151
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Nyvold O, Nygaard E, Augusti EM, Tamnes CK. Unity or diversity of executive functioning in children and adolescents with post-traumatic stress symptoms? A systematic review and meta-analysis. Child Neuropsychol 2021; 28:374-393. [PMID: 34553675 DOI: 10.1080/09297049.2021.1979950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
For some children, psychological reactions to a traumatic event develop into severe or persistent post-traumatic stress symptoms (PTSS) or the clinical condition of post-traumatic stress disorder (PTSD). Cognitive problems in children with PTSS have been reported, but it is not clear which specific functions are affected. Executive functions is a domain of particular interest, given its importance for academic performance and social and emotional functioning. A systematic literature search was performed, and 12 studies with 55 comparisons of executive functions in children with PTSS and healthy controls were eligible for meta-analysis. A subset of the studies also included a comparison group of children with traumatic experienced but without PTSS. Overall, across all tasks and measures, children with PTSS showed lower executive functioning than healthy controls (SMD = -0.57). The effect sizes between the subdomains complex tasks, verbal fluency, inhibition, shifting and working memory were not significantly different from each other, but was largest for verbal fluency (SMD = -1.45). Analyses comparing children with traumatic experiences with and without PTSS similarly showed overall lower executive functioning in the PTSS group (SMD = -0.34) and no significant differences in effect sizes between subdomains. The results have implications for assessment and clinical work with youth exposed to traumatic events. We should be aware of the poor executive functioning that may be an issue for some children with a history of trauma and subsequent development of PTSS, and the impact this could have on everyday functioning.
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Affiliation(s)
- Otelie Nyvold
- Nic Waals Institute, Lovisenberg Hospital, Oslo, Norway
| | - Egil Nygaard
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Else-Marie Augusti
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Christian K Tamnes
- PROMENTA Research Center, Department of Psychology, University of Oslo, Oslo, Norway.,NORMENT, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
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152
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Brewerton TD, Gavidia I, Suro G, Perlman MM, Genet J, Bunnell DW. Provisional posttraumatic stress disorder is associated with greater severity of eating disorder and comorbid symptoms in adolescents treated in residential care. EUROPEAN EATING DISORDERS REVIEW 2021; 29:910-923. [PMID: 34523192 DOI: 10.1002/erv.2864] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Revised: 08/21/2021] [Accepted: 09/02/2021] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Past traumatic events, subsequent posttraumatic stress disorder (PTSD) and related psychiatric comorbidities are commonly associated with eating disorders (EDs) in adults but remain understudied in adolescents. METHODS Adolescent participants (mean [SD] age = 15.1 ± 1.5 years, 96.5% female) with EDs entering residential treatment (n = 647) at six sites in the United States completed validated self-report assessments of ED, PTSD, major depression, anxiety disorders and quality of life. Provisional DSM-5 PTSD diagnoses (PTSD+) were made via the Childhood Trauma Questionnaire, admission interviews and the PTSD Symptom Checklist for DSM-5. RESULTS PTSD+ occurred in 35.4% of participants, and those with ED-PTSD+ had significantly higher scores on all assessments (p ≤ 0.001), including measures of ED psychopathology, major depression, anxiety disorders and quality of life, as well as significantly higher rates of all forms of childhood trauma. Those with PTSD+ also exhibited a significantly higher percent median body mass index for age and sex and a lower propensity toward anorexia nervosa, restricting type. CONCLUSIONS Results confirm that adolescent patients in residential treatment with ED-PTSD+ are more symptomatic and have worse quality of life than their ED counterparts without PTSD. Integrated treatment approaches that effectively address ED-PTSD+ are greatly needed in ED programs that treat adolescents.
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Affiliation(s)
- Timothy D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA.,LLC, Mt. Pleasant, South Carolina, USA.,Monte Nido and Affiliates, Miami, Florida, USA
| | | | - Giulia Suro
- Monte Nido and Affiliates, Miami, Florida, USA
| | - Molly M Perlman
- Monte Nido and Affiliates, Miami, Florida, USA.,Department of Psychiatry and Behavioral Health, Florida International University Herbert Wertheim College of Medicine, Miami, Florida, USA
| | | | - Douglas W Bunnell
- Monte Nido and Affiliates, Miami, Florida, USA.,Private Practice, Westport, Connecticut, USA
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153
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Magalhaes AA, Gama CMF, Gonçalves RM, Portugal LCL, David IA, Serpeloni F, Wernersbach Pinto L, Assis SG, Avanci JQ, Volchan E, Figueira I, Vilete LMP, Luz MP, Berger W, Erthal FS, Mendlowicz MV, Mocaiber I, Pereira MG, de Oliveira L. Tonic Immobility is Associated with PTSD Symptoms in Traumatized Adolescents. Psychol Res Behav Manag 2021; 14:1359-1369. [PMID: 34512046 PMCID: PMC8420784 DOI: 10.2147/prbm.s317343] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 08/11/2021] [Indexed: 11/23/2022] Open
Abstract
Purpose Growing evidence suggests that peritraumatic tonic immobility, an involuntary defensive response that involves extreme physical immobility and the perceived inability to escape, is a significant predictor of post-traumatic stress disorder (PTSD) symptomatology. However, this issue has not been specifically addressed in adolescents. Here, we investigated whether tonic immobility response experienced during the worst childhood or adolescent trauma is associated with PTSD symptom severity in a non-clinical student sample. Methods The sample was composed of students in 9th grade who were attending public and private schools. Symptoms of post-traumatic stress and tonic immobility were assessed using questionnaires. We performed bivariate and multivariate negative binomial regressions to examine whether tonic immobility was associated with PTSD symptomatology after controlling for confounders (peritraumatic dissociation, peritraumatic panic reactions, gender, age and time since trauma). Results We found an association between tonic immobility and PTSD symptom severity, even after controlling for confounders. Therefore, tonic immobility is associated with PTSD symptoms in trauma-exposed adolescents. Conclusion These findings highlight tonic immobility as a possible risk factor that could be used to provide direction for more targeted trauma interventions for individuals, particularly those at risk for developing PTSD. Therefore, it contributes to preventing and reducing the psychiatric burden in adolescence and later in life.
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Affiliation(s)
- Andressa A Magalhaes
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Camila M F Gama
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Raquel M Gonçalves
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Liana C L Portugal
- Department of Physiological Sciences, State University of Rio de Janeiro, Rio de Janeiro, RJ, 20550-170, Brazil
| | - Isabel A David
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Fernanda Serpeloni
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Liana Wernersbach Pinto
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Simone G Assis
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil.,The Neurology Postgraduate Program, Hospital Gaffrée and Guinle, Unirio, RJ, 20270-901, Brazil
| | - Joviana Q Avanci
- Department of Violence and Health Studies, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, 21040-900, Brazil
| | - Eliane Volchan
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Ivan Figueira
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Liliane M P Vilete
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Mariana P Luz
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - William Berger
- Psychiatry Institute, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 22290-140, Brazil
| | - Fatima S Erthal
- Institute of Biophysics Carlos Chagas Filho, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, 21941-902, Brazil
| | - Mauro V Mendlowicz
- Department of Psychiatry and Mental Health, Fluminense Federal University, Niterói, RJ, 24030-215, Brazil
| | - Izabela Mocaiber
- Institute of Humanities and Health, Federal Fluminense University, Rio das Ostras, RJ, 28890-000, Brazil
| | - Mirtes G Pereira
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
| | - Leticia de Oliveira
- Biomedical Institute, Fluminense Federal University, Niterói, RJ, 24210-130, Brazil
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154
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Avery JC, Morris H, Galvin E, Misso M, Savaglio M, Skouteris H. Systematic Review of School-Wide Trauma-Informed Approaches. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:381-397. [PMID: 34471456 PMCID: PMC8357891 DOI: 10.1007/s40653-020-00321-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/25/2020] [Indexed: 05/25/2023]
Abstract
Extensive research on traumatic life experiences reveals how healthy development can be derailed and brain architecture altered by excessive or prolonged activation of the body's stress response, impacting health, mental health, learning, behavior and relationships. Schools offer a unique environment to prevent and counter the impacts of childhood trauma. This study aimed to investigate empirical evidence for school-wide trauma-informed approaches that met at least two of the three essential elements of trauma-informed systems defined by SAMSHA (2014). SAMHSA's concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville: Substance Abuse and Mental Health Services Administration. https://store.samhsa.gov/shin/content/SMA14-4884.pdf) and consider commonalities in approaches, drivers of change, challenges and learnings related to implementation, sustainability and outcomes for students. A systematic review searching foremost databases was conducted for evidence of trauma-informed school-wide approaches used between 2008 and 2019. Four papers were identified, incorporating four school-wide approaches, The Healthy Environments and Response to Trauma in Schools (HEARTS) Model; The Heart of Teaching and Learning (HTL): Compassion, Resiliency, and Academic Success Model; The New Haven Trauma Coalition (NHTC) and The Trust-Based Relational Intervention. Although heterogeneous, the models shared core elements of trauma-informed staff training, organization-level changes and practice change, with most models utilizing student trauma-screening. Generalizability of the findings was low given the small number of studies, the mix of mainstream and specialist schools and high risk of bias. Given the limitations of research in this emergent but rapidly accelerating field, future research is urgently required to understand the interaction between core elements of a trauma-informed approach, teaching pedagogy and organizational factors that support the embedding, use and transferability of school-wide approaches.
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Affiliation(s)
- Julie C. Avery
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-52 Kanooka Grove Clayton; Locked Bag 29 Clayton Vic, Melbourne, 3168 Australia
| | - Heather Morris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-52 Kanooka Grove Clayton; Locked Bag 29 Clayton Vic, Melbourne, 3168 Australia
| | - Emma Galvin
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-52 Kanooka Grove Clayton; Locked Bag 29 Clayton Vic, Melbourne, 3168 Australia
| | - Marie Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-52 Kanooka Grove Clayton; Locked Bag 29 Clayton Vic, Melbourne, 3168 Australia
| | - Melissa Savaglio
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-52 Kanooka Grove Clayton; Locked Bag 29 Clayton Vic, Melbourne, 3168 Australia
| | - Helen Skouteris
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43-52 Kanooka Grove Clayton; Locked Bag 29 Clayton Vic, Melbourne, 3168 Australia
- School of Business, Warwick University, Coventry, UK
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155
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Lori A, Schultebraucks K, Galatzer-Levy I, Daskalakis NP, Katrinli S, Smith AK, Myers AJ, Richholt R, Huentelman M, Guffanti G, Wuchty S, Gould F, Harvey PD, Nemeroff CB, Jovanovic T, Gerasimov ES, Maples-Keller JL, Stevens JS, Michopoulos V, Rothbaum BO, Wingo AP, Ressler KJ. Transcriptome-wide association study of post-trauma symptom trajectories identified GRIN3B as a potential biomarker for PTSD development. Neuropsychopharmacology 2021; 46:1811-1820. [PMID: 34188182 PMCID: PMC8357796 DOI: 10.1038/s41386-021-01073-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 04/26/2021] [Accepted: 05/24/2021] [Indexed: 12/11/2022]
Abstract
Biomarkers that predict symptom trajectories after trauma can facilitate early detection or intervention for posttraumatic stress disorder (PTSD) and may also advance our understanding of its biology. Here, we aimed to identify trajectory-based biomarkers using blood transcriptomes collected in the immediate aftermath of trauma exposure. Participants were recruited from an Emergency Department in the immediate aftermath of trauma exposure and assessed for PTSD symptoms at baseline, 1, 3, 6, and 12 months. Three empirical symptom trajectories (chronic-PTSD, remitting, and resilient) were identified in 377 individuals based on longitudinal symptoms across four data points (1, 3, 6, and 12 months), using latent growth mixture modeling. Blood transcriptomes were examined for association with longitudinal symptom trajectories, followed by expression quantitative trait locus analysis. GRIN3B and AMOTL1 blood mRNA levels were associated with chronic vs. resilient post-trauma symptom trajectories at a transcriptome-wide significant level (N = 153, FDR-corrected p value = 0.0063 and 0.0253, respectively). We identified four genetic variants that regulate mRNA blood expression levels of GRIN3B. Among these, GRIN3B rs10401454 was associated with PTSD in an independent dataset (N = 3521, p = 0.04). Examination of the BrainCloud and GTEx databases revealed that rs10401454 was associated with brain mRNA expression levels of GRIN3B. While further replication and validation studies are needed, our data suggest that GRIN3B, a glutamate ionotropic receptor NMDA type subunit-3B, may be involved in the manifestation of PTSD. In addition, the blood mRNA level of GRIN3B may be a promising early biomarker for the PTSD manifestation and development.
