Post-traumatic stress disorder (PTSD) in adults following disaster-precipitated family relocation was investigated in a longitudinal study of family and individual response to natural disasters. Adult participants included 78 women and 77 men in two communities. Psychosocial adjustment was measured at two points in time: at 4 months and 16 months after the disaster. Instruments used for assessing stress-related symptomatology included the Horowitz Impact of Event Scale (HIES) and the Diagnostic Interview Schedule (DIS). Major findings included: (a) levels of short-term stress symptomatology and diagnosable PTSD were substantial in both communities: (b) significant decrements in these levels occurred by 16-months postdisaster; (c) substantial gender differences (greater levels for women) were apparent in both short-and long-term PTSD response rates; and (d) patterns and levels of PTSD symptoms were different in the two communities. Findings have implications for the interpretation of PTSD within the context of family-and community-level variables.

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OBJECTIVE--The purpose of this article is to review the empirical evidence for the efficacy of a range of treatments for posttraumatic stress disorder (PTSD). Reviewed studies focused on rape victims, combat veterans, the tragically bereaved, torture victims, accident victims, of physical assault, and child abuse victims. DATA SOURCES--Peer-reviewed journals (Psych-Info, MEDLINE), book chapters (PILOTS database), active investigators, abstracts from the 1990 and 1991 International Society for Traumatic Stress Studies. STUDY SELECTION--We identified 255 English-language reports of treatment for PTSD. We restricted our focus to randomized, clinical trials that included a systematic assessment of PTSD using DSM-III or DSM-III-R criteria (N = 11). DATA EXTRACTION--Studies were assessed according to methodological strength: random assignment to the treatment of interest, and either an alternative treatment or control group; sample selection; and inclusion of statistical tests of significance. DATA SYNTHESIS--Drug studies show a modest but clinically meaningful effect on PTSD. Stronger effects were found for behavioral techniques involving direct therapeutic exposure, particularly in terms of reducing PTSD intrusive symptoms. However, severe complications have also been reported from the use of these techniques in patients suffering from other psychiatric disorders. Studies of cognitive therapy, psychodynamic therapy, and hypnosis suggest that these approaches may also hold promise. However, further research is needed before any of these approaches can be pronounced effective as lasting treatment of PTSD. CONCLUSIONS--Further studies should specifically address combined treatment approaches, optimal treatment length and timing, effects of comorbidity, and unstudied traumatized populations.

Mental health practitioners are often called upon to provide services to children, adolescents, and families in the aftermath of traumatic experiences such as child neglect, sexual or physical abuse, family/domestic violence, sexual assault, interpersonal violence, school and community violence, serious accidental injury, catastrophic medical illness, traumatic bereavement, or mass casualty events, including natural and man-made disasters. The National Child Traumatic Stress Network (NCTSN) was established in 2001 to raise the standard of care and improve access to services for traumatized children, their families, and communities throughout the United States. This article describes the development of the NCTSN, its structure, programs, and many of the products and resources-including online lectures, training programs and videos, and searchable databases of child trauma resources-available through the NCTSN Web site (www.nctsn.org) to assist professionals in providing state-of-the-art assessment, treatment, and services to these children and their families.