School-Related Outcomes of Traumatic Event Exposure and Traumatic Stress Symptoms in Students: A Systematic Review of Research from 1990 to 2015

Mitigating adolescent social anxiety symptoms: the effects of social support and social self-efficacy in findings from the Young-HUNT 3 study

Adolescents' exposure to negative life events (NLEs) and potentially traumatic events is highly prevalent and increases their risk of developing psychological disorders considerably. NLE exposure has also been linked to the development of social anxiety disorder (SAD) among older children and young adolescents. Despite the relatively low treatment efficacy reported for children and adolescents suffering from SAD, few studies have addressed the extent to which resilience factors, such as social support and social self-efficacy, are associated with SAD symptoms. This study examined whether social support and social self-efficacy predict, and buffer against SAD symptoms using a large, population-based sample of adolescents, among whom a large proportion have experienced NLEs. The results reveal that NLEs are significantly associated with SAD symptoms, while social support and social self-efficacy are both negatively associated with SAD symptoms. Only the NLEs × social support interaction significantly predicted SAD symptoms, with social support attenuating the association between NLEs and SAD symptoms. Moreover, increases in both social self-efficacy and social support were associated with reduced SAD symptoms, over and above variance explained by social support alone. Our cumulative results suggest that interventions that can modify both social support and social self-efficacy may help reduce SAD symptoms in at-risk adolescents.

Expanding the search for emerging mental ill health to safeguard student potential and vocational success in high school: A narrative review

AIM

Young people experiencing mental ill health are more likely than their healthy aged peers to drop out of high school. This can result in social exclusion and vocational derailment. Identifying young people at risk and taking action before an illness is established or school dropout occurs is an important goal. This study aimed to examine evidence for the risk markers and at risk mental states of the clinical staging model (stage 0-1b) and whether these risk states and early symptoms impact school participation and academic attainment.

METHOD

This narrative review assembles research from both the psychiatry and education literature. It examines stage 0 to stage 1b of the clinical staging model and links the risk states and early symptoms to evidence about the academic success of young people in high school.

RESULTS

In accordance with the clinical staging model and evidence from education literature, childhood trauma and parental mental illness can impact school engagement and academic progress. Sleep disturbance can result in academic failure. Undifferentiated depression and anxiety can increase the risk for school dropout. Subthreshold psychosis and hypomanic states are associated with functional impairment and high rates of Not in Employment, Education, or Training (NEET) but are not recognized in the education literature.

CONCLUSION

Risk markers for emerging mental ill health can be identified in education research and demonstrate an impact on a student's success in high school. Clear referral protocols need to be embedded into school life to reduce risk of progression to later stages of illness and support school participation and success.

The nature of posttraumatic nightmares and school functioning in war-affected youth

Children and adolescents who have experienced traumatic events demonstrate a variety of posttraumatic symptoms, including recurrent nightmares, as well as adverse reactions in the school setting. The current study examined nightmare symptoms, posttraumatic stress, sleep disturbance, and self- and teacher-reported school functioning of 64 youths in the Gaza Strip, ages 12 to 16, who have lived through three wars and experience ongoing conflict and political insecurity. Students were treatment-seeking for sleep-problems and reported, on average, five nightmares per week for an average of three years, with concomitant disrupted sleep, fear of going to sleep, and not feeling rested in the morning. Both teachers and students reported that participants exhibited impaired academic functioning and daytime sleepiness. The content of the students’ nightmares demonstrated frightening themes of being under attack and loss of self-efficacy/control; threat levels were high, and almost 60% included the threat of death. Approximately half of the nightmares included surreal elements in addition to more realistic scenes of violence. Participants in the study demonstrated substantial posttraumatic sleep problems with intensely distressing, frequent and chronic nightmares, andnightmare symptoms were associated with impairment in school functioning. Given the disruptive and distressing nature of these students’ nightmare disturbance, we suggest that increasing self-efficacy in relation to the experience of recurrent nightmares may be a good point of intervention with these recurrently traumatized youth. Thus, increasing the understanding of students’ nightmare symptoms may lead to ameliorating the suffering of youths in war zones and may have positive effects on their school functioning.

