Research Paper When Home is No Longer a Safe Place – Symptoms of Anxiety, Depression and Post-Traumatic Stress in Children Exposed to Earthquakes in Zagreb During the COVID-19 Pandemic

Background: The capital of Croatia was hit by several earthquakes during the COVID-19 pandemic in 2020, simultaneously introducing two sources of stressors to the same cohort. This study aimed to determine the individual and joint effects on children’s mental health. Methods: The study comprised a web-based survey for parents (N = 22,202), deployed in February 2021. Exposure to COVID-19 and earthquake related stressors were assessed using scales constructed for this study and symptoms of posttraumatic stress symptoms (PTS) and anxiety/depression were assessed using the CATS-C and RCADS-25-P. Demographic data were used to assess the effects of gender and age. Regression analyses were conducted to identify and evaluate predictors of PTS and anxiety/depression and test for possible interactions between pandemic-related and earthquake-related factors. Findings: Results indicate that impaired mental health is more likely among girls, children who were affected by earthquake and suffered more home damage, and those who are at increased risk for severe illness from COVID-19 or have a family member at risk. Further, anxiety/depression symptoms were higher among children whose family member was self-isolated and whose homes were more damaged. Interpretation: Our findings link earthquake exposure and pandemic related stressors to symptoms of PTS, anxiety, and depression. It demonstrated limited interactions of both stressors on children’s mental health. The risk was higher for girls and no age differences were found. Future studies should expand the aspects of both resilience and risk factors, allowing for development of effective intervention strategies. Funding: The study was self-funded by the authors. Declaration of Interest: The authors declare that they have no conflicts of interest. Ethical Approval: The study design was approved by the Ethics Committee of the Zagreb Child and Youth Protection Centre, Ministry of Education and Croatian Education and Teacher Training Agency