{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T19:14:50Z","timestamp":1791314090534,"version":"4.3.1"},"reference-count":55,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2022,7,30]],"date-time":"2022-07-30T00:00:00Z","timestamp":1659139200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Although the effect of the COVID-19 pandemic on children and adolescents\u2019 mental health has been studied, there is still scarce evidence of the influence of nuclear family on the development of post-traumatic stress disorder (PTSD). This study aimed to determine the association between family dysfunction and PTSD in Peruvian high-school students during the COVID-19 pandemic. A cross-sectional study was conducted using a virtual survey administered to 562 high-school students in three schools in Chiclayo, Peru. The dependent variable was PTSD, which was measured with the Child PTSD Symptom Scale. Family dysfunction was the main independent variable, measured with the Family APGAR Questionnaire. Prevalence ratios (PR) and 95% confidence intervals (95% CI) were estimated with generalized linear models. Most of the students were female (88.3%) and the average age was 14.4 years. We found that 21.4% showed severe family dysfunction and 60.3% had PTSD. Students with mild and moderate family dysfunction had 37% (PR: 1.37; 95% CI: 1.14\u20131.65) and 26% (PR: 1.26; 95% CI: 1.04\u20131.54) higher PTSD prevalence, respectively. In conclusion, family dysfunction may influence the development of PTSD in adolescents. This study suggests the importance to develop a healthy family environment to help adolescents face critical situations experienced during the pandemic.<\/jats:p>","DOI":"10.3390\/ijerph19159343","type":"journal-article","created":{"date-parts":[[2022,7,31]],"date-time":"2022-07-31T23:37:29Z","timestamp":1659310649000},"page":"9343","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Association between Family Dysfunction and Post-Traumatic Stress Disorder in School Students during the Second COVID-19 Epidemic Wave in Peru"],"prefix":"10.3390","volume":"19","author":[{"given":"Maria A.","family":"Fernandez-Canani","sequence":"first","affiliation":[{"name":"School of Medicine, Universidad de San Mart\u00edn de Porres, Chiclayo 14012, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefany C.","family":"Burga-Cachay","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad de San Mart\u00edn de Porres, Chiclayo 14012, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0839-2419","authenticated-orcid":false,"given":"Mario J.","family":"Valladares-Garrido","sequence":"additional","affiliation":[{"name":"South American Center for Education and Research in Public Health, Universidad Norbert Wiener, Lima 15046, Peru"},{"name":"Hospital Regional Lambayeque, Chiclayo 14012, Peru"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,7,30]]},"reference":[{"key":"ref_1","first-page":"462","article-title":"La Familia En El Cuidado de La Salud","volume":"36","year":"2014","journal-title":"Rev. M\u00e9d. Electr."},{"key":"ref_2","unstructured":"(2022, March 03). La Influencia de La Funcionalidad Familiar En El Riesgo Suicida y Trastorno Depresivo En Adolescentes Del Cant\u00f3n Puerto Quito. Available online: http:\/\/repositorio.puce.edu.ec\/handle\/22000\/12860."},{"key":"ref_3","unstructured":"(2022, March 03). Trastorno de Estr\u00e9s Postraum\u00e1tico en Ni\u00f1os y Adolescentes. Revisi\u00f3n del Concepto y Actualizaciones. Available online: https:\/\/psiquiatria.com\/bibliopsiquis\/trastorno-de-estres-postraumatico-en-ninos-y-adolescentes-revision-del-concepto-y-actualizaciones."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Bhushan, B., Basu, S., and Ganai, U.J. (2022). Post-Traumatic Stress and Growth Among the Children and Adolescents in the Aftermath of COVID-19. Front. Psychol., 12.","DOI":"10.3389\/fpsyg.2021.791263"},{"key":"ref_5","first-page":"e14880","article-title":"Anxiety, Depression and Post-Traumatic Stress Disorder Symptoms in Adolescents during the COVID-19 Outbreak and Associated Factors","volume":"75","author":"Demir","year":"2021","journal-title":"Int. J. Clin. Pract."},{"key":"ref_6","unstructured":"(2021, November 04). COVID-19 Related Posttraumatic Stress Disorder in Children and Adolescents in Saudi Arabia. Available online: https:\/\/journals.plos.org\/plosone\/article?id=10.1371\/journal.pone.0255440."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1016\/j.rcp.2020.05.006","article-title":"Trastornos psiqui\u00e1tricos en los ni\u00f1os y adolescentes en tiempo de la pandemia por COVID-19","volume":"49","year":"2020","journal-title":"Rev. Colomb. Psiquiatr."