identify the objective status, but what influences our status is subjective
distress. However, the methodology and assessment instruments chosen
can influence results. For instance, Hsu et al. (2002) observed that PTSD
among adolescent victims of a severe earthquake is not as high as that
reported in other studies.
Tufnell (2005) identifies some important moderating factors: the
childs age and maturity, sex, personality, previous experience of trauma
and coping resources.
Age did not have a significant effect on either anxiety or other
symptoms, but there were significant interactions between age and
maturity and coping abilities. It is possible that younger children are less
able to cognitively and emotionally process traumatic experiences than
older ones. However, Giannopoulou, Strouthos, Smith, Dikaiakou,
Galanopoulou, & Yule (2006) suggest significant age effect on PTSD, with
younger children reporting more symptoms. Younger children run a higher
risk of developing post-traumatic stress reactions, in particular symptoms
of avoidance, following this type of trauma.
Another pre-existing factor that predicted psychological effects at
follow-up is sex, with girls at higher risk. It is suggested that girls greater
risk appears at the stage of subjective interpretation of events rather than at
the stage of objective exposure (Norris et al., 2002). Female gender seems
to be the best predictor of anxiety levels for children. It is possible that
emotional factors and communication have a greater influence on girls than
on boys. Gender differences were found by Yule and Williams (1990) and
more recently by Giannopoulou et al. (2006). Shannon et al. (1994) found
that males reported more symptoms related to cognitive and behavioural
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factors, while females were more likely to report symptoms associated

with emotional processing and reaction to the trauma.
Some studies have highlighted the effects of the characteristics of a
natural disaster. The intensity, duration and extent of the damage seem to
influence psychological reactions differently. In the region closest to the
epicenter, the youngest children had the highest PTSD and anxiety
symptom scores, but in the group furthest from the epicenter the older
children had the highest PTSD and anxiety symptom scores. Children who
were relocated after a natural disaster did no worse than children who
remained in the disaster zone. Relocation should be considered as an
alternative after catastrophic natural disasters in situations where resources
are so limited that rebuilding cannot take place for an indefinite period of
time. Kitayama et al. (2000) reported that symptoms of PSTD (PostTraumatic Stress Disorder) were more frequently found among children
from the severely damaged area than those from mildly a damaged area.
The relationship between emotional reactions to a disaster and later
development of dysfunctional reactions seems to be clear, even if it is not
possible to assume a causal relationship. It is possible to hypothesize a
correlation between childrens vulnerability and psychological reaction in
the long term: more vulnerable children can exhibit high levels of
psychological disturbance during a disaster and can be more vulnerable to
developing symptoms of behavioural changes. Researches report various
psychological consequences following an earthquake which can be
manifested in infancy, childhood or adolescence.
It is our opinion that individual characteristics combined with the
impact of a disaster (localization, intensity, the entity of damage, etc.) and
with family and social contexts represent the principal factors that can
protect the child and reduce the impact of a natural disaster. Considered
separately, each variable would not have a direct effect on the
psychological status of a child. For this reason, it is necessary to focus on
all these aspects and on their relationships. These risk factors are
influenced by situational risk factors, including the degree of direct
involvement and exposure to the event, parental coping, and presence of
other stressors, such as separation from parents or loss of personal
belongings.

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4.

PSYCHOSOCIAL RESILIENCE: ROLE OF THE FAMILY SYSTEM AND THE

IMPORTANCE OF SOCIAL SUPPORT.

Boin (2008) reviewed the impact of the disaster trauma on the

resilience or vulnerability of the child and the influence of the family and
the community on the onset and duration of symptoms.
A natural disaster affects the family system (Pynoos, Steinberg,
Wraith, 1995), and symptoms displayed by a family member may affect
other family members, especially children. For example, childrens
anxiety is related to general family functioning. Kilic and Ulusoy (2003)
reported a greater impact on the parents' mental health and subsequent
PTSD symptoms in their children. Natural disasters are distressing both for
adults and children and family resilience must be analyzed considering
both individual and family vulnerability (Walsh, 2008).
The results of previous studies show that children's psychological
symptoms are affected by the mental health of their parents (Kili, Ozguven,
Sayil, 2003). More specifically, the psychological state of children after the
earthquake is affected by the presence of even mild psychological
instability in their parents. This assumption is supported by previous
researches that have shown that psychosocial stressors and parental mental
health status are related to the development of PTSD in children and
adolescents after an earthquake (Kili, Ozguven, Sayil, 2003).
Literature has highlighted that in adults more severe symptoms are
related to greater fear during the earthquake, female gender, older age,
participation in rescue work, being trapped under rubble, and personal
history of psychiatric illness. In particular, more severe depression
symptoms related to the loss of close ones, single marital status, previous
trauma experience and family history of psychiatric illness.
Adverse parental mental health status is associated with PTSD-related
behavioural changes in children and parental distress may contribute to
lasting psychological effects in children. Researches conducted after a
range of major disasters demonstrate that children manifest a consistent
pattern of adjustment difficulties and confirm that family functioning,
parental coping and stress represent relevant risk factors.
The Resiliency Model of Family Stress, Adjustment, and Adaptation,
(McCubbin, Thompson, McCubbin, 1996) focuses on family types,

