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Publication: National Association of School Psychologists. Communique
Author: Brock, Stephen E
Date published: March 1, 2012
Language: English
PMID: 89808
ISSN: 0164775X
Journal code: NASP

Posttraumatic Stress Symptoms in Croatian Children Exposed to War: A Prospective Study

Summarized by Lance Havens and Richard Lieberman, NCSP, Loyola Marymount University

The purpose of this study was to examine posttraumatic stress disorder (PTSD) in children who were exposed to military attacks, and to explore the correlation between predictive variables and the presence of PTSD. The participant pool included 252 school-age children from four elementary schools who were exposed to military attacks in Osijek, Croatia. The children were assessed for symptoms of posttraumatic stress during the war, and then 30 months later, when the war had ended. This longitudinal comparison study looks at data from questionnaires that were gathered during these time periods.

The study analyzed the correlation between levels of posttraumatic stress symptoms and predictive variables, which included locus of control, perceived social support, coping strategies, displacement/separation, victimization of self and family members, and witnessing violence. All variables were defined by, and assessed through the use of standardized questionnaires (i.e., Questionnaire for Examination of Posttraumatic Stress Reactions in Children (QPTSR-C), Questionnaire on Children's Stressful and Traumatic War Experiences (QSTWE), Externality of Control Scale for Children (ECS-C), Revised School-Agers' Coping Strategies Inventory (SCSI-R), and Perceived Social Support Scale for Children (PSSS-C)].

The overall QPTSR-C results showed a significant decline in posttraumatic stress symptoms over the 30-month study time frame. Children who reported initially higher symptoms of posttraumatic stress on the QPTSR-C were found to have higher intensity of posttraumatic stress reactions over time. Similarly, children who reported mild or moderate symptoms exhibited significantly lower levels after 30 months.

The study also looked for correlations between predictive variables and levels of PTSD. Results indicate that 70% of correlations between the predictors were not statistically significant (r= .13). However, a statistically significant correlation was found between the number of war experiences a child had, and the intensity of posttraumatic stress reactions. It was also found that children who experienced more war activity, separations from family, forceful displacement, and witnessed violence reportedhigher PTSD symptoms. Coping strategies were found to be a statistically significant predictor of posttraumatic stress reactions. In addition, higher degrees of perceived support for self-esteem produced higher QPTSR-C scores. Over time, a higher predictive power was foundfor variables related to a child's personality and social support.

A potential limitation of this study was that 25% of the original sample was not available for the second round of PTSD assessment due to change in school placement. Many children also returned to their hometowns, which altered the initial sample pool. Attrition was 58% among displaced children and 29% among those who were not displaced. Data was only analyzed if obtained during both assessment points.

Ultimately, this study indicates that exposure to traumatic events is a major contributor to initial PTSD symptomatology. However, over time, a child's personality becomes more significant in predicting future PTSD symptoms. The authors conclude that these positive personality traits should be strengthened in children to diminish long-term PTSD. School psychologists can supplement these personality traits through psychoeducation and by providing support networks for students who have been exposed to trauma. Specifically, school psychologists should focus on increasing student's locus of control and coping strategies. Additionally, school psychologists may utilize this information to identify students who have been exposed to previous traumas, as these students are clearly more susceptible to PTSD.


Kuterovac-Jagodic, G. (2003). Posttraumatic stress symptoms in Croatian children exposed to war: A prospective study. Journal of Clinical Psychology, 59, 9-25.

Author affiliation:

STEPHEN E. BROCK is a professor and coordinator of the school psychology program at California State University, Sacramento. He is a member of NASP's National Emergency Assistance Team (NEAT), cochair of the PREPaRE Workgroup, a past coordinator of the Crisis Management Interest Group, and lead author of the NASP book titled School Crisis Prevention and Intervention: The PREPaRE Model. This column will appear several times during the year. If you would like to write a research summary and/or know of a study that should be summarized please contact Dr. Brock at

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