},{"key":"ref_8","first-page":"107","article-title":"Disfunci\u00f3n familiar y depresi\u00f3n en ni\u00f1os de 8-12 a\u00f1os de edad","volume":"2","year":"2014","journal-title":"Rev. Med. E Investig."},{"key":"ref_9","unstructured":"Escobar S\u00e1ez, M.J. (2022, June 15). Disfunci\u00f3n Familiar En Adolescentes de Quinto de Secundar\u00eda de Un Colegio P\u00fablico y Un Colegio Privado En El Distrito de La Molina; Universidad de Lima, Lima, Peru: 2015. Available online: https:\/\/repositorio.ulima.edu.pe\/handle\/20.500.12724\/1721."},{"key":"ref_10","unstructured":"V\u00e1squez Coba, C.X. (2022, June 15). El Estr\u00e9s Postraum\u00e1tico y las Condiciones Familiares, en los Ni\u00f1os y Adolescentes. Available online: http:\/\/www.dspace.uce.edu.ec\/handle\/25000\/1202."},{"key":"ref_11","first-page":"717","article-title":"Family Functioning and Posttraumatic Stress Disorder in Adolescent Survivors of Childhood Cancer","volume":"23","author":"Alderfer","year":"2009","journal-title":"J. Fam. Psychol. JFP J. Div. Fam. Psychol. Am. Psychol. Assoc. Div."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1016\/j.jbi.2008.08.010","article-title":"Research Electronic Data Capture (REDCap)\u2014A Metadata-Driven Methodology and Workflow Process for Providing Translational Research Informatics Support","volume":"42","author":"Harris","year":"2009","journal-title":"J. Biomed. Inform."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"103208","DOI":"10.1016\/j.jbi.2019.103208","article-title":"The REDCap Consortium: Building an International Community of Software Platform Partners","volume":"95","author":"Harris","year":"2019","journal-title":"J. Biomed. Inform."},{"key":"ref_14","first-page":"53","article-title":"Apgar familiar: Una herramienta para detectar disfunci\u00f3n familiar","volume":"20","year":"2014","journal-title":"Rev. M\u00e9d. Paz"},{"key":"ref_15","first-page":"303","article-title":"Validity and Reliability of the Family APGAR as a Test of Family Function","volume":"15","author":"Smilkstein","year":"1982","journal-title":"J. Fam. Pract."},{"key":"ref_16","first-page":"289","article-title":"Validez y fiabilidad del cuestionario de funci\u00f3n familiar Apgar-familiar","volume":"18","year":"1996","journal-title":"Aten. Primaria"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"140","DOI":"10.22199\/S07187475.2015.0002.00003","article-title":"An\u00e1lisis factorial confirmatorio de la escala de percepci\u00f3n del funcionamiento familiar de Smilkstein en adolescentes peruanos","volume":"6","author":"Cabello","year":"2015","journal-title":"Salud Soc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"57","DOI":"10.4067\/S0718-48082014000100006","article-title":"Propiedades Psicom\u00e9tricas de La Escala de S\u00edntomas de TEPT Para Ni\u00f1os (CPSS) En Poblaci\u00f3n Chilena Afectada Por El Terremoto y Tsunami Del 27-F de 2010","volume":"32","author":"Gysling","year":"2014","journal-title":"Ter. Psicol."},{"key":"ref_19","first-page":"113","article-title":"Validaci\u00f3n Preliminar de La Escala Infantil de S\u00edntomas Del Trastorno de Estr\u00e9s Postraum\u00e1tico (Child PTSD Symptom Scale, CPSS) En Ni\u00f1os\/as y Adolescentes V\u00edctimas de Violencia Sexual","volume":"18","author":"Bustos","year":"2009","journal-title":"Psykhe Santiago"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1019","DOI":"10.1002\/jts.20271","article-title":"Psychometric Analysis and Refinement of the Connor-Davidson Resilience Scale (CD-RISC): Validation of a 10-Item Measure of Resilience","volume":"20","author":"Stein","year":"2007","journal-title":"J. Trauma. Stress"},{"key":"ref_21","unstructured":"(2019, June 14). Escala de Resiliencia de Connor-Davidson (CD-RISC). Available online: https:\/\/www.researchgate.net\/publication\/277139516_Escala_de_Resiliencia_de_Connor-Davidson_CD-RISC."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1080\/13607863.2017.1399340","article-title":"Spanish Validation of the 10-Item Connor-Davidson Resilience Scale (CD-RISC 10) with Non-Professional Caregivers","volume":"23","author":"Blanco","year":"2019","journal-title":"Aging Ment. Health"},{"key":"ref_23","first-page":"14","article-title":"Validity of the Connor-Davidson resilience scale (10 items) in a population of elderly","volume":"23","year":"2013","journal-title":"Enferm. Clin."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1186\/1477-7525-12-14","article-title":"Validity and Reliability of the Spanish Version of the 10-Item CD-RISC in Patients with Fibromyalgia","volume":"12","year":"2014","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/1477-7525-9-63","article-title":"Reliability and Validity of the Spanish Version of the 10-Item Connor-Davidson Resilience Scale (10-Item CD-RISC) in Young Adults","volume":"9","year":"2011","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch. Intern. Med."