A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents

Post-traumatic stress disorder in a national sample of preadolescent children: Prevalence, correlates, clinical sequelae, and treatment utilization

Although posttraumatic stress disorder (PTSD) has been well characterized in adults, its epidemiology in children is unclear. The current study provides the first population-based examination of the prevalence of PTSD, sociodemographic and psychiatric correlates, clinical sequelae, and associations with psychiatric treatment in preadolescents in the United States. Data from the Adolescent Brain and Cognitive Development (ABCD) Study (release 5.0) was analyzed. Participants (unweighted n = 11, 875) were recruited from 21 sites across the United States. Current and lifetime PTSD prevalence were estimated, as was treatment use among children with PTSD. Sociodemographic, psychiatric correlates and sequelae of PTSD were analyzed using logistic regression, as was the association between PTSD and psychiatric treatment. Lifetime prevalence of PTSD was 2.17%. Sexual minority status, being multiracial, having unmarried parents, and family economic insecurity were associated with greater odds of PTSD. Among psychiatric disorders, separation anxiety was most strongly associated with PTSD, although general comorbid psychopathology was associated with greater odds of PTSD. Prior history of PTSD predicted new onset of other psychiatric disorders after PTSD remission. Nearly one in three children with lifetime PTSD did not receive psychiatric treatment, despite negative long-term outcomes of PTSD and significant psychiatric comorbidity. Even among preadolescents who experience full remission of PTSD, significant risk for future psychiatric illness remains. Further, the current findings underscore the need for improved efforts to reduce unmet treatment needs among those with PTSD at this age.

Prospective associations between social support and posttraumatic stress disorder may be spurious: A re-meta-analysis of longitudinal studies and a simulation

A recent meta-analysis concluded to have found proof for both a social causation model, according to which social support protects against posttraumatic stress disorder (PTSD), and a social selection model, which claims that PTSD erodes social support. However, the prospective cross-lagged effects were estimated while adjusting for a prior measurement of the outcome and this method is vulnerable for spurious findings due to correlations with residuals and regression toward the mean. The present re-analyses of the meta-analytic effects indicated that depending on used model one can choose to claim that social support has either a decreasing, an increasing, or no prospective effect on subsequent change in PTSD symptom severity, and vice versa. Therefore, claims over and above a negative cross-sectional correlation between social support and PTSD, including the social causation and social selection models, can be questioned. The findings were validated by analyses of simulated data, which indicated that prospective effects were not necessary for the observed meta-analytic associations.

Predicting individual cases of major adolescent psychiatric conditions with artificial intelligence

Three-quarters of lifetime mental illness occurs by the age of 24, but relatively little is known about how to robustly identify youth at risk to target intervention efforts known to improve outcomes. Barriers to knowledge have included obtaining robust predictions while simultaneously analyzing large numbers of different types of candidate predictors. In a new, large, transdiagnostic youth sample and multidomain high-dimension data, we used 160 candidate predictors encompassing neural, prenatal, developmental, physiologic, sociocultural, environmental, emotional and cognitive features and leveraged three different machine learning algorithms optimized with a novel artificial intelligence meta-learning technique to predict individual cases of anxiety, depression, attention deficit, disruptive behaviors and post-traumatic stress. Our models tested well in unseen, held-out data (AUC ≥ 0.94). By utilizing a large-scale design and advanced computational approaches, we were able to compare the relative predictive ability of neural versus psychosocial features in a principled manner and found that psychosocial features consistently outperformed neural metrics in their relative ability to deliver robust predictions of individual cases. We found that deep learning with artificial neural networks and tree-based learning with XGBoost outperformed logistic regression with ElasticNet, supporting the conceptualization of mental illnesses as multifactorial disease processes with non-linear relationships among predictors that can be robustly modeled with computational psychiatry techniques. To our knowledge, this is the first study to test the relative predictive ability of these gold-standard algorithms from different classes across multiple mental health conditions in youth within the same study design in multidomain data utilizing >100 candidate predictors. Further research is suggested to explore these findings in longitudinal data and validate results in an external dataset.

MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations

3,4-Methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement. We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms. Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on (1) reinforcing motivation, (2) the development of a strong therapeutic alliance, (3) additional emotion and behavior management techniques, (4) more directive exposure-based methods during MDMA sessions, (5) more support for concomitant challenges and integrating treatment benefits, and (6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues. We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents.

Community trauma exposure and post-traumatic stress disorder in Chinese children and adolescents

Background

An increasing number of studies have shown the association between traumatic events occurring in childhood and adolescence and post-traumatic stress disorder (PTSD). A gap remains in the literature on the epidemiology and influencing factors of traumatic events and post-traumatic stress disorder in communities in northern China. This study aimed to determine the prevalence of traumatic events and PTSD in communities in northern China, to explore the types of stressful traumatic events and the impact of these traumatic events on children and adolescents, and to investigate the effect of sociodemographic factors on PTSD.

Methods

A cross-sectional survey study was conducted among 6,027 students (7-17 years old) from 6 cities in Liaoning Province, China. The sample consisted of 2,853 males (47.34%) and 3,174 females (52.66%). The Essen Trauma-Inventory for Children and Adolescents (ETI-CA) Scale was used. The ETI-CA has 5 sections, which include type of traumatic events, worst traumatic event, post-traumatic symptoms, onset, duration, burden of PTSD, and present difficulties in different areas of life. PTSD symptoms were assessed with 23 items in Part 3 of the ETI-CA.

Results

We found that 2,068 (34.3%) of 6,027 participants experienced trauma events and 686 (33.2%) of 2,068 reported PTSD. Among trauma-exposed youth (2,068), the sudden death of close relatives (33.9%), serious accidents (20.9%), and parental divorce (15.5%) were reported as the worst traumatic events. Studies have shown that after exposure to stressful life events, more than 30% of people feel nervous or upset (39.8%), scared (33.4%), helpless (32.6%), and about 10% have headaches (15.5%), rapid heartbeat (13.3%), and dizziness (11.8%). Multivariable logistic regression analyses showed that students in middle school [OR = 1.29 (1.016, 1.637)], not a student leader [OR = 0.738 (0.618, 0.881)], and their parents in single marital status significantly predicted higher PTSD prevalence the remarried [OR = 0.474 (0.252, 0.893)], married [OR = 0.42 (0.227, 0.778)].

Conclusion

The present study suggests the government to train psychological counselors in schools and communities to provide emotional and psychological support, as well as the school leaders and parents to elevate adolescents' psychological suzhi. Particularly, counseling and professional support should be given to those students whose parents are single.

Resilience as Mediator in Relation to Parental Attachment and Posttraumatic Stress Disorder in Adolescents Following the Yancheng Tornado

Resilience and secure parental attachment have been proven as important factors to alleviate the posttraumatic stress disorder (PTSD). However, the effects of the two factors on PTSD and the mechanisms of its effect at different time points in the aftermath of trauma are still unclear. This study explores the relationship among parental attachment, resilience, and development of PTSD symptoms in adolescents from a longitudinal perspective following the Yancheng Tornado. Using cluster sampling method, a total of 351 Chinese adolescents, survivors of a severe tornado, were tested on their PTSD, parental attachment and resilience at 12-months and 18-months after experiencing the natural disaster. The results showed that our proposed model fit the data well: χ2/df = 3.197, CFI = 0.967, TLI = 0.950, RMSEA = 0.079. It revealed that the resilience at 18-months partially mediated the relationship between parental attachment at 12-months and PTSD at 18-months. Research results showed that parental attachment and resilience are key resources for coping with trauma.

Pretrauma risk factors and posttraumatic stress disorder symptoms following subsequent exposure: Multilevel and univariate meta-analytical approaches

The endeavour to comprehend why certain individuals develop posttraumatic stress disorder (PTSD) symptoms subsequent to experiencing traumatic events, while others do not, underscores the paramount importance of pretraumatic risk factors. This meta-analysis summarises the extant results of studies assessing risk factors prior exposure and PTSD symptoms following an index event on the same participants. It includes 43 studies (N = 19,239) yielding 174 effect sizes of pretraumatic risk factors categories such as demographic factors, cognitive factors, personality traits, coping styles, psychopathology, psychophysiological and environmental factors, which were examined using a three-level meta-analysis. Additionally, univariate random-effects meta-analyses were performed to separately investigate individual risk factors reported in more than one study. The findings revealed significant, small and medium associations for all categories, except for demographic factors and coping styles, also highlighting that certain individual risk factor domains (i.e. previous mental disorders, negative emotionality, sleep complaints and PTSD symptoms) represent the strongest predictors for PTSD symptoms after subsequent exposure. Several moderators were also investigated for individual risk factors. Future research could benefit from considering the interplay of pretraumatic risk factors to draw a more complex picture of the aetiology and underlying mechanisms of PTSD symptoms.

