## Children's coping styles and trauma symptoms after an explosion disaster

Mette Elmose 1* , Christina Duch 2 , Ask Elklit 1,2

1 Department of Psychology, University of Southern Denmark, Odense, Denmark 2 Odense University Hospital, Odense, Denmark

*Corresponding author: melandersen@health.sdu.dk

## Abstract

Background: The negative impact of trauma on children and adolescents is well documented. However, few studies have investigated the relationship between coping and trauma and distress symptoms after man-made disasters, especially those not related to war.

Objective: This study investigated the relationship between children's coping styles and their self-reported levels of trauma and distress symptoms after an explosion disaster in a residential area.

Method: Participants were recruited through the local public school that served the affected residential area. A total of 333 children and adolescents from grades 3 through 10 participated in the study 16 months after the explosion. All participants filled  out  questionnaires  to  assess  their  trauma  and  distress  symptoms  as  well  as  their  coping  strategies.  The  adolescents answered additional questions about pre-, peri-, and post-traumatic factors and filled out questionnaires about their trauma and distress symptoms, including aspects of somatization and negative affectivity.

Results: The following variables were associated with a higher degree of trauma symptoms for children in grades 6 through 10 and explained 39% to 48% of the unique variance in these symptoms: female gender; the experience of traumatic events pre-disaster; the destruction of property or danger to life occurring during the disaster; the experience of traumatic events post-disaster; and the use of self-blame, emotion regulation, wishful thinking, and cognitive restructuring. For the younger children, pre-, peri-, and post-disaster factors were not measured. However, female gender and the use of self-blame as a coping strategy explained 26% of the variance in trauma symptoms.

Conclusions: This study generally supports the findings of the limited literature addressing coping skills after man-made disasters. However, contrary to previous findings in community samples after episodes of terrorism, adaptive coping strategies such as cognitive restructuring were found to influence the variance of trauma and distress symptoms.

Keywords: children; disaster; coping strategies; trauma symptoms

## Introduction

The  negative  impact  of  natural  and  man-made trauma on children and adolescents is well documented (1). However, little is known about the variables that influence the post-traumatic adjustment process. Knowledge of this process is of great importance for the family members  and professionals that wish to help and support children after  a  trauma,  and  coping  strategies  have  been suggested as relevant factors. Lazarus and Folkman (2) defined coping as 'constantly changing cognitive and  behavioral  efforts  to  manage  specific  external and/or internal demands that are appraised as taxing or exceeding the resources of the person' (p. 141);

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this  definition  still  seems  to  be  at  the  core  of  the concept and to cover a range of ways of coping. In a literature review, Skinner and colleagues (3,4) identified  more  than  400  subtypes  of  coping  skills that have been studied. Different conceptualizations of these coping styles have been attempted, but there is still continued debate regarding how the different subtypes should be organized. Skinner and colleagues (3,4) argued that the most commonly used distinctions of approach versus avoidance, emotionfocused  versus  problem-focused,  and  engagement versus disengagement do not adequately classify and distinguish  between  specific  coping  styles,  because coping  skills  typically  serve  multiple  functions  and are multidimensional. Instead, these researchers suggest that coping strategies may be structured with regard to how the strategy improves or is meant to improve  the  fit  between  the  individual  and  the context. In line with this is the fact that the actual adaptive functioning of a strategy is not inherent in the  strategy;  rather,  it  may  vary  on  the  basis  of  a specific individual in a specific context and how the strategy may or may not realign the individual and the context. Understanding children's coping styles after a disaster and how such coping styles may relate to other  aspects  of  the  disaster  and  the  subsequent mental  health  of  the  affected  children  is  of  great importance for the planning and execution of postdisaster  interventions.  Such  an  understanding  may also help to identify children who may benefit from more extensive support.