Health-Related Quality of Life and Costs of Posttraumatic Stress Disorder in Adolescents and Young Adults in Germany

BACKGROUND

Posttraumatic stress disorder (PTSD) is one of the psychopathological consequences of sexual and/or physical abuse. The economic burden is assumed to be high, whereas health-related quality of life and education is negatively affected. This study aims to determine health care costs, health-related quality of life, and educational interruption in adolescents and young adults with PTSD after sexual and/or physical abuse in Germany.

METHODS

This analysis used data of 87 participants aged 14-21 years of a randomized controlled trial. Health care utilization, health-related quality of life (EQ-5D-5L), sick leave days, productivity, and delay or failure to achieve educational aims were assessed. Health care costs from a payer perspective were calculated using unit costs for the year 2014.

RESULTS

Mean health care costs for a six-month period were 5,243€ (SE 868€). In particular, costs of inpatient stays in psychiatric hospitals, general hospitals and rehabilitation as well as child welfare institutions were high. In addition, health-related quality of life was lower due to anxiety/depression, resulting in a mean EQ-5D index and EQ-VAS score of 0.70 and 61.0, respectively. Furthermore, participants reported on average 27 sick leave days, a productivity loss of 61%, and a delay in education attainment as well as having been unable to achieve educational aims.

CONCLUSION

PTSD in adolescents and young adults is associated with a high economic burden. Health-related quality of life was substantially reduced. Furthermore, delay and productivity losses in education were observed.

CLINICAL TRIAL REGISTRATION

German Clinical Trials Register identifier: DRKS00004787; date of registration: 18th March 2013; https://www.drks.de.

Cognitive outcomes of children who have experienced complex trauma: a systematic review protocol

OBJECTIVE

The objective of this systematic review is to assess cognitive outcomes of children who have experienced complex trauma in comparison to children who have not, and to test the effect of potential moderating factors.

INTRODUCTION

A relatively high proportion of children have experienced complex trauma, which can lead to negative consequences on various aspects of development, including cognitive functions. Studies and reviews have documented cognitive outcomes of children who have experienced complex trauma, but with conflicting results. Additionally, previous reviews only included few longitudinal studies. Thus, the short- and long-term effects of complex trauma on cognitive functions and the causal relationships between complex trauma and cognitive functions remain unclear; however, this information could help in the targeting of interventions.

INCLUSION CRITERIA

This review will consider primary prospective longitudinal studies that have assessed cognitive functions in children who have experienced complex trauma compared to children not exposed to a traumatic event.

METHODS

The following databases will be searched for primary studies: APA PsycNET, PubMed Central, ERIC, CINAHL and Embase. Gray literature will also be searched. Study selection, assessment of methodological quality and data extraction will be conducted by two independent evaluators. Standard meta-analysis as well as a longitudinal meta-analysis will be performed, based on the general linear mixed model, to take into account previous cognitive functioning. Subgroup analysis and meta-regression analysis will be undertaken to explore potential sources of heterogeneity, and a funnel plot will be generated to visually explore reporting bias. The quality of evidence will be assessed using the GRADE approach.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42019121610.

Adapting an evidence-based positive youth development intervention to prevent sexual and teen dating violence