Associations between constructs related to social relationships and mental health conditions and symptoms: an umbrella review

BACKGROUND

Loneliness and social isolation are increasingly recognised as prevalent among people with mental health problems, and as potential targets for interventions to improve quality of life and outcomes, as well as for preventive strategies. Understanding the relationship between quality and quantity of social relationships and a range of mental health conditions is a helpful step towards development of such interventions.

PURPOSE

Our aim was to give an overview of associations between constructs related to social relationships (including loneliness and social isolation) and diagnosed mental conditions and mental health symptoms, as reported in systematic reviews of observational studies.

METHODS

For this umbrella review (systematic review of systematic reviews) we searched five databases (PsycINFO, MEDLINE, EMBASE, CINAHL, Web of Science) and relevant online resources (PROSPERO, Campbell Collaboration, Joanna Briggs Institute Evidence Synthesis Journal). We included systematic reviews of studies of associations between constructs related to social relationships and mental health diagnoses or psychiatric symptom severity, in clinical or general population samples. We also included reviews of general population studies investigating the relationship between loneliness and risk of onset of mental health problems.

RESULTS

We identified 53 relevant systematic reviews, including them in a narrative synthesis. We found evidence regarding associations between (i) loneliness, social isolation, social support, social network size and composition, and individual-level social capital and (ii) diagnoses of mental health conditions and severity of various mental health symptoms. Depression (including post-natal) and psychosis were most often reported on, with few systematic reviews on eating disorders or post-traumatic stress disorder (PTSD), and only four related to anxiety. Social support was the most commonly included social construct. Our findings were limited by low quality of reviews and their inclusion of mainly cross-sectional evidence.

CONCLUSION

Good quality evidence is needed on a wider range of social constructs, on conditions other than depression, and on longitudinal relationships between social constructs and mental health symptoms and conditions.

THE PAINS OF PARAMILITARISM: The Latent Criminogenic Effects of Exposure to Paramilitary Violence Among Young Men in a Post-Conflict Society

Purpose: Whilst most people who experience adversity recover, there is a cumulative body of evidence that illustrates that the effects can be long lasting, and can even become debilitating over time. Links have been made between traumatic distress, mental health disorders and disturbances in behavioural and emotional regulatory systems that may in context elevate the risk of offending. Despite the burgeoning evidence around the criminogenic effects of adversity, few studies have examined the traumatic effects of paramilitary related adversity in the context of post-conflict Northern Ireland. Methods: With reference to DSM-V PTSD diagnostic clusters, the aim of this study was to explore the latent impact of adversity and latent trauma among justice involved young men and identify potential criminogenic effects of exposure to paramilitary related adversity. Results and conclusions: This study found that across the sample, young men had self-reported to have experienced significant adversity, including violent victimisation. Exposure to paramilitary adversity often began during early adolescence. The participants described symptoms that were consistent with clinically diagnosable disorders such as Post-Traumatic Stress Disorder. Despite this, there appears to be a paucity of trauma screening and assessment, and few supports that victim could benefit from. In the absence of appropriate and evidence-based supports, many young men appear to find other (and more maladaptive) ways to cope. This exacerbates the risk of interfacing with the justice system and may even contribute towards a deterioration in wider psycho-social outcomes. Implications for practice are discussed.

The Incidence of Posttraumatic Stress Symptoms in Children

OBJECTIVE

To determine the incidence of posttraumatic stress disorder (PTSD) symptoms and risk factors for their development in children and adolescents undergoing orthopaedic surgery for trauma.

DESIGN

Prospective cohort study.

SETTING

Level-1 trauma center.

PATIENTS

Children (8 to 18), undergoing surgery for orthopaedic trauma.

INTERVENTION

Upper and lower extremity surgery for orthopaedic trauma.

MAIN OUTCOME MEASUREMENTS

PTSD symptoms at postoperative follow-up as determined by the Child PTSD Symptom Scale (CPSS).

RESULTS

A total of 176 children with an average age at surgery of 13 years (8 to 18.8 years) participated in the study. Twenty-six subjects had high levels of PTSD symptoms (15%; 95% CI = 10.0 to 21.1%). Univariable and multivariable analyses determined that female sex (OR 2.63, 95% CI = 1.06 to 6.67, P = 0.04), older age at surgery (OR 1.25, 95% CI = 1.04 to 1.51, P = 0.02), and undergoing a previous surgery (OR 2.86, 95% CI = 1.06 to 7.73, P = 0.04) were all associated with increased PTSD risk.

CONCLUSIONS

Children and adolescents experience a high level of PTSD symptoms (15%) after surgery for orthopaedic trauma. Clinicians should be aware of PTSD symptoms in children and adolescents after surgery for orthopaedic injuries and use comprehensive screening to facilitate timely intervention and treatment.

LEVEL OF EVIDENCE

II.

Risk and Resilience Measures Related to Psychopathology in Youth

Childhood adversity places youth at risk for multiple negative outcomes. The current study aimed to understand how a constellation of risk and resilience factors influenced mental health outcomes as a function of adversities: socioeconomic status (SES) and traumatic stressful events (TSEs). Specifically, we examined outcomes related to psychosis and mood disorders, as well as global clinical functioning. The current study is a longitudinal follow up of 140 participants from the Philadelphia Neurodevelopmental Cohort (PNC) assessed for adversities at Time 1 (Mean age: 14.11 years) and risk, resilience, and clinical outcomes at Time 2 (mean age: 21.54 years). In the context of TSE, a limited set of predictors emerged as important; a more diverse set of moderators emerged in the context of SES. Across adversities, social support was a unique predictor of psychosis spectrum diagnoses and global functioning; emotion dysregulation was an important predictor for mood diagnoses. The current findings underscore the importance of understanding effects of childhood adversity on maladaptive outcomes within a resilience framework.

Exposure to self-reported traumatic events and probable PTSD in a national sample of Poles: Why does Poland's PTSD prevalence differ from other national estimates?

BACKGROUND

There is a lack of studies on trauma exposure and PTSD prevalence in Poland on representative samples. Available data from studies on convenient samples show very high rates of probable PTSD compared with relevant estimates in other countries.

OBJECTIVE

This study aimed to measure the exposure to self-report traumatic events (PTEs) and to estimate the current rate of prevalence of probable posttraumatic stress disorder (PTSD) in accordance with DSM-5 criteria in a population-based sample of Poles. Additionally, the link between PTSD intensity and level of life satisfaction was investigated.

METHOD

A representative sample of 1,598 adult Poles was recruited. Probable PTSD was assessed with the Posttraumatic Diagnostic Scale for DSM-5 (PDS-5) and the Satisfaction with Life Scale (SWLS) was also used.

RESULTS

The findings showed that 60.3% of Poles had experienced at least one PTE and 31.1% of those who had been exposed to trauma reported symptoms of PTSD. At the level of the entire sample, the obtained rate for probable PTSD was 18.8%. The traumatic events with the highest probabilities of PTSD symptoms were child abuse and sexual assault. Levels of life satisfaction were significantly lower in the group of participants with probable PTSD.

CONCLUSIONS

We found that the current prevalence of probable PTSD in Poland is intriguingly high relative to rates reported in comparable representative samples from other countries across the world. Possible mechanisms are discussed, including a lack of social acknowledgement of WWII and other traumas as well as poor access to trauma-focused care. We hope that this research may inspire more studies investigating cross-national differences in PTSD and trauma exposure.

Strengths-Based Factors Related to Post-Traumatic Stress Problems in Black Youth with High Body Weights

OBJECTIVE

Black youth with high body weights [BYHW; Body Mass Index (BMI)≥95th percentile] endure unique stressors (e.g., exposure to discrimination due to race and size) that may contribute to psychopathology. Factors that decrease mental health problems associated with these stressors have been underexamined in BYHW. The current study assessed how multisystemic resilience, weight-related quality of life (QOL), and discrimination were associated with post-traumatic stress problems in BYHW from the perspective of youth and their caregivers.

METHODS

A total of 93 BYHW and one of their primary caregivers were recruited from a Midsouth children's hospital. Youth ranged in age from 11 to 17 years (Mage=13.94, SD = 1.89), were mostly girls (61.3%), and had CDC-defined BMI scores above the 95th percentile. Nearly all caregivers were mothers (91.4%; Mage=41.73 years, SD = 8.08). Youth and their caregivers completed measures of resilience, discrimination, weight-related QOL, and post-traumatic stress problems.

RESULTS

Utilizing linear regression modeling, the youth model was significant [F(3, 89)=31.63, p<.001, Adj. R2=.50], with higher resilience (β=-.23; p=.01) and lower discrimination (β=.52; p<.001) associated with fewer post-traumatic stress problems. The caregiver regression model was also significant [F(2, 90)=10.45, p<.001, Adj. R2=.17], with higher weight-related QOL associated with lower post-traumatic stress problems (β=-.37; p<.001).