},{"key":"ref_27","unstructured":"Ventura Bances, M.P. (2009). Eficacia de un programa de intervenci\u00f3n grupal cognitivo-conductual para disminuir el trastorno de ansiedad generalizada en pacientes del Puesto de Salud Las Dunas-Surco. Univ. Nac. Mayor San Marcos, Available online: https:\/\/cybertesis.unmsm.edu.pe\/handle\/20.500.12672\/618."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1037\/a0036523","article-title":"The Psychometric Properties of the Generalized Anxiety Disorder-7 Scale in Hispanic Americans with English or Spanish Language Preference","volume":"20","author":"Mills","year":"2014","journal-title":"Cultur. Divers. Ethnic Minor. Psychol."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Villarreal-Zegarra, D., Copez-Lonzoy, A., Bernab\u00e9-Ortiz, A., Melendez-Torres, G.J., and Bazo-Alvarez, J.C. (2019). Valid Group Comparisons Can Be Made with the Patient Health Questionnaire (PHQ-9): A Measurement Invariance Study across Groups by Demographic Characteristics. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0221717"},{"key":"ref_30","first-page":"661","article-title":"Usefulness of the Patient Health Questionnaire-9 for Korean Medical Students","volume":"38","author":"Yoon","year":"2014","journal-title":"Acad. Psychiatry J. Am. Assoc. Dir. Psychiatr. Resid. Train. Assoc. Acad. Psychiatry"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1176\/appi.ajp.157.3.451","article-title":"Childhood Trauma and Dissociative Symptoms in Panic Disorder","volume":"157","author":"Marshall","year":"2000","journal-title":"Am. J. Psychiatry"},{"key":"ref_32","unstructured":"Florenzano, R., Weil, K., Carvajal, C., and Cruz, C. (2005). Validaci\u00f3n Externa de La Escala de Trauma de Marshall. Trauma Infanto-Juvenil y Psicopatolog\u00eda Adulta, Universidad de los Andes. Chapter 9."},{"key":"ref_33","first-page":"255","article-title":"Intento suicida y antecedente de experiencias traum\u00e1ticas durante la infancia en adultos con diagn\u00f3stico de depresi\u00f3n, trastorno de personalidad lim\u00edtrofe o esquizofrenia","volume":"76","year":"2013","journal-title":"Rev. Neuropsiquiatr."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"288","DOI":"10.4067\/S0717-92272007000400004","article-title":"Mujeres Con Depresi\u00f3n Severa: Relaci\u00f3n Entre Trauma Infantil y Gravedad de S\u00edntomas Cl\u00ednicos","volume":"45","author":"Ballesteros","year":"2007","journal-title":"Rev. Chil. Neuro-Psiquiatr."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1111\/j.1360-0443.1993.tb00822.x","article-title":"Alcohol Consumption and Related Problems among Primary Health Care Patients: WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption\u2014I","volume":"88","author":"Saunders","year":"1993","journal-title":"Addict. Abingdon Engl."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1111\/j.1360-0443.1993.tb02093.x","article-title":"Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO Collaborative Project on Early Detection of Persons with Harmful Alcohol Consumption\u2014II","volume":"88","author":"Saunders","year":"1993","journal-title":"Addict. Abingdon Engl."},{"key":"ref_37","first-page":"11","article-title":"Validaci\u00f3n de La Prueba Para La Identificaci\u00f3n de Trastornos Por Uso de Alcohol (AUDIT) En Atenci\u00f3n Primaria","volume":"198","year":"1998","journal-title":"Rev. Cl\u00edn. Esp."},{"key":"ref_38","unstructured":"(2022, January 11). Cuestionario AUDIT Para La Detecci\u00f3n Del Consumo de Alcohol. Available online: https:\/\/www.msdmanuals.com\/medical-calculators\/AlcoholScreen-es.htm."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1038\/s41398-021-01438-z","article-title":"Prevalence of and Factors Associated with Post-Traumatic Stress Disorder among French University Students 1 Month after the COVID-19 Lockdown","volume":"11","author":"Wathelet","year":"2021","journal-title":"Transl. Psychiatry"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.jadohealth.2021.01.011","article-title":"The Impact of Positive Youth Development Attributes on Posttraumatic Stress Disorder Symptoms Among Chinese Adolescents Under COVID-19","volume":"68","author":"Shek","year":"2021","journal-title":"J. Adolesc. Health Off. Publ. Soc. Adolesc. Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"701945","DOI":"10.3389\/fpsyg.2021.701945","article-title":"The Influence of Family Function on State Anxiety of Chinese College Students During the Epidemic of COVID-19","volume":"12","author":"Yang","year":"2021","journal-title":"Front. Psychol."