Adapting evidence-based interventions (EBIs) guided by implementation science frameworks is a promising way to accelerate the translation of effective violence prevention in schools. School-based interventions offer an opportunity to reduce the risk of multiple forms of violence, including sexual violence (SV) and teen dating violence (TDV). EBIs in schools reach large populations of adolescents, including those underserved in other settings. Although specific SV/TDV prevention programs exist, evaluations indicate limited effectiveness over time. We adapted systematically the Youth Empowerment Solutions (YES) violence-prevention EBI using key adaptation steps described in implementation science frameworks to expand the scope of YES to integrate an SV/TDV focus and meet the needs of local youth. In the formative project year, the team adapted YES to integrate SV/TDV content informed by key steps outlined in frameworks including ADAPT-ITT, research-tested intervention programs, and map of the adaptation process. These steps include: (a) assess school and student needs, (b) identify, select an EBI, (c) consult with experts with knowledge in the new topic area (SV/TDV), (d) collaborate with community partners and stakeholders, (e) identify areas for adaptation while maintaining fidelity to core elements, (f) train staff, (g) pilot test adapted materials, (h) implement, and (i) evaluate. We developed the YES for Healthy Relationships (YES-HR), a school-based prevention program that retained core elements of YES, including content related to mastery, adult resources, leadership skills, and community engagement, while integrating SV/TDV-specific content (e.g., consent). Implementation science adaptation frameworks are useful in guiding the systematic adaptation of existing EBIs to meet the needs of youth.

Future Research: Global Implications

Therapists trained to provide eye movement desensitization and reprocessing (EMDR) therapy have a global responsibility. This article summarizes the multiple impacts of high stress events, and their long-term effects on individuals, families, communities, and nations. While it is well documented that EMDR treatment will remediate the individual symptoms of posttraumatic stress, research is still needed to determine how far-reaching such outcomes are. Future studies should determine whether treatment reverses the neurobiological changes, cognitive deficits, and affective dysregulation, which are associated with exposure to traumatic events. Research should also investigate whether successful treatment decreases high-risk and/or perpetrator behavior, and whether these effects are translated into behavioral and attitudinal changes sufficient to bring an end to intergenerational trauma and ethnopolitical conflicts. It seems self-evident that the ideal way to address pressing societal needs, on both local and global levels, is by the integration of science and practice. The article also discusses the development of nonprofit EMDR humanitarian assistance programs, and their essential work in the alleviation of suffering around the world. In addition to recommending the examination of EMDR's efficacy in treating traumatization from direct, natural, structural, and cultural causes, this article advocates that research resources be dedicated for testing interventions in the areas of the world with the greatest needs. The alleviation of suffering is the duty of our profession.

Child-Centered Play Therapy for Youths Who Have Experienced Trauma: a Systematic Literature Review

This systematic review examines the literature on the effectiveness of child-centered play therapy (CCPT) for youths who have experienced traumatic events. Two independent reviewers conducted the search procedures, as well as all data extraction and coding. Seven peer-reviewed articles reporting treatment outcomes were included in the review. As the focus of the review was on CCPT, treatment methods were similar across the seven articles (e.g., use of similar materials). There was also some consistency in findings regarding outcomes related to internalizing problems, self-concept, and self-competence. However, there was significant variability in the outcome measures used to evaluate effects, as well as limitations regarding the study methods that impact the overall conclusions regarding the use of CCPT to treat children that have experienced traumatic events. Treatment recommendations and suggestions for future research are discussed.

Longitudinal relations between trauma-related psychological distress and physical aggression among urban early adolescents

There is convincing evidence that trauma-related psychological distress and aggressive behavior are highly related among adolescents. The evidence is less clear regarding the direction of this relation.

OBJECTIVE

The purpose of this study was to examine reciprocal longitudinal relations between trauma-related distress and physical aggression.

METHOD

A predominantly African American sample of early adolescents (N = 2,271; mean age = 12.9) living in an urban, under-resourced community participated in this investigation. The current study used autoregressive cross-lagged models to examine changes across four waves of data within each grade of middle school.

RESULTS

Support was found for trauma-related distress uniquely predicting increased levels of physical aggression. This effect was consistent across gender and within and across middle school grades. Conversely, physical aggression did not predict changes in trauma-related distress.

CONCLUSIONS

Violence prevention efforts should routinely screen for trauma-related distress.