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Affiliation(s)
- Adriana Lori
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Katharina Schultebraucks
- Department of Emergency Medicine, Columbia University Medical Center, New York, NY, USA
- Data Science Institute, Columbia University, New York, NY, USA
| | - Isaac Galatzer-Levy
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA
| | - Nikolaos P Daskalakis
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Seyma Katrinli
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Alicia K Smith
- Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA
| | - Amanda J Myers
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Ryan Richholt
- Neurogenomics Division and Center for Rare Childhood Disorders, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Matthew Huentelman
- Neurogenomics Division and Center for Rare Childhood Disorders, Translational Genomics Research Institute, Phoenix, AZ, USA
| | - Guia Guffanti
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA
| | - Stefan Wuchty
- Department of Biology, University of Miami, Coral Gables, FL, USA
- Department of Computer Science, University of Miami, Coral Gables, FL, USA
- Institute of Data Science and Computing, University of Miami, Coral Gables, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA
| | - Felicia Gould
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | - Philip D Harvey
- Department of Psychiatry and Behavioral Sciences, University of Miami, Miller School of Medicine, Miami, FL, USA
| | | | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | | | | | - Jennifer S Stevens
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Vasiliki Michopoulos
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Barbara O Rothbaum
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA
| | - Aliza P Wingo
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.
- Division of Mental Health, Atlanta VA Medical Center, Decatur, GA, USA.
| | - Kerry J Ressler
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA.
- Department of Psychiatry, Harvard Medical School and McLean Hospital, Belmont, MA, USA.
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156
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Asnaani A, Narine K, Suzuki N, Yeh R, Zang Y, Schwartz B, Mannarino A, Cohen J, Foa EB. An Innovative Mobile Game for Screening of Pediatric PTSD: a Study in Primary Care Settings. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:357-366. [PMID: 34471454 PMCID: PMC8357874 DOI: 10.1007/s40653-020-00300-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Childhood is a developmental period associated with high risk of posttraumatic stress disorder (PTSD). Available validated pencil-and-paper diagnostic tools can be difficult for younger children to engage with given format and length. This study investigated psychometric properties of a briefer, more interactive game version of the Child PTSD Symptom Scale for DSM-5 (CPSS-5). Participants (n = 49) were children attending primary care appointments between 8 to 12 years of age who were exposed to a DSM-5 Criterion A trauma. Participants completed the 6-item screening version of the CPSS-5 delivered in mobile tablet game format (the CPSS-5 Screen Team Game) and a self-report version of the full CPSS-5 (CPSS-5-SR) before their medical appointments. The mobile game showed adequate internal consistency (α = 0.79), was significantly positively correlated to the total CPSS-5-SR (r = .74, p < .001, n = 49), and with the total of the six identical items of the CPSS-5-SR (r = .79, p < .001, n = 49), demonstrating good convergent validity. Receiver operating characteristic (ROC) analyses revealed a cut-off score of 9 on the screening game as indicative of probable PTSD. Implementation of this screening game into primary care settings could be a low-burden method to greatly increase the detection of pediatric PTSD for referral to appropriate integrated care interventions.
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Affiliation(s)
- Anu Asnaani
- Department of Psychology, University of Utah, 380 S. 1530 E BEH S 502, Salt Lake City, UT USA
| | - Kevin Narine
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
| | - Noah Suzuki
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
| | - Rebecca Yeh
- Clinical Psychology Department, La Salle University, Philadelphia, PA USA
| | - Yinyin Zang
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
| | - Billie Schwartz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Anthony Mannarino
- Department of Psychiatry, Drexel University College of Medicine/Allegheny Health Network, Pittsburgh, PA USA
| | - Judith Cohen
- Department of Psychiatry, Drexel University College of Medicine/Allegheny Health Network, Pittsburgh, PA USA
| | - Edna B. Foa
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA USA
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157
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Kell PA, Hellman N, Huber FA, Lannon EW, Kuhn BL, Sturycz CA, Toledo TA, Demuth MJ, Hahn BJ, Shadlow JO, Rhudy JL. The Relationship Between Adverse Life Events and Endogenous Inhibition of Pain and Spinal Nociception: Findings From the Oklahoma Study of Native American Pain Risk (OK-SNAP). THE JOURNAL OF PAIN 2021; 22:1097-1110. [PMID: 33819573 PMCID: PMC8419014 DOI: 10.1016/j.jpain.2021.03.146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 03/09/2021] [Accepted: 03/12/2021] [Indexed: 12/26/2022]
Abstract
Adverse life events (ALEs) are a risk factor for chronic pain; however, mechanisms underlying this association are not understood. This study examined whether cumulative ALE exposure impairs endogenous inhibition of pain (assessed from pain report) and spinal nociception (assessed from nociceptive flexion reflex; NFR) in healthy, pain-free Native Americans (n = 124) and non-Hispanic Whites (n = 129) during a conditioned pain modulation (CPM) task. Cumulative ALE exposure was assessed prior to testing by summing the number of potentially traumatic events experienced by each participant across their lifespan. Multilevel modeling found that ALEs were associated with NFR modulation during the CPM task even after controlling for general health, body mass index, sex, age, blood pressure, sleep quality, stimulation intensity, stimulus number, perceived stress, and psychological distress. Low exposure to ALEs was associated with NFR inhibition, whereas high exposure to ALEs was associated with NFR facilitation. By contrast, pain perception was inhibited during the CPM task regardless of the level of ALE exposure. Race/ethnicity did not moderate these results. Thus, ALEs may be pronociceptive for both Native Americans and non-Hispanic Whites by impairing descending inhibition of spinal nociception. This could contribute to a chronic pain risk phenotype involving latent spinal sensitization. PERSPECTIVE: This study found that adverse life events were associated with impaired descending inhibition of spinal nociception in a sample of Native Americans and non-Hispanic Whites. These findings expand on previous research linking adversity to chronic pain risk by identifying a proximate physiological mechanism for this association.
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Affiliation(s)
- Parker A Kell
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Natalie Hellman
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | | | - Edward W Lannon
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Bethany L Kuhn
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | | | - Tyler A Toledo
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Mara J Demuth
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Burkhart J Hahn
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Joanna O Shadlow
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma
| | - Jamie L Rhudy
- Department of Psychology; The University of Tulsa; Tulsa, Oklahoma.
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158
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Agbaria N, Petzold S, Deckert A, Henschke N, Veronese G, Dambach P, Jaenisch T, Horstick O, Winkler V. Prevalence of post-traumatic stress disorder among Palestinian children and adolescents exposed to political violence: A systematic review and meta-analysis. PLoS One 2021; 16:e0256426. [PMID: 34437595 PMCID: PMC8389374 DOI: 10.1371/journal.pone.0256426] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 08/06/2021] [Indexed: 11/19/2022] Open
Abstract
Objective We undertook a systematic review of the literature to explore the prevalence of post-traumatic stress disorder (PTSD) in Palestinian children and adolescents exposed to political violence. This is the first systematic review and meta-analysis of the prevalence of PTSD in this population. Methods PubMed, Embase, PsycInfo, Google Scholar and Cochrane library were searched until June 2020. To estimate the prevalence of PTSD, sub-group and meta-analysis were conducted. Results The search resulted in 2786 studies, of which 28 articles representing 32 samples with a total of 15,121 participants from Gaza Strip and West Bank met either the DSM-4 or DSM-5 criteria and were included. The pooled prevalence of PTSD was 36% (95% CI 30–41%; I2 98.6%) and ranged from 6% to 70%. Sub-group analysis showed that the PTSD prevalence did not differ according to region (West Bank, Gaza Strip) and tended to decrease after including only studies using a representative sample (p<0.001), and among those with low risk of bias (p<0.001). Visual inspection of the included studies revealed significant discrepancies in study design and assessment measures. Conclusion We identified high prevalence of PTSD among Palestinian children and adolescents exposed to political violence. However, the pooled results should be interpreted with caution, due to the high heterogeneity and risk of bias in the included studies. These limitations also reflect the challenge in conceptualizing and measuring PTSD in the Palestinian context with a background of continuous and cumulative trauma. Understanding the contextual factors and developing locally adapted survey measures are of relevance to future research, public health planning, and the provision of mental healthcare in Palestine.
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Affiliation(s)
- Nisreen Agbaria
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
- * E-mail:
| | - Stephanie Petzold
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Andreas Deckert
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Nicholas Henschke
- Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Guido Veronese
- Department of Human Sciences & Education, University of Milano-Bicocca, Milan, Italy
| | - Peter Dambach
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Thomas Jaenisch
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
- Section Clinical Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany
- Centre for Global Health, Colorado School of Public Health, Aurora, Colorado, United States of America
| | - Olaf Horstick
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
| | - Volker Winkler
- Institute of Global Health, Heidelberg Research to Practice Group, Heidelberg University, Heidelberg, Germany
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159
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Determinants of Implementing Evidence-Based Trauma-Focused Interventions for Children and Youth: A Systematic Review. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 47:705-719. [PMID: 31813066 DOI: 10.1007/s10488-019-01003-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
A systematic review was conducted to identify determinants (barriers and facilitators) of implementing evidence-based psychosocial interventions for children and youth who experience emotional or behavioral difficulties due to trauma exposure. Determinants were coded, abstracted, and synthesized using the Exploration, Preparation, Implementation, and Sustainment framework. Twenty-three articles were included, all of which examined implementation of Trauma-Focused Cognitive Behavioral Therapy or Cognitive-Behavioral Intervention for Trauma in Schools. This review identified multilevel and multiphase determinants that can be addressed by implementation strategies to improve implementation and clinical outcomes, and suggests how future studies might address gaps in the evidence base.
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160
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Righi MK, Bogen KW, Kuo C, Orchowski LM. A Qualitative Analysis of Beliefs About Sexual Consent Among High School Students. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP8290-NP8316. [PMID: 30973037 DOI: 10.1177/0886260519842855] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Examining how adolescents understand the concept of sexual consent, and expect to garner or confer consent in sexual encounters, can contribute to the design of age- and developmentally appropriate prevention programs that promote healthy adolescent dating and sexual relationships. The current qualitative study utilized semi-structured in-depth interviews (N = 33) to explore perceptions of sexual consent among high school students (ages 14-18). Thematic analysis identified three salient themes pertaining to (a) the definition of consent as indicating a verbal "yes" to engage in sexual activity, (b) beliefs that an array of verbal and nonverbal strategies would be utilized to garner or convey consent in actual sexual encounters, and (c) expectations that consent would be communicated differently following an initial sexual encounter. Specifically, whereas consent was defined as a verbal provision of affirmative consent, both male and female adolescents believed girls typically conveyed consent nonverbally in sexual encounters. Adolescent girls indicated that they would convey sexual refusal through nonverbal cues, whereas adolescent boys reported they would proceed with sexual activity until they heard the verbal expression of "no." Regardless of gender, participants shared the perception that adolescents who previously engaged in sexual activity can expect that sexual activity will happen again without the need for verbal consent, particularly within established relationships. These findings highlight important discrepancies in adolescents' definition of sexual consent-primarily through verbal consent-and how they behaviorally indicated sexual consent and sexual refusal-primarily through nonverbal actions.
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161
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Koposov R, Isaksson J, Vermeiren R, Schwab-Stone M, Stickley A, Ruchkin V. Community Violence Exposure and School Functioning in Youth: Cross-Country and Gender Perspectives. Front Public Health 2021; 9:692402. [PMID: 34386472 PMCID: PMC8353073 DOI: 10.3389/fpubh.2021.692402] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Many children and adolescents experience violent events which can be associated with negative consequences for their development, mental health, school, and social functioning. However, findings between settings and on the role of gender have been inconsistent. This study aimed to investigate cross-country and gender differences in the relationship between community violence exposure (CVE) and school functioning in a sample of youths from three countries. Methods: A self-report survey was conducted among school students (12-17 years old) in Belgium (Antwerp, N = 4,743), Russia (Arkhangelsk, N = 2,823), and the US (New Haven, N = 4,101). Students were recruited from within classes that were randomly selected from within schools that had themselves been randomly selected (excepting New Haven, where all students were included). CVE was assessed with the Screening Survey of Exposure to Community Violence. School functioning was assessed with four measures: the Perceived Teacher Support scale, Negative Classroom Environment scale, and Academic Motivation and Perception of Safety at School scales. Multivariate Analyses of Covariance were performed to assess differences in the levels of school-related problem behaviors in boys and girls, who reported different degrees of CVE. Results: Participants in all three countries reported a relatively high prevalence of violence exposure (36.2% in Belgium, 39.3% in Russia and 45.2% in the US who witnessed violence), with a higher proportion of girls than boys witnessing violent events (varied from 37.4 to 51.6% between the countries), whereas boys reported more episodes of victimization by violence than girls (varied from 32.3 to 49.9% between the countries). Youths who experienced increased CVE (from no exposure to witnessing to victimization) reported an increase in all school functioning problems in all of the countries and this association was not gender-specific. Conclusions: Our findings suggest that regardless of differences in the level of CVE by country and gender, violence exposure is negatively associated with school functioning across countries. Nonetheless, even though reactions to community violence among adolescents may be expressed in a similar fashion, cross-country differences in social support systems should also be taken into account in order to provide culturally sensitive treatment modalities.
