Exposure to interpersonal violence and risk for PTSD, depression, delinquency, and binge drinking among adolescents: data from the NSA-R

Genetic and psychosocial predictors of alcohol use trajectories among disaster-exposed adolescents

BACKGROUND AND OBJECTIVES

Adolescent alcohol misuse is associated with numerous long-term adverse outcomes, so we examined predictors of alcohol use among disaster-exposed adolescents, a group at-risk for alcohol misuse.

METHODS

The current study (n = 332) examined severity of tornado-related exposure, posttraumatic stress disorder (PTSD) symptoms, emotional support, and a genetic risk sum score (GRSS) as predictors of alcohol use trajectories.

RESULTS

Severity of exposure interacted with the GRSS to predict both intercept (12-month follow up quantity of alcohol use) and growth rate. Emotional support also interacted with adolescent PTSD symptoms to predict intercept and growth rate.

DISCUSSION AND CONCLUSIONS

Adolescents with greater severity of disaster exposure and high genetic risk comprise a high risk group, on which efforts to prevent alcohol use should be focused. Additionally, emotional support is essential in buffering the effects of PTSD symptoms on alcohol use outcomes among adolescents.

SCIENTIFIC SIGNIFICANCE

Toward the aim of reducing adolescent alcohol misuse following disaster exposure, there is utility in inserting immediate supports (e.g., basic resources) into communities/families that have experienced significant disaster-related severity, particularly among adolescents at high levels of genetic risk for alcohol use/misuse. Additionally, prevention efforts aimed at improving emotional supports for adolescents with more PTSD symptoms may reduce propensity for alcohol misuse following disaster. This information can be easily incorporated into existing web-based interventions. (Am J Addict 2017;26:623-631).

Childhood maltreatment preceding depressive disorder at age 18 years: A prospective Brazilian birth cohort study

BACKGROUND

Childhood maltreatment is linked with increased risk for mental illness in adolescence and adulthood. However, little evidence is available on whether different forms of maltreatment have specific effects, and no prospective studies in low- or middle-income countries have addressed this issue.

METHODS

Participants in a population-based, birth cohort study in Pelotas, Brazil (N=3715) self-reported exposure to maltreatment (emotional abuse, physical neglect, physical abuse, sexual abuse, domestic violence) in confidential questionnaires at age 15 years, and were assessed for major depression in interviews at age 18 years, using the MINI. Confounding variables concerning family characteristics were measured in interviews with mothers in the perinatal period and at age 11 years.

RESULTS

Females exposed to emotional abuse (OR=2.7; 95%CI=1.9, 3.8) and domestic violence (OR=1.9; 95%CI=1.2, 2.9) were at increased risk for depression after adjustment for confounders and other types of maltreatment. Females exposed to two or more forms of maltreatment were at particularly high risk for depression (OR=4.1; 95%Cl=2.8, 6.1) compared with females not exposed to maltreatment. In adjusted analyses, maltreatment was not associated with depression for males.

LIMITATIONS

Detailed information about maltreatment such as timing and frequency was not available, and 1534 individuals were not included in the analyses, who had poorer and less educated mothers.

CONCLUSIONS

Emotional abuse and domestic violence are strong risk factors for major depression for females. Early intervention to prevent maltreatment and its consequences is critical, especially for girls exposed to poly-maltreatment.

Racial/ethnic differences in trauma exposure and mental health disorders in adolescents

OBJECTIVE

Research has cited increased prevalence of mood disorders, anxiety disorders, and exposure to interpersonal violence for Hispanics and non-Hispanic Black adolescents, as well as ethnic differences in externalizing behavior (e.g., substance use, delinquency). The current study combined these areas by examining racial/ethnic differences in mental health correlates of trauma exposure.

METHOD

Interviews were conducted to assess polyvictimization, posttraumatic stress disorder (PTSD), major depressive disorder (MDD), substance use, and delinquency in a nationally representative sample of adolescents (N = 3,614; 15.4% non-Hispanic Black; 11.3% Hispanic; 64.9% non-Hispanic White).

RESULTS

Hispanic and non-Hispanic Black adolescents endorsed greater polyvictimization than non-Hispanic Whites; however, differences in MDD and PTSD were only significant when assessed with symptom counts. Non-Hispanic Black adolescents reported the least drug use. Non-Hispanic Black and Hispanic adolescents endorsed more delinquency than non-Hispanic White adolescents. Polyvictimization only accounted for ethnic disparities in delinquency.

CONCLUSION

Trauma-related disparities may differ across internalizing and externalizing concerns. Subsequent research should continue to examine other factors that may contribute to racial/ethnic differences in trauma sequelae. (PsycINFO Database Record

Longitudinal Trajectory of Adolescent Exposure to Community Violence and Depressive Symptoms Among Adolescents and Young Adults: Understanding the Effect of Mental Health Service Usage

Research on the impact of exposure to community violence tends to define victimization as a single construct. This study differentiates between direct and indirect violence victimization in their association with mental health problems and mental health service use. This study includes 8947 individuals from four waves of the National Longitudinal Study of Adolescent to Adult Health and examines (1) whether sub-types of adolescent victimization are linked to depressive symptoms; (2) whether adolescent victimization is linked with mental health service use; and (3) the role of mental health service use in attenuating symptoms arising from victimizations. Adolescents witnessing community violence were more likely to experience depressive symptoms during adolescence but not during their young adulthood; direct exposure to violence during adolescence does not predict depressive symptoms in adolescence but does in adulthood. Use of mental health service mediates report of depressive symptoms for adolescent witnessing community violence.