Disaster Impacts on Students and Staff from a Specialist, Trauma-Informed Australian School

Children from disadvantaged backgrounds often experience high levels of traumatic stress, however, little is known about their experiences and the responses of their teachers following disasters. The aim of this study was to examine, from the perspective of teachers, the impact of a critical community-wide traumatic event on student and staff wellbeing, and student learning and teaching practices at a specialist school for disadvantaged and displaced youth in Australia. Eight school staff were interviewed, including administrative, teaching, and support personnel, with their responses interpreted using Interpretative Phenomenological Analysis. Results focused largely on the impact of the event and the resultant relocation of the school on staff and student health, reduced opportunities for learning, changes to teaching and student engagement, and the strengths and limitations of the trauma-informed approach of the school. Implications for teacher education and school trauma-informed models are discussed.

A Secondary Spatial Analysis of Gun Violence near Boston Schools: a Public Health Approach

School neighborhood violence continues to be a major public health problem among urban students. A large body of research addresses violence at school; however, fewer studies have explored concentrations of violence in areas proximal to schools. This study aimed to quantify the concentration of shootings near schools to elucidate the place-based dynamics that may be focal points for violence prevention. Geocoded databases of shooting and school locations were used to examine locational patterns of firearm shootings and elementary, middle, and high schools in Boston, Massachusetts. Analyses utilized spatial statistics for point pattern data including distance matrix and K function methodology to quantify the degree of spatial dependence of shootings around schools. Results suggested that between 2012 and 2015, there were 678 shooting incidents in Boston; the average density was 5.1 per square kilometer. The nearest neighbor index (NNI = 0.335 km, p < .001, O = 0.95 km, E = 0.28 km) and G function analysis revealed a clustered pattern of gun shooting incidents indicative of a spatially non-random process. The mean and median distance from any school to the nearest shooting location was 0.35 and 0.33 km, respectively. A majority (56%, 74/133) of schools in Boston had at least one shooting incident within 400 m, a distance that would take about 5 min to walk if traveling by foot. The bivariate K function indicated that a significantly greater number of shootings were clustered within short distances from schools than would be expected under a null hypothesis of no spatial dependence. Implications for students attending schools in racially homogenous neighborhoods across all income levels are discussed.

The effects of traumatic experiences on academic relationships and expectations in justice-involved children

Positive school experiences are an important predictor of long-term health and well-being. Developing positive relationships with school personnel and positive academic expectations set the foundation for success. Positive relationships and expectations can be a powerful protective factor or intervention to redirect troubled children toward a more positive path. Unfortunately, children who experience trauma are more prone to academic underachievement and negative school experiences. This link is especially evident and troubling for children-also called justice-involved children (JIC)-in the juvenile justice system. JIC are exposed to more traumatic experiences and have a higher prevalence of academic failure than other children. Despite evidence showing that (1) trauma is harmful to achievement in the general population, (2) JIC have a higher prevalence of trauma, and (3) JIC have a higher prevalence of academic underachievement and failure, only a few studies have examined traumatic experiences and achievement in JIC. The Childhood Trauma Model (CTM) submits that childhood trauma is central to understanding adolescent outcomes. CTM hypothesizes that (H-1) JIC who experience trauma will have more academic risk factors than those who do not, and (H-2) JIC who experience multiple types of trauma will have higher academic risks than those who experience a single type of trauma. The current study tests (1) whether 10 different types of traumatic experiences are individually associated with increased risks for fewer positive adult relationships and lower expectations of graduating from high school among JIC, and (2) whether experiencing multiple types of trauma has a larger impact than experiencing a single type of trauma.

Evidence for a relationship between child maltreatment and absenteeism among high-school students in Sweden