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Affiliation(s)
- Roman Koposov
- Regional Centre for Child and Youth Mental Health and Child Welfare, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.,Department of Epidemiology and Modern Technologies of Vaccination, Institute of Professional Education, Sechenov First Moscow State Medical University, Moscow, Russia
| | - Johan Isaksson
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden
| | | | | | - Andrew Stickley
- Stockholm Center for Health and Social Change, Södertörn University, Stockholm, Sweden
| | - Vladislav Ruchkin
- Child and Adolescent Psychiatry Unit, Department of Neuroscience, Uppsala University, Uppsala, Sweden.,School of Medicine, Yale University, New Haven, CT, United States.,Sater Forensic Psychiatric Clinic, Sater, Sweden
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162
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Lisitsa E, Bolden CR, Johnson BD, Mezulis AH. Impact of stress and parenting on respiratory sinus arrythmia trajectories in early adolescence. Dev Psychobiol 2021; 63:e22165. [PMID: 34292618 DOI: 10.1002/dev.22165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/22/2021] [Accepted: 06/27/2021] [Indexed: 11/06/2022]
Abstract
The effects of stress and parenting on 1-year trajectories of physiological emotion regulation capacity among adolescents were examined. Consistent with the vulnerability-stress and allostatic load models, stress (chronic family and marital) was hypothesized to be associated with less favorable trajectories of basal respiratory sinus arrhythmia (RSA) over 1 year. This relationship was further hypothesized to be moderated by parenting practices (warmth, neglect, and rejection) and adolescent sex. Participants included 150 adolescents (51.3% female), 11-15 years of age (M = 13.04, SD = 0.89). Basal RSA and stress were assessed four times across 1 year. Results indicated a significant decrease in RSA over the course of 1 year (β = -0.15, p = .010). Warm parenting style was associated with lower RSA in environments of low marital stress and was also related with higher RSA in environments of high marital stress (β = 0.86, p = .021). Rejecting parenting styles were associated with higher RSA in environments of low family stress and lower RSA in environments of high family stress (β = -0.60, p = .014). These findings may be explained by the Yerkes-Dodson law of optimal stress, suggesting that sufficient environmental challenge is needed to catalyze regulatory development.
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Affiliation(s)
- Ellie Lisitsa
- Department of Clinical Psychology, Seattle Pacific University, Seattle, Washington, USA
| | - China R Bolden
- Department of Clinical Psychology, Seattle Pacific University, Seattle, Washington, USA
| | - Benjamin D Johnson
- Department of Clinical Psychology, Seattle Pacific University, Seattle, Washington, USA
| | - Amy H Mezulis
- Department of Clinical Psychology, Seattle Pacific University, Seattle, Washington, USA
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163
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Bagneris JR, Noël LT, Harris R, Bennett E. School-Based Interventions for Posttraumatic Stress Among Children (Ages 5–11): Systematic Review and Meta-Analysis. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09451-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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164
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Sandu RD. Defining severe and multiple disadvantage from the inside: Perspectives of young people and of their support workers. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:1470-1486. [PMID: 33942920 DOI: 10.1002/jcop.22572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/17/2021] [Accepted: 03/18/2021] [Indexed: 06/12/2023]
Abstract
The aim of this study was to explore the way young people facing severe and multiple disadvantage and their support workers perceive the circumstances of the young person. The leaders of 11 U.K. and five U.S. support-providing organisations identified 30 young people aged 16 to 25 who were in great need and 35 workers for this study. Thematic analysis of the semi-structured interviews found that shame was a primary emotional reaction to severe and multiple disadvantage. A history of poor relationships led them to develop an acute assessment of others and a tendency to back away from help. Over time, they perceived themselves to be unworthy and unable. Findings underscored the young people's role in shaping their trajectories and shone light on the role of emotions in explaining disconnection from support.
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165
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Dong F, Calkins ME, Compton P, Medoff-Cooper B, Barzilay R, Taylor JH, Moore TM, Gur RC, Gur RE, Hodgson NA. Association between traumatic stressful events and schizotypal symptoms among a community-based sample of adolescents: A 2-year longitudinal study. Schizophr Res 2021; 233:44-51. [PMID: 34225026 DOI: 10.1016/j.schres.2021.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 04/30/2021] [Accepted: 06/22/2021] [Indexed: 01/05/2023]
Abstract
BACKGROUND Traumatic stressful events (TSEs) are among the most studied risk factors for subsequent schizotypal symptoms. However, specificity and aggregate effects of trauma exposure on schizotypal symptoms remain unclear. This study investigates these relationships among a community-based sample of US adolescents. MATERIAL AND METHODS A sub-sample of 426 adolescents (51.6% female) from the Philadelphia Neurodevelopmental Cohort study were selected for longitudinal follow-up based on presence (n = 209) or absence (n = 217) of psychosis spectrum symptoms (PSS). At baseline, they completed assessments of demographic, TSEs, other psychopathology (e.g., PSS, anxiety, depression, and behavioral disorder) and family history of psychopathology. Schizotypal symptom dimensions (cognitive-perceptual, interpersonal and disorganized) were evaluated approximately two years later. RESULTS More than half of adolescents experienced at least one type of TSE. Adolescents with assaultive trauma reported about 1.5 times as many symptoms on all three schizotypal symptom dimensions, compared to adolescents with non-assaultive TSE, adjusting for demographic and family history variables. No statistical significance was found after further adjusting for other baseline psychopathology (p > 0.05). There was a significant aggregate effect of TSEs on cognitive-perceptual symptoms with small effect size (p < 0.001, Cohen's f2 = 0.034). CONCLUSIONS We found evidence of an association between aggregate TSEs and cognitive-perceptual symptoms, but trauma type was not associated with schizotypal symptom dimensions when controlling for potential confounders. Our findings highlight the importance of considering aggregate TSE effects and potential confounds when examining associations between TSEs and schizotypy. Trauma and psychosis spectrum screening may be important in the effort to provide trauma-informed care.
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Affiliation(s)
- Fanghong Dong
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA 19104, USA
| | - Peggy Compton
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Ran Barzilay
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA 19104, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA 19104, USA
| | - Jerome H Taylor
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA 19104, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA 19104, USA
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA 19104, USA
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA 19104, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA 19104, USA
| | - Raquel E Gur
- Department of Psychiatry, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA 19104, USA; Lifespan Brain Institute, Penn Medicine and Children's Hospital of Philadelphia (CHOP), Philadelphia, PA 19104, USA; Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA 19104, USA
| | - Nancy A Hodgson
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA.
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166
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Wang P, Peng Z, Liu L, An L, Liu Y, Cao Q, Sun L, Ji N, Chen Y, Yang B, Wang Y. Neural response to trauma-related and trauma-unrelated negative stimuli in remitted and persistent pediatric post-traumatic stress disorder. Brain Behav 2021; 11:e02173. [PMID: 34076367 PMCID: PMC8323042 DOI: 10.1002/brb3.2173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 04/06/2021] [Accepted: 04/23/2021] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Most youths who suffer from post-traumatic stress disorder (PTSD) lose their diagnosis in the first 1-2 years. However, there are few studies on this brain mechanism, and the heterogeneity of the findings is partially due to the different stimuli applied and the mixed trauma history. Therefore, the use of trauma-related/unrelated stimuli to study the remittance mechanism of earthquake-induced PTSD could advance our knowledge of PTSD and inspire future treatment. METHODS Thirteen youths with PTSD, 18 remitted participants, and 18 control participants underwent functional magnetic resonance imaging (fMRI), while viewing trauma-related pictures, trauma-unrelated negative pictures, and scrambled pictures. RESULTS Under trauma-unrelated condition, the neural activity of the left hippocampus in the remitted group was between the two other groups. Under trauma-related condition, the PTSD and the remitted group exhibited higher neural activity in the right middle occipital gyrus than controls. The remitted group showed higher neural activity in the right parahippocampal gyrus and right lingual gyrus under trauma-related condition than trauma-unrelated condition, while no significant difference was found in PTSD group. CONCLUSION PTSD status-related group differences are mainly reflected in the left hippocampus under the trauma-unrelated condition, while the hyperactivity in the right middle occipital gyrus under trauma-related condition could be an endophenotype for PTSD.
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Affiliation(s)
- Peng Wang
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
- Shenzhen Children's HospitalShenzhenChina
- Cardiac Rehabilitation Center, Fuwai Hospital CAMS&PUMCBeijingChina
| | - Zu‐Lai Peng
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | - Lu Liu
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | - Li An
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | - Yu‐Xin Liu
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | - Qing‐Jiu Cao
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | - Li Sun
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | - Ning Ji
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | - Yun Chen
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
| | | | - Yu‐Feng Wang
- Sixth Hospital/Institute of Mental HealthPeking UniversityBeijingChina
- National Clinical Research Center for Mental Disorders & The Key Laboratory of Mental HealthMinistry of Health (Peking University)BeijingChina
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167
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Eilers R, Rosner R. Die einfache und komplexe Posttraumatische Belastungsstörung in der Praxis. KINDHEIT UND ENTWICKLUNG 2021. [DOI: 10.1026/0942-5403/a000342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die ICD-11 enthält reformulierte Kriterien für die Posttraumatische Belastungsstörung (PTBS) und die neue Diagnose komplexe PTBS (kPTBS). Fragestellung: Wie wirken sich die Neuerungen auf die Diagnostik und Behandlung von Kindern und Jugendlichen aus? Methode: In dieser Übersichtsarbeit werden die neuen Kriterien vorgestellt und mit früheren Diagnosemanualen verglichen. Bisherige Forschungsergebnisse zu PTBSICD-11 und kPTBS bei Kindern und Jugendlichen werden zusammengefasst und diskutiert. Ergebnisse: Die PTBSICD-11-Kriterien führen eher zu geringeren Prävalenzraten verglichen mit PTBSICD-10, PTBSDSM-IV und PTBSDSM-5. Erste Studien weisen darauf hin, dass evidenzbasierte traumafokussierte Therapiemanuale auch zur Behandlung der kPTBS geeignet sind. Diskussion und Schlussfolgerung: Die Anwendung neuer Kriterien stellt Praktiker_innen und Forscher_innen vor Herausforderungen. Bisherige Ergebnisse deuten an, dass die kPTBS gut behandelbar ist.
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Affiliation(s)
| | - Rita Rosner
- Katholische Universität Eichstätt-Ingolstadt
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168
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Vogel A, Steil R, Comteße H, Eilers R, Renneberg B, Rosner UR. Routineversorgung für Jugendliche und junge Erwachsene mit Posttraumatischer Belastungsstörung nach sexualisierter und physischer Gewalt in Deutschland. KINDHEIT UND ENTWICKLUNG 2021. [DOI: 10.1026/0942-5403/a000346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Für die Behandlung der Posttraumatischen Belastungsstörung (PTBS) im Jugend- und jungen Erwachsenenalter liegen diverse evidenzbasierte Interventionen (EBIs) vor. Fragestellung: Inwiefern sind EBIs für Jugendliche und junge Erwachsene mit PTBS nach sexualisierter und physischer Gewalt in Deutschland verfügbar? Methode: Es wurden die Daten von 39 Teilnehmenden einer multizentrischen Behandlungsstudie analysiert, die für die Diagnose einer PTBS ambulante Behandlungsempfehlungen erhalten hatten. Ergebnisse: In den folgenden sieben Monaten erhielten 21 der Teilnehmenden eine Behandlung; bei nur acht wurden in deren Rahmen die traumatischen Erfahrungen adressiert. Alle Teilnehmenden verbesserten sich hinsichtlich der PTBS-Symptomatik unabhängig von der Art der Behandlung. Diskussion und Schlussfolgerung: Die Ergebnisse weisen auf Barrieren für den Zugang zu EBIs in unserer Stichprobe hin. Künftige Forschung sollte die Hintergründe für diese Barrieren fokussieren.