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strengths and capabilities, and explains why some families are better able
to adjust to changes.
Williams and Drury (2009) described two kinds of psychosocial
resilience. Personal resilience depends on personal skills, beliefs and
attitudes and describes how particular people respond to adversity, threat
or challenge. Flexibility, coping ability, positive outlook, sense of control,
and adaptability are crucial to provide adequate resilience (Doucette,
Pinelli, 2004). Collective resilience describes how people respond to
emergencies and refers to the way people express and expect solidarity,
cohesion, and emotional support adapting to deal with an emergency or
disaster (Drury, Cocking, Reicher, 2009). While personal resilience
emphasizes the importance of finding adequate responses to peoples
needs, collective resilience underlines the role of groups and community
that can be a resource for social-psychological individual needs (Williams,
Drury, 2009). Interaction skills, relationships and achievements are
important aspects that can be relevant factors of protection. Tufnell (2005)
systemized the principal factors affecting risk and resilience: perceived
severity of trauma exposure; parental mental health problems, pre-trauma
psychopathology, insufficient social/cultural support.
The need for psychological support for children and their families
after a disaster is well documented in literature: the role of the community
following a disaster has been shown to be important. Galante and Foa
(1986) reported that children fared better if their community was prepared
and able to give support to the victims, and parents coping strategies are
crucial to provide adequate child care. However, Jensen, Dyb, Nygaard
(2009) confirmed that children who have received mental health services
prior to the trauma might also be vulnerable.
Protecting people and communities against the psychosocial effects of
disasters must be a priority. Treatment alleviates symptoms, but the
number of children at risk seems to be more related to the length of time
needed for the community to reorganize itself after the disaster.
However, after a natural disaster, the presence of appropriate
information and professional assistance can contribute to help parents and
their children. Jensen, Dyb, Nygaard (2009) and Terranova, Boxer,
Morris (2009) underlined the importance of early assessments of childrens
subjective experiences, focusing on assessing the mental health and coping
styles of children and adolescents after an earthquake.
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Literature proposes two different ways to analyze how social support

affects, both directly and indirectly, coping with stressful events (Frey,
Rothlisberger, 1996). Social networks provide people with positive
experiences and stable roles, and, independently of individual stress, social
support seems to directly influence mental health. Efficient social support
has a permanent influence on the individuals overall psychological health.
On the other hand, social support has an indirect and stress-reducing effect
by buffering the negative consequences of the stressful event (Frey,
Rothlisberger, 1996).
Specific and immediate social support must be provided to promote
individual resilience. Psychological support must be considered as part of
the first form of help (prevention) rather than part of the solution (only if
and when people present same physiological disorders).
Immediately after a natural disaster, psychological support should be
provided for both children and parents to ensure normal psychological
development. However, any psychological support for children and adults
needs to be organized in well-structured steps, using a method which
facilitates the screening and treatment of large numbers children.
The assessment phase is probably the most important and analyzing
parents reports is not enough. Even though most of the questionnaires and
psychological instruments are standardized, they are useful, but they are
not sufficient to identify children and parents at risk. Clinical observations
of psychological problems, analysis of family functioning and the
background context must be carried out by properly trained staff. It is
important to extend the outreach program beyond its traditional therapeutic
role to an advisory one to other relief organizations. In addition, long-term
follow-up of these victims is recommended to prevent the development of
other psychiatric complications.
However, multiple severe post-earthquake adversities (such as the
collapse of the social network, the delay of reconstruction and political
support) can contribute to the victims' psychological problems and can
delay their recovery.

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