CONCLUSIONS

Findings illustrate differences in youth and caregiver perceptions of factors related to post-traumatic stress problems in BYHW. Youth emphasized both internal and external contributors to stress, while caregivers focused on internal variables. Such knowledge could be harnessed to develop strengths-based interventions that address health and well-being among BYHW.

Relationship between adult attachment and cognitive emotional regulation style in women and men

Cognitive emotion regulation (CER) strategies are useful in evaluating the risk of developing emotional disorders and that they may define subjects' styles. This study aims to explore the extent to which specific styles of CER strategies relate to the anxious and avoidant attachment dimensions in adults and whether such relationships operate similarly for women and men. Two hundred and fifteen adults (between 22 and 67 years old) completed the Spanish versions of the Cognitive Emotion Regulation Questionnaire and the Experiences in Close Relationships instrument. Cluster analysis, ANOVA and Student's t-test were used. Our results show that women and men can be successfully classified into two CER clusters (Protective and Vulnerable), distinguished by the higher use in the protective cluster of the CER strategies considered most adaptive and complex (Acceptance, Positive Refocusing, Refocus on Planning, Positive Reappraisal, and Putting into Perspective). However, only in women were the anxious and avoidant attachment dimensions significantly associated with CER style. In conclusion, from a clinical and interpersonal perspective, it is interesting to be able to predict the belonging to a Protective or Vulnerable coping style by analysing the CER strategies and to know their relationship with the adult affective system.

Preconception maternal posttraumatic stress and child negative affectivity: Prospectively evaluating the intergenerational impact of trauma

The developmental origins of psychopathology begin before birth and perhaps even prior to conception. Understanding the intergenerational transmission of psychopathological risk is critical to identify sensitive windows for prevention and early intervention. Prior research demonstrates that maternal trauma history, typically assessed retrospectively, has adverse consequences for child socioemotional development. However, very few prospective studies of preconception trauma exist, and the role of preconception symptoms of posttraumatic stress disorder (PTSD) remains unknown. The current study prospectively evaluates whether maternal preconception PTSD symptoms predict early childhood negative affectivity, a key dimension of temperament and predictor of later psychopathology. One hundred and eighteen women were recruited following a birth and prior to conception of the study child and were followed until the study child was 3-5 years old. Higher maternal PTSD symptoms prior to conception predicted greater child negative affectivity, adjusting for concurrent maternal depressive symptoms and sociodemographic covariates. In exploratory analyses, we found that neither maternal prenatal nor postpartum depressive symptoms or perceived stress mediated this association. These findings add to a limited prospective literature, highlighting the importance of assessing the mental health of women prior to conception and providing interventions that can disrupt the intergenerational sequelae of trauma.

A global perspective on gun violence injuries

INTRODUCTION AND DEFINITIONS

Civilian gunshot violence is a growing public health issue on a global scale. Treatment of patients with gunshot injuries is based on algorithms derived from military studies, but the distinct differences in weaponry, energy of injury, timing and type of care, and environment translate to a gap in knowledge. With a focus on non-accidental gunshot trauma and excluding suicide etiologies, we propose to build a collaborative research group to address important questions focused on best practices for gunshot injury patients.

PRE-HOSPITAL CARE

There are important differences in the care of gunshot victims across the globe; some countries provide advanced interventions in the field and others deliver basic support until transport to a higher level of care in hospital. Some simple interventions include the use of extremity tourniquets and intravenous fluid support; others to consider are tranexamic acid, whole blood, and hemostatic agents.

ACUTE TREATMENT

Control of exsanguinating hemorrhage is a key priority for gunshot injuries. Military doctrine has evolved to prioritize exsanguination over airway or breathing as the critical first step. The X-ABC protocol focuses on exsanguinating hemorrhage, then standard evaluation of Airway, Breathing and Circulation (ABCs) to enhance survival in trauma patients. The timing of bony stabilization, in terms of damage-control vs definitive care, needs further study in this population, as does use of antibiotics for bony extremity injuries. Finally, recognition of the mental health effects of gun trauma, including post-traumatic stress disorder (PTSD), anxiety disorders, substance abuse and depression is important in advocating for prevention such as implementation of social support and specific interventions.

DEFINITIVE CARE

The need for abdominal closure after exploratory laparotomy, definitive fracture treatment, and other treatment all contribute to length of stay for gunshot injured patients. Optimizing stabilization allows earlier mobilization and decreases nosocomial complications. Nerve injuries are often a source of long-term disability and their evaluation and treatment require further investigation.

RESOURCES AND ETHICS

There are growing numbers of mass-casualty gunshot events, which require consideration of how to organize and use resources for treatment, including staff, operating room access, blood products, and order of treatment. Drills and planning for incident command hierarchy and communication are key to optimizing resource utilization. The ethics of choosing treatment priorities and resources are important considerations as well.

Post-traumatic stress disorders, anxiety, and depression in college students during the COVID-19 pandemic: a cross-sectional study

OBJECTIVES

The COVID-19 pandemic has caused an increase in psychiatric disorders in college students, particularly posttraumatic stress disorders (PTSD), depression, and anxiety. While existing studies assess the prevalence of these disorders and their predictors, they overlook potential complications caused by comorbidity between these disorders. To fill this gap, this study examined the prevalence of PTSD, depression, anxiety, and their comorbidity to inform targeted intervention for college students during the COVID-19 pandemic.

DESIGN

Self-report questionnaires were used to assess 6,898 college students about six months after the COVID-19 outbreak.

RESULTS

The results found that the prevalence of PTSD, depression, and anxiety were 15.5%, 32.2%, and 32.1% respectively, and the prevalence of comorbid PTSD and depression, comorbid PTSD and anxiety, comorbid depression and anxiety, and comorbid PTSD, depression, and anxiety symptoms were 11.5%, 11.6%, 20.4%, and 9.4% respectively. Moreover, left-behind status, lower economic status, previous trauma experiences, exposure to the pandemic, and rumination were risk factors of psychological distress, but self-disclosure was a protective factor for these disorders.

CONCLUSION

These results indicate that distinct psychiatric disorders may be comorbid in individuals, and are further influenced by pre-, within-, and post-disaster factors. Furthermore, psychological service targeted at college students should pay attention to comorbid symptoms rather than only symptoms of single disorders.

A Longitudinal Investigation of the Relationship Between Trauma-Related Cognitive Processes and Internalising and Externalising Psychopathology in Young People in Out-of-Home Care

Young people in out-of-home care are at increased risk of developing a range of posttrauma mental health difficulties, including PTSD, but more commonly anxiety, depression and externalising symptoms. Cognitive models of PTSD indicate that trauma-related maladaptive appraisals, coping strategies and trauma memory qualities are key processes in the development and maintenance of PTSD, yet there has been limited investigation of the potential role of these processes in broader posttrauma psychopathology, particularly in young people who have been exposed to complex, rather than acute, trauma. We recruited 120 10-18 years olds in out-of-home care, and their caregivers, who completed assessments at two time points: baseline and 12-month follow-up. Young people completed self-report measures of trauma-related maladaptive appraisals, coping strategies and trauma-memory qualities, as well as reporting on PTSD, anxiety, depression and externalising symptoms. Carers also reported on internalising and externalising symptoms. We found that all three cognitive processes were associated with baseline self-reported internalising symptoms, with maladaptive appraisals most robustly associated with both anxiety and depression. Changes in all three processes over 12-months predicted a change in self-reported internalising and externalising symptoms, with maladaptive appraisals and coping predicting anxiety symptoms, and coping uniquely predicting depression and externalising symptoms. Effects remained after controlling for co-occurring PTSD symptoms. Findings were not replicated when using carer-reported symptoms. These findings suggest that existing cognitive models of PTSD may also usefully explain broader posttrauma depression, anxiety and externalising symptoms in young people who have experienced maltreatment and live in out-of-home care. Clinical implications are discussed.

Sex differences in the severity and natural recovery of child PTSD symptoms: a longitudinal analysis of children exposed to acute trauma

BACKGROUND

Higher levels of PTSD symptoms are present among trauma-exposed females v. males in adulthood; however, much less is known about the emergence of this sex difference during development.

METHODS

In a multi-study sample of 7-18-year-olds (n = 3397), we examined the effect of sex and age on the severity of PTSD symptoms after a single incident trauma at 1 month (T1), and on symptom change after a natural recovery period of 3 (T2) and 6 months (T3). PTSD scores were harmonised across measurement types, and linear regressions were used to determine sex and age effects, adjusting for study level variance and trauma type.