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Affiliation(s)
- Anna Vogel
- Lehrstuhl für Klinische und Biologische Psychologie, Katholische Universität Eichstätt-Ingolstadt
| | - Regina Steil
- Institut für Psychologie, Klinische Psychologie und Psychotherapie, Goethe Universität Frankfurt
| | - Hannah Comteße
- Lehrstuhl für Klinische und Biologische Psychologie, Katholische Universität Eichstätt-Ingolstadt
| | - Rebekka Eilers
- Lehrstuhl für Klinische und Biologische Psychologie, Katholische Universität Eichstätt-Ingolstadt
| | - Babette Renneberg
- Arbeitsbereich Klinische Psychologie und Psychotherapie, Fachbereich Erziehungswissenschaft und Psychologie, Freie Universität Berlin
| | - und Rita Rosner
- Lehrstuhl für Klinische und Biologische Psychologie, Katholische Universität Eichstätt-Ingolstadt
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169
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Vogel A, Rosner R. Lost in Transition? Evidence-Based Treatments for Adolescents and Young Adults with Posttraumatic Stress Disorder and Results of an Uncontrolled Feasibility Trial Evaluating Cognitive Processing Therapy. Clin Child Fam Psychol Rev 2021; 23:122-152. [PMID: 31620891 DOI: 10.1007/s10567-019-00305-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Posttraumatic stress disorder (PTSD) is not uncommon among adolescents and young adults (AYAs). Left untreated, transition to adulthood might be especially challenging and/or prolonged for AYAs. However, it is unclear whether AYAs are adequately represented in current PTSD treatment research and whether they benefit to the same degree as younger or older individuals. In the first part of the paper, we reflect on developmental considerations in the treatment of AYAs and give an overview of current age-specific results in PTSD treatment research. Furthermore, we review individual trauma-focused evidence-based treatments that were examined in AYAs over the last 10 years. In the second part, we present data from an uncontrolled feasibility trial evaluating cognitive processing therapy (CPT) with some age-adapted modifications and an exposure component (written accounts). We treated 17 AYAs (aged 14 to 21) suffering from posttraumatic stress symptoms (PTSS). At posttreatment, participants had improved significantly with respect to clinician-rated PTSS severity (d = 1.32). Treatment gains were maintained throughout the 6-week and 6-month follow-ups. Results indicated that CPT, with only minor adaptations, was feasible and safe in AYAs. The recommendations for future research focus on the inclusion of young adults in trials with adolescents, more refined age reporting in clinical trials, and the encouragement of dismantling studies in youth. To conclude, clinical recommendations for caregiver involvement and the addressing of developmental tasks, motivational issues and emotion regulation problems are discussed.
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Affiliation(s)
- Anna Vogel
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Germany.
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Germany
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170
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Orzechowski M, Wigand ME, Nowak M, Becker T, Steger F. Post-traumatic stress disorder, human rights and access to healthcare: an analysis of judgments of the European Court of Human Rights from an ethical perspective. Eur J Psychotraumatol 2021; 12:1930704. [PMID: 34211639 PMCID: PMC8221123 DOI: 10.1080/20008198.2021.1930704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Background: Human rights violations such as torture are associated with a high risk of post-traumatic stress disorder (PTSD). The judgements of the European Court of Human Rights (ECtHR) include a normative perspective on PTSD and address central ethical questions. Objective: To help bridge the gap between the psycho-medical and the legal discourse on human rights violations and to illustrate their medico-ethical implications by systematically assessing and categorizing all judgements by the ECtHR dealing with PTSD. Method: The ECtHR database was searched for 'post-traumatic stress disorder'. A descriptive statistic was performed on the Articles of the European Convention on Human Rights involved and violations to these articles. In a qualitative analysis, the judgements were thematically grouped. Results: The search yielded n = 103 judgements, of which n = 90 were included. There were mostly violations of Article 3 (prohibition of torture), Article 8 (Right to respect for private and family life) and Article 6 (Right to a fair trial). PTSD in these judgements is normatively discussed with regards to ethical, social and political themes such as inadequate access to healthcare, especially in prison, matters of asylum, expulsion and extradition, protection of minorities and minors, as well as rights and duties of traumatized witnesses. Conclusion: PTSD plays a central role in a large number of ECtHR judgements. Our results show that PTSD as a medical diagnosis also encompasses legal, ethical, social, and political dimensions. This knowledge is essential for healthcare professionals working with traumatized persons, but can also be relevant for political decision-makers.
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Affiliation(s)
- Marcin Orzechowski
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Moritz E Wigand
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany.,Department of Psychiatry II, Ulm University and BKH Günzburg, Günzburg, Germany
| | - Marianne Nowak
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
| | - Thomas Becker
- Department of Psychiatry II, Ulm University and BKH Günzburg, Günzburg, Germany
| | - Florian Steger
- Institute of the History, Philosophy and Ethics of Medicine, Ulm University, Ulm, Germany
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171
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Schønning V, Dovran A, Hysing M, Hafstad GS, Stokke K, Aarø LE, Tobiassen S, Jonassen JAB, Vedaa Ø, Sivertsen B. Study protocol: the Norwegian Triple-S Cohort Study - establishing a longitudinal health survey of children and adolescents with experiences of maltreatment. BMC Public Health 2021; 21:1082. [PMID: 34090417 PMCID: PMC8179690 DOI: 10.1186/s12889-021-11125-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 05/24/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Child maltreatment is prevalent and associated with both short- and long-term health problems. Previous studies have established child maltreatment as a risk factor for a wide range of problems over the life course such as mental- and somatic health problems, self-harm, alcohol- and drug abuse and decreased work-life participation. Still, there are few large and well-conducted longitudinal studies focusing on describing prevalence and identifying risk factors and long-term consequences of child maltreatment. The purpose of the current study is to recruit a large number of children and adolescents exposed to maltreatment and follow them long-term. METHODS/DESIGN The current study is a longitudinal cohort study and will use a multi-informant design (child/adolescent, caregiver, and administrative data). Participants will be recruited from the Stine Sofie Centre (SSC), a learning and coping centre for children and adolescents (≤18 years) exposed to maltreatment, which includes physical and emotional abuse, neglect and/or sexual abuse. Questionnaire-based assessments from self-reports (as well as parent-reports) will be carried out at regular time intervals throughout their lives, on topics such as abuse, negative life events, mental and somatic health problems, resilience and coping, satisfaction with health services, social-, family-, and school function, as well as self-harm and substance abuse. Participants will be assessed upon entry to the centre and followed up annually until they reach 18 years and bi-annually after. Given written consent, participants' responses will be linked to relevant national registries in order to examine predictive factors and important outcomes in terms of subsequent health, education, criminal records and work affiliation. DISCUSSION This study will examine short- and long-term consequences of child maltreatment across a range of health-related outcomes in a longitudinal perspective. Results from the current study might have implications for the development of preventive and intervention programs related to child maltreatment and the organization and follow-up of the services these children receive. The current study will hopefully contribute with knowledge of risk-factors, short- and long-term health-related and other issues that can contribute to practices aimed at improving the overall life-course for children and adolescents who have experienced childhood maltreatment.
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Affiliation(s)
- Viktor Schønning
- Department of Health Promotion, Norwegian Institute of Public Health, Postboks 973 Sentrum, 5808, Bergen, Norway.
- Department of Psychosocial Science, University of Bergen, Bergen, Norway.
| | - Anders Dovran
- Stine Sofie Foundation & Stine Sofie Centre, Grimstad, Norway
- Department of Psychosocial Health, University of Agder, Grimstad, Norway
| | - Mari Hysing
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | | | - Kristin Stokke
- Stine Sofie Foundation & Stine Sofie Centre, Grimstad, Norway
| | - Leif Edvard Aarø
- Department of Health Promotion, Norwegian Institute of Public Health, Postboks 973 Sentrum, 5808, Bergen, Norway
| | - Stian Tobiassen
- Stine Sofie Foundation & Stine Sofie Centre, Grimstad, Norway
| | | | - Øystein Vedaa
- Department of Health Promotion, Norwegian Institute of Public Health, Postboks 973 Sentrum, 5808, Bergen, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Voss District Psychiatric Hospital, NKS Bjørkeli, Voss, Norway
- Department of Research and Development, St Olavs University Hospital, Trondheim, Norway
| | - Børge Sivertsen
- Department of Health Promotion, Norwegian Institute of Public Health, Postboks 973 Sentrum, 5808, Bergen, Norway
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Research & Innovation, Helse Fonna HF, Haugesund, Norway
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Abstract
ABSTRACT US women who report having experienced significant trauma at some point in their lives range from 50% to 90%. Yet posttraumatic stress disorder (PTSD) goes largely unrecognized in women. This article discusses ways to monitor, screen, and intervene for PTSD in women.
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Affiliation(s)
- Elizabeth Heavey
- Elizabeth Heavey is a professor of nursing and Graduate Program Director at State University of New York Brockport and certified nurse-midwife at the Hazen Center for Integrated Care, Brockport, N.Y
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173
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Dams J, Rimane E, Steil R, Renneberg B, Rosner R, König HH. Reliability, Validity and Responsiveness of the EQ-5D-5L in Assessing and Valuing Health Status in Adolescents and Young Adults with Posttraumatic Stress Disorder: a Randomized Controlled Trail. Psychiatr Q 2021; 92:459-471. [PMID: 32803473 PMCID: PMC8110499 DOI: 10.1007/s11126-020-09814-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
To validate the EQ-5D-5L health-related quality of life (HrQoL) questionnaire in adolescents and young adults with posttraumatic stress disorder (PTSD) after sexual and/or physical abuse. We used data from a randomized controlled trial of 87 participants with PTSD aged 14-21 years. The discriminative ability was evaluated by comparing participants scores on the descriptive system of the EQ-5D-5L with general population scores. Furthermore, the discriminative ability between subgroups of participants with different disease severity levels was estimated. Correlations between the EQ-5D index and clinical parameters were used to measure construct validity. Test-retest reliability was measured by intraclass correlation coefficients (ICC) between baseline, posttreatment and 3-month follow-up scores of participants with stable symptoms. Finally, the responsiveness of the EQ-5D was calculated by mean differences, effect sizes and receiver operating characteristic (ROC) analyses for participants with improved symptoms. Participants reported significantly more problems on the dimensions "mobility", "usual activities", "pain/discomfort" and "anxiety/depression" than the general population. The EQ-5D-5L was able to discriminate between different disease severity levels. The EQ-5D index and clinical scales were significantly correlated with absolute values of correlation coefficients varying between 0.21 and 0.59. Furthermore, ICCs between 0.65 and 0.91 indicated good test-retest reliability for the EQ-5D index. The ICCs for the EQ-VAS between baseline and 3-month follow-up, and posttreatment and 3-month follow-up were statistically significant with 0.71 and 0.87, respectively, whereas the ICC between baseline and posttreatment was 0.08 and not statistically significant. Effect sizes to measure the responsiveness ranged between -0.008 and 0.40 for the EQ-5D index and - 0.32 and 0.40 for the EQ-VAS. Furthermore, the area under the curve in ROC analyses was between 0.40 and 0.64 for the EQ-5D index and 0.60 and 0.70 for the EQ-VAS. Discriminative ability, test-retest reliability and construct validity of the EQ-5D-5L were good, whereas the responsiveness was rather weak. Nevertheless, the EQ-5D-5L can be used to measure HrQoL in adolescents and young adults with PTSD. German Clinical Trials Register identifier: DRKS00004787; date of registration: 18th March 2013; https://www.drks.de.
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Affiliation(s)
- Judith Dams
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany.
| | - Eline Rimane
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Babette Renneberg
- Department of Clinical Psychology and Psychotherapy, Freie Universitaet Berlin, Berlin, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
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174
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Kim SY, Yang K, Oh IH, Park S, Cheong HK, Hwang JW. Incidence and Direct Medical Cost of Acute Stress Disorder and Post-traumatic Stress Disorder in Korea: Based on National Health Insurance Service Claims Data from 2011 to 2017. J Korean Med Sci 2021; 36:e125. [PMID: 33975398 PMCID: PMC8111042 DOI: 10.3346/jkms.2021.36.e125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/15/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND We aimed to investigate the annual incidence of trauma and stress-related mental disorder including acute stress disorder (ASD) and post-traumatic stress disorder (PTSD) using the National Health Insurance Service Database. In addition, we estimated direct medical cost of ASD and PTSD in Korea. METHODS To examine the incidence, we selected patients who had at least one medical claim containing a 10th revision of the International Statistical Classification of Diseases and Related Health Problems code for ASD (F43.0) and PTSD (F43.1) and had not been diagnosed in the previous 360 days, from 2010 to 2017. We estimated annual incidence and the number of newly diagnosed patients of ASD and PTSD. Annual prevalence and direct medical cost of ASD and PTSD were also estimated. RESULTS The number of newly diagnosed cases of ASD and PTSD from 2011 to 2017 totaled 38,298 and 21,402, respectively. The mean annual incidence of ASD ranged from 8.4 to 13.7 per 100,000 population and that of PTSD ranged from 4.2 to 8.3 per 100,000 population, respectively. The incidence of ASD was found more in females and was highest among the 70-79 years of age group and the self-employed individuals group. The incidence of PTSD was also more common in the female group. However, the incidence of PTSD was highest in the 60-69 years of age group and in the medical aid beneficiaries group. The annual estimated medical cost per person of ASD ranged from 104 to 149 US dollars (USD). In addition, that of PTSD ranged from 310 to 426 USD. CONCLUSION From 2011 to 2017, the annual incidence and direct medical cost of ASD and PTSD in Korea were increased. Proper information on ASD and PTSD will not only allows us to accumulate more knowledge about these disorders themselves but also lead to more appropriate therapeutic interventions by improving the ability to cope with these trauma related psychiatric sequelae.