School absenteeism is a potent predictor of academic failure. Maltreated adolescents have been found to be more absent from school compared to their peers. However, it is scarcely studied in what degree a general population of students with high levels of school absenteeism has been exposed to child maltreatment. Furthermore, it is not known if maltreated school-absentees have specific characteristics compared to not-maltreated absentees. In this article, the first objective was to present and compare the prevalence of six types of child maltreatment in a general population of high school students reporting no, moderate or excessive absenteeism. The second objective was to compare maltreated and not-maltreated students who report absenteeism in respect to mental health, perceived school environment and peer victimization in school. Data from 667 girls and 649 boys (mean age 14.3) was used from the longitudinal multidisciplinary research program LoRDIA (Longitudinal Research on Development In Adolescence). Data was collected via self-report questionnaires in classroom settings. All six types of child maltreatment were overrepresented among absentees. Roughly 25% of absentees reported one subtype of maltreatment (16% in the total population) and a mean of 22% of absentees reported two or more types of maltreatment (11% in the total population). Maltreated absentees reported more mental health problems, personal harassment and worse relationship with their teachers than not-maltreated absentees. There might be specific correlates of school absenteeism among maltreated adolescents and professionals involved in preventing school-absenteeism should be made aware of the relationship between maltreatment and absenteeism.

Screening for PTSD symptoms in unaccompanied refugee minors: a test of the CRIES-8 questionnaire in routine care

AIMS

The dramatic increase in the number of refugees in Europe presents a major public health challenge. The limited existing evidence indicates that the mental health needs of refugees are significant; unaccompanied refugee minors (URMs) constitute a particularly vulnerable group. In this study, we aimed to investigate whether a short questionnaire (Children's Revised Impact of Event Scale; CRIES-8) could be used as a screening tool for PTSD symptoms in URMs, 8-18 years old, during their routine health check-up.

METHODS

Data were collected at the healthcare centre for asylum-seekers in Uppsala, Sweden. In total, 208 URMs completed the CRIES-8 during their health assessment.

RESULTS

The CRIES-8 was feasible to use, showed good internal consistency and its factor structure was confirmed. Children with less than four years of education often had difficulties completing the questionnaire by themselves and needed help reading the questions. Almost all the respondents were male (98%), aged 9-18 years. The majority (81%) came from Afghanistan. About 76% scored above the cut-off and therefore were considered to be at risk of PTSD. The proportion of children who screened positive did not differ based on age, country of origin or current living arrangements.

CONCLUSIONS

The CRIES-8 is a useful tool in clinical settings, however, children should be provided with reading support and instructions about how to complete the questionnaire. The high number of children who screened positive for PTSD symptoms indicates the need for a more thorough mental health assessment, and early prevention/intervention programmes to address URMs' mental health issues.

Linear Relationship between Resilience, Learning Approaches, and Coping Strategies to Predict Achievement in Undergraduate Students

The aim of the present research was to analyze the linear relationship between resilience (meta-motivational variable), learning approaches (meta-cognitive variables), strategies for coping with academic stress (meta-emotional variable) and academic achievement, necessary in the context of university academic stress. A total of 656 students from a southern university in Spain completed different questionnaires: a resiliency scale, a coping strategies scale, and a study process questionnaire. Correlations and structural modeling were used for data analyses. There was a positive and significant linear association showing a relationship of association and prediction of resilience to the deep learning approach, and problem-centered coping strategies. In a complementary way, these variables positively and significantly predicted the academic achievement of university students. These results enabled a linear relationship of association and consistent and differential prediction to be established among the variables studied. Implications for future research are set out.

Mental Health and School Functioning for Girls in the Child Welfare System: the Mediating Role of Future Orientation and School Engagement

This study investigated the association between mental health problems and academic and behavioral school functioning for adolescent girls in the child welfare system and determined whether school engagement and future orientation meditated the relationship. Participants were 231 girls aged between 12 and 19 who had been involved with the child welfare system. Results indicated that 39% of girls reported depressive symptoms in the clinical range and 54% reported posttraumatic symptoms in the clinical range. The most common school functioning problems reported were failing a class (41%) and physical fights with other students (35%). Participants reported a mean number of 1.7 school functioning problems. Higher levels of depression and PTSD were significantly associated with more school functioning problems. School engagement fully mediated the relationship between depression and school functioning and between PTSD and school functioning, both models controlling for age, race, and placement stability. Future orientation was not significantly associated with school functioning problems at the bivariate level. Findings suggest that school engagement is a potentially modifiable target for interventions aiming to ameliorate the negative influence of mental health problems on school functioning for adolescent girls with histories of abuse or neglect.