RESULTS

A sex × age interaction was observed at T1 (p < 0.001) demonstrating that older age was associated with greater PTSD symptom severity in females (β = 0.008, p = 0.047), but less severe symptoms in males (β = -0.011, p = 0.014). The same pattern was observed at T2 and T3, with sex differences beginning to emerge by age 12 years. PTSD symptoms decreased naturally by ~25% at T2 with little further improvement by T3. Further, females showed a greater reduction in symptoms at T3 than males, although the same effect was not observed at T2.

CONCLUSIONS

Sex differences in PTSD symptoms become apparent during adolescence, due to opposing changes in susceptibility occurring in females and males with age. Understanding the factors contributing to these findings is likely to provide wider insight into sex-specific psychological vulnerability to trauma-related psychopathology.

Parent-Led Stepped Care Trauma Treatment: Parents' Experiences With Helping Their Child Recover

Purpose

There is a need for interventions for traumatized children that are easily accessible and effective, and that involve parents directly in the recovery process. To meet this challenge, stepped care trauma-focused cognitive behavioral treatment (SC TF-CBT), which consists of a parent-led therapist-assisted intervention as the first step, was developed. Parent-led trauma-treatment is a promising, but novel approach. The aim of this study was therefore to gain knowledge on how parents experience the model.

Methods

Parents who participated in a SC TF-CBT feasibility study were consecutively recruited and interviewed with semi-structured interviews, which were then analysed using interpretative phenomenological analysis.

Results

The parents described that the intervention gave them insights that led to a sense of parental agency. Through the analysis we identified and labelled four themes: (i) understanding my child: how the trauma has affected my child and our relationship; (ii) understanding myself: how my reactions have stood in the way of helping my child; (iii) gaining competence: how to learn specific tasks that were not part of my normal parenting skills; and (iv) receiving support: how guidance, warmth and encouragement was necessary.

Conclusions

The results from this study show how the shifting of therapeutic tasks to parents may facilitate parental empowerment and improve the parent-child relationship. This knowledge may guide clinicians on how to provide support to parents so they can take a leading role in their child's recovery process after trauma.

Trial registration

ClinicalTrials.gov, NCT04073862. Retrospectively registered 03 June 2019 (first patient recruited May 2019), https://clinicaltrials.gov/ct2/show/NCT04073862.

Disrupting the cycle of youth violence: The role of social support for youth in a Northern Irish Youth Work Programme

Youth violence is a significant concern and previous research has found that violence is both trauma inducing and violence inducing. Meta-analyses have demonstrated that peri-trauma contextual factors such as the presence or absence of social supports following the onset of trauma may be predictive of the onset and duration of psychological stress. The aim of this study is to build upon the existing research evidence to clarify the links between social support, psychological stress and physical violence among a cross-section of youth living in high-violence areas of Northern Ireland. Participants were a sample of 10-25-year-olds (N = 635) who participated in a targeted youth work programme in Northern Ireland. This study conducted a mediation analysis, entering social support as the independent variable, psychological distress as the mediator and self-reported violence as the outcome variable. Violent victimisation was entered as a covariate in the analysis. After controlling for violent victimisation, social support operates through psychological stress to influence the risk of physical violence. Social support may contribute to reductions in psychological stress and thus buffer against the risks of living in areas of elevated community violence. Specialist youth work approaches may provide an opportunity to reduce psychological stress and thus help to mitigate the risk of further violence. Combined, these insights provide opportunities for harm reduction and prevention. At the same time, these findings advance our understanding of the distinct mechanisms of change involved in youth work-led violence prevention efforts.

Exposure to potentially traumatic events and PTSD symptomatology in Norwegian 11-13-year-olds: results from the Bergen Child Study

BACKGROUND

Exposure to potentially traumatic experiences (PTEs) is common among children and adolescents, but relatively little is known about the epidemiology of trauma and trauma-related psychopathology in children and youth. The present cross- sectional epidemiological study aimed to explore factors that is associated with posttraumatic stress symptoms (PTSS) in children.

METHOD

Data stem from the Bergen Child Study, a series of cross-sectional multi-phase surveys of children born between 1993 and 1995 in Bergen, Norway. The sample used is from the second wave of the Bergen Child Study (BCS) conducted in 2006, a two-phase study. The study entailed a detailed psychiatric evaluation using the Development and well-being assessment (DAWBA). The DAWBA was administered to parents or caregivers and covered diagnostic areas, child and family background, and child strengths. A total of 2043 parents participated.

RESULTS

Out of the total sample, parents reported that 4.8% children had experienced PTEs at some point in their lives. The findings revealed current PTSS in 30.9% of children exposed to PTE, which was 1.5% of the total sample. None of the parents reported PTSS in their children over the threshold for diagnosing posttraumatic stress disorder (PTSD). The most common PTSS cluster was arousal reactivity (90.0%), followed by negative cognitions and mood (80%). The least frequent symptom cluster was intrusions (63.3%) and avoidance (60%). Children with PTSS were reported to live in families with significantly more family stressors (p = 0.001, d = 0.8) and had utilized significantly more sources for help relative to those without PTSS (p = 0.001, d = 0.75).

CONCLUSION

The present population study on children revealed a lower prevalence rate of PTEs and PTSD than previous studies. It provided findings in the field of trauma on parent- reported PTSS and PTSD symptom clusters not restricted to the clinical level of PTSD. Lastly, it highlighted how family-life stressors and support differed between those who had PTSS and those with no PTSS.

Post-traumatic stress disorder in refugee minors in an outpatient care center: prevalence and associated factors

Due to their likelihood for experiencing a number of traumatic events, refugee minors have an increased risk of developing post-traumatic stress disorder (PTSD). However, the prevalence of PTSD in refugee children varies widely between studies, and it remains somewhat unclear what factors increase children's risk of PTSD. This study aimed to assess the prevalence of PTSD in a clinical outpatient sample of refugee minors, and to evaluate the association of different risk factors with a PTSD diagnosis. N = 417 refugee minors were recruited from an outpatient clinical center in Hamburg, Germany. The median age was 15.4 years and 74.6% of the minors were male. As part of the standard diagnostic process, their social history and a potential PTSD diagnosis using the Module K of the Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) was assessed. The predictive value of age, gender, number of interpersonal traumatic events, un-/accompanied status, presence of family member in the host country, flight duration, residence status, and time since arrival in the host country were investigated using logistic regression analysis. The prevalence of PTSD among the young refugee patients was 61.6%. Significant predictors of a PTSD diagnosis were number of interpersonal traumatic life events, age, residence status, and time since arrival in the host country. The prediction model explained 33.8% of variance of the outcome with the number of interpersonal traumatic events having the largest contribution (20.8%). The high prevalence of PTSD among refugee minors in outpatient care emphasizes the need to establish appropriate care structures and train specialists in the treatment of PTSD.

Beliefs About Traumatic Memories, Thought Control Strategies, and the Impact on PTSD Symptoms After a Natural Disaster

ABSTRACT

This study aimed to investigate the relationships among self-reported meta-memory beliefs, thought control strategies ( i.e. , distraction, reappraisal, worry, social control, and punishment), and posttraumatic stress disorder (PTSD) symptomology, among a sample of earthquake survivors ( N = 412). Correlational analysis and structural equation modeling were used on the responses and showed that stronger positive and negative meta-memory beliefs, and greater worry and punishment, were associated with greater PTSD symptom severity. The results also indicated that meta-memory beliefs had a prominent indirect influence toward PTSD symptomology via their effects toward thought control strategies. Follow-up analysis of variance indicated that those with a history of mental health difficulties reported higher levels of PTSD symptom severity, were more likely to score in the range of clinically relevant PTSD, and had a stronger tendency to negatively appraise unwanted thinking styles. The results of this research provide overall support for the validity of the metacognitive model for PTSD.

The PTSD Symptom Presentation and the Effect of Polytrauma on PTSD Symptom Clusters Among Young People Who Have Experienced Commercial Sexual Exploitation and Trafficking

Purpose

The purpose of this study was to describe the PTSD symptom presentation (including dissociative symptoms) of PTSD using the Diagnostic and Statistical Manual of Mental Disorders 5 th Edition diagnostic criteria and explore associations between the symptom severity for each of the four PTSD symptom clusters and polytrauma, defined as multiple exposures to different categories of potentially traumatic events.

Methods

This is a secondary analysis of cross-sectional program evaluation data among 95 young people (aged 11-19) at therapy initiation in a southeastern state in the U.S. We used descriptive statistics and multivariable linear regression to test study objectives.