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MESH Headings
- Adaptation, Psychological
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Child
- Child, Preschool
- Diagnostic and Statistical Manual of Mental Disorders
- Direct Service Costs/statistics & numerical data
- Female
- Humans
- Incidence
- Infant
- Infant, Newborn
- Insurance Claim Review/economics
- Insurance Claim Review/statistics & numerical data
- Male
- Middle Aged
- National Health Programs
- Republic of Korea/epidemiology
- Stress Disorders, Post-Traumatic/diagnosis
- Stress Disorders, Post-Traumatic/economics
- Stress Disorders, Post-Traumatic/epidemiology
- Stress Disorders, Traumatic, Acute/diagnosis
- Stress Disorders, Traumatic, Acute/economics
- Stress Disorders, Traumatic, Acute/epidemiology
- Young Adult
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Affiliation(s)
| | - KyoJin Yang
- Department of Psychiatry, Kangwon National University Hospital, Kangwon University School of Medicine, Chuncheon, Korea
| | - In Hwan Oh
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Saengryeol Park
- Department of Physical Education, School of Education, Chonnam National University, Gwangju, Korea
| | - Hyeon Kyoung Cheong
- Department of Preventive Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jun Won Hwang
- Department of Psychiatry, Kangwon National University Hospital, Kangwon University School of Medicine, Chuncheon, Korea.
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175
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Measuring the Impact of Trauma-Focused, Cognitive Behavioral Group Therapy with Middle School Students. SCHOOL MENTAL HEALTH 2021. [DOI: 10.1007/s12310-021-09452-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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176
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Ensink JBM, Keding TJ, Henneman P, Venema A, Papale LA, Alisch RS, Westerman Y, van Wingen G, Zantvoord J, Middeldorp CM, Mannens MMAM, Herringa RJ, Lindauer RJL. Differential DNA Methylation Is Associated With Hippocampal Abnormalities in Pediatric Posttraumatic Stress Disorder. BIOLOGICAL PSYCHIATRY: COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2021; 6:1063-1070. [PMID: 33964519 DOI: 10.1016/j.bpsc.2021.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 04/01/2021] [Accepted: 04/26/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Recent findings in neuroimaging and epigenetics offer important insights into brain structures and biological pathways of altered gene expression associated with posttraumatic stress disorder (PTSD). However, it is unknown to what extent epigenetic mechanisms are associated with PTSD and its neurobiology in youth. METHODS In this study, we combined a methylome-wide association study and structural neuroimaging measures in a Dutch cohort of youths with PTSD (8-18 years of age). We aimed to replicate findings in a similar independent U.S. cohort. RESULTS We found significant methylome-wide associations for pediatric PTSD (false discovery rate p < .05) compared with non-PTSD control groups (traumatized and nontraumatized youths). Methylation differences on nine genes were replicated, including genes related to glucocorticoid functioning. In both cohorts, methylation on OLFM3 gene was further associated with anterior hippocampal volume. CONCLUSIONS These findings point to molecular pathways involved in inflammation, stress response, and neuroplasticity as potential contributors to neural abnormalities and provide potentially unique biomarkers and treatment targets for pediatric PTSD.
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Affiliation(s)
- Judith B M Ensink
- Genome Diagnostics Laboratory, Department of Clinical Genetics, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands; Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands; Academic Centre for Child and Adolescent Psychiatry, De Bascule, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Taylor J Keding
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin
| | - Peter Henneman
- Genome Diagnostics Laboratory, Department of Clinical Genetics, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Andrea Venema
- Genome Diagnostics Laboratory, Department of Clinical Genetics, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ligia A Papale
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Reid S Alisch
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Yousha Westerman
- Academic Centre for Child and Adolescent Psychiatry, De Bascule, Amsterdam, the Netherlands
| | - Guido van Wingen
- Department of Psychiatry, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Jasper Zantvoord
- Department of Psychiatry, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands
| | - Christel M Middeldorp
- Children's Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Marcel M A M Mannens
- Genome Diagnostics Laboratory, Department of Clinical Genetics, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands; Amsterdam Reproduction and Development Research Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ryan J Herringa
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; Neuroscience Training Program, University of Wisconsin-Madison, Madison, Wisconsin.
| | - Ramon J L Lindauer
- Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, location AMC, Amsterdam, the Netherlands; Academic Centre for Child and Adolescent Psychiatry, De Bascule, Amsterdam, the Netherlands
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177
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Nadeem E, Floyd-Rodríguez V, de la Torre G, Greswold W. Trauma in Schools: An Examination of Trauma Screening and Linkage to Behavioral Health Care in School-Based Health Centers. THE JOURNAL OF SCHOOL HEALTH 2021; 91:428-436. [PMID: 33728655 DOI: 10.1111/josh.13014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND This study examined trauma screening and behavioral health linkage rates in school-based health centers (SBHCs). METHODS Participants included 4161 English- and Spanish-speaking patients between the ages of 12 and 22 across 8 urban SBHCs 2 years. Screening rates at medical visits and linkage to additional behavioral health screening and services were assessed via electronic medical records and a chart audit. RESULTS Medical providers administered the Primary Care-PTSD screen to 66.3% of patients in year 1 and 46.7% of patients in year 2. Rates of positive trauma screens were 27.5% and 32.1%, respectively, with more girls screening positive than boys. Few (year 1; 8.1%; year 2: 9.6%) adolescents received additional trauma screening by a behavioral health clinician. However, the majority were linked to services (year 1: 66%; year 2: 74%). Lack of documentation (year 1: 24%; year 2: 33%) was a common gap in the charts of patients who did not receive a second stage trauma screening. Demographic differences in screening rates were minimal. CONCLUSION The current study supports the feasibility of traumatic stress screening and linkage within an integrated care setting. Process improvement efforts should, however, address communication gaps around trauma assessment and its integration into ongoing care.
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Affiliation(s)
- Erum Nadeem
- Associate Professor, , Graduate School of Applied and Professional Psychology, Rutgers University, 152 Frelinghuysen Road, Piscataway, NJ, 08854., USA
| | - Vanessa Floyd-Rodríguez
- Program Analyst, , City of Oakland, 150 Frank Ogawa Plaza, Suite 4340, Oakland, CA, 94612., USA
| | - Gabriela de la Torre
- Operations Manager, , Integrated Behavioral Health, La Clínica de La Raza, Inc., 1450 Fruitvale Avenue 3rd Floor, Oakland, CA, 94601., USA
| | - Whitney Greswold
- Integrated Behavioral Health Operations Administrator, , La Clínica de La Raza, Inc., 1450 Fruitvale Avenue, 3rd Floor, Oakland, CA, 94601., USA
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178
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Lowe SR, Ratanatharathorn A, Lai BS, van der Mei W, Barbano AC, Bryant RA, Delahanty DL, Matsuoka YJ, Olff M, Schnyder U, Laska E, Koenen KC, Shalev AY, Kessler RC. Posttraumatic stress disorder symptom trajectories within the first year following emergency department admissions: pooled results from the International Consortium to predict PTSD. Psychol Med 2021; 51:1129-1139. [PMID: 32008580 PMCID: PMC8318129 DOI: 10.1017/s0033291719004008] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics. METHODS This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course. RESULTS Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory. CONCLUSIONS The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.
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Affiliation(s)
| | - Andrew Ratanatharathorn
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Betty S Lai
- Lynch School of Education and Human Development, Boston College, Chestnut Hill, USA
| | | | | | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, NSW2052, Australia
- Brain Dynamics Centre, Westmead Institute of Medical Research, University of Sydney, Westmead, Australia
| | | | - Yutaka J Matsuoka
- Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan
| | - Miranda Olff
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- ARQ National Psychotrauma Centre, Diemen, The Netherlands
| | | | - Eugene Laska
- Steven and Alexandra Cohen Veterans Center for the Study of Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University School of Medicine
| | - Karestan C Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Arieh Y Shalev
- Department of Psychiatry, New York University School of Medicine, New York, New York
| | - Ronald C Kessler
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
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179
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Moreland A, Ressler KJ. A Perspective for Understanding Trauma and the Criminal Juvenile Justice System: Using a Trauma-Informed Lens for Meaningful and Sustained Change. Harv Rev Psychiatry 2021; 29:216-224. [PMID: 33660626 DOI: 10.1097/hrp.0000000000000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Trauma exposure and posttraumatic stress disorder are common and are associated with a wide range of negative psychiatric and physical outcomes. Furthermore, a large percentage of justice-involved youth have high rates of trauma exposure and trauma-related symptoms. Addressing these issues would improve outcomes at the level of the justice system overall and in the lives of justice-involved youth. Nonetheless, awareness, education, and implementation of trauma-informed approaches in the criminal juvenile justice system are lacking. This article explores current literature that operationalizes trauma-informed practices and approaches in the criminal and juvenile justice systems. Unfortunately, there is no shared understanding or definition of trauma and no predictability in trauma-informed practices and approaches in the criminal juvenile justice system. Despite the presence of written policies, the application and execution of such policies are limited and inconsistent throughout the system. These limitations contribute to ongoing, systemic institutional racism, lack of mental health or substance abuse treatment, limited diversion options, and unnecessary jail and prison sentences, which together amplify financial and humanitarian costs. We argue that in order for the criminal juvenile justice system to become trauma-informed, it should (1) meet basic needs of clients, (2) check and change narratives, and check underlying assumptions, (3) focus on skill building/habilitation, (4) move away from punishment and toward rehabilitation and humanitarian approaches, and (5) heal and support members that work in and for the system. We conclude that there is a need to improve processes for education, training, and coaching in, and consistent application of, trauma-informed practices and approaches within the criminal and juvenile justice systems.
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Affiliation(s)
- Alisha Moreland
- From the Department of Psychiatry, Oregon Health Sciences University (Dr. Moreland); Harvard Medical School (Dr. Ressler); McLean Hospital, Belmont, MA (Dr. Ressler)
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180
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Rittenberger M, Ostrowski-Delahanty S, Woods K. The impact of trauma exposure on headache outcomes. CHILDRENS HEALTH CARE 2021. [DOI: 10.1080/02739615.2021.1913163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Morgan Rittenberger
- NeuroDevelopmental Science Center, Akron Children’s Hospital, Akron, Ohio, USA
- Speech and Hearing, Cleveland State University, Cleveland, Ohio, USA
| | | | - Kristine Woods
- NeuroDevelopmental Science Center, Akron Children’s Hospital, Akron, Ohio, USA
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181
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Azza Y, Grueschow M, Karlen W, Seifritz E, Kleim B. How stress affects sleep and mental health: nocturnal heart rate increases during prolonged stress and interacts with childhood trauma exposure to predict anxiety. Sleep 2021; 43:5682806. [PMID: 31863098 DOI: 10.1093/sleep/zsz310] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/17/2019] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES Stress can adversely impact sleep health by eliciting arousal increase and a cascade of endocrine reactions that may impair sleep. To date, little is known regarding continuous effects of real-world stress on physiological sleep characteristics and potential effects on stress-related psychopathology. We examined effects of stress on heart rate (HR) during sleep and total sleep time (TST) during prolonged real-world stress exposure in medical interns. Moreover, we investigated the influence of previous stress and childhood trauma exposure on HR during sleep, TST, and its interaction in predicting anxiety. METHODS We examined a sample of 50 medical students prior to and during their first internship, a well described real-world stressor. HR and TST were continuously collected over 12 weeks non-invasively by a wrist-worn activity monitor. Prior to starting the internship, at baseline, participants reported on their sleep, anxiety, and childhood trauma exposure. They also tracked stress exposure during internship and reported on their anxiety symptoms 3 months after this professional stress. RESULTS Mean HR during sleep increased over time, while TST remained unchanged. This effect was more pronounced in interns exposed to childhood trauma exposure. In multilevel models, childhood trauma exposure also moderated the relation between individual HR increase and development of anxiety. CONCLUSIONS Prolonged stress may lead to increased HR during sleep, whereas individuals with childhood trauma exposure are more vulnerable. Childhood trauma exposure also moderated the relation between individual HR increase and development of anxiety. These findings may inform prevention and intervention measures.
