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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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202
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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: 23] [Impact Index Per Article: 7.7] [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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203
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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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204
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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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205
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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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206
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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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207
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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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208
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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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209
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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: 126] [Impact Index Per Article: 42.0] [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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210
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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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211
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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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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: 28] [Impact Index Per Article: 9.3] [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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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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214
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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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215
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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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216
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Aune T, Juul EML, Beidel DC, Nordahl HM, Dvorak RD. Mitigating adolescent social anxiety symptoms: the effects of social support and social self-efficacy in findings from the Young-HUNT 3 study. Eur Child Adolesc Psychiatry 2021; 30:441-449. [PMID: 32300894 PMCID: PMC8019414 DOI: 10.1007/s00787-020-01529-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 04/06/2020] [Indexed: 12/24/2022]
Abstract
Adolescents' exposure to negative life events (NLEs) and potentially traumatic events is highly prevalent and increases their risk of developing psychological disorders considerably. NLE exposure has also been linked to the development of social anxiety disorder (SAD) among older children and young adolescents. Despite the relatively low treatment efficacy reported for children and adolescents suffering from SAD, few studies have addressed the extent to which resilience factors, such as social support and social self-efficacy, are associated with SAD symptoms. This study examined whether social support and social self-efficacy predict, and buffer against SAD symptoms using a large, population-based sample of adolescents, among whom a large proportion have experienced NLEs. The results reveal that NLEs are significantly associated with SAD symptoms, while social support and social self-efficacy are both negatively associated with SAD symptoms. Only the NLEs × social support interaction significantly predicted SAD symptoms, with social support attenuating the association between NLEs and SAD symptoms. Moreover, increases in both social self-efficacy and social support were associated with reduced SAD symptoms, over and above variance explained by social support alone. Our cumulative results suggest that interventions that can modify both social support and social self-efficacy may help reduce SAD symptoms in at-risk adolescents.
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Affiliation(s)
- Tore Aune
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway.
| | | | - Deborah C Beidel
- UCF RESTORES, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, USA
| | - Hans M Nordahl
- Department of Mental Health, NTNU, Trondheim, Norway
- Division of Psychiatry, St.Olavs Hospital, Nidaros DPS, Trondheim, Norway
| | - Robert D Dvorak
- Department of Psychology, College of Science, University of Central Florida, 4111 Pictor Lane, Orlando, FL, 32816, USA
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217
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Zhang A, Shi L, Yan W, Xiao H, Bao Y, Wang Z, Deng J, Ravindran A, Yuan K, Mei H, Shi J, Liu Z, Liu J, Lu L. Mental Health in Children in the Context of COVID-19: Focus on Discharged Children. Front Psychiatry 2021; 12:759449. [PMID: 34858232 PMCID: PMC8631929 DOI: 10.3389/fpsyt.2021.759449] [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] [Received: 08/16/2021] [Accepted: 10/18/2021] [Indexed: 01/12/2023] Open
Abstract
Introduction: To date, the mental health consequences of children hospitalized with COVID-19 remain unclear. We aimed to assess mental health status in children in the context of COVID-19, with a focus on discharged children. Methods: We recruited discharged children who recovered from COVID-19 and healthy controls between July and September 2020 in Wuhan Children's Hospital. Post-traumatic stress disorder (PTSD), anxiety, depression, and sleep problems were assessed in these children using questionnaires. Univariable and multivariable logistic and linear regressions were conducted to identify risk factors. Results: Totally, there were 152 children (61 discharged children and 91 healthy controls) aged 7-18 years old in our study. An increasing trend in the prevalence of PTSD, anxiety, and depression was observed in the discharged children compared with healthy controls (PTSD: 8.20 vs. 2.20%, anxiety: 22.95 vs. 13.19%; depression: 47.54 vs. 32.97%). Discharged children tended to report more depressive symptoms (β = 0.39) and less sleep problems (β = -0.37). Discharged children who lived in nuclear families and had longer hospital stays were more likely to report depression [odds ratio (OR) = 3.68 and 1.14, respectively]. Anxiety symptoms and the severity of sleep problems of discharged children were positively associated with caregivers' depression and PTSD symptoms (OR = 21.88 and 31.09, respectively). Conclusion: In conclusion, PTSD, anxiety, and depression symptoms were common among recovered children 4 months after COVID-19 hospitalization. Children from nuclear family and those had longer hospital stays need special attention. In addition, parental mental health had a significant impact on their children's mental resilience and recovery.