Coping strategies used by children and adolescents have been studied in relation to juvenile illness (4-6), suicidal  ideation  (8,9),  hypothetical  situations  (e.g., dealing  with  a  friend  being  diagnosed  with  AIDS) (10), natural disasters (8,11,12),  and  man-made disasters  (e.g.,  traffic  accidents,  fires)  (13,14)  but mostly  in  relation  to  war  or  terrorism (14-17). Weisenberg and colleagues (18) studied coping behaviors  in  a  sealed  room  during  a  scud  missile attack  in  relation  to  post-traumatic  stress  disorder (PTSD) in 492 children. Three weeks after the end of the war the children were asked to document their present  and  retrospective  experiences  and  feelings related  to  the  missile  attacks.  More  severe  stress reactions were found among children who reported more  behaviors  directed  at  threats  in  the  situation (e.g.,  checking  gasmasks and the seal of the room) and reduced emphasis on avoidance and distraction activities.  This  pattern  of  coping  was  more  likely among children from lower grades as compared with higher  grades.  Paardekooper  and  colleagues  (17) studied the coping strategies of 345 refugee children in Uganda and compared them with 80 non-refugee children.  The  refugee  children  were  found  to  use more  coping  strategies,  especially  wishful  thinking, self-blame,  social  support,  cognitive  restructuring, and problem solving.

After  9/11,  community  studies  of  children  and adolescents not directly involved in the disaster have focused  on  understanding  how  these  individuals cope with terrorism (15,16). Cardena and colleagues (15) studied the differential effects of coping styles and  demographics  on  post-traumatic  reactions  in 3134 individuals in a nationwide representative sample 3 weeks after 9/11. The sample included 405 teenagers. For the whole sample, the main conclusions  were  that  coping  styles-aside  from active coping and positive reframing-accounted for

almost 30% of the variance in stress reactions. The coping strategies of seeking emotional support, selfblame, denial, venting, and behavioral disengagement accounted  for  most  of  this  variance.  The  authors reported  that  the  teen  group  also  demonstrated  a very similar pattern. However, these results were not reported separately. The authors suggested that it was primarily the use of maladaptive strategies (e.g., selfblame,  denial,  venting,  behavioral  disengagement) and not the use of adaptive strategies that explained the variance in distress and that intervention strategies should focus on identifying and reducing maladaptive  strategies.  Furthermore,  acute  distress was  related  to  being  a  New  York  resident;  this confirms an association between exposure and greater  distress,  which  has  also  been  described  in relation to natural disasters (8,11,12,19). Lengua and colleagues (16) studied the degree of PTSD symptoms in a community-based sample of children one month after 9/11. The study included both preand post-attack measures and found that both pre(dispositional)  and  post-trauma  (situational)  coping contributed to the degree of PTSD symptoms. It was found that 9/11 post-trauma avoidant coping predicted a higher degree of PTSD symptoms. The likelihood of using 9/11 post-trauma avoidant coping was reduced or increased in relation to the tendency to use active or avoidant coping, respectively, prior to 9/11.

Stallard and colleagues (13) studied 97 children 6 weeks and 8 months after the children were in traffic accidents.  They  found  that  younger  children  and those with PTSD used more coping strategies than older  children  and  those  without  PTSD.  Children with  PTSD  were  more  likely  to  report  the  use  of distraction, social withdrawal, emotional regulation, and blaming others as coping strategies. Jones and Ollendick (14) reported findings from two studies of children's and adolescents' coping in the context of residential  fire  using  comprehensive  interviews  3 months  after  the  fire occurred.  In 46  children between  the  ages  of  8  and  16  years,  they  found avoidant coping to be related to heightened levels of fear. They further investigated the potential predictors of coping strategies in 92 children between the ages of 9 and  13  years.  They  investigated demographic variables, total resource loss, impact of negative life events, social support, self-worth, and coping efficacy as potential predictors of the frequency and type of coping strategies, which were grouped  as active coping, distraction strategies, avoidance, and support seeking. The results showed that  none  of  the  included  variables  significantly predicted  differences  in  the  use  or  frequency  of coping  strategies.  Despite  this  divergent  finding, current studies of the coping of children in relation to man-made disasters seem to support the importance  of  investigating  coping  in  relation  to post-traumatic  stress  reactions.  A  higher  degree  of post-traumatic  symptoms  are  related  to  a  higher number  of  strategies  used.  Across  the  different coping measures used, it seems to be the use of more avoidant coping strategies that contributes the most; however,  the  results  are  still  mixed.  Pre-disaster coping,  gender,  age,  and  disaster  exposure  are  of relevance  for  understanding  the  coping  strategies used. These findings are in line with studies of coping in relation to natural disasters (8,11,12,19).