Narrative Exposure Therapy: A Proposed Model to Address Intimate Partner Violence-Related PTSD in Parenting and Pregnant Adolescents

Pregnant and parenting adolescents experience high rates of intimate partner violence (IPV) and its sequelae posttraumatic stress disorder (PTSD) and depression. Narrative exposure therapy (NET) is an innovative intervention that has demonstrated strong preliminary evidence in improving mental health. The specific aims of this article are 3-fold: (1) provide a brief background about IPV-related PTSD and depression among pregnant and parenting adolescents; (2) describe NET's theoretical principles, its therapeutic process, and provide a review of existing evidence; and (3) discuss NET as a potential treatment to address the mental health burden among adolescents experiencing IPV-related PTSD and depression.

Changes in functional connectivity of the amygdala during cognitive reappraisal predict symptom reduction during trauma-focused cognitive-behavioral therapy among adolescent girls with post-traumatic stress disorder

BACKGROUND

While trauma-focused cognitive-behavioral therapy (TF-CBT) is the 'gold standard' treatment for pediatric post-traumatic stress disorder (PTSD), little is known about the neural mechanisms by which TF-CBT produces clinical benefit. Here, we test the hypothesis that PTSD symptom reduction during TF-CBT among adolescent girls with PTSD is associated with changes in patterns of brain functional connectivity (FC) with the amygdala during cognitive reappraisal.

METHOD

Adolescent girls with PTSD related to physical or sexual assault (n = 34) were enrolled in TF-CBT, delivered in an approximately 12-session format, in an open trial. Before and after treatment, they were engaged in a cognitive reappraisal task, probing neural mechanisms of explicit emotion regulation, during 3 T functional magnetic resonance imaging.

RESULTS

Among adolescent girls completing TF-CBT with usable pre- and post-treatment scans (n = 20), improvements in self-reported emotion from pre- to post-treatment were positively related to improvements in PTSD symptoms. Adolescent girls with greater post-treatment symptom reduction were also able to suppress amygdala-insula FC while re-appraising, which was not evident in girls with less symptom reduction. Pre- to post-treatment changes in right amygdala to left insula FC that scaled with PTSD symptom reduction also scaled with improvements in emotion regulation.

CONCLUSIONS

These preliminary results suggest the neurocircuitry mechanisms through which TF-CBT produces clinical outcomes, providing putative brain targets for augmenting TF-CBT response.

Cumulative trauma, adversity and grief symptoms associated with fronto-temporal regions in life-course persistent delinquent boys

Delinquent youth have substantial trauma exposure, with life-course persistent delinquents [LCPD] demonstrating notably elevated cross-diagnostic psychopathology and cognitive deficits. Because adolescents remain in the midst of brain and neurocognitive development, tailored interventions are key to improving functional outcomes. This structural magnetic resonance imaging study compared neuroanatomical profiles of 23 LCPD and 20 matched control adolescent boys. LCPD youth had smaller overall gray matter, and left hippocampal, volumes alongside less cortical surface area and folding within the left pars opercularis and supramarginal cortex. LCPD youth had more adversity-related exposures, and their higher Cumulative Trauma, Adversity and Grief [C-TAG] symptoms were associated with less surface area and folding in the pars opercularis and lingual gyrus. Neuroanatomical differences between LCPD and control youth overlap with data from both maltreatment and antisocial literatures. The affected left frontal regions also share connections to language- and executive-related functions, aligning well with LCPD youths' cognitive and behavioral difficulties. These data also dovetail with research suggesting the possibility of neurodevelopmental delays or disruptions related to cumulative adversity burden. Thus, concurrent treatment of LCPD youths' C-TAG symptoms and, cognitive deficits with overlapping neuroanatomical bases, may be most effective in improving outcomes and optimizing neurodevelopmental trajectories.

The Impact of Specific and Complex Trauma on the Mental Health of Homeless Youth

This study investigates the relative impact of trauma experiences that occurred prior to and since becoming homeless on depressive symptoms, posttraumatic stress disorder (PTSD) symptoms, and self-injurious behaviors among a sample of homeless youth (N = 389). Youth (aged 13 to 25) who had been homeless or precariously housed in the past year completed a survey about housing history, experiences of violence and victimization, mental health, and service utilization. In addition to examining the impact associated with specific trauma types, we also considered the effect of "early-on" poly-victimization (i.e., cumulative number of reported traumas prior to homelessness) and the influence of a compound sexual trauma variable created to represent earlier complex trauma. This created-variable has values ranging from no reported trauma, single trauma, multiple non-sexual traumas, and multiple traumas that co-occurred with sexual abuse. Multivariate analyses revealed that specific traumatic experiences prior to homelessness, including sexual abuse, emotional abuse/neglect, and adverse home environment, predicted greater mental health symptoms. Poly-victimization did not add to the prediction of mental health symptoms after the inclusion of specific traumas. Results with early compound sexual trauma revealed significant differences between lower-order trauma exposures and multiple-trauma exposures. Specifically, experience of multiple traumas that co-occurred with sexual trauma was significantly more detrimental in predicting PTSD symptoms than multiple traumas of non-sexual nature. Findings support the utility of an alternate/novel conceptualization of complex trauma, and support the need to carefully evaluate complex traumatic experiences that occurred prior to homelessness, which can impact the design and implementation of mental health care and services for homeless youth.