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Affiliation(s)
- Anyi Zhang
- National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Peking University, Beijing, China
| | - Le Shi
- National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Peking University, Beijing, China
| | - Wei Yan
- National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Peking University, Beijing, China
| | - Han Xiao
- Institute of Maternal and Child Health, Tongji Medical College, Wuhan Children's Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yanping Bao
- Beijing Key Laboratory on Drug Dependence Research, National Institute on Drug Dependence, Peking University, Beijing, China
| | - Zhe Wang
- National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Peking University, Beijing, China
| | - Jiahui Deng
- National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Peking University, Beijing, China
| | - Arun Ravindran
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Kai Yuan
- National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Peking University, Beijing, China
| | - Hong Mei
- Institute of Maternal and Child Health, Tongji Medical College, Wuhan Children's Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jie Shi
- Beijing Key Laboratory on Drug Dependence Research, National Institute on Drug Dependence, Peking University, Beijing, China
| | - Zhisheng Liu
- Department of Neurology, Tongji Medical College, Wuhan Children's Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Jiajia Liu
- School of Nursing, Peking University, Beijing, China
| | - Lin Lu
- National Health Commission Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Peking University Institute of Mental Health, Peking University Sixth Hospital, Peking University, Beijing, China.,Peking-Tsinghua Center for Life Sciences and IDG/McGovern Institute for Brain Research at Peking University, Peking University, Beijing, China
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218
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Rimane E, Steil R, Renneberg B, Rosner R. Get secure soon: attachment in abused adolescents and young adults before and after trauma-focused cognitive processing therapy. Eur Child Adolesc Psychiatry 2021; 30:1591-1601. [PMID: 32918100 PMCID: PMC8505313 DOI: 10.1007/s00787-020-01637-x] [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] [Received: 03/10/2020] [Accepted: 08/29/2020] [Indexed: 11/20/2022]
Abstract
Severe posttraumatic stress symptoms (PTSS) are connected to a variety of health-related and interpersonal problems, among them are the insecure attachment orientations. However, psychotherapy seems to improve not only PTSS but also attachment insecurities. In a large multicenter, randomized clinical trial, the attachment characteristics and PTSS of 85 adolescents and young adults (aged 14-21 years) with clinically relevant abuse-related PTSS were assessed at study entry, at the end of treatment, and 3 months after the end of treatment. Participants were randomized either to a developmentally adapted cognitive processing therapy (D-CPT) or to a wait-list with treatment advice (WL/TA). The purpose of the study was to analyze the association between PTSS and attachment at study entry as well as changes in attachment during the trial. We found that attachment-related avoidance (AR avoidance) was positively associated with PTSS from both self-reports and clinician ratings, whereas attachment-related anxiety (AR anxiety) was only related to self-reported PTSS (Pearson correlation coefficients between 0.37 and 0.46). Changes in AR anxiety occurred in both conditions at some point during the study (baseline to 3-month follow-up effect size was d = 0.60 for D-CPT and d = 0.44 for WL/TA) whereas for AR avoidance, only participants in D-CPT improved significantly (baseline to 3-month follow-up effect size was d = 0.75). The results indicate that PTSS and attachment are connected. Positive changes in attachment insecurities brought about by trauma-focused psychotherapy seem possible.Trial registration: German Clinical Trials Register (DRKS); Germanctr.de; identifier: DRKS00004787; date of registration: 18 March 2013.