The aims of the present study were to increase the understanding of coping strategies during the posttraumatic adjustment process and to assess how the use of coping strategies may be associated with subsequent trauma symptoms in children after they had experienced an explosion disaster. The disaster investigated was a firework accident in a residential area of approximately 2000 residents. The fire started in a container outside of a firework factory. Because the fire could not be controlled, police warnings were sent out, and the area was evacuated. The explosion occurred during the late afternoon of November 3, 2004,  and  measured  2.2  on  the  Richter  scale.  The explosion  resulted  in  one  death,  €100  million  in property  damage,  and  long  evacuation  periods.  It took 3 to 4 days before the area was approachable. Ultimately, 355 houses were damaged; of these, 175 of were uninhabitable, 75 were burned out, and the reconstruction of the damaged houses ranged from months to years. Fifty-two percent of the children had  their  homes  damaged  by  the  explosion.  A previous study by Elklit (20) found that, at 3 months after the accident, 13% of the adults included from the  affected  area  met  the Diagnostic  and  Statistical Manual of Mental Disorders, Fourth Edition criteria for PTSD as compared with 1% of adults from a similar type  of  residential  setting  that  was  not  directly affected by the accident. The study further found that disputes with insurance companies were significantly associated with PTSD. This indicates that, after the explosion, there was an extended period characterized by both a high degree of concrete and practical reminders of the disaster as well as added practical  demands  on  the  families.  Although  this particular disaster was not an act of war or terror, it was  characterized  by  the  significant  destruction  of houses in a small area and resulted in evacuation, a long period of displacement for many families, and a long period of reconstruction.

On the basis of the previous studies of coping in relation to man-made disasters, it was predicted that higher  levels  of  distress  would  be  associated  with younger  age,  female  gender,  and  higher  levels  of disaster  exposure.  Although  the  findings  related  to coping  strategies  are  mixed,  there  is  a  tendency  to find  a  relationship  between  more  avoidant  coping strategies (e.g., withdrawal, denial, blaming others or self) and higher degrees of later trauma symptoms. It is thus likely that avoidant  strategies  are  more strongly associated with the current degree of trauma symptoms.

## Method Subjects

The potential pool of subjects for the current study consisted of 455 children in grades 3 through 10 who attended a public school that served the residential area  affected  by  the  firework  accident.  The  final sample consisted of 333 children (73%  of all students) for whom parental consent to participate in the study was obtained. The sample was distributed as  follows:  51  third  graders,  38  fourth  graders,  29 fifth graders, 38 sixth graders, 63 seventh graders, 47 eighth graders, 47  ninth  graders,  and  20  tenth graders. The sample included 167 girls and 165 boys; one  child  did  not  state  his  or  her  gender.  Nonparticipating children did not differ from participating children with regard to grade or gender.

## Procedure

Data  were collected as part of a larger study investigating PTSD among children after exposure to a disaster (21). Data were obtained 16 months after the explosion. Participants in grades 3, 4, and 5 (n = 118) were gathered into small groups at their school that included one researcher and 6 to 8 children. The children were told that the purpose of the study was to understand their reactions to the explosion. The second  author  guided  the  children  through  the KIDCOPE  checklist,  which  is  described  in  the 'Coping styles' section later in this article. Each item was  read  aloud  to  the  children  as  a  group,  and individual participants were helped as needed. Subjects in grades 6 through 10 (n = 215) filled out different  evaluation  instruments  at  school  with  the second  author  present;  more  information  about these  instruments  is  also  found  in  the  measures section of this article. Confidentiality was emphasized, and openness was encouraged.

## Measures

As a result of the age distribution of the participants, the  measures  used  to  collect  data  vary  to  some degree. Pre-, peri-, and post-disaster information are only collected for the older children, and an additional measure of trauma symptoms was added for this group as well.

Demographic  information  related  to  gender  and grade  level was  collected  for  all children.  Peritraumatic information was collected from the older children  (grades  6  through  10),  and  this  included distance  from  the  factory  during  the  explosion, degree of experienced life danger to self or others, and  destroyed  property.  The  older  children  also described their experience of any potentially traumatic  events  before  or  after  the  disaster  being studied.

