This revised proposal focuses on the mental health of children evacuated from the 30-kilometer area surrounding Chernobyl who now reside in Kiev. The research questions and study design draw on our research on the mental health of children living near Three Mile Island (TMI), on studies of children's responses to disasters, other life stressors, and chronic illness, on research on the stress process, and on the feasibility study we conducted in 1992. The study addresses six questions in a random sample of 300 evacuees in Kiev and 300 age-sex matched neighborhood controls born between 1980-1986: (1) Compared to controls, do evacuee children have significantly higher rates of diagnosable major depression and anxiety disorders, symptoms of depression, hopelessness, anxiety, anger, or post- traumatic stress, or concentration and memory impairment? (2) Compared to controls, do evacuee children have significantly higher rates of behavioral disturbance, as evidenced by absenteeism, poor school performance, conduct disorders, and substance abuse? (3) Are evacuee children experiencing significantly higher levels of somatic symptoms and medical illness than controls? (4) Are the mothers' fears associated with Chernobyl and/or relocation to Kiev significantly related to their mental health (particularly depression, anxiety, somatic symptoms, hopelessness, and anger), sensitivity to symptoms in their children, and familial stress? (5) Are the children's beliefs about the effects of the Chernobyl disaster directly related to disorder and impairment? Are the effects moderated by age, sex, locus of control, and social support? (6) what is the utility of a modified vulnerability model for explaining impairment and disorder in evacuee children? We propose to test a model in which the mother's level of fear is directly related to her psychological and somatic symptoms, family conflict, and sensitivity to symptoms in her child (Aim 4) and in turn, these variables are associated with the mental health of the children. Although the specific findings have been inconsistent, we will again examine the stress-moderating effects of the child's age, gender, locus of control and social support. We will also determine whether the child's personal level of stress from the sequelae of Chernobyl serve a moderating function. Face-to-face assessments will be administered using translated versions of standard mental health assessment tools. Physical examinations and routine blood screening will be performed by local physicians who will be trained and monitored by an American family practice physician with similar experience in Moscow. The study represents a collaboration between American and Ukrainian scientists. Its success will determine the advisability of conducting follow-up assessments or expanding the size or nature of the sample.
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