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Affiliation(s)
- Eline Rimane
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072, Eichstätt, Germany.
| | - Regina Steil
- grid.7839.50000 0004 1936 9721Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Varrentrappstr. 40-42, 60486 Frankfurt am Main, Germany
| | - Babette Renneberg
- grid.14095.390000 0000 9116 4836Department of Clinical Psychology and Psychotherapy, Freie Universitaet of Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Rita Rosner
- grid.440923.80000 0001 1245 5350Department of Psychology, Catholic University Eichstätt-Ingolstadt, Ostenstr. 25, 85072 Eichstätt, Germany
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219
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Ross SL, Sharma-Patel K, Brown EJ, Huntt JS, Chaplin WF. Complex trauma and Trauma-Focused Cognitive-Behavioral Therapy: How do trauma chronicity and PTSD presentation affect treatment outcome? CHILD ABUSE & NEGLECT 2021; 111:104734. [PMID: 33162104 DOI: 10.1016/j.chiabu.2020.104734] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/26/2020] [Accepted: 09/08/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Traumatic experiences are common in youth and can be classified as acute (one incident or short-term) or complex (chronic exposure to multiple traumas) experiences. Posttraumatic stress disorder (PTSD) is a common response to trauma, often co-occurring with other mental health symptoms. According to the International Classification of Diseases, 11th Edition (World Health Organization, 2018), complex PTSD includes difficulties with affect regulation, interpersonal relationships, and self-blame. OBJECTIVE The aims of this study were to evaluate trauma chronicity and PTSD presentation as moderators of outcomes of trauma-focused cognitive behavior therapy (TF-CBT). PARTICIPANTS AND SETTING Participants included 176 youth and caregiver dyads who were participants in an ongoing effectiveness study of TF-CBT at a community-based clinic in NYC. METHODS Multilevel modeling was used to examine longitudinal, within-subject variability. Moderation analyses were used to assess the role of trauma chronicity and levels of PTSD on change in the outcomes. RESULTS There were no baseline differences between youth with acute versus chronic trauma. At baseline, participants who had PTSD plus 2 or 3 of the ICD-11 Complex PTSD symptom domains had significantly worse functioning than those with simple PTSD. We found significant improvement on most measures of PTSD and complex PTSD domains. Level of improvement was found to vary based on PTSD presentation at baseline. CONCLUSIONS This is the first study to evaluate both trauma chronicity and PTSD presentation in the context of evidence-based treatment, and findings support the effectiveness of TF-CBT for simple and complex PTSD for youth who have experienced acute and chronic trauma.
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Affiliation(s)
| | - Komal Sharma-Patel
- St. John's University, 8000 Utopia Parkway, Queens, NY, 11439, United States
| | - Elissa J Brown
- St. John's University, 8000 Utopia Parkway, Queens, NY, 11439, United States
| | - Jessica S Huntt
- St. John's University, 8000 Utopia Parkway, Queens, NY, 11439, United States
| | - William F Chaplin
- St. John's University, 8000 Utopia Parkway, Queens, NY, 11439, United States
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220
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Trouble de stress post-traumatique en milieu pénitentiaire. Encephale 2020; 46:493-499. [DOI: 10.1016/j.encep.2020.04.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 04/07/2020] [Accepted: 04/08/2020] [Indexed: 11/17/2022]
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221
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Temkin D, Harper K, Stratford B, Sacks V, Rodriguez Y, Bartlett JD. Moving Policy Toward a Whole School, Whole Community, Whole Child Approach to Support Children Who Have Experienced Trauma. THE JOURNAL OF SCHOOL HEALTH 2020; 90:940-947. [PMID: 33184886 PMCID: PMC7702060 DOI: 10.1111/josh.12957] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 08/20/2020] [Indexed: 05/20/2023]
Abstract
BACKGROUND As attention to the potential negative outcomes of childhood trauma has grown, so have calls for schools to take an active role in supporting students experiencing trauma. These calls extend beyond efforts initiated by individual schools to include those mandated by state law, which largely focus on teacher training and on screening for adversity. METHODS This article explores the evidence base and limitations for current approaches in state law and explores how policies to address other student health, safety, and wellness issues can help either ameliorate or exacerbate students' experiences with trauma. RESULTS Few trainings for nonclinical staff have rigorous evidence of effectiveness, and based on evidence of teacher trainings on other topics, cannot work in environments that do not actively reinforce and encourage the application of that knowledge. Trainings also largely do not acknowledge the structures and systems, including systemic racism within schools, that may contribute to disparate rates of adversity for black and American Indian and Alaskan Native children. Screening carries several risks, including confounding adversity with experiencing trauma, missing broader contextual adversity, and potentially retraumatizing children. CONCLUSIONS State policymakers need to take a more holistic approach in creating policies to support students experiencing trauma.