Coping styles: The KIDCOPE self-report instrument (22) was used primarily for its brevity and its previous use  in  similar  studies.  The  version  developed  for children between the ages of 7 and 12 years was used for all participants. The tool consists of 15 items that reflect  10  different  coping  strategies.  The  children were asked to think about a specific situation and to then  rate  each  item  with  regard  to  their  use  of  a specific coping strategy (yes/no) and the perceived effectiveness of that strategy using a 3-point Likert scale (1 = not at all; 2 = somewhat; 3 = very much). Five coping strategies were assessed by two items: 1) distraction  (try  to  forget  it;  do  something  else  to forget  it);  2)  social  withdrawal  (stay  on  your  own; keep quiet about the problem); 3) problem solving (try to sort out the problem by thinking of answers or talking to someone about it; try to sort it out by doing  something);  4)  emotional  regulation  (shout, scream, and get angry; try to  calm  yourself  down); and 5) wishful thinking (wish the problem had never happened;  wish  you  could  make  things  different). These five strategies were coded as positive for use if at  least  one  of  the  two  items  were  endorsed.  The remaining  five  coping  strategies  were  measured  by one item each: 1) cognitive restructuring (try to see the good  side of things); 2)  self-blame  (blame yourself for causing the problem); 3) blaming others (blame  someone  else  for  causing  the  problem);  4) social  support  (try  to  feel  better  by  spending  time with family or friends); and  5) resignation (do nothing  because  the  problem  could  not  be  fixed). The  psychometric  properties  of  the  KIDCOPE instrument have been reported and indicate acceptable reliability and moderate correlations when assessing coping strategies across two similar situations (r = .56-.71) and moderate correlations in test-retest reliability for the same personal situation over 3 to 7 days (r = .41-.83) (22).

Trauma symptoms: Two measures were used to assess trauma  symptoms.  An  adapted  version  of  Darryl (21,23) was used for all children. Darryl is a cartoonbased  measure  of  PTSD  symptomatology;  for  this study, it was  adapted  to  address  the  fireworks explosion.  Darryl  consists  of  both  general  pictures and pictures that address three symptom clusters: reexperiencing,  avoidance  and/or  affective  numbing, and  hyperarousal.  The  summed  scores  provide  a measurement of symptom severity. Elklit and colleagues (21) provided a detailed description of the measure,  including  an  analysis  of  the  estimated prevalence of probable PTSD and the validity and reliability of the measure. They found an estimated prevalence  of  probable  PTSD  of  17%  for  the children  in  grades  3,  4,  and  5  and  of  11%  for  the children in grades 6 through 10.

The Trauma Symptom Checklist (TSC) (24,25) was used  for  the  older  children.  TSC  is  a  scale  that addresses somatization in addition to depression and anxiety. Depression and anxiety are highly comorbid with  PTSD  in  adolescents  (1,26).  Among  schoolaged children, posttraumatic symptoms continue to be  expressed  behaviorally  to  a  notable  degree  and may include regressive behaviours. School children may  not  be  capable  of  abstractly  interpreting  the somatic  affective  experiences  inherent  in  PTSD symptomatology (e.g., anxiety, re-experiencing), and they may consequently describe these experiences by listing physiological symptoms, such as stomachaches and headaches (27). This focus was the primary reason for including the TSC. Krog and Duel (24) identified negative affectivity and somatization in a factor analysis of data from 4152 cases identified in  16  studies  of  trauma  populations  in  which  the original version of the TSC by Briere and Runtz (25) was used. In accordance with the recommendations of Krog and Duel (24), an 26-item version of the TSC was selected. All items in this instrument are rated using  a  4-point  Likert  scale  (1=  not  occurring;  4= occurs very often). The dissociation subscale had 5 items (α = .69), the negative affectivity scale had 10 items (α = .81), and the somatization subscale had 11 items (α = .80). The α for the total scale was .90. The mean inter-item correlations for the three subscales were between .26 and .31, thereby indicating optimal discriminatory power (28). In this study, TSC scores were collected for children in grades 6 through 10, and  the  total  scores  were  used  as  more  complex measures of distress.