Results

Eighty-one respondents (90.0%) experienced a potentially traumatic event in ≥ 2 trauma categories, in addition to experiencing CSE/T. Approximately two-thirds of respondents experienced clinically significant PTSD symptoms for each symptom cluster. Of the 31 young people who met full criteria for PTSD, 9 met criteria for the standard PTSD diagnosis, while 22 met criteria for the dissociative subtype of PTSD. On average, experiencing additional trauma categories was associated with substantively higher PTSD symptom cluster scores for each cluster.

Conclusions

These findings support the need for a comprehensive assessment of trauma symptoms that includes cluster-specific PTSD symptoms. They also underscore the need to assess the full breadth and chronicity of trauma experiences to guide treatment planning and delivery, targeting specific domains of trauma impact. These findings can also inform the tailoring and adaptation of evidence-based interventions and strategies to better meet the needs of young people who have experienced CSE/T.

The impact of COVID-19 on youth mental health: A mixed methods survey

The COVID-19 pandemic has presented profound disruptions to young people at a critical period of psychosocial development. The current study aimed to explore the perceived negative and positive impacts of the COVID-19 pandemic on young people's mental health and wellbeing across a spectrum of clinical needs. A cross-sectional online survey including both quantitative and qualitative responses captured positive and negative impacts of COVID-19 across 593 young people with and without mental health care needs. Findings revealed high levels of clinical depression (48%), anxiety (51%), and loneliness in both samples. Approximately 75% of young people in primary mental health care services, and over 80% in the general population, reported a negative impact on work, non-work activities and mental health and wellbeing. Open-ended responses reflected positive impacts in the domains of greater capacity for self-care and reflection due to the decreased pressures of daily life. Negative impacts reflected worsening mental health, disruptions to key developmental milestones regarding relationships with self and others, and limited capacity for self-care. Together, these data highlight the critical need for early intervention support for the psychosocial impacts experienced by young people due to the pandemic, particularly among those with existing mental health care needs.

Associations between the Trauma Memory Quality Questionnaire and posttraumatic stress symptoms in youth: A systematic review and meta-analysis

Cognitive models of posttraumatic stress disorder (PTSD) propose that trauma memory characteristics are implicated in the etiology of the disorder. Empirical support for cognitive models in youth is necessary to ensure psychological interventions are based on appropriate theory. This meta-analysis was conducted to quantitatively investigate the strength of the associations between self-reported trauma memory characteristics (e.g., sensory and temporal features), measured using the Trauma Memory Quality Questionnaire (TMQQ), and posttraumatic stress symptoms (PTSS) in children and adolescents. PsycINFO, MEDLINE, CINAHL, PTSDPubs, and ProQuest Dissertations and Theses Global were searched for relevant literature. In total, 11 studies (N = 1,270 participants) met the inclusion criteria for the random-effects meta-analysis. A large effect size was observed for the association between trauma memory characteristics and PTSS, r = .51, 95% CI [.44, .58], and was maintained in subgroup analyses of the prospective association between trauma memory characteristics and later PTSS (k = 5, n = 6 28), r = .51, 95% CI [.42, .59]. A slightly larger effect size was observed in subgroup analyses of the cross-sectional association between trauma memory characteristics and concurrent PTSS (k = 11, N = 1,270), r = .62, 95% CI [.53, .70]. Sensitivity analyses on study quality, TMQQ alteration, chronic trauma exposure, geographical location, and PTSS measure supported the robustness of these results. These findings provide empirical support for the role of trauma memory characteristics in PTSS, congruent with cognitive models, suggesting this theoretical framework is appropriate for youth populations. Limitations and recommendations for future research are discussed.

The journey back to normality: Support systems and posttrauma needs following exposure to single-incident trauma among children and adolescents

Social support has been linked to posttrauma adjustment in children and adolescents, but the components of good support remain poorly defined. We conducted qualitative interviews with 30 youths aged 7-16 years after being admitted to a hospital following a single-incident trauma, predominantly injury or illness. The aim was to identify youths' support needs and examine the support they received across different recovery stages. Thematic analysis revealed that although participants appreciated increased attention and warm support during their hospital stay, most wanted their lives to return to normal soon afterward and were frustrated by barriers to achieving this. Participants received support from different sources, but parents and peers were the most important providers of emotional support and the people with whom these individuals most frequently engaged in trauma-related conversations. Furthermore, although it was important that schools were sensitive to the youths' potential limitations regarding their ability to engage with lessons, emotional support from teachers was less valued. Overall, this study implies that ecological models incorporating multiple interacting layers capture the structure of youths' posttrauma support systems well. These findings may be used to tailor posttrauma interventions more closely to child and adolescent needs at different recovery stages and highlight the importance of having parents and, where possible, peers involved in posttrauma interventions or prevention programs.

Socioeconomic Factors and Pediatric Injury

Purpose of Review

The goal of this review is to describe how socioeconomic status (SES) is evaluated in the pediatric trauma literature and further consider how differences in SES can lead to inequities in pediatric injury.

Recent Findings

Insurance status, area-level income, and indices of socioeconomic deprivation are the most common assessments of socioeconomic status. Children from socioeconomically disadvantaged backgrounds experience higher rates of firearm-related injuries, motor vehicle-related injuries, and violence-related injuries, contributing to inequities in morbidity and mortality after pediatric injury. Differences in SES may also lead to inequities in post-injury care and recovery, with higher rates of readmission, recidivism, and PTSD for children from socioeconomically disadvantaged backgrounds.

Summary

Additional research looking at family-level measures of SES and more granular measures of neighborhood deprivation are needed. SES can serve as an upstream target for interventions to reduce pediatric injury and narrow the equity gap.

Exposure to Parental Violence During Childhood and Later Psychological Distress Among Arab Adults in Israel: The Role of Gender and Sense of Coherence

Exposure to parental violence in childhood is a significant predictor of psychological distress in adulthood. Factors at the individual level may explain the variance in psychological distress among adults exposed to parental violence. The current study examined the effect of exposure to different forms (i.e., physical violence and psychological aggression) and different patterns of parental violence (i.e., witnessing interparental violence, experiencing parental violence) on later psychological distress. The mediating role of sense of coherence (SOC) and the moderating role of gender in this relationship were also examined. A cross-sectional survey was conducted among 604 married Arab adults in Israel (age = 20-60, M = 33.5, SD = 6.52) using a retrospective, self-administered questionnaire. Results indicate a significant positive relationship between all forms and types of parental violence explored in the current study with levels of psychological distress. Furthermore, exposure to parental violence correlated negatively with SOC, and low levels of SOC predicted higher levels of psychological distress. SOC was found to partially mediate the relationship between exposure to parental violence and psychological distress. Gender differences were found only with regard to experiencing physical violence as a predictor of psychological distress, indicating that the relationship between these variables is stronger in females. These results highlight the importance of SOC as a personal resource and its role in promoting psychological wellbeing. Healthcare practitioners should be aware of possible gender differences in psychological distress among Arab adults exposed to parental violence.

Stress and the brain: Emotional support mediates the association between myelination in the right supramarginal gyrus and perceived chronic stress

Perceived stress, which refers to people's evaluation of a stressful event and their ability to cope with it, has emerged as a stable predictor for physical and mental health outcomes. Increasing evidence has suggested the buffering effect of social support on perceived stress. Although previous studies have investigated the brain structural features (e.g., gray matter volume) associated with perceived stress, less is known about the association between perceived chronic stress and intra-cortical myelin (ICM), which is an important microstructure of brain and is essential for healthy brain functions, and the role of social support in this association. Using a sample of 1076 healthy young adults drawn from the Human Connectome Project, we quantified the ICMby the contrast of T1w and T2w images and examined its association with perceived chronic stress during the last month and social support. Behavioral results showed that perceived chronic stress was negatively associated with both emotional support and instrumental support. Vertex-wise multiple regression analyses revealed that higher level of perceived chronic stress was significantly associated with lower ICM content of a cluster in the right supramarginal gyrus (rSMG). Interestingly, the emotional support, but not the instrumental support, significantly mediated the association of perceived chronic stress with ICM in the rSMG. Overall, the present study provides novel evidence for the cortical myelination of perceived chronic stress in humans and highlights the essential role of the rSMG in perceived chronic stress and emotional support.

Breaking up with my idol: A qualitative study of the psychological adaptation process of renouncing fanship

Introduction

This study aimed to explore the psychological adaptation process of renouncing fanship due to para-loveshock in the context of fandom culture.

Methods

We adopted netnography to explore social media platforms used by fans in China (Weibo, WeChat, and Douban) as research fields for 3 years.