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Affiliation(s)
- Yasmine Azza
- Department of Psychology, University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Sleep & Health Zürich, University of Zurich, Zurich, Switzerland
| | - Marcus Grueschow
- Zurich Center for Neuroeconomics, Department of Economics, University of Zurich, Zurich, Switzerland
| | - Walter Karlen
- Mobile Health Systems Lab, Institute of Robotics and Intelligent Systems, Department of Health Sciences and Technology, ETH Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Sleep & Health Zürich, University of Zurich, Zurich, Switzerland
| | - Birgit Kleim
- Department of Psychology, University of Zurich, Zurich, Switzerland.,Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric Hospital, University of Zurich, Zurich, Switzerland.,Sleep & Health Zürich, University of Zurich, Zurich, Switzerland
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182
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Hu T, Wang Y, Lin L, Tang W. The mediating role of daytime sleepiness between problematic smartphone use and post-traumatic symptoms in COVID-19 home-refined adolescents. CHILDREN AND YOUTH SERVICES REVIEW 2021; 126:106012. [PMID: 33846662 PMCID: PMC8028598 DOI: 10.1016/j.childyouth.2021.106012] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/23/2021] [Accepted: 04/06/2021] [Indexed: 02/08/2023]
Abstract
Background COVID-19 was first recognized in late 2019 in China, at which time school closures forced most students to isolate at home or maintain social distance, both of which increased smartphone use, daytime sleepiness and post traumatic disorder (PTSD) risks. However, to date, no research has fully explored these behavioral risks or the consequences. Methods Two thousand and ninety home-confined students from two Chinese high schools participated in an online-based questionnaire battery that assessed their sociodemographic characteristics, COVID-19 related exposures, daytime sleepiness, problematic smartphone use, and PTSD. The subsequent data were subjected to mediation analysis, and structural equation models (SEM) were employed to explore the variable relationships. Results The problematic smartphone use, daytime sleepiness and PTSD prevalence were respectively 16.4%, 20.2% and 6.9%. The number of COVID-19 related exposure was directly associated with problematic smartphone use and PTSD symptoms. Problematic smartphone use was found to be a mediator between COVID-19 related exposure and PTSD symptoms, and daytime sleepiness was found to partially mediate the associations between problematic smartphone use and PTSD. Conclusions The more exposure associated with the pandemic, the more psychological and behavioral problems the adolescents had. The relatively high rate of problematic smartphone use in home isolated adolescents possibly increased the risk of daytime sleepiness and psychological problems. Therefore, targeted improvements are needed to reduce the risk of psychological problems and daytime sleepiness in adolescents.
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Affiliation(s)
- Tao Hu
- Department of Psychology, Chengdu Normal University, Chengdu, China
| | - Ying Wang
- Department of Psychology, Chengdu Normal University, Chengdu, China
| | - Ling Lin
- Department of Psychology, Chengdu Normal University, Chengdu, China
| | - Wanjie Tang
- Centre for Educational and Health Psychology, Sichuan University, Chengdu, China.,Mental Health Center, State Key Lab of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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183
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Levy IP, Hess CW, Elber A, Hayden L. A Community-Based Intervention: A Hip Hop Framework Toward Decolonizing Counseling Spaces. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2021. [DOI: 10.1080/15401383.2020.1762816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ian P. Levy
- Department of Counseling and Therapy, Manhattan College, New York, NY, USA
| | - Courtney W. Hess
- Department of Counseling and School Psychology, University of Massachusetts-Boston, Boston, MA, USA
| | - Allison Elber
- Department of Counseling and School Psychology, University of Massachusetts-Boston, Boston, MA, USA
| | - Laura Hayden
- Department of Counseling and School Psychology, University of Massachusetts-Boston, Boston, MA, USA
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184
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Cooper DK, Erolin KS, Wieling E, Durtschi J, Aguilar E, Higuera MOD, Garcia-Huidobro D. Family Violence, PTSD, and Parent-Child Interactions: Dyadic Data Analysis with Mexican Families. CHILD & YOUTH CARE FORUM 2021; 49:915-940. [PMID: 33746465 DOI: 10.1007/s10566-020-09564-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Family violence has been shown to have a dramatic impact on individual and family life in the United States and other countries. Numerous studies have assessed the influence that exposure to violence can have on family dynamics and parent-child relationships. However, less is known about the association between family violence and parent-child relationships with Mexican families. OBJECTIVE Guided by social interaction learning theory, the purpose of this study was to explore the role of exposure to family violence on PTSD and mother-child interaction patterns. METHODS Eighty-seven mother-child dyads from Mexico completed assessments for exposure to family violence, PTSD, and observational tasks were analyzed to assess prosocial parent-child interactions (i.e., positive communication and problem solving). We conducted an actor-partner independence model (APIM) to examine the association between exposure to family violence, PTSD and mother-child relationship dynamics. RESULTS As expected, higher exposure to family violence was linked to higher PTSD symptoms for mothers. Unexpectedly, higher maternal PTSD symptoms were associated with better communication during dyadic interaction tasks with their children. CONCLUSIONS The present study suggests that individuals from certain cultures (i.e., Mexico) may respond differently to experiencing family violence. The use of multiple measurement methods to assess the relational effects of trauma on family dynamics can advance the scientific understanding of trauma affected families.
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Affiliation(s)
- Daniel K Cooper
- Methodology Center and Edna Bennett Pierce Prevention Research Center, the Pennsylvania State University
| | - Kara S Erolin
- Department of Family Therapy, Nova Southeastern University
| | - Elizabeth Wieling
- Marriage and Family Therapy, Department of Human Development and Family Science, University of Georgia
| | - Jared Durtschi
- Department of Family Studies and Human Services, Kansas State University
| | | | | | - Diego Garcia-Huidobro
- Department of Family Medicine, School of Medicine, Pontificia Universidad Católica de Chile
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185
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Barzilay R, Moore TM, Calkins ME, Maliackel L, Jones JD, Boyd RC, Warrier V, Benton TD, Oquendo MA, Gur RC, Gur RE. Deconstructing the role of the exposome in youth suicidal ideation: Trauma, neighborhood environment, developmental and gender effects. Neurobiol Stress 2021; 14:100314. [PMID: 33869680 PMCID: PMC8040329 DOI: 10.1016/j.ynstr.2021.100314] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 12/28/2020] [Accepted: 03/04/2021] [Indexed: 02/06/2023] Open
Abstract
Environment (E) is pivotal in explaining variability in brain and behavior development, including suicidal ideation (SI) and behavior. It is therefore critical to systematically study relationships among environmental exposures (i.e., exposome) and suicidal phenotypes. Here, we evaluated the role of individual-level adversity and neighborhood environment and their interaction (E x E) in association with youth SI. Sample included youth (N = 7,054, ages 11–21) from the Philadelphia Neurodevelopmental Cohort, which investigated clinical phenotypes in a diverse US community population. We examined cross-sectional associations of environmental exposures with lifetime history of SI (n = 671), focusing on interactions between individual-level exposures to assaultive trauma (n = 917) and neighborhood-level socioeconomic status (SES) quantified using geocoded Census data. Models included potential confounds and overall psychopathology. Results showed that assaultive trauma was strongly associated with SI (OR = 3.3, 95%CI 2.7–4, p < .001), while low SES was not (p = .395). Both assault and low SES showed stronger association with SI in females, and in early adolescence (all E X gender/age interactions, p < .05). In traumatized youths, lower SES was associated with less SI, with no SES effects on SI in non-traumatized youths (Assault X SES interaction, Wald = 8.19, p = .004). Associations remained significant controlling for overall psychopathology. No single SES variable emerged above others to explain the moderating effect of SES. These findings may suggest a stress inoculation effect in low SES, where youths from higher SES are more impacted by the deleterious trauma-SI association. Determining which environmental factors contribute to resilience may inform population specific suicide prevention interventions. The cross-sectional study design limits causal inferences. Environment (E) is key in shaping development of suicidal ideation (SI). We integrated individual-level trauma exposure and neighborhood-level data on socioeconomic status (SES) in N=7,054 youths. Trauma was robustly associated with youth SI in our cohort, while SES had no association with SI. Only in youth with history of assaultive trauma, low SES was associated with lower SI rates (trauma by SES interaction). Results suggest a stress inoculation effect that was shown in animal models, but has not been shown in human suicide research.
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Affiliation(s)
- Ran Barzilay
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine; The Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania. Philadelphia, PA, USA
| | - Tyler M Moore
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine; The Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania. Philadelphia, PA, USA
| | - Monica E Calkins
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine; The Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania. Philadelphia, PA, USA
| | - Lydia Maliackel
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine; The Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania. Philadelphia, PA, USA
| | - Jason D Jones
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine; The Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA, USA
| | - Rhonda C Boyd
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine; The Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania. Philadelphia, PA, USA
| | - Varun Warrier
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridgeshire, UK
| | - Tami D Benton
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine; The Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania. Philadelphia, PA, USA
| | - Maria A Oquendo
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania. Philadelphia, PA, USA
| | - Ruben C Gur
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine; The Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania. Philadelphia, PA, USA
| | - Raquel E Gur
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine; The Department of Child and Adolescent Psychiatry and Behavioral Sciences, CHOP, Philadelphia, PA, USA.,Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania. Philadelphia, PA, USA
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186
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Li L, Pan N, Zhang L, Lui S, Huang X, Xu X, Wang S, Lei D, Li L, Kemp GJ, Gong Q. Hippocampal subfield alterations in pediatric patients with post-traumatic stress disorder. Soc Cogn Affect Neurosci 2021; 16:334-344. [PMID: 33315100 PMCID: PMC7943370 DOI: 10.1093/scan/nsaa162] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/15/2020] [Accepted: 12/14/2020] [Indexed: 02/05/2023] Open
Abstract
The hippocampus, a key structure with distinct subfield functions, is strongly implicated in the pathophysiology of post-traumatic stress disorder (PTSD); however, few studies of hippocampus subfields in PTSD have focused on pediatric patients. We therefore investigated the hippocampal subfield volume using an automated segmentation method and explored the subfield-centered functional connectivity aberrations related to the anatomical changes, in a homogenous population of traumatized children with and without PTSD. To investigate the potential diagnostic value in individual patients, we used a machine learning approach to identify features with significant discriminative power for diagnosis of PTSD using random forest classifiers. Compared to controls, we found significant mean volume reductions of 8.4% and 9.7% in the right presubiculum and hippocampal tail in patients, respectively. These two subfields' volumes were the most significant contributors to group discrimination, with a mean classification accuracy of 69% and a specificity of 81%. These anatomical alterations, along with the altered functional connectivity between (pre)subiculum and inferior frontal gyrus, may underlie deficits in fear circuitry leading to dysfunction of fear extinction and episodic memory, causally important in post-traumatic symptoms such as hypervigilance and re-experience. For the first time, we suggest that hippocampal subfield volumes might be useful in discriminating traumatized children with and without PTSD.
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Affiliation(s)
- Lei Li
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Nanfang Pan
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Lianqing Zhang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Su Lui
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xiaoqi Huang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Xin Xu
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Song Wang
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Du Lei
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA
| | - Lingjiang Li
- Mental Health Institute, The Second Xiangya Hospital of Central South University, Changsha 410008, China
| | - Graham J Kemp
- Liverpool Magnetic Resonance Imaging Centre and Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L693BX, UK
| | - Qiyong Gong
- Huaxi MR Research Center (HMRRC), Department of Radiology, West China Hospital of Sichuan University, Chengdu 610041, China
- Research Unit of Psychoradiology, Chinese Academy of Medical Sciences, Chengdu 610041, China
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187
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Yanchar NL, Lockyer L, Ball CG, Assen S. Pediatric versus adult paradigms for management of adolescent injuries within a regional trauma system. J Pediatr Surg 2021; 56:512-519. [PMID: 32933764 DOI: 10.1016/j.jpedsurg.2020.07.032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 07/07/2020] [Accepted: 07/22/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND We aimed to examine process and outcome indicators for adolescents with specific injury patterns managed in pediatric versus adult paradigms within the same trauma system. METHODS Adolescents (15-17 years old) admitted to the region's adult trauma center (ATC) or pediatric trauma center (PTC) with an abdominal injury, femur fracture or traumatic brain injury (TBI) were reviewed retrospectively. Global and injury-specific process and outcome indicators were compared. RESULTS Of 141 ATC and 69 PTC patients, injury patterns differed significantly with more TBI and abdominal injuries at the ATC and femur fractures at the PTC. Overall injury severity was greater at the ATC. Patients with solid organ injuries appeared more likely to undergo embolization or splenectomy at the ATC; however, higher injury grade and later time period were the only variables significantly associated with this. Computed tomography (CT) was used significantly more frequently at the ATC overall, most notable with panscanning and head CTs for major TBI. Time to operative management did not differ for patients with isolated femur fractures. Neuropsychological follow up after minor TBI was documented more often at the PTC than the ATC; there was no difference for those with more severe TBIs. CONCLUSIONS Management varies for adolescents between PTCs and ATCs with more exposure to radiation and less neuropsychological follow-up of less severe TBIs at the ATC. This presents distinct opportunities to identify best policies for triage and sharing of management practices within a single regional inclusive trauma system in order to optimize short and long-term outcomes for this population. TYPE OF STUDY Retrospective cohort. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Natalie L Yanchar
- Alberta Children's Hospital Trauma Program, 28 Oki Drive NW, Calgary, Alberta, Canada, T3B6A8; Department of Surgery, University of Calgary, 3333 Hospital Drive NW, Calgary, Alberta, Canada, T2N4N1.