## Analyses

Due to the large age span of the children included, separate  analyses  were  made  for  younger  children (grades  3,  4,  and  5)  and  older  children  (grades  6 through 10). Correlations between coping style usage (reported as the percentage of subjects endorsing the strategy)  and  coping  style  efficacy  (mean  efficacy scores  ranging  from  0  to  4,  with  higher  numbers being more effective) were investigated with the use of the procedure described by Jeney-Gammon and colleagues (8). Correlates for each strategy are shown in  Table  1.  Coping  style  usage  and  efficacy  were found to be highly correlated ( pvalues  of  <.001; r values of >.53). Due to this high level of intercorrelation and the higher association between coping style usage and TSC scores (as compared with coping style efficacy and TSC scores), the following analyses were based only on coping style usage. Chisquared tests for independence (with Yates's correction  for  continuity)  were  used  to  investigate potential differences in the use of coping strategies by younger children (grades 3, 4, and 5) and older children  (grades  6  through  10).  Because  of  the number of analyses, a Bonferroni adjustment with a pvalue of less than .005 as the criterion for significance was made to control for the overall Type I  error  rate.  For  the  younger  children,  hierarchical multiple regression analysis was used to investigate the relationship between demographic variables and PTSD-related symptoms as measured by the adapted Darryl  test.  For  the  older  children, hierarchical multiple regression analysis was used to investigate the relationships among demographic variables, the experience of potentially traumatic events predisaster,  peri-traumatic  factors,  the  experience  of potentially traumatic events post-disaster, and both the adapted Darryl test and the TSC.

TABLE 1 . Usage of KIDCOPE coping strategies across subjects

## Results

The usages of coping strategies for younger and older children are presented in Table 1. The use of coping strategies only differed significantly for younger and older children for cognitive restructuring (χ²(1, 330) = 9.02; p = .003; phi = .17) and emotion regulation (χ²(1,  328)  =  9.62; p =  .002; phi =  -.18.)  Older children used cognitive restructuring more frequently, whereas younger children used emotion regulation more frequently.

| Strategy                                          | Percentage of subjects using strategy (n )   | Percentage of subjects using strategy (n )   | Percentage of subjects using strategy (n )   | Percentage of subjects using strategy (n )   | Percentage of subjects using strategy (n )   | Percentage of subjects using strategy (n )   |
|---------------------------------------------------|----------------------------------------------|----------------------------------------------|----------------------------------------------|----------------------------------------------|----------------------------------------------|----------------------------------------------|
|                                                   | Grades 3, 4, and 5 a                         | Grades 3, 4, and 5 a                         | Grades 6 through 10 b                        | Grades 6 through 10 b                        | Total group c                                | Total group c                                |
| Distraction                                       | 71                                           | (83)                                         | 57                                           | (120)                                        | 62                                           | (203)                                        |
| Social withdrawal                                 | 66                                           | (77)                                         | 74                                           | (156)                                        | 71                                           | (232)                                        |
| Cognitive restructuring                           | 61                                           | (71)                                         | 77                                           | (164)                                        | 71                                           | (235)                                        |
| Self-blame                                        | 1                                            | (1)                                          | 7                                            | (15)                                         | 5                                            | (16)                                         |
| Blaming others                                    | 13                                           | (15)                                         | 14                                           | (29)                                         | 13                                           | (44)                                         |
| Problem solving                                   | 60                                           | (69)                                         | 63                                           | (135)                                        | 62                                           | (204)                                        |
| Emotional regulation                              | 73                                           | (85)                                         | 55                                           | (117)                                        | 62                                           | (202)                                        |
| Wishful thinking                                  | 87                                           | (101)                                        | 78                                           | (165)                                        | 81                                           | (266)                                        |
| Social support                                    | 69                                           | (79)                                         | 64                                           | (136)                                        | 66                                           | (215)                                        |
| Resignation                                       | 37                                           | (43)                                         | 24                                           | (50)                                         | 29                                           | (93)                                         |
| Total use of strategies mean (standard deviation) | 5.42                                         | (2.05)                                       | 5.13                                         | (1.83)                                       | 5.24                                         | (1.91)                                       |
| Range                                             | 0-9                                          |                                              | 0-9                                          |                                              | 0-9                                          |                                              |

a Total n varies from 114 to 117, b Total n varies from 208 to 213, c Total n varies from 324 to 330