Results

(1) The process of "breaking up with" or renouncing an idol can be divided into three phases: the resistance phase with acute stress, the negotiation phase with bargaining, and the recovery phase with attachment reconstruction. In the resistance phase, fans displayed acute stress responses due to loveshock in psychological, physical, and behavioral aspects. In the negotiation phase, fans faced four barriers to renouncement: cognitive dissonance, emotional attachment, behavioral dependence, and social threat. They bargained within the three types of cognitive framework before deciding to "leave" or "re-follow" their idol. In the recovery phase, fans adopted two types of strategies to promote recovery: healing the past and facing the future. Healing the past involved public outcry, sharing their breakup plans, cognitive reconstruction, and seeking closure to the fan role. Facing the future involved switching environments, seeking new interests, and inhibiting the re-intrusion of trauma cues. (2) Internal factors affecting the psychological adaptation process of renouncement include the level of initiative, attribution styles, experience, attachment status and core belief systems, and alternative lifestyles; external factors include social support, peer pressure from the fan community, life stressors, and types and impact of traumatic events. (3) Based on the two dimensions of orientation and commitment, fans were classified into four types: short-term rational, short-term passionate, bounded loyal, and unconditionally loyal, corresponding to non-traumatic, stressful, accumulated, and traumatic breakup processes, respectively. (4) The post-renouncement growth of fans mainly manifested in the development of mental modes, coping skills toward trauma, emotional adaptation experience, and behavior patterns.

Implications

This investigation of the recovery process from para-loveshock after renouncement of fanship can provide theoretical and practical insights into the development of psychological resilience for fans, reduction of the psychological distress and negative outcomes, and public governance on social media platform and cyber pop culture industry.

Associations between parent posttraumatic stress symptoms (PTSS) and later child PTSS: Results from an international data archive

The extant literature indicates that parent and child posttraumatic stress symptoms (PTSS) are associated. However, the magnitude of this association at different time points and in the context of covariates has been difficult to quantify due to the methodological limitations of past studies, including small sample sizes. Using data from the Prospective studies of Acute Child Trauma and Recovery Data Archive, we harmonized participant-level parent and child data from 16 studies (N = 1,775 parent-child dyads) that included prospective assessment of PTSS during both the acute and later posttrauma periods (i.e., 1-30 days and 3-12 months after exposure to a potentially traumatic event, respectively). Parent and child PTSS demonstrated small-to-moderate cross-sectional, ρs = .22-.27, 95% CI [.16, .32], and longitudinal associations, ρ = .30, CI [.23, .36]. Analyses using actor-partner interdependence models revealed that parent PTSS during the acute trauma period predicted later child PTSS. Regression analyses demonstrated that parent gender did not moderate the association between parent and child PTSS. The findings suggest that parent PTSS during the acute and later posttrauma periods may be one of a constellation of risk factors and indicators for child PTSS.

Acute stress and PTSD among trauma-exposed children and adolescents: Computational prediction and interpretation

BACKGROUND

Youth receiving medical care for injury are at risk of PTSD. Therefore, accurate prediction of chronic PTSD at an early stage is needed. Machine learning (ML) offers a promising approach to precise prediction and interpretation.

AIMS

The study proposes a clinically useful predictive model for PTSD 6-12 months after injury, analyzing the relationship among predictors, and between predictors and outcomes.

METHODS

A ML approach was utilized to train models based on 1167 children and adolescents of nine perspective studies. Demographics, trauma characteristics and acute traumatic stress (ASD) symptoms were used as initial predictors. PTSD diagnosis at six months was derived using DSM-IV PTSD diagnostic criteria. Models were validated on external datasets. Shapley value and partial dependency plot (PDP) were applied to interpret the final model.

RESULTS

A random forest model with 13 predictors (age, ethnicity, trauma type, intrusive memories, nightmares, reliving, distress, dissociation, cognitive avoidance, sleep, irritability, hypervigilance and startle) yielded F-scores of.973,0.902 and.961 with training and two external datasets. Shapley values were calculated for individual and grouped predictors. A cumulative effect for intrusion symptoms was observed. PDP showed a non-linear relationship between age and PTSD, and between ASD symptom severity and PTSD. A 43 % difference in the risk between non-minority and minority ethnic groups was detected.

CONCLUSIONS

A ML model demonstrated excellent classification performance and good potential for clinical utility, using a few easily obtainable variables. Model interpretation gave a comprehensive quantitative analysis on the operations among predictors, in particular ASD symptoms.

The child and family traumatic stress intervention: Factors associated with symptom reduction for children receiving treatment

OBJECTIVE

We examine factors associated with changes in posttraumatic stress symptoms for children following completion of an early and brief, trauma-focused mental health treatment that engages children together with their caregivers, with the child as the identified patient.

METHOD

The Child and Family Traumatic Stress Intervention (CFTSI), a brief (5-8 session) trauma-focused mental health treatment designed to reduce trauma symptoms in the aftermath of traumatic experiences in children aged 7 years and older. CFTSI has been widely disseminated in Child Advocacy Centers (CAC) and community treatment clinics nationally. We report on results of a naturalistic treatment study of CFTSI implementation without a comparison group that includes 1190 child caregiver dyads from 13 community-based clinical settings.

RESULTS

Mixed modeling revealed a significant reduction in child reported posttraumatic stress scores from pre to post-CFTSI. Scores on the Child Posttraumatic Checklist (CPSS) declined an average of 8.74 points from pre to post-CFTSI (p < .0001). There were no statistically significant differences in CPSS score changes based on age, gender, ethnicity, race, number of prior trauma types the child had experienced, caregiver posttraumatic stress symptoms, child relationship to the perpetrator, nature of event or length of time to begin treatment.

CONCLUSION

This study provides further evidence that CFTSI can reduce child posttraumatic stress symptoms when implemented by community-based providers.

Responding to the psychological needs of children following admission to paediatric Intensive Care for paediatric inflammatory multisystem syndrome: A Narrative Therapy based Photography Workshop

This article briefly describes the development of a novel narrative therapy-based photography workshop group for children following acute hospital admission for Paediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 (PIMS-TS). The workshop was a collaboration between the psychology team, an artist and the medical multi-disciplinary team (MDT) to develop a group during the COVID-19 pandemic. The aims were to reduce isolation and promote resilience and psychological recovery post discharge from hospital. Nine children aged 8-11 years joined the photography group. Parents (n = 8) and children (n = 8) provided feedback on the group through semi-structured telephone interviews. Thematic analysis of the interviews identified three narrative themes for parents: reducing isolation through shared experience, creative activity as a different experience of hospital, and the positive sharing of experiences after the day. The resulting narrative themes for the children included that the workshop was a fun and interactive day and an opportunity to share in hospital experience with peers.

Caregiver support buffers posttraumatic stress disorder symptoms following a natural disaster in relation to binge drinking

OBJECTIVE

We investigate if posttraumatic stress disorder (PTSD) symptoms mediate the effects of disaster severity or prior trauma on binge drinking following disaster exposure and test if support from caregiver moderates the relation between disaster severity and PTSD symptoms as well as prior trauma and PTSD symptoms.

METHOD

A population-based clinical trial used address-based sampling to enroll 1,804 adolescents and parents from communities affected by tornadoes in Missouri and Alabama. Data collection via baseline (averaging 8 months postdisaster), 4-month postbaseline, and 12-month postbaseline semistructured telephone interviews was completed between September 2011 and August 2013. Longitudinal analyses, testing the indirect effects of disaster severity and prior traumatic events on alcohol use through PTSD symptoms, as potentially moderated by support from caregiver, were conducted.

RESULTS

PTSD symptoms mediated the effect of prior trauma, but not disaster severity, on binge drinking. Specifically, those with more prior traumas reported more PTSD symptoms, which in turn increased risk for binge drinking. Support from caregiver moderated the effect of disaster severity, but not prior trauma, on PTSD symptoms. Specifically, the effect of disaster severity on PTSD symptoms was significant for adolescents with average or below-average caregiver support.

CONCLUSION

Findings suggest that PTSD symptomatology is one mechanism by which prior trauma can impact binge drinking among adolescents following exposure to a natural disaster. Caregiver support can serve as a buffer for reducing PTSD symptomatology related to the severity of a natural disaster, which can decrease the likelihood of adolescent binge drinking. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Predictors of nonresponse and drop-out among children and adolescents receiving TF-CBT: investigation of client-, therapist-, and implementation factors

BACKGROUND

There is a paucity of evidence about effective implementation strategies to increase treatment response and prevent drop-out among children receiving evidence-based treatment. This study examines patient, therapist, and implementation factors and their association to nonresponse and drop-out among youth receiving Trauma-Focused Cognitive Behavioral Therapy (TF-CBT).

METHODS

Youth (n = 1240) aged 6-18 (M = 14.6) received TF-CBT delivered by 382 TF-CBT therapists at 66 clinics. Odds ratio analyses were used to investigate whether pretreatment child (age, gender, number of trauma experiences, post-traumatic stress symptoms (PTSS), therapist (education), and implementation strategy factors (high-low, low-low, low-high intensity therapist and leadership training respectively) or tele-mental health training during the Covid-19 pandemic are associated with nonresponse (above clinical PTSS level post-treatment) and drop-out (therapist-defined early termination). Fidelity checks were conducted to ensure that TF-CBT was used consistently.