| | - Lisette Lockyer
- Alberta Children's Hospital Trauma Program, 28 Oki Drive NW, Calgary, Alberta, Canada, T3B6A8
| | - Chad G Ball
- Foothills Medical Center Trauma Program, 1403 29 St NW, Calgary, Alberta, Canada, T2N2T9; Department of Surgery, University of Calgary, 3333 Hospital Drive NW, Calgary, Alberta, Canada, T2N4N1
| | - Scott Assen
- Department of Surgery, University of Calgary, 3333 Hospital Drive NW, Calgary, Alberta, Canada, T2N4N1
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188
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Stylianou AM, Ebright E. Providing Coordinated, Immediate, Trauma-Focused, and Interdisciplinary Responses to Children Exposed to Severe Intimate Partner Violence: Assessing Feasibility of a Collaborative Model. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP2773-NP2799. [PMID: 29642770 DOI: 10.1177/0886260518769359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Despite the known consequences associated with children's exposure to intimate partner violence (IPV), numerous children exposed to IPV never access victim services and/or mental health treatment. Informed by the Child Development-Community Policing Program (CD-CP), the Child Trauma Response Team (CTRT) is designed to provide a coordinated, immediate, trauma-informed, and interdisciplinary response to children, adolescents, and their impacted family members who are exposed to severe IPV. The aim of this study was to explore the feasibility of the CTRT from the perspective of the key stakeholders and to identify what facilitated and/or hindered the collaborative model. Interviews were conducted with all 12 CTRT stakeholders of whom three worked for law enforcement, four worked for the district attorney's office, four worked for the nonprofit victim service organization, and one worked for the city office funding the pilot. Results indicated that the CTRT program evolved through a cyclical process including (a) implementing and enhancing program services, (b) defining and nurturing partner relationships, and (c) shifting practices among partnering agencies. The results provide concrete tools and practices that were successful in the CTRT pilot implementation. Despite the potential barriers to successful multidisciplinary collaborations, it is critical that we invest in developing and implementing collaborative intervention models in the IPV field. The CTRT model is an innovative model that conducts multidisciplinary coordinated outreach to families experiencing severe IPV to enhance family engagement in services and, when appropriate, in the criminal justice process.
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189
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Tineo P, Bonumwezi JL, Lowe SR. Discrimination and Posttraumatic Growth Among Muslim American Youth: Mediation via Posttraumatic Stress Disorder Symptoms. J Trauma Dissociation 2021; 22:188-201. [PMID: 33492194 DOI: 10.1080/15299732.2020.1869086] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Muslim Americans increasingly have been targets of discrimination. Previous research has provided preliminary evidence that higher perceived discrimination is associated with higher symptoms of discrimination-related posttraumatic stress disorder (PTSD) symptoms and higher discrimination-related posttraumatic growth (PTG). Further research in other contexts has shown that PTSD symptoms mediate the relationship between event severity and PTG. However, no existing studies have explored discrimination-related PTG and whether PTSD symptoms mediate the relationship between perceived discrimination and discrimination-related PTG among Muslim Americans. The current study included 110 Muslim American college students who completed an online survey assessing perceived discrimination, discrimination-related PTSD symptoms, and discrimination-related PTG. Higher perceived discrimination was significantly associated with higher discrimination-related PTG at the bivariate level. In a multivariable mediation model, the indirect effect of perceived discrimination on discrimination-related PTG via discrimination-related PTSD was statistically significant. The results suggest that clinicians working with Muslim American college students should attend to the ways in which their discriminatory experiences could foster PTG, in addition to helping them cope with PTSD symptoms.
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Affiliation(s)
- Petty Tineo
- Department of Psychology, Montclair State University, Montclair, New Jersey, USA
| | - Jessica L Bonumwezi
- Department of Psychology, Montclair State University, Montclair, New Jersey, USA
| | - Sarah R Lowe
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
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190
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Pfefferbaum B, Nitiéma P, Newman E. A Critical Review of Effective Child Mass Trauma Interventions: What We Know and Do Not Know from the Evidence. Behav Sci (Basel) 2021; 11:bs11020025. [PMID: 33670239 PMCID: PMC7916921 DOI: 10.3390/bs11020025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 12/19/2022] Open
Abstract
Over the last 20 years, numerous interventions have been developed and evaluated for use with children exposed to mass trauma with six publications reporting meta-analyses of randomized controlled trials of child mass trauma interventions using inactive controls to examine intervention effects on posttraumatic stress, depression, anxiety, and functional impairment. The current report reviews the results of these meta-analytic studies to examine the status of the evidence for child mass trauma mental health interventions and to evaluate potential moderators of intervention effect and implications for practice. The meta-analyses reviewed for the current report revealed a small to medium overall effect of interventions on posttraumatic stress, a non-statistically significant to small overall effect on depression, a non-statistically significant overall effect on anxiety, and a small overall effect on functional impairment. The subgroup analyses suggest that interventions should be matched to the populations being served and to the context. Additional research is needed to tailor future interventions to further address outcomes other than posttraumatic stress including depression, anxiety, and functional impairment.
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Affiliation(s)
- Betty Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, P.O. Box 26901, WP3217, Oklahoma City, OK 73126, USA
- Correspondence: ; Tel.: +1-405-271-5121
| | - Pascal Nitiéma
- Department of Management Information Systems, Price College of Business, University of Oklahoma, Norman, OK 73069, USA;
| | - Elana Newman
- Dart Center for Journalism and Trauma, Department of Psychology, University of Tulsa, Tulsa, OK 74104, USA;
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191
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Opara I, Weissinger GM, Lardier DT, Lanier Y, Carter S, Brawner BM. Mental Health Burden among Black Adolescents: The Need for Better Assessment, Diagnosis and Treatment Engagement. SOCIAL WORK IN MENTAL HEALTH 2021; 19:88-104. [PMID: 34248423 PMCID: PMC8262091 DOI: 10.1080/15332985.2021.1879345] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
This study examines mental health symptoms among Black adolescents who were currently in mental health treatment and those who were not in treatment. The study uses a sample of Black adolescents (N=154) and logistic regression was performed to determine which psychological factors were associated with exhibiting mental health symptoms. Both groups experienced high amounts of trauma exposure history, recent suicidality, substance use, and depressive symptoms. Nearly one in four adolescents in the out of treatment group met diagnostic criteria for anxiety disorders. Implications include better screening for mental health symptoms to ensure Black adolescent have access to mental health treatment.
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192
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Peverill M, Dirks MA, Narvaja T, Herts KL, Comer JS, McLaughlin KA. Socioeconomic status and child psychopathology in the United States: A meta-analysis of population-based studies. Clin Psychol Rev 2021; 83:101933. [PMID: 33278703 PMCID: PMC7855901 DOI: 10.1016/j.cpr.2020.101933] [Citation(s) in RCA: 113] [Impact Index Per Article: 37.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/26/2020] [Accepted: 10/13/2020] [Indexed: 12/31/2022]
Abstract
Children raised in families with low socioeconomic status (SES) are more likely to exhibit symptoms of psychopathology. However, the strength of this association, the specific indices of SES most strongly associated with childhood psychopathology, and factors moderating the association are strikingly inconsistent across studies. We conducted a meta-analysis of 120 estimates of the association between family SES and child psychopathology in 13 population-representative cohorts of children studied in the US since 1980. Among 26,715 participants aged 3-19 years, we observed small to moderate associations of low family income (g = 0.19), low Hollingshead index (g = 0.21), low subjective SES (g = 0.24), low parental education (g = 0.25), poverty status (g = 0.25), and receipt of public assistance (g = 0.32) with higher levels of childhood psychopathology. Moderator testing revealed that receipt of public assistance showed an especially strong association with psychopathology and that SES was more strongly related to externalizing than internalizing psychopathology. Dispersion in our final, random effects, model suggested that the relation between SES and child psychopathology is likely to vary in different populations of children and in different communities. These findings highlight the need for additional research on the mechanisms of SES-related psychopathology risk in children in order to identify targets for potential intervention.
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Affiliation(s)
- Matthew Peverill
- University of Washington, Department of Psychology, Seattle, WA, United States of America; Harvard University, Department of Psychology, Cambridge, MA, United States of America.
| | - Melanie A Dirks
- McGill University, Department of Psychology, Montreal, Canada
| | - Tomás Narvaja
- University of Washington, School of Medicine, Seattle, WA, United States of America
| | - Kate L Herts
- Weill Cornell Medicine, Department of Psychiatry, White Plains, NY, United States of America
| | - Jonathan S Comer
- Florida International University, Department of Psychology, Miami, FL, United States of America
| | - Katie A McLaughlin
- Harvard University, Department of Psychology, Cambridge, MA, United States of America
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193
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Holfeld B, Mishna F. The Development of Post-traumatic Stress Symptoms among Adolescents Who Experience Cyber and Traditional Victimization over Time. J Youth Adolesc 2021; 50:2339-2350. [PMID: 33515371 DOI: 10.1007/s10964-021-01394-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 01/03/2021] [Indexed: 11/30/2022]
Abstract
Adolescents' experiences of bullying victimization are positively associated with their post-traumatic stress symptoms. The development of these symptoms alongside experiences of bullying victimization over time, however, are not well understood. The current study used a transactional theory of development to examine the bidirectional associations between adolescents' post-traumatic stress symptoms and experiences of cyber and traditional victimization across three academic years. Participants were 510 Canadian students in grade 7 or 10 (Mage = 13.7, 61.6% girls) who completed surveys annually. The findings show that adolescents' concurrent experiences of cyber and traditional victimization were uniquely associated with their post-traumatic stress symptoms. Over time, greater post-traumatic stress symptoms were associated with more experiences of cyber and traditional victimization among adolescent boys and girls. Prevention and intervention efforts must address the role of post-traumatic stress symptoms that may limit adolescents' ability to develop or maintain healthy relationships.
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Affiliation(s)
- Brett Holfeld
- Department of Psychology, Grenfell Campus, Memorial University of Newfoundland, Corner Brook, NL, A2H 5G4, Canada.
| | - Faye Mishna
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
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194
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Neurobehavioral correlates of impaired emotion recognition in pediatric PTSD. Dev Psychopathol 2021; 34:946-956. [PMID: 33487187 PMCID: PMC9717496 DOI: 10.1017/s0954579420001704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Despite broad evidence suggesting that adversity-exposed youth experience an impaired ability to recognize emotion in others, the underlying biological mechanisms remains elusive. This study uses a multimethod approach to target the neurological substrates of this phenomenon in a well-phenotyped sample of youth meeting diagnostic criteria for posttraumatic stress disorder (PTSD). Twenty-one PTSD-afflicted youth and 23 typically developing (TD) controls completed clinical interview schedules, an emotion recognition task with eye-tracking, and an implicit emotion processing task during functional magnetic resonance imaging )fMRI). PTSD was associated with decreased accuracy in identification of angry, disgust, and neutral faces as compared to TD youth. Of note, these impairments occurred despite the normal deployment of visual attention in youth with PTSD relative to TD youth. Correlation with a related fMRI task revealed a group by accuracy interaction for amygdala-hippocampus functional connectivity (FC) for angry expressions, where TD youth showed a positive relationship between anger accuracy and amygdala-hippocampus FC; this relationship was reversed in youth with PTSD. These findings are a novel characterization of impaired threat recognition within a well-phenotyped population of severe pediatric PTSD. Further, the differential amygdala-hippocampus FC identified in youth with PTSD may imply aberrant efficiency of emotional contextualization circuits.
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195
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Bachmann CJ, Czwikla J, Jacobs H, Fegert JM, Hoffmann F. Prävalenz und Versorgung der Posttraumatischen Belastungsstörung in Deutschland: Eine bundesweite Auswertung von Krankenkassendaten aus den Jahren 2008 und 2017. PSYCHIATRISCHE PRAXIS 2021; 48:316-323. [DOI: 10.1055/a-1347-5410] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Zusammenfassung
Ziel der Studie Gewinnung von Daten zur Prävalenz sowie medizinischen und psychotherapeutischen Versorgung von Menschen mit PTBS in Deutschland.