TABLE 2. Summary of hierarchical multiple regression for variables predicting post-traumatic stress disorder symptoms as measured by the adapted Darryl test for children in grades 3, 4, and 5 (younger) and children in grades 6 through 10 (older)

|           |                         | Grades 3, 4, and 5   | Grades 3, 4, and 5   | Grades 6 through 10   | Grades 6 through 10   |
|-----------|-------------------------|----------------------|----------------------|-----------------------|-----------------------|
| Predictor |                         | ΔR 2                 |                     | ΔR 2                  |                      |
| Step 1    |                         | .09*                 |                      | .12***                |                       |
|           | Gender                  |                      | .27*                 |                       | .21**                 |
|           | Grade                   |                      | -.04                 |                       | -.01                  |
| Step 2    |                         | .17**                |                      | .17***                |                       |
|           | Distraction             |                      | .15                  |                       | .03                   |
|           | Social withdrawal       |                      | .14                  |                       | .13                   |
|           | Cognitive restructuring |                      | -.01                 |                       | -.19**                |
|           | Self-blame              |                      | .23*                 |                       | .19**                 |
|           | Blaming others          |                      | .05                  |                       | -.04                  |
|           | Problem solving         |                      | .07                  |                       | .01                   |
|           | Emotion regulation      |                      | .05                  |                       | .11                   |
|           | Wishful thinking        |                      | -.02                 |                       | .18*                  |
|           | Social support          |                      | .08                  |                       | .12                   |
|           | Resignation             |                      | .04                  |                       | -.06                  |
| Total R 2 |                         | .26***               |                      | .29***                |                       |

* p < .05; ** p < .01; *** p < .001

Hierarchical multiple regression analysis was used to investigate the ability of demographic variables to predict the level of PTSD symptoms as measured by the adapted Darryl test. During Step 1, the demographic variables gender and grade were entered;  during  Step  2,  the  use  of  specific  coping strategies  was  entered.  Total  variance  explained  by the model as a whole was 26% (F(12, 88) = 2.53; p < .01) for the younger children and 29% (F(12, 168) = 5.82, p < .001) for the older children. Final beta values are presented for all variables in Table 2. For the  younger  and  older  children,  the  demographic variables  contributed  9%  and  12%  of  the  unique variance  in  distress,  respectively,  while  the  use  of coping strategies contributed 17% and 17% of the unique  variance,  respectively.  In  the  final  model, gender (but not grade) was statistically significant for both  grade  groups.  For  the  younger  children,  selfblame was the only coping style that was statistically significant, but it represented the positive response of one child only. For the older children, the reported use of cognitive restructuring, wishful thinking and self-blame  were  statistically  significant.  With  the reported  use  of  cognitive  restructuring  associated with lower symptom level and the reported use of wishful thinking and  self-blame associated with higher symptom level.

For the older children, three additional steps were added to the model to further explore the variation in their levels of PTSD-related symptoms. The demographic variables gender and grade were entered during Step 1, the experience of potentially traumatic events pre-disaster was entered during Step 2, the peri-traumatic factors: distance from the factory at the time of the explosion, degree of experienced or feared danger to own or other's life, destroyed property were entered during Step 3, and the experience of potentially traumatic events postdisaster was entered during Step 4. Coping variables were entered during the final fifth step. The model was investigated for both the adapted Darryl test and for the TSC. Final beta values are presented for all variables in Table 3.

TABLE 3. Summary of hierarchical multiple regression of variables predicting post-traumatic stress disorder symptoms as measured by the adapted Darryl test and the Trauma Symptom Checklist for children in grades 6 through