Affective Dispositions and PTSD Symptom Clusters in Female Interpersonal Trauma Survivors

Interpersonal trauma (IPT) against women can have dire psychological consequences including persistent maladaptive changes in the subjective experience of affect. Contemporary literature has firmly established heightened negative affect (NA) as a risk and maintenance factor for posttraumatic stress disorder (PTSD). However, the relationship between NA and PTSD symptoms is not well understood within IPT survivors, the majority of whom are female, as much of this research has focused on combat veterans. In addition, the connection between positive affect (PA) and PTSD symptoms has yet to be examined. With increased emphasis on "negative alterations in cognitions and mood . . ." as an independent symptom cluster of PTSD in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5), understanding the relationship between self-reported affectivity and the classic PTSD symptom clusters may be increasingly useful in differentiating symptom presentations of trauma-related psychopathology. The current study directly compared self-reported trait NA and PA with total severity and frequency cluster scores from the Clinician-Administered PTSD Scale (CAPS) in 54 female survivors of IPT who met criteria for PTSD. Results identify NA (but not PA) as a consistent predictor of total PTSD symptoms and, specifically, re-experiencing symptoms.

Amygdala response predicts trajectory of symptom reduction during Trauma-Focused Cognitive-Behavioral Therapy among adolescent girls with PTSD

Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is the gold standard treatment for pediatric PTSD. Nonetheless, clinical outcomes in TF-CBT are highly variable, indicating a need to identify reliable predictors that allow forecasting treatment response. Here, we test the hypothesis that functional neuroimaging correlates of emotion processing predict PTSD symptom reduction during Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) among adolescent girls with PTSD. Thirty-four adolescent girls with PTSD related to physical or sexual assault were enrolled in TF-CBT, delivered in an approximately 12 session format, in an open trial. Prior to treatment, they were engaged in an implicit threat processing task during 3T fMRI, during which they viewed faces depicting fearful or neutral expressions. Among adolescent girls completing TF-CBT (n = 23), slopes of PTSD symptom trajectories during TF-CBT were significantly related to pre-treatment degree of bilateral amygdala activation while viewing fearful vs neutral images. Adolescents with less symptom reduction were characterized by greater amygdala activation to both threat and neutral images (i.e., less threat-safety discrimination), whereas adolescents with greater symptom reduction were characterized by amygdala activation only to threat images. These clinical outcome relationships with pre-treatment bilateral amygdala activation remained when controlling for possible confounding demographic or clinical variables (e.g., concurrent psychotropic medication, comorbid diagnoses). While limited by a lack of a control group, these preliminary results suggest that pre-treatment amygdala reactivity to fear stimuli, a component of neurocircuitry models of PTSD, positively predicts symptom reduction during TF-CBT among assaulted adolescent girls, providing support for an objective measure for forecasting treatment response in this vulnerable population.

The expression of personality among adolescents exposed to community interpersonal violence

The high level of crime in South Africa affects many adolescents. Experience of community interpersonal violence affects the social, emotional, and cognitive functioning of adolescents and could have an impact on their personality development. The aim of the study was to explore possible differences in the expression of personality between adolescents exposed to community interpersonal violence and those not exposed to such violence. The sample comprised 183 Grade 12 learners from a secondary school in a middle-class community in Gauteng. Participants were divided into two groups: adolescents who reported exposure to community interpersonal violence ( n = 93) and those who did not report exposure to such violence ( n = 90). Both groups completed the 16 Personality Factor and Posttraumatic Diagnostic Scales. Differences between the groups were explored using a one-way between-groups multivariate analysis of variance and t-tests for independent groups. Results indicated statistically significant differences between the two groups on Factor G (rule consciousness), Factor I (emotional sensitivity), and Factor Q4 (anxiety). Adolescents exposed to interpersonal violence reported higher levels of posttraumatic stress disorder symptoms than the control group. The group that experienced posttraumatic stress disorder symptoms differed more in terms of personality functioning (Factors I and Q4). Violence-exposed adolescents experienced more emotional volatility, difficulty to regulate emotions, anxiety, and sensitivity to environmental stressors than those not exposed to such violence. Although causality cannot be assumed, it is possible that exposure to community interpersonal violence, which could result in posttraumatic stress disorder symptoms, has implications for the personality development of adolescents. Interventions for adolescents exposed to interpersonal violence are recommended to prevent the development of posttraumatic stress disorder symptoms.

Intimate partner violence, power, and equity among adolescent parents: relation to child outcomes and parenting

Intimate partner violence (IPV) victimization and perpetration and power imbalances in parenting partners may result in poor outcomes for parents and children. Previous work in this area has focused on the maternal experiences, neglecting to examine paternal effects. The present study aimed to elucidate the role of IPV, power, and equity in parenting and child outcomes in an urban sample of adolescent parents. 159 male and 182 female parents in a relationship were recruited through university-affiliated hospitals. Power, equity, and IPV were measured at 6 months post-partum and were used as predictors for parenting and child outcomes 12 months post-partum using general estimating equations. Gender interactions and mediation effects of depression were also assessed. Higher perceived relationship equity was related to better infant temperament (B = 0.052, SE = 0.023, p = 0.02) whereas higher partner power was related to poorer social development (B = -0.201, SE = 0.088, p = 0.02) and fine motor development (B = -0.195, SE = 0.078, p = 0.01). IPV victimization was associated with poor infant temperament (B = -2.925, SE = 1.083, p = 0.007) and lower parenting competence (B = -3.508, SE = 1.142, p = 0.002). Depression mediated the relationship between IPV and parenting and IPV and infant temperament. No gender effects were found. IPV, inequities, and power imbalances were disadvantageous for parenting and child outcomes. Our results suggest that these dynamics may negatively affect both males and females. Interventions to reduce violence in both partners and promote equity in relationships could benefit couples and their children.