RESULTS

One fourth of the children (24.4%) were nonresponders and 13.3 percent dropped out. Exposure to three or more traumatic experiences were related to nonresponse and drop-out. Higher baseline PTSS was related to a higher probability of nonresponse. There was no effect of therapist education or child gender on nonresponse and drop-out, whereas children over 15 years had a higher likelihood of both. After controlling for baseline PTSS, the effect of age on nonresponse was no longer significant. Drop-out was related to fewer sessions, and most dropped out during the first two phases of TF-CBT. Fidelity was high throughout the different implementation phases. High-intensity therapist training was related to a lower probability of both nonresponse and drop-out, whereas low therapist and leadership training were related to a higher likelihood of both. Multivariate analysis revealed higher child age and higher PTSS baseline scores as significant predictors of nonresponse, and number of trauma experiences (> = 3) at baseline as the only predictor of drop-out.

CONCLUSIONS

High-intensity therapist training seem key to prevent patient nonresponse and drop-out. Leadership training might positively affect both, although not enough to compensate for less intensive therapist training. More complex cases (higher PTSS and exposure to more traumas) predict nonresponse and drop-out respectively, which underscores the importance of symptom assessment to tailor the treatment. The lack of predictive effect of therapist education increases the utilization of TF-CBT.

TRIAL REGISTRATION

Retrospectively registered in ClinicalTrials, ref. nr. NCT05248971.

Querschnittstudie zum Versorgungsstand von Familien nach Suizid und Suizidversuch eines Elternteils in Bayern

Hintergrund

In Bayern wurde 2019 mit 1520 Fällen die höchste absolute Anzahl von Suiziden in Deutschland registriert. Suizid als Todesursache ist besonders belastend für Angehörige und das Risiko von betroffenen Kindern, selbst im weiteren Lebensverlauf Suizid zu begehen, ist signifikant erhöht. Frühe und spezifische Ansätze der sog. psychosozialen Notfallversorgung sind nach hoch belastenden Lebenserfahrungen, wie Suizid im Nahfeld, fachlich indiziert.

Ziel der Arbeit

Ziel der Querschnittstudie ist es, die Versorgungssituation von Familien nach Suizid und Suizidversuch eines Elternteils in Bayern zu erheben und dadurch Bedarfe zu erkennen.

Methoden

Daten zu Versorgungsangeboten, der (Selbst)einschätzung der Kompetenzen zu traumaspezifischen Aspekten und der grundsätzlichen Beurteilung der Versorgungssituation und -qualität in Bayern wurden bei 108 Jugendämtern und Beratungsstellen per telefonischer Befragung erhoben und deskriptiv ausgewertet.

Ergebnisse

Fälle von Suizid/-versuch kommen in der Beratungs- und Betreuungsrealität von Mitarbeitenden in Jugendämtern und Beratungsstellen vor. Die am häufigsten genannte Hilfe ist die Weitervermittlung in andere zumeist heilkundliche Angebote. 80 % der befragten Mitarbeitenden in Beratungsstellen und Jugendämtern halten die Einführung einer zentralen Notfallrufnummer für Familien und Fachkräfte für sinnvoll.

Schlussfolgerung

Fachkräfte sehen den Bedarf für Beratung bei den Betroffenen und wollen diesem auch in der eigenen Einrichtung entsprechen, fühlen sich jedoch in Folge begrenzter interner und externer Angebote sowie eigener Qualifikation dafür nicht ausreichend ermächtigt. Die Angebote, in die weitervermittelt wird, sind in den meisten Fällen weder spezifisch, passgenau noch kurzfristig verfügbar, was angesichts des hohen Erkrankungsrisikos der betroffenen Kinder und Jugendlichen einen kritischen Faktor darstellt. Es besteht ein Bedarf für unmittelbar erreichbare spezifische Unterstützung sowohl für Fachkräfte als auch für betroffene Familien, z. B. durch eine Notfallrufnummer.

Psychosoziale Notfallversorgung von Kindern nach hoch belastenden Lebenserfahrungen

Hoch belastende Lebensereignisse wie die Erfahrung einer lebensbedrohlichen Situation oder das Bezeugen von plötzlichem Tod, schwerer Verletzung oder Suizid stellen für die psychische Verarbeitung eine außergewöhnliche Herausforderung dar. Sie stehen in kausalem Zusammenhang mit dem Risiko, an verschiedenen psychischen und psychosomatischen Traumafolgestörungen zu erkranken. Diesem Wissen folgend, sind die Aufgaben der Psychosozialen Notfallversorgung (PSNV): die Prävention psychosozialer Belastungsfolgen, die Früherkennung weiteren Hilfs- oder Versorgungsbedarfs und die Bereitstellung adäquater Hilfe zur Belastungsverarbeitung. Sind Kinder von einem Notfallereignis betroffen, befinden sich diese aufgrund entwicklungspsychologischer Aspekte in einer anderen Position als erwachsene Betroffene.

Der vorliegende Beitrag beschreibt praxisnah die Besonderheiten in der Notfallversorgung der Zielgruppe Kinder. Dabei geht er anhand ausgewählter Forschungsbefunde aus den Feldern Psychotraumatologie und Psychosoziale Notfallversorgung insbesondere der Frage nach, welche Auswirkungen das Bezugspersonenverhalten auf die kindliche Verarbeitung von Notfallereignissen hat. Entsprechende Folgerungen für die Praxis der PSNV werden gezogen. Darüber hinaus werden allgemeine Empfehlungen zur Akutbetreuung von Kindern vorgestellt und Herausforderungen in der Praxis diskutiert.

Die Psychosoziale Notfallversorgung von Kindern erfordert ein im Vergleich zu der Begleitung von erwachsenen Betroffenen angepasstes Vorgehen. Verhaltenskompetenz und Stabilität der Bezugspersonen haben Einfluss auf die kindlichen Verarbeitungsmöglichkeiten. Abhängig vom Zeitpunkt der Intervention bedarf die PSNV unterschiedlicher Kompetenzen. Der niederschwellige Zugang zu Hilfsangeboten stellt in der Versorgungspraxis eine Herausforderung dar.

Caregivers' and Young Children's Emotional Health Needs After Pediatric Traumatic Injury

Pediatric traumatic injury (PTI) is associated with emotional health difficulties, but most US trauma centers do not adequately address emotional recovery needs. This study aimed to assess families' emotional health needs following PTI and determine how technology could be used to inform early interventions. Individual semi-structured, qualitative interviews were conducted with caregivers of children admitted to a Level I trauma center in the Southeastern United States to understand families' experiences in-hospital and post-discharge. Participants included 20 caregivers of PTI patients under age 12 (M = 6.4 years; 70% male, 45% motor vehicle collision). Thematic analysis was used to analyze data from interviews that were conducted until saturation. Caregivers reported varying emotional needs in hospital and difficulties adjusting after discharge. Families responded enthusiastically to the potential of a technology-enhanced resource for families affected by PTI. A cost-effective, scalable intervention is needed to promote recovery and has potential for widespread pediatric hospital uptake.

Pediatric Medical Traumatic Stress (PMTS) following Surgery in Childhood and Adolescence: a Systematic Review

The purpose of the present review was to systematically review, synthesize and quantify prevalence rates of subclinical and clinical psychological symptoms in children and adolescents who have undergone surgery. Systematic literature searches were conducted twofold in April 8, 2020 and March 7, 2021 in PsycInfo and PubMed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Manuscripts were screened against eligibility criteria and were included if they investigated psychological symptoms in children or adolescents (age between 1 to 21 years at the time of study) who were hospitalized for pediatric surgery. Means and standard deviations weighted by sample size were calculated. Eleven articles met inclusion criteria. The review revealed that a small but substantial number of children and adolescents are at an elevated risk for postoperative psychological symptoms and disorders. Up to 13% had symptoms consistent with a diagnosis of a posttraumatic stress disorder, 6% to 8% exhibited elevated symptoms of depression or anxiety, and about 25% showed internalizing and externalizing symptoms. This review provides preliminary evidence that children and adolescents experience significant psychological distress and posttraumatic stress symptoms after pediatric surgery. Apart from better training of clinicians, prevention, early psychological screening and psychosocial care in surgical wards of hospitals are recommended. Well-designed studies of high methodological quality are necessary to replicate existing findings and provide a broader base of evidence.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40653-021-00391-9.