|           |                                | Adapted Darryl test   | Adapted Darryl test   | Trauma Symptom Checklist   | Trauma Symptom Checklist   |
|-----------|--------------------------------|-----------------------|-----------------------|----------------------------|----------------------------|
| Variable  |                                | ΔR 2                  |                      | ΔR 2                       |                           |
| Step 1    |                                | .12***                |                       | .06**                      |                            |
|           | Gender                         |                       | .25**                 |                            | .13*                       |
|           | Grade                          |                       | -.03                  |                            | .02                        |
| Step 2    |                                | .03*                  |                       | .05**                      |                            |
|           | Pre-disaster traumatic events  |                       | .13                   |                            | .16**                      |
| Step 3    |                                | .13***                |                       | .20***                     |                            |
|           | Destroyed property             |                       | -.20**                |                            | -.25***                    |
|           | Danger to life (self/other)    |                       | -.08                  |                            | -.15*                      |
|           | Distance to explosion          |                       | -.10                  |                            | -.10                       |
| Step 4    |                                | .00                   |                       | .02*                       |                            |
|           | Post-disaster traumatic events |                       | .02*                  |                            | .14*                       |
| Step 5    |                                | .11**                 |                       | .16***                     |                            |
|           | Distraction                    |                       | .02                   |                            | .08                        |
|           | Social withdrawal              |                       | .11                   |                            | .10                        |
|           | Cognitive restructuring        |                       | -.14*                 |                            | -.14*                      |
|           | Self-blame                     |                       | .17*                  |                            | .21*                       |
|           | Blaming others                 |                       | -.09                  |                            | .07                        |
|           | Problem solving                |                       | -.05                  |                            | -.11                       |
|           | Emotion regulation             |                       | .12                   |                            | .29*                       |
|           | Wishful thinking               |                       | .17*                  |                            | .02                        |
|           | Social support                 |                       | .07                   |                            | -.02                       |
|           | Resignation                    |                       | -.05                  |                            | -.04                       |
| Total R 2 |                                | .39***                |                       | .48***                     |                            |

* p < .05; ** p < .01; *** p < .001

For  the  adapted  Darryl  test,  the  total  variance explained by the model as a whole was 39% (F(17, 145) = 5.38; p < .001). In Step 1, the demographic variables contributed 12% of the variance in distress ( p <  .001).  In  Step  2,  the  experience  of  potentially traumatic  events  pre-disaster  explained  3%  of  the variance in distress ( p =  .027).  In  Step  3,  the  peri- traumatic stressors explained 13% of the variance in distress  ( p <  .001).  In  Step  4,  the  experience  of potentially traumatic events post-disaster did not add significantly to the model. Finally, in Step 5, the usage of specific coping strategies explained an additional 11%  of  the  variance  in  distress  ( p =  .005)  after controlling  for  the  previous  variables.  In  the  final model, gender, destroyed property, cognitive restructuring, self-blame, and wishful thinking were statistically significant.

For the TSC, the total variance explained by the final model as a whole was 48% (F(17, 160) = 8.75; p <  .001). In Step 1, the  demographic  variables explained 6% of the variance in distress ( p = .006). In Step 2, the experience of potentially traumatic events pre-disaster explained 5% of the variance ( p = .004). In Step 3, the peri-traumatic stressors explained 20% of the variance in distress ( p < .001). In Step 4, the experience  of potentially  traumatic  events  postdisaster  explained  2%  ( p =  .021).  In  Step  5,  the coping strategies explained an additional 16% of the variance in distress after controlling for the previous variables. In the final model, gender, the experience of life danger to self or others, destroyed property, the experience of potentially traumatic events postdisaster, cognitive restructuring, emotion regulation, and self-blame were statistically significant.

## Discussion

The  study  investigated  the self-reported use of coping strategies after an explosion disaster. It adds to  the  very  limited  literature  on  coping  after  manmade disasters that are not linked to war or terror. The results confirmed previous results, which showed  that  increased  levels  of  trauma  symptoms were associated with female gender and higher levels of disaster exposure. Grade level did not significantly contribute to the variance in psychological distress. The  presence  of  a  link  between  coping  style  and trauma symptoms varied in relation to the grade level of the child and the specific measure of psychological distress.  The  only  coping  style  that  was  found  to contribute  significantly  to  the  variance  in  trauma symptoms  for  younger  children  was  self-blame. However, this strategy was only reported by one of the younger children, thereby limiting any interpretation of this result. For the older children, cognitive  restructuring,  wishful  thinking  and  selfblame  contributed  significantly  to  the  variance  in trauma symptoms. This association was still significant after controlling for pre-, peri-, and postdisaster  factors.  However,  when  using  a  broader measure  of  symptoms  that  included  somatization, negative affectivity, and dissociation, emotion regulation,  self-blame  and  cognitive  restructuring contributed to the variance. Emotion regulation and self-blame  were  associated  with  higher  symptom level and cognitive restructuring was associated with lower  symptom  level.  Contrary  to  the  study  by Cardena and colleagues (15), this study supports the relevance  of  cognitive  restructuring  for  decreasing symptom  levels  to  some  degree.  An  important difference is that, in the present study, the included children were all directly affected by or living in the affected  area,  whereas  this  was  not  the  case  in  the community  study  by  Cardena  and  colleagues  (15). The  use  of  cognitive  restructuring  may  be  more important when the disaster exposure is more direct.