Altered Trust Learning Mechanisms Among Female Adolescent Victims of Interpersonal Violence

Early-life interpersonal violence (IV) is a significant risk factor for a broad range of mental health disorders, increased rates of re-victimization, and psychosocial dysfunction. However, the cognitive mechanisms by which these risks are conferred are largely unknown. The current study attempted to address this empirical gap. Thirty-two adolescent girls, aged 12 to 16 (15 victims of IV), completed a social learning task. A computational learning model was fit to the behavioral data (ratings of trustworthiness during the learning task) to test for group differences in the cognitive mechanisms by which adolescent girls learn to differentially trust others. Specifically, we tested for differences in task performance and subject-level learning parameters: learning rate (the extent to which preferences are updated with new information) and preference stochasticity (the extent to which preferences seem random). Adolescent girls who were victims of IV demonstrated significantly worse performance than their control counterparts. Among IV victims, we observed a relationship between higher learning rates and greater preference stochasticity. Theoretical and clinical implications are discussed.

Polyvictimization, income, and ethnic differences in trauma-related mental health during adolescence

PURPOSE

The purpose of the present study was to investigate ethnic differences in trauma-related mental health symptoms among adolescents, and test the mediating and moderating effects of polyvictimization (i.e., number of types of traumas/victimizations experienced by an individual) and household income, respectively.

METHODS

Data were drawn from the first wave of the National Survey of Adolescents-replication study (NSA-R), which took place in the US in 2005 and utilized random digit dialing to administer a telephone survey to adolescents ages 12-17. Participants included in the current analyses were 3312 adolescents (50.2 % female; mean age 14.67 years) from the original sample of 3614 who identified as non-Hispanic White (n = 2346, 70.8 %), non-Hispanic Black (n = 557, 16.8 %), or Hispanic (n = 409, 12.3 %). Structural equation modeling was utilized to test hypothesized models.

RESULTS

Non-Hispanic Black and Hispanic participants reported higher levels of polyvictimization and trauma-related mental health symptoms (symptoms of posttraumatic stress and depression) compared to non-Hispanic Whites, though the effect sizes were small (γ ≤ 0.07). Polyvictimization fully accounted for the differences in mental health symptoms between non-Hispanic Blacks and non-Hispanic Whites, and partially accounted for the differences between Hispanics and non-Hispanic Whites. The relation between polyvictimization and trauma-related mental health symptoms was higher for low-income youth than for high-income youth.

CONCLUSIONS

Disparities in trauma exposure largely accounted for racial/ethnic disparities in trauma-related mental health. Children from low-income family environments appear to be at greater risk of negative mental health outcomes following trauma exposure compared to adolescents from high-income families.

Web-Based Training for an Evidence-Supported Treatment: Training Completion and Knowledge Acquisition in a Global Sample of Learners

The purpose of this investigation is to describe the characteristics of professional and preprofessional learners who registered for and completed TF-CBTWeb, a modular, web-based training program designed to promote the dissemination of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) and to demonstrate the feasibility of this method of dissemination. Between October 1, 2005, and October 1, 2012, a total of 123,848 learners registered for TF-CBTWeb, of whom 98,646 (79.7%) initiated the learning activities by beginning the first module pretest. Of those, 67,201 (68.1%) completed the full training. Registrants hailed from 130 countries worldwide, and they had varied educational backgrounds, professional identities (both professional and preprofessional), and a range of experience working with child trauma victims. Learners who were from the United States, students, those with master's degrees, and those with fewer years of experience working with child trauma victims tended to have the highest course completion rates. Learners displayed significant increases in knowledge about each component of TF-CBT, based on module pretest and posttest scores. The advantages and limitations of this web-based training program evaluation are discussed, while important implications for the use of web-based trainings are reviewed.

Mediators of interpersonal violence and drug addiction severity among methamphetamine users in Cape Town, South Africa

South Africa has high rates of interpersonal violence and a rapidly growing methamphetamine epidemic. Previous research has linked experiences of interpersonal violence to higher rates of substance use, and identified mental health constructs as potential mediators of this association. The aim of this study was to examine the relationship between interpersonal violence and addiction severity among active methamphetamine users in Cape Town, South Africa, and to explore symptoms of posttraumatic stress disorder (PTSD) and substance use coping as mediators of this relationship. A community sample of 360 methamphetamine users was recruited through respondent driven sampling and surveyed on their experiences of violence, mental health, coping, and drug use and severity. A series of one-way ANOVAs were conducted to examine the relationship of self-reported interpersonal violence with drug addiction severity, and multiple mediation analyses were used to determine if PTSD symptoms and substance use coping mediated this relationship. The majority (87%) of the sample reported experiencing at least one instance of interpersonal violence in their lifetime, and the number of violent experiences was associated with increased drug addiction severity. PTSD and substance use coping were significant mediators of this association. Only the indirect effect of substance use coping remained significant for the female sample when the mediation model was conducted separately for men and women. The findings point to the need for integrated treatments that address drug use and PTSD for methamphetamine users in South Africa and highlight the importance of coping interventions for women.