},{"key":"ref_42","first-page":"290","article-title":"Estr\u00e9s postraum\u00e1tico en la poblaci\u00f3n pedi\u00e1trica atendida en el Hospital Infantil del estado de Chihuahua, M\u00e9xico","volume":"68","year":"2011","journal-title":"Bol. M\u00e9d. Hosp. Infant. M\u00e9xico"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.jsp.2018.04.002","article-title":"Family Dysfunction and Anxiety in Adolescents: A Moderated Mediation Model of Self-Esteem and Perceived School Stress","volume":"69","author":"Guo","year":"2018","journal-title":"J. Sch. Psychol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1037\/dev0001237","article-title":"COVID-19 Disruption Gets inside the Family: A Two-Month Multilevel Study of Family Stress during the Pandemic","volume":"57","author":"Browne","year":"2021","journal-title":"Dev. Psychol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"935","DOI":"10.1007\/s10802-020-00732-6","article-title":"Parental Buffering of Stress in the Time of COVID-19: Family-Level Factors May Moderate the Association Between Pandemic-Related Stress and Youth Symptomatology","volume":"49","author":"Cohodes","year":"2021","journal-title":"Res. Child Adolesc. Psychopathol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"703899","DOI":"10.3389\/fpubh.2021.703899","article-title":"Family Cohesion and Stress Consequences Among Chinese College Students During COVID-19 Pandemic: A Moderated Mediation Model","volume":"9","author":"Zeng","year":"2021","journal-title":"Front. Public Health"},{"key":"ref_47","first-page":"1","article-title":"Supporting Family and Friends of Young People with Mental Health Issues Using Online Technology: A Rapid Scoping Literature Review","volume":"2021","author":"Migliorini","year":"2021","journal-title":"Early Interv. Psychiatry"},{"key":"ref_48","unstructured":"(2022, January 11). Asociaciones Entre Exposici\u00f3n a Traumas, Trastorno de Estr\u00e9s Postraum\u00e1tico y S\u00edntomas de Depresi\u00f3n en Adolescentes Sobrevivientes del Terremoto de Lushan 2013. Available online: https:\/\/psiquiatria.com\/depresion\/asociaciones-entre-exposicion-a-traumas-trastorno-de-estres-postraumatico-y-sintomas-de-depresion-en-adolescentes-sobrevivientes-del-terremoto-de-lushan-2013\/."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"779","DOI":"10.1016\/j.dsx.2020.05.035","article-title":"Psychosocial Impact of COVID-19","volume":"14","author":"Dubey","year":"2020","journal-title":"Diabetes Metab. Syndr."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"154","DOI":"10.1016\/j.ajp.2019.05.030","article-title":"Prevalence, Comorbidity and Predictors of Post-Traumatic Stress Disorder, Depression, and Anxiety in Adolescents Following an Earthquake","volume":"43","author":"Marthoenis","year":"2019","journal-title":"Asian J. Psychiatry"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"105634","DOI":"10.1016\/j.childyouth.2020.105634","article-title":"Psychological Effects of the COVID-19 Pandemic on Wuhan\u2019s High School Students","volume":"119","author":"Yang","year":"2020","journal-title":"Child. Youth Serv. Rev."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Avanci, J.Q., Serpeloni, F., de Oliveira, T.P., and de Assis, S.G. (2021). Posttraumatic Stress Disorder among Adolescents in Brazil: A Cross-Sectional Study. BMC Psychiatry, 21.","DOI":"10.1186\/s12888-021-03062-z"},{"key":"ref_53","unstructured":"(2022, January 11). Resultados Preliminares Del Impacto de La COVID-19 En Ni\u00f1os\/as y Adolescentes Expuestos a Maltrato Intrafamiliar|Terapia Psicol\u00f3gica. Available online: https:\/\/teps.cl\/index.php\/teps\/article\/view\/301."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.amepre.2008.06.024","article-title":"The effectiveness of interventions to reduce psychological harm from traumatic events among children and adolescents: A systematic review","volume":"35","author":"Wethington","year":"2008","journal-title":"Am. J. Prev. Med."},{"key":"ref_55","first-page":"188","article-title":"The Psychological Effects of COVID-19-Related Containment in Children: The E-COCCON French Study","volume":"29","author":"Claudet","year":"2022","journal-title":"Arch. Pediatr. Organe Off. Soc. Francaise Pediatr."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/15\/9343\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:59:48Z","timestamp":1760140788000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/15\/9343"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,30]]},"references-count":55,"journal-issue":{"issue":"15","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["ijerph19159343"],"URL":"https:\/\/doi.org\/10.3390\/ijerph19159343","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,30]]}}}