The experience of potentially traumatic events predisaster  and  the  experience  of  destroyed  property contributed to the unique variance in psychological distress as measured by both the adapted Darryl test and  the  TSC.  However,  the  contribution  of  the experience of potentially traumatic events predisaster  to  these  two  tests  was  small  (3%  and  5%, respectively), and the variable only reached statistical significance in the final model for the TSC and not for the Darryl test. For the TSC, the experience of potentially traumatic events post-disaster also contributed  14%  of  the  unique  variation  in  the model.

Non-participators constitute  a  potential sampling bias. The percentage of eligible children (73%) who obtained parental permission and participated in the study was high. However, the pattern of participation varied markedly in relation to which classroom the children attend (the classrooms to which the children were assigned); this was recognized by the administrative staff of the school from other occasions and attributed to some teachers being very efficient and dedicated to the project. The teachers serving as gatekeepers to the parents appeared to be an  important  factor  in  this  study  and  should  be addressed in a more effective way in future studies. In  addition,  the  disaster  type  and  the  middle-class community in which it occurred may limit generalization regarding the use of coping strategies. Care  should  also  be  taken  when  considering  the results indicating that the use of self-blame was a risk factor for PTSD symptoms, because this strategy was only reported by a very limited number of children and adolescents, especially among  the younger children.

Time  elapsed  since  the  occurrence  of  disaster  is also a potential limitation of this study with regard to the reporting of coping strategies used. The reported use of coping style may have presented differently if the study had been conducted closer to the time of the  disaster.  Children  and  other  subjects  may  have difficulty reporting the use of such strategies while they are actually  using  them  in  the  immediate aftermath of the disaster; when these strategies are discussed  further  out  from  the  disaster,  as  in  the current study, respondents may report their current experiences of strategies used, which may reflect the strategies used at the time of the disaster, those used during the months  after the disaster, and the respondent's level of distress. Still, the reporting of coping strategies at this point in time is related to two different measures of trauma symptoms, so it does contain  important  information  that  may  help  to identify  children  in  distress  and  thus  improve  the direction  of  support  measures.  It  may  also  reflect that, for some children, the disaster may affect them for  a  significantly  longer  period  due  to  massive destruction, relocation, and strain related to rebuilding  a  house  or  struggling  with  an  insurance company. According to the results of the TSC, the links to both pre- and post-disaster traumatic events indicate that the measure may generally pick up on the more general vulnerability of the respondent. If possible, a prospective study design that assesses the use of coping strategies both as close to the disaster as possible and  at later  time  points  would  be preferable. Ideally,  the  research  would  also  involve access  to  pre-disaster  measures,  but  this  is  rarely possible  due  to  the  nature  of  both  man-made  and natural disasters. The self-report procedure is valuable because it documents children's experiences of distress, coping, and coping efficiency. However, this is just one part of the picture. A mixed-method research design that includes other informants and observations would be preferable.

## Clinical significance

From a practical  perspective,  the  understanding  of the relationship between coping strategies and levels of distress may help with the direction of appropriate interventions  toward  children  who  are  affected  by man-made  disasters.  Implications  for  intervention could  include  an  emphasis  on  building  a  shared understanding and evaluating behaviors and roles in uncontrollable situations to reduce feelings of responsibility  that  may  later  turn  into  self-blame. Cognitive interventions that focus on negative beliefs and on helping with a restructuring process may also be  beneficial.  During  the  period  after  a  disaster  in which there is significant destruction of homes and property,  parents  may  themselves  be  affected  by increased levels of PTSD and trauma symptoms, as indicated  by  Elklit  (20),  and  they  may  also  be occupied with practical problems. Therefore, intervention by school staff may  ultimately be relevant,  and  schools  may  prove  to  be  the  best settings  for  reaching  children  affected  by  disaster (21,29,30).

## Conflicts of Interest

The authors declare no conflict of interest.

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