The effects of violence exposure on the development of impulse control and future orientation across adolescence and early adulthood: Time-specific and generalized effects in a sample of juvenile offenders

Impulse control and future orientation increase across adolescence, but little is known about how contextual factors shape the development of these capacities. The present study investigates how stress exposure, operationalized as exposure to violence, alters the developmental pattern of impulse control and future orientation across adolescence and early adulthood. In a sample of 1,354 serious juvenile offenders, higher exposure to violence was associated with lower levels of future orientation at age 15 and suppressed development of future orientation from ages 15 to 25. Increases in witnessing violence or victimization were linked to declines in impulse control 1 year later, but only during adolescence. Thus, beyond previous experiences of exposure to violence, witnessing violence and victimization during adolescence conveys unique risk for suppressed development of self-regulation.

Does adolescent's exposure to parental intimate partner conflict and violence predict psychological distress and substance use in young adulthood? A longitudinal study

Little is known about the extent to which parental conflict and violence differentially impact on offspring mental health and substance use. Using data from a longitudinal birth cohort study this paper examines: whether offspring exposure to parental intimate partner violence (involving physical violence which may include conflicts and/or disagreements) or parental intimate partner conflict (conflicting interactions and disagreements only) are associated with offspring depression, anxiety and substance use in early adulthood (at age 21); and whether these associations are independent of maternal background, depression and anxiety and substance use. Data (n=2,126 women and children) were taken from a large-scale Australian birth-cohort study, the Mater University of Queensland Study of Pregnancy (MUSP). IPC and IPV were measured at the 14-year follow-up. Offspring mental health outcomes--depression, anxiety and substance use--were assessed at the 21-year follow-up using the Composite International Diagnostic Interview (CIDI). Offspring of women experiencing IPV at the 14-year follow-up were more likely to manifest anxiety, nicotine, alcohol and cannabis disorders by the 21-year follow-up. These associations remained after adjustment for maternal anxiety, depression, and other potential confounders. Unlike males who experience anxiety disorders after exposure to IPV, females experience depressive and alcohol use disorders. IPV predicts offspring increased levels of substance abuse and dependence in young adulthood. Gender differences suggest differential impact.

Emotional and physiological desensitization to real-life and movie violence

Youth are exposed to large amounts of violence in real life and media, which may lead to desensitization. Given evidence of curvilinear associations between exposure to violence and emotional distress, we examined linear and curvilinear associations of exposure to real-life and movie violence with PTSD symptoms, empathy, and physiological arousal, as well emotional and physiological reactivity to movie violence. College students (N = 209; mean age = 18.74) reported on their exposure to real-life and televised violence, PTSD symptoms, and empathy. Then, students were randomly assigned to view a series of violent or nonviolent high-action movie scenes, providing ratings of emotional distress after each clip. Blood pressure was measured at rest and during video viewing. Results showed that with increasing exposure to real-life violence, youth reported more PTSD symptoms and greater identification with fictional characters. Cognitive and emotional empathy increased from low to medium levels of exposure to violence, but declined at higher levels. For males, exposure to higher levels of real-life violence was associated with diminishing (vs. increasing) emotional distress when viewing violent videos. Exposure to televised violence was generally unrelated to emotional functioning. However, those with medium levels of exposure to TV/movie violence experienced lower elevations of blood pressure when viewing violent videos compared to those with low exposure, and those with higher levels of exposure evidenced rapid increase in blood pressure that quickly declined over time. The results point to diminished empathy and reduced emotional reactivity to violence as key aspects of desensitization to real-life violence, and more limited evidence of physiological desensitization to movie violence among those exposed to high levels of televised violence.

Attenuated behavioral and brain responses to trust violations among assaulted adolescent girls

Physical and sexual assault during adolescence is a potent risk factor for mental health and psychosocial problems, as well as revictimization, especially among female victims. To better understand this conferred risk, we conducted an exploratory study comparing assaulted and non-assaulted girls׳ behavioral and brain responses during a trust learning task. Adolescent girls (14 assaulted, 16 non-assaulted) performed a functional magnetic resonance imaging task that manipulated the percentages of which three different faces delivered positive and negative outcomes. Analyses focused on comparing unexpected to expected outcomes. We found that assaulted adolescent girls demonstrated less behavioral slowing in response to unexpected negative social outcomes, or trust violations (i.e., when a presumably trustworthy face delivered a negative outcome), relative to control girls. Trust violations were also associated with less activation in anterior insular and anterior cingulate regions among the assaulted group compared to the control group. Furthermore, we found that the severity of participants׳ exposure to assaultive events scaled negatively with recruitment of these regions. These preliminary results suggest that assault victims may engage differential learning processes upon unexpected negative social outcomes. These findings have implications for understanding impaired trust learning and social functioning among assault victims.