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Affiliation(s)
- Deborah Temkin
- Child Trends, 7315 Wisconsin Avenue, Ste 1200WBethesdaMD20814
| | - Kristen Harper
- Child Trends, 7315 Wisconsin Avenue, Ste 1200WBethesdaMD20814
| | | | - Vanessa Sacks
- Child Trends, 7315 Wisconsin Avenue, Ste 1200WBethesdaMD20814
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Khan A, O’Donovan A, Neylan T, Gross J, Cohen B. Suppression, but not reappraisal, is associated with inflammation in trauma-exposed veterans. Psychoneuroendocrinology 2020; 122:104871. [PMID: 33010600 PMCID: PMC8425342 DOI: 10.1016/j.psyneuen.2020.104871] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 08/10/2020] [Accepted: 09/11/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Emotion dysregulation can elicit inflammatory activity. The current study examined whether specific maladaptive and adaptive emotion regulation strategies were associated with inflammatory markers in trauma-exposed veterans, above and beyond PTSD. METHODS In a cohort study, 606 participants exposed to a Criterion A trauma and recruited from Veteran Health Administration facilities completed fasting blood draws, the Emotion Regulation Questionnaire, and the Clinician Administered PTSD Scale-IV. Inflammation was assessed with high sensitivity C-reactive protein (hsCRP), white blood cell count (WBC), and fibrinogen levels. An inflammation index was created by summing standardized log-transformed levels of the three biomarkers. Our primary linear regression models were adjusted for sex, age, race, education, income, creatinine, and PTSD. RESULTS Suppression, but not cognitive reappraisal, was significantly associated with higher levels of the inflammatory index (β = 0.14, p = 0.001). Parallel analyses for the individual inflammatory markers also showed suppression, but not reappraisal, was significantly associated with higher hsCRP (β = 0.11, p = 0.01), WBC (β = 0.11, p = 0.01), and fibrinogen (β = 0.10, p = 0.02). CONCLUSIONS Emotional suppression is related to elevated systemic inflammation independent of PTSD. Cognitive reappraisal is unrelated to inflammation. Findings suggest over-utilization of maladaptive, rather than under-utilization of adaptive, emotion regulation strategies may be associated with systemic inflammation in trauma-exposed veterans.
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Affiliation(s)
- A.J. Khan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States,Department of Psychiatry, University of California, San Francisco, CA, United States,Corresponding author at: San Francisco VA Health Care System 4150 Clement Street, San Francisco, CA, 94121, United States. (A.J. Khan)
| | - A. O’Donovan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States,Department of Psychiatry, University of California, San Francisco, CA, United States
| | - T.C. Neylan
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States,School of Medicine, University of California, San Francisco, CA, United States
| | - J.J. Gross
- Department of Psychology, Stanford University, Stanford, CA, United States
| | - B.E. Cohen
- San Francisco Veterans Affairs Health Care System, San Francisco, CA, United States,School of Medicine, University of California, San Francisco, CA, United States
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Fonseca A, Vagos P, Moreira H, Pereira J, Canavarro MC, Rijo D. Psychometric Properties of the Portuguese Version of the Child Post-traumatic Cognitions Inventory in a Sample of Children and Adolescents Following a Wildfire Disaster. Child Psychiatry