Methodik Aus Sekundärdaten der BARMER wurde die Prävalenz von PTBS-Diagnosen (ICD-10: F43.1) sowie psychiatrischen Komorbiditäten, Psychotherapie und Pharmakotherapie für diese Versichertengruppe abgeleitet. Ergänzend wurden Prävalenztrends (2008 vs. 2017) berechnet.
Ergebnisse Im Jahr 2017 lag die PTBS-Diagnoseprävalenz bei 0,7 % (Frauen: 0,9 %; Männer: 0,4 %); gegenüber 0,3 % in 2008. 74,4 % aller Versicherten mit PTBS-Diagnose erhielten ambulante Psychotherapie, 43,6 % erhielten Antidepressiva (meistverordnet: Venlafaxin) und 14,4 % Antipsychotika (häufigste Substanz: Quetiapin).
Schlussfolgerung Im untersuchten Zeitraum hat sich die Diagnosehäufigkeit von PTBS mehr als verdoppelt. Sie liegt jedoch weiterhin unter der in epidemiologischen Studien ermittelten Prävalenz, was auf Potenzial für eine verbesserte diagnostische Erkennung von PTBS hindeutet.
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Affiliation(s)
| | - Jonas Czwikla
- Abteilung Ambulante Versorgung und Pharmakoepidemiologie, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg
| | - Hannes Jacobs
- Abteilung Ambulante Versorgung und Pharmakoepidemiologie, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg
| | - Jörg M. Fegert
- Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie, Universitätsklinikum Ulm
| | - Falk Hoffmann
- Abteilung Ambulante Versorgung und Pharmakoepidemiologie, Department für Versorgungsforschung, Carl von Ossietzky Universität Oldenburg
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196
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Cisler JM, Herringa RJ. Posttraumatic Stress Disorder and the Developing Adolescent Brain. Biol Psychiatry 2021; 89:144-151. [PMID: 32709416 PMCID: PMC7725977 DOI: 10.1016/j.biopsych.2020.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/30/2020] [Accepted: 06/01/2020] [Indexed: 02/07/2023]
Abstract
Posttraumatic stress disorder (PTSD) in adolescents is common and debilitating. In contrast to adult PTSD, relatively little is known about the neurobiology of adolescent PTSD, nor about how current treatments may alter adolescent neurodevelopment to allow recovery from PTSD. Improving our understanding of biological mechanisms of adolescent PTSD, taken in the context of neurodevelopment, is crucial for developing novel and personalized treatment approaches. In this review, we highlight prevailing constructs of PTSD and current findings on these domains in adolescent PTSD. Notably, little data exist in adolescent PTSD for prominent adult PTSD constructs, including threat learning and attentional threat bias. Most work to date has examined general threat processing, emotion regulation, and their neural substrates. These studies suggest that adolescent PTSD, while phenomenologically similar to adult PTSD, shows unique neurodevelopmental substrates that may impair recovery but could also be targeted in the context of adolescent neuroplasticity to improve outcomes. Both cross-sectional and longitudinal data suggest abnormal frontolimbic development compared with typically developing youths, a pattern that may differ from resilient youths. Whether current treatments such as trauma-focused psychotherapy engage these targets and restore healthy neurodevelopment remains an open question. We end our review by highlighting emerging areas and knowledge gaps that could be addressed to better characterize the biology underlying adolescent PTSD. Emerging studies in computational modeling of decision making, caregiver-related transmission of traumatic stress, and other areas may offer new targets that could harness adolescent neurobehavioral plasticity to improve resilience and recovery for some of our most vulnerable youths.
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197
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Jones S, Castelnovo A, Riedner B, Flaherty B, Prehn-Kristensen A, Benca R, Tononi G, Herringa R. Sleep and emotion processing in paediatric posttraumatic stress disorder: A pilot investigation. J Sleep Res 2021; 30:e13261. [PMID: 33442931 PMCID: PMC8365752 DOI: 10.1111/jsr.13261] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/29/2020] [Accepted: 11/23/2020] [Indexed: 11/28/2022]
Abstract
Emotion processing abnormalities and sleep pathology are central to the phenomenology of paediatric posttraumatic stress disorder, and sleep disturbance has been linked to the development, maintenance and severity of the disorder. Given emerging evidence indicating a role for sleep in emotional brain function, it has been proposed that dysfunctional processing of emotional experiences during sleep may play a significant role in affective disorders, including posttraumatic stress disorder. Here we sought to examine the relationship between sleep and emotion processing in typically developing youth, and youth with a diagnosis of posttraumatic stress disorder . We use high-density electroencephalogram to compare baseline sleep with sleep following performance on a task designed to assess both memory for and reactivity to negative and neutral imagery in 10 youths with posttraumatic stress disorder, and 10 age- and sex-matched non-traumatized typically developing youths. Subjective ratings of arousal to negative imagery (ΔArousal = post-sleep minus pre-sleep arousal ratings) remain unchanged in youth with posttraumatic stress disorder following sleep (mean increase 0.15, CI -0.28 to +0.58), but decreased in TD youth (mean decrease -1.0, 95% CI -1.44 to -0.58). ΔArousal, or affective habituation, was negatively correlated with global change in slow-wave activity power (ρ = -0.58, p = .008). When considered topographically, the correlation between Δslow-wave activity power and affective habituation was most significant in a frontal cluster of 27 electrodes (Spearman, ρ = -0.51, p = .021). Our results highlight the importance of slow-wave sleep for adaptive emotional processing in youth, and have implications for symptom persistence in paediatric posttraumatic stress disorder. Impairments in slow-wave activity may represent a modifiable risk factor in paediatric posttraumatic stress disorder.
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Affiliation(s)
- Stephanie Jones
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Anna Castelnovo
- Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Regional Hospital (EOC) of Lugano, Lugano, Switzerland.,Faculty of Biomedical Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Brady Riedner
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Bethany Flaherty
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Alexander Prehn-Kristensen
- Department of Child and Adolescent Psychiatry and Psychotherapy, Centre for Integrative Psychiatry, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Ruth Benca
- Department of Psychiatry & Human Behavior, School of Medicine, University of California-Irvine, Irvine, CA, USA
| | - Giulio Tononi
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA.,Wisconsin Institute for Sleep and Consciousness, University of Wisconsin-Madison, Madison, WI, USA
| | - Ryan Herringa
- Department of Psychiatry, University of Wisconsin-Madison, Madison, WI, USA
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198
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Cervin M, Salloum A, Ruth LJ, Storch EA. Posttraumatic Symptoms in 3-7 Year Old Trauma-Exposed Children: Links to Impairment, Other Mental Health Symptoms, Caregiver PTSD, and Caregiver Stress. Child Psychiatry Hum Dev 2021; 52:1173-1183. [PMID: 33245454 PMCID: PMC8528747 DOI: 10.1007/s10578-020-01093-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2020] [Indexed: 11/26/2022]
Abstract
Few studies have examined how PTSD symptoms in young children are associated with other mental health symptoms and mood and functioning in caregivers. This is an important gap in the literature as such knowledge may be important for assessment and treatment. This study used network analysis to identify how the major symptom domains of PTSD in young trauma-exposed children were related to impairment, internalizing and externalizing symptoms, caregiver PTSD, and caregiver stress. Caregivers of 75 trauma-exposed 3-7 year old children reported on their child's symptoms and impairment and their own PTSD symptoms and caregiver stress. A strong association between the child PTSD domains of intrusions and avoidance emerged, which is in line with theoretical notions of how PTSD onsets and is maintained in adolescents and adults. Externalizing child symptoms were strongly linked to PTSD-related impairment and caregiver stress, highlighting the need to carefully assess and address such symptoms when working with young trauma-exposed children. Internalizing symptoms were uniquely associated with all three of the major childhood PTSD symptom domains with further implications for assessment and treatment.
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Affiliation(s)
- Matti Cervin
- Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Faculty of Medicine, Lund University, Sofiavägen 2D, 22241, Lund, Sweden.
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199
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Dunn BJ, Keane CA, Paterson JL. The Tern Programme Study protocol for an implementation trial of a flexible, long-term psychosocial intervention for complex posttraumatic stress in young people. Eur J Psychotraumatol 2021; 12:1988479. [PMID: 34868480 PMCID: PMC8635648 DOI: 10.1080/20008198.2021.1988479] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Complex Trauma (CT) is a term used to refer to multiple or prolonged traumatic experiences. Such experiences are often first encountered during childhood and may impact key developmental periods. CT is a risk for a broad range of deleterious physical, psychological, social, and occupational outcomes. The diagnosis of Complex Posttraumatic Stress Disorder (C-PTSD) has been proposed to capture the symptomatology resulting from CT exposure.In Australia, there are few publicly funded services that target, and are purposely designed to support, the mental health needs of young people with symptoms of complex post-traumatic stress (C-PTSD). The Tern Programme has been designed as a purpose-built model of care for providing mental health support to young people with C-PTSD. METHODS This implementation trial will involve a longitudinal examination of Tern participants for a fixed 24-month period. Participants will be recruited from the young people referred to Tern at headspace centres in regional Australia where Tern operates. Eligible participants will have reported a history of complex trauma, and present with symptoms of C-PTSD. All participants will be invited to complete a series of surveys during their participation in the programme. Survey items will assess C-PTSD symptom change, quality of life and occupational functioning.The Tern model of care is delivered in a semi-structured format to accommodate a person-centred flexible approach. Fidelity will be monitored through the completion of a clinician post-session checklist and through group supervision. DISCUSSION This study will provide the first quantitative data on the new Tern model of care and evaluate mental health and functional outcomes of its participants. If effective, Tern may be suitable for replication in other Australian or international youth mental health services where complex post-traumatic stress is prevalent. TRIAL REGISTRATION Australia and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000079842p. Prospectively registered on 29 January 2021. ABBREVIATIONS CT = Complex Trauma; C-PTSD = Complex Posttraumatic Stress Disorder.
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Affiliation(s)
- Braden J Dunn
- School of Health, Medical and Applied Sciences, Central Queensland University, Townsville, Australia
| | - Carol A Keane
- College of Health and Human Sciences, Charles Darwin University, Casurina, Australia
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200
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Hiscox LV, Hiller R, Fraser A, Rabie S, Stewart J, Seedat S, Tomlinson M, Halligan SL. Sex differences in post-traumatic stress disorder in a high adversity cohort of South African adolescents: an examination of depressive symptoms, age, and trauma type as explanatory factors. Eur J Psychotraumatol 2021; 12:1978669. [PMID: 34691370 PMCID: PMC8530480 DOI: 10.1080/20008198.2021.1978669] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Evidence from high-income countries (HICs) has documented a higher rate of post-traumatic stress disorder (PTSD) in females than males. However, data are limited on sex differences in PTSD from low- and middle-income countries (LMICs), despite particularly high levels of trauma experienced by LMIC youth. OBJECTIVES In a sample of adolescents from an impoverished South African community, we examined sex differences in PTSD, as well as co-occurring depression, adolescent age, and the type and extent of trauma exposure as potential contributors to female vulnerability. METHODS Participants were recruited from high schools in the Khayelitsha area of Cape Town. Self-reported trauma exposure, PTSD and depressive symptoms were measured in 797 adolescents (62% female) aged 13-17 years. Poisson regressions were used to examine Risk Ratios (RR) based on probable PTSD diagnoses, and linear regressions were applied to assess posttraumatic stress symptom (PTSS) severity. RESULTS 92% of adolescents reported trauma exposure, of whom 28% had probable PTSD. Prevalence of PTSD was higher for females than for males, even when controlling for total trauma exposure (RR = 1.71, p < .001) and co-occurring depressive symptoms (RR = 1.45, p = .005). By contrast, sex differences in depression were eliminated after controlling for co-occurring PTSS. There was little evidence of age effects on the emergence of sex differences. At lower thresholds of interpersonal trauma, females showed higher levels of PTSS compared to males, but no sex differences were found at high levels of exposure. CONCLUSION Higher PTSD rates are observed in adolescent females in a high adversity-LMIC sample suggesting sex differences are robust across international contexts. Sex differences in PTSD are unlikely to be explained by co-occurring depression and in this context sex differences in depression may be secondary to trauma and PTSD. However, exposure to significant interpersonal trauma appears to overrule any specific female vulnerability.
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Affiliation(s)
- Lucy V Hiscox
- Department of Psychology, University of Bath, Bath, UK
| | - Rachel Hiller
- Department of Psychology, University of Bath, Bath, UK
| | - Abigail Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Stephan Rabie
- Department of Psychiatry and Mental Health, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jackie Stewart
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Soraya Seedat
- Medical Research Council (MRC) Unit on Anxiety and Stress Disorders, Department of Psychiatry, Stellenbosch University, Tygerberg, Western Cape, South Africa
| | - Mark Tomlinson
- Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
| | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
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