Witnessing a violent death and smoking, alcohol consumption, and marijuana use among adolescents

Witnessing violence has been linked to maladaptive coping behaviors such as smoking, alcohol consumption, and marijuana use. However, more research is required to identify mechanisms in which witnessing violence leads to these behaviors. The objectives of this investigation were to examine the association between witnessing a violent death and smoking, alcohol consumption, and marijuana use among adolescents, to identify whether exhibiting depressive symptoms was a mediator within this relationship, and to determine if those who had adult support in school were less likely to engage in risky health behaviors. Data were collected from a sample of 1,878 urban students, from 18 public high schools participating in the 2008 Boston Youth Survey. In 2012, we used multilevel log-binomial regression models and propensity score matching to estimate the association between witnessing a violent death and smoking, alcohol consumption, and marijuana use. Analyses indicated that girls who witnessed a violent death were more likely to use marijuana (relative risk (RR) = 1.09, 95% confidence interval (CI) = 1.02, 1.17), and tended towards a higher likelihood to smoke (RR = 1.06, 95% CI = 1.00, 1.13) and consume alcohol (RR = 1.07, 95% CI = 0.97, 1.18). Among boys, those who witnessed a violent death were significantly more likely to smoke (RR = 1.20, 95% CI = 1.11, 1.29), consume alcohol (RR = 1.30, 95% CI = 1.17, 1.45) and use marijuana (RR = 1.33, 95% CI = 1.21, 1.46). When exhibiting depressive symptoms was included, estimates were not attenuated. However, among girls who witnessed a violent death, having an adult at school for support was protective against alcohol consumption. When we used propensity score matching, findings were consistent with the main analyses among boys only. This study adds insight into how witnessing violence can lead to adoption of adverse health behaviors.

A Life Course Model of Self-Reported Violence Exposure and Ill-health with A Public Health Problem Perspective

Violence has probably always been part of the human experience. Its impact can be seen, in various forms, in all parts of the world. In 1996, WHO:s Forty-Ninth World Health Assembly adopted a resolution, declaring violence a major and growing public health problem around the world. Public health work centers around health promotion and disease prevention activities in the population and public health is an expression of the health status of the population taking into account both the level and the distribution of health. Exposure to violence can have many aspects, differing throughout the life course ― deprivation of autonomy, financial exploitation, psychological and physical neglect or abuse — but all types share common characteristics: the use of destructive force to control others by depriving them of safety, freedom, health and, in too many instances, life; the epidemic proportions of the problem, particularly among vulnerable groups; a devastating impact on individuals, families, neighborhoods, communities, and society. There is considerable evidence that stressful early life events influence a variety of physical and/or psychological health problems later in life. Childhood adversity has been linked to elevated rates of morbidity and mortality from number of chronic diseases. A model outlining potential biobehavioural pathways is put forward that may be a potential explanation of how exposure to violence among both men and women work as an important risk factor for ill health and should receive greater attention in public health work.

Hospitalized youth and child abuse: a systematic examination of psychiatric morbidity and clinical severity

Many children and adolescents who require psychiatric hospitalization have been physically or sexually abused, yet the association between reported histories of abuse and the complexity and severity of mental illness among psychiatrically hospitalized youth is poorly described with regard to current inpatient psychiatric practice. We sought to determine the association between histories of abuse and psychiatric complexity and severity in psychiatrically hospitalized youth including comorbidity patterns, psychotropic medication use, reason for admission and length of hospitalization. A systematic chart review was performed on 1433 consecutive psychiatric hospitalizations of children and adolescents that occurred over a 10-month period. Children with a history of abuse were more likely to be diagnosed with multiple DSM-IV-TR disorders than non-traumatized children. A history of sexual abuse was associated with more medication use than in their non-traumatized peers and a higher likelihood of treatment with antipsychotic medications, both at admission and discharge. Physical and sexual abuse were independently associated with increased length of stays, with exposure to both physical and sexual abuse associated with a 2-day increase in duration of hospitalization compared to non-traumatized patients. The findings from this study draw attention to the adverse impact of abuse on psychiatric morbidity and complexity and suggest the need for trauma-informed treatment in psychiatric hospital settings.

Neural processing correlates of assaultive violence exposure and PTSD symptoms during implicit threat processing: a network-level analysis among adolescent girls

Assaultive violence exposure during childhood is a significant risk factor for posttraumatic stress disorder (PTSD). The purpose of the present study was to characterize the relationships of assault and PTSD severity with the organization of large-scale networks identified during emotion processing. Adolescent girls aged 12-16 with (N=15) and without (N=15) histories of assault underwent functional magnetic resonance imaging (fMRI) while engaged in a task that presented images of fearful or neutral facial expressions. Independent component analysis (ICA) identified a frontocingulate network, a frontoparietal network, and a default mode network. Assault exposure was associated with significantly greater activation of the frontocingulate network for fear versus neutral faces. Within the frontocingulate network, Posttraumatic stress disorder (PTSD) severity was associated with weakened functional connectivity between the left amygdala and the perigenual anterior cingulate. Within the frontoparietal network, assaulted girls demonstrated weakened connectivity of the premotor cortex with the right middle frontal gyrus. Within the default mode network, assault exposure and PTSD severity were associated with strengthening functional connectivity of the parahippocampus with the medial and lateral prefrontal cortex, respectively. Individual differences in functional connections within the frontocingulate network and frontoparietal network among the assaulted group were strongly associated with caregiver-rated family disengagement. These results demonstrate associations between assault and PTSD symptoms with the functional organization of large-scale frontoparietal, frontocingulate, and default mode networks during emotion processing. The relationship with caregiver-rated family disengagement suggests the impact of family support on the neural processing correlates of assault and PTSD symptoms.