The Theoretical and Practical Evolution of Customer Journey and Its Significance in Services Sustainability

In the scientific literature, the concept of the “customer journey (CJ)” has only recently been introduced, and, accordingly, it lacks robust empirical evidence. Still, the number of papers concerning the CJ has increased exponentially in recent years. The aim of this paper is to fully represent the available CJ research in services and highlight its importance for service sustainability. Since the current CJ literature mainly includes qualitative data, this paper is a narrative review based on the Preferred Reporting Items for Systematic Review and Meta-Analysis checklist. The systematic literature review conducted by the authors is based on peer-reviewed articles published up until 2019. The main findings mostly concern the conceptualization of the CJ at a theoretical and practical level—CJ definitions and evolution for the former and customer journey mapping for the latter—as well as to present new perspectives of the examined terms in the services peer-reviewed bibliography and verify their contribution to service sustainability. CJ monitoring helps the development of a more sustainable service because it advances service innovation and effective channel management. Furthermore, it leads managers to understand their customer decision-making process and better allocate their resources by establishing a sustainable service design throughout the various service phases.

Prevalence and predictors of ICD-11 posttraumatic stress disorder and complex PTSD in young people

OBJECTIVE

The prevalence, construct validity, risk factors and psychopathological correlates associated with ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as measured by the International Trauma Questionnaire for Children and Adolescents (ITQ-CA) were assessed in a sample of young people from Northern Ireland.

METHOD

Participants were trauma-exposed 11-19-year-olds (N = 507) who participated in the Northern Ireland Youth Wellbeing Prevalence Survey (YWS-NI, 2020). Factor mixture modelling (FMM) was used to test the latent structure of the ITQ-CA. Risk-factors and psychopathological correlates associated with latent class membership, and ICD-11diagnostic status, were also investigated.

RESULTS

More participants met the ITQ-CA criteria for CPTSD (3.4%, n = 44) than PTSD (1.5%, n = 19). A second-order FMM comprising a 'partial-PTSD class', a 'CPTSD class', a 'DSO class' and a 'low symptom endorsement class' was the best-fitting model. Younger age and cumulative trauma were risk factors for all trauma classes. Female gender and two or more violent traumas were significant predictors of the 'PTSD' and 'CPTSD' classes, while single sexual trauma was a significant predictor of the 'DSO' and 'CPTSD' classes. Two or more sexual traumas was a unique predictor of 'CPTSD class', while two or more vicarious traumas was a unique predictor of 'DSO class'. The 'CPTSD' class displayed the most notable comorbidity.

CONCLUSIONS

Findings indicate that CPTSD may be more prevalent than PTSD in children and young people. Support for the ICD-11 conceptualisation of CPTSD as representing a unique diagnostic construct was supported using FMM, with findings indicating trauma symptom class-specific risk profiles.

Posttraumatic Cognitions and Posttraumatic Stress Symptoms Among Young People Who Have Experienced Commercial Sexual Exploitation and Trafficking

OBJECTIVES

The impact of posttraumatic cognitions on the development and maintenance of posttraumatic stress symptoms (PTSS) is understudied among children and adolescents who have experienced commercial sexual exploitation/trafficking (CSE/T). The objectives of this study were to (1) explore posttraumatic cognitions among help-seeking young people aged 11-19 who have experienced CSE/T; (2) determine whether experiencing direct violence, witnessing violence, polyvictimization (ie, multiple exposures to different categories of potentially traumatic events), or demographic characteristics differentially affect whether these young people meet clinical criteria for posttraumatic cognitions using established cutoffs; and (3) explore associations between posttraumatic cognitions and PTSS among young people who have experienced CSE/T.

METHODS

This study is a secondary analysis of a baseline cross-sectional survey of 110 young people with substantiated CSE/T experiences who started trauma-focused cognitive behavioral therapy (mean [SD] age = 15.8 [1.5]) from August 1, 2013, through March 31, 2020, in a southeastern US state. We used descriptive statistics, adjusted modified Poisson regression, and adjusted linear regression to test study objectives.

RESULTS

Fifty-seven of 110 (51.8%) young people aged 11-19 met clinical criteria for posttraumatic cognitions. Increased age and a greater number of trauma categories experienced were significantly associated with meeting clinical criteria for posttraumatic cognitions. On average, higher posttraumatic cognition scores were associated with higher PTSS scores, controlling for demographic characteristics (β = 0.95; 95% CI, 0.64-1.26).

CONCLUSIONS

These findings underscore the importance of assessing comprehensive trauma history and PTSS of young people who have experienced CSE/T, with added usefulness of measuring cognitive appraisals to inform a therapeutic treatment plan. Measuring cognitive appraisals that may influence PTSS and therapeutic success can ensure an effective public health response for this population.

Work-family conflict and posttraumatic stress symptoms among college teachers during the COVID-19 pandemic

The study aimed to examine the indirect factors underlying the association between work–family conflict and posttraumatic stress symptoms (PTSS) in college teachers during the COVID‐19 pandemic. Three potential indirect factors were examined: perceived stress, basic psychological needs, and rumination. A total of 274 college teachers were recruited. All participants completed an electronic questionnaire that assessed their exposure to the pandemic, work–family conflict, perceived stress, basic psychological needs, rumination, and PTSS. The results showed that after controlling for pandemic exposure, gender, and age, work–family conflict was associated with PTSS via perceived stress alone, rumination alone, a path from perceived stress to basic psychological needs, and a path from perceived stress to rumination. These results indicate that work–family conflict is positively associated with PTSS indirectly via perceived stress, rumination, and basic psychological needs during the COVID‐19 pandemic. These three mediators may completely explain the relation of work–family conflict to PTSS.

Impact of war and forced displacement on children's mental health-multilevel, needs-oriented, and trauma-informed approaches

The infliction of war and military aggression upon children must be considered a violation of their basic human rights and can have a persistent impact on their physical and mental health and well-being, with long-term consequences for their development. Given the recent events in Ukraine with millions on the flight, this scoping policy editorial aims to help guide mental health support for young victims of war through an overview of the direct and indirect burden of war on child mental health. We highlight multilevel, need-oriented, and trauma-informed approaches to regaining and sustaining outer and inner security after exposure to the trauma of war. The impact of war on children is tremendous and pervasive, with multiple implications, including immediate stress-responses, increased risk for specific mental disorders, distress from forced separation from parents, and fear for personal and family's safety. Thus, the experiences that children have to endure during and as consequence of war are in harsh contrast to their developmental needs and their right to grow up in a physically and emotionally safe and predictable environment. Mental health and psychosocial interventions for war-affected children should be multileveled, specifically targeted towards the child's needs, trauma-informed, and strength- and resilience-oriented. Immediate supportive interventions should focus on providing basic physical and emotional resources and care to children to help them regain both external safety and inner security. Screening and assessment of the child's mental health burden and resources are indicated to inform targeted interventions. A growing body of research demonstrates the efficacy and effectiveness of evidence-based interventions, from lower-threshold and short-term group-based interventions to individualized evidence-based psychotherapy. Obviously, supporting children also entails enabling and supporting parents in the care for their children, as well as providing post-migration infrastructures and social environments that foster mental health. Health systems in Europe should undertake a concerted effort to meet the increased mental health needs of refugee children directly exposed and traumatized by the recent war in Ukraine as well as to those indirectly affected by these events. The current crisis necessitates political action and collective engagement, together with guidelines by mental health professionals on how to reduce harm in children either directly or indirectly exposed to war and its consequences.

Quality of Mother-child Dialogue About Emotional Events, Coping and Posttraumatic Stress Symptoms Among Children Exposed to Interpersonal Trauma

Children exposed to traumatic events are at increased risk for developing symptoms of a Post-Traumatic Stress Disorder. Children often discuss emotional, and therefore also traumatic, events in their lives with their parents, and the quality of these discussions can facilitate coping and further development. The study aim was 1) to explore whether the association between the quality of dialogue between mothers and children about emotional events and children's posttraumatic stress symptoms (PTSS) might be indirectly linked through children's adaptive coping skills, and 2) whether this association differed when discussing different negative emotions. 169 mother-child dyads with interpersonal trauma-exposure (86% domestic violence, 14% mother and/or child sexually abused) participated in the Autobiographical Emotional Events Dialogue (AEED). Quality of mother-child emotion dialogue, captured in maternal sensitive guidance and child cooperation, and approach-oriented coping were coded from transcripts. PTSS was measured with the Child Behavior Checklist. Lower quality of mother-child emotion dialogue was associated with less approach-oriented coping and more symptoms of posttraumatic stress. There was an indirect effect of approach-oriented coping with angry feelings linking quality of mother-child emotion dialogue and child PTSS. Children's symptoms of posttraumatic stress were reflected in the quality of mother-child dialogues about traumatic and other emotional events. Findings support that dialogues about emotional events may be a promising target for intervention with children exposed to trauma.