At 1.5- and five-year follow-ups after the Spitak earthquake, there was a significant dose–response relation between earthquake exposure and severity of PTSD and depression. The more severely exposed Spitak group had higher PTSD and depression scores than the less severely exposed group from Gumri. However, at twenty-five years, this relation had dissipated. PTSD severity of the Spitak group that had experienced comparatively fewer post-earthquake adversities (lack of heat, electricity, food, medicine, housing, transportation) and post-earthquake traumatic experiences (e.g., fights, accidents) was comparable to that of the Gumri group; while depression severity of the Gumri group, which had been significantly lower than the Spitak group at baseline, was higher at follow-up. The detrimental impact of adversities was greater for depression than for PTSD.

Risk factors for PTSD and depression at twenty-five years included adversities, baseline PTSD and separation anxiety severity, loss of home, and chronic medical illnesses. Social support by family and friends emerged as a protective factor. Compared with those who lost one parent and controls, orphans were at greater risk for clinical depression. Although there was a decrease in PTSD rates from baseline to twenty-five years post-earthquake (48% to 22%), earthquake-related PTSD remained a significant public health problem. Alleviation of adversities, improving the social ecology, and monitoring chronic medical illnesses should be considered essential components of disaster recovery programs.

There is a paucity of long-term treatment outcome studies among children and adolescents after natural disasters. This chapter summarizes findings from three long-term studies among severely traumatized early adolescents after the 1988 Spitak earthquake in Armenia, including a twenty-five-year follow-up that represents the most extended prospective treatment outcome study to date after a disaster. School-based trauma-grief-focused psychotherapy was provided at 1.5 years post-earthquake. The intervention addressed trauma and loss experiences due to the earthquake; post-trauma distress reactions, including PTSD and grief; current problems and adversities; trauma and loss reminders, interpersonal conflicts, and developmental progression. The findings showed significant long-term benefits of treatment in reducing PTSD and depressive symptoms. We also present findings regarding differences in recovery trajectories among treated and not treated subjects and risk and protective factors associated with PTSD and depression. Despite the improvements, a sub-group of the students continued to experience earthquake-related chronic PTSD and depressive symptoms at twenty-five-year follow-up, indicating the need for ongoing surveillance of severely traumatized survivors. The findings underscore the benefit of post-disaster therapeutic intervention, social support by family members and friends, and the need for assistance by governmental and non-governmental agencies to mitigate post-disaster adversities that contributed significantly to the chronicity of symptoms.