Finalizing PTSD in DSM-5: getting here from there and where to go next

The process that resulted in the diagnostic criteria for posttraumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association; ) was empirically based and rigorous. There was a high threshold for any changes in any DSM-IV diagnostic criterion. The process is described in this article. The rationale is presented that led to the creation of the new chapter, "Trauma- and Stressor-Related Disorders," within the DSM-5 metastructure. Specific issues discussed about the DSM-5 PTSD criteria themselves include a broad versus narrow PTSD construct, the decisions regarding Criterion A, the evidence supporting other PTSD symptom clusters and specifiers, the addition of the dissociative and preschool subtypes, research on the new criteria from both Internet surveys and the DSM-5 field trials, the addition of PTSD subtypes, the noninclusion of complex PTSD, and comparisons between DSM-5 versus the World Health Association's forthcoming International Classification of Diseases (ICD-11) criteria for PTSD. The PTSD construct continues to evolve. In DSM-5, it has moved beyond a narrow fear-based anxiety disorder to include dysphoric/anhedonic and externalizing PTSD phenotypes. The dissociative subtype may open the way to a fresh approach to complex PTSD. The preschool subtype incorporates important developmental factors affecting the expression of PTSD in young children. Finally, the very different approaches taken by DSM-5 and ICD-11 should have a profound effect on future research and practice.

Mental disorders associated with subpopulations of women affected by violence and abuse

Violence against women is a major public health problem associated with mental disorders. Few studies have examined the heterogeneity of interpersonal violence and abuse (IVA) among women and associated mental health problems. Latent class analysis was used to identify subpopulations of women with similar lifetime histories of IVA victimization and to examine 10 associated past-year mental disorders. Participants were 19,816 adult women who participated in Wave 2 of the National Epidemiologic Study on Alcohol and Related Conditions (NESARC). The 3-class model was best supported by the data. Class 1 (6.7%) had a high probability of witnessing domestic violence as a child. Class 2 (21.8%) had a low probability of all events except lifetime sexual assault. Class 3 (71.5%) had a low probability for all events. Mental disorders were more common among members of Classes 1 and 2 than Class 3. For example, members in Class 1 were approximately 8 and 9 times more likely than members in Class 3 to have had posttraumatic stress disorder or a drug use disorder, respectively, during the past year. Of the 10 mental disorders, 5 were more common among members of Class 1 than of Class 2. Findings suggest the mental health consequences of IVA among women are extensive and interventions should be tailored for distinct subpopulations affected by IVA.

Trauma histories, substance use coping, PTSD, and problem substance use among sexual assault victims

Sexual assault history is associated with higher risk of problem drinking and drug use in women, yet little is known about mechanisms linking trauma histories in general to women's drinking or drug use problems. This study examined how various types of trauma, substance use coping, and PTSD relate to past-year problem drinking and drug use in women who experienced sexual assault. Data from a large, diverse sample of women who had experienced adult sexual assault were analyzed with structural equation modeling to test a theoretical model of the relationship between trauma types, substance use coping, PTSD symptoms, and past-year drinking and drug use (N=1863). Results show that PTSD symptoms fully mediated the association between non-interpersonal trauma and the use of substances to cope. However, the association between both interpersonal trauma and child sexual abuse severity on substance use to cope was only partially mediated by PTSD symptoms. In turn, use of substances to cope fully mediated the relationship between PTSD and problem drug use as well as partially mediated the effect of PTSD on problem drinking. These results suggest that different trauma types and substance use coping may be important risk factors distinguishing sexually assaulted women who develop PTSD and problematic substance use from those who do not. Identifying women's histories of different traumas may help to identify those at greater risk for substance use problems.

Correlates of depressive symptoms among at-risk youth presenting to the emergency department

OBJECTIVE

The study's objective was to identify correlates of depressive symptoms among at-risk youth in an urban emergency department (ED).

METHOD

A systematic sample of adolescents (ages 14-18) in the ED were recruited as part of a larger study. Participants reporting past-year alcohol use and peer aggression self-administered a survey assessing: demographics, depressive symptoms and risk/protective factors. Logistic regression identified factors associated with depressive symptoms.

RESULTS

Among 624 adolescents (88% response rate) meeting eligibility criteria, 22.8% (n=142) screened positive for depressive symptoms. In logistic regression, depressive symptoms were positively associated with female gender [odds ratio (OR): 2.84, 95% confidence interval (CI): 1.78-4.51], poor academic performance (OR: 1.57, 95% CI: 1.01-2.44), binge drinking (OR: 1.88, 95% CI: 1.21-2.91), community violence exposure (OR: 2.25, 95% CI: 1.59-3.18) and dating violence (OR: 2.14, 95% CI: 1.36-3.38) and were negatively associated with same-sex mentorship (OR: 0.52, 95% CI: 0.29-0.91) and older age (OR: 0.55, 95% CI 0.34-0.89). Including gender interaction terms did not significantly change findings.

CONCLUSIONS

Screening and intervention approaches for youth in the urban ED should address the co-occurrence of depressive symptoms with peer and dating violence, alcohol and nonmarijuana illicit drug use.

Treatment of posttraumatic stress disorder in children and adolescents

PURPOSE OF REVIEW

We review recent evidence regarding risk factors for childhood posttraumatic stress disorder (PTSD) and treatment outcome studies from 2010 to 2012 including dissemination studies, early intervention studies and studies involving preschool children.

RECENT FINDINGS

Recent large-scale epidemiological surveys confirm that PTSD occurs in a minority of children and young people exposed to trauma. Detailed follow-up studies of trauma-exposed young people have investigated factors that distinguish those who develop a chronic PTSD from those who do not, with recent studies highlighting the importance of cognitive (thoughts, beliefs and memories) and social factors. Such findings are informative in developing treatments for young people with PTSD. Recent randomized controlled trials (RCTs) confirm that trauma-focused cognitive behaviour therapy (TF-CBT) is a highly efficacious treatment for PTSD, although questions remain about effective treatment components. A small number of dissemination studies indicate that TF-CBT can be effective when delivered in school and community settings. One recent RCT shows that TF-CBT is feasible and highly beneficial for very young preschool children. Studies of early intervention show mixed findings.

SUMMARY

Various forms of theory-based TF-CBT are highly effective in the treatment of children and adolescents with PTSD. Further work is needed to replicate and extend initial promising outcomes of TF-CBT for very young children. Dissemination studies and early intervention studies show mixed findings and further work is needed.

Gender inequality and structural violence among depressed women in South India

PURPOSE

While exploring experiences of psychological distress among psychiatric outpatients in Southern India, we set out to further understand interpersonal and socio-cultural factors that are associated with depressive symptoms.

METHODS

Using a grounded theory framework, we thematically coded narrative accounts of the women who sought treatment at the psychiatric clinic. In addition, we included author notes from participant observation and field work experiences in the South Indian psychiatric clinic.

RESULTS

Of the 32 women who participated in the study, 75 % qualified for a diagnosis of a current major depressive episode. Depressive symptoms were associated with experiences of domestic violence and, in Farmer's terms, structural violence. Although only a partial response to gender-based suffering, allopathic psychiatric treatment seemed the best available means of coping with their circumstances.

CONCLUSION

The paper moves beyond a medicalized model of disease and behavior to explore social and contextual factors that enabled these women to brave additional stigmas surrounding psychiatric treatment and seek a better outcome for themselves. It concludes by discussing the need for a multi-layered approach to addressing the suffering that women in South India experience.

Twelve-month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States

Estimates of 12-month and lifetime prevalence and of lifetime morbid risk (LMR) of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) anxiety and mood disorders are presented based on US epidemiological surveys among people aged 13+. The presentation is designed for use in the upcoming DSM-5 manual to provide more coherent estimates than would otherwise be available. Prevalence estimates are presented for the age groups proposed by DSM-5 workgroups as the most useful to consider for policy planning purposes. The LMR/12-month prevalence estimates ranked by frequency are as follows: major depressive episode: 29.9%/8.6%; specific phobia: 18.4/12.1%; social phobia: 13.0/7.4%; post-traumatic stress disorder: 10.1/3.7%; generalized anxiety disorder: 9.0/2.0%; separation anxiety disorder: 8.7/1.2%; panic disorder: 6.8%/2.4%; bipolar disorder: 4.1/1.8%; agoraphobia: 3.7/1.7%; obsessive-compulsive disorder: 2.7/1.2. Four broad patterns of results are most noteworthy: first, that the most common (lifetime prevalence/morbid risk) lifetime anxiety-mood disorders in the United States are major depression (16.6/29.9%), specific phobia (15.6/18.4%), and social phobia (10.7/13.0%) and the least common are agoraphobia (2.5/3.7%) and obsessive-compulsive disorder (2.3/2.7%); second, that the anxiety-mood disorders with the earlier median ages-of-onset are phobias and separation anxiety disorder (ages 15-17) and those with the latest are panic disorder, major depression, and generalized anxiety disorder (ages 23-30); third, that LMR is considerably higher than lifetime prevalence for most anxiety-mood disorders, although the magnitude of this difference is much higher for disorders with later than earlier ages-of-onset; and fourth, that the ratio of 12-month to lifetime prevalence, roughly characterizing persistence, varies meaningfully in ways consistent with independent evidence about differential persistence of these disorders.

Common stressful life events and difficulties are associated with mental health symptoms and substance use in young adolescents

BACKGROUND

Stressful life events are associated with mood disorders in adults in clinical settings. Less described in the literature is the association between common life stressors and a wide range of psychopathology in young adolescents. This study uses a large non-clinical sample of young adolescents to describe the associations among worry or stress about common life events/difficulties, mental health and substance use.

METHODS

Data on lifetime stress or worry about common life events/difficulties (i.e., romantic breakups, family disruption, interpersonal difficulties, and personal stress (health, weight, school work)), symptoms of depression, conduct disorder symptoms, and substance use were collected from 1025 grade 7 students (mean age 12.9 years; 45% male). The association between each source of stress and each mental health and substance use indicator was modeled in separate logistic regression analyses.

RESULTS

The proportion of adolescents reporting worry or stress ranged from 7% for new family to 53% for schoolwork. Romantic breakup stress was statistically significantly associated with all the mental health and substance use indicators except illicit drug use. Family disruption was statistically significantly associated with depression symptoms, marijuana use, and cigarette use. Interpersonal difficulties stress was statistically significantly associated with depression symptoms. All sources of personal stress were statistically significantly related to depression symptoms. In addition, health-related stress was inversely related to binge drinking.

CONCLUSION

Young adolescents may benefit from learning positive coping skills to manage worry or stress about common stressors and in particular, worry or stress related to romantic breakups. Appropriate management of mental health symptoms and substance use related to common stressful life events and difficulties may help reduce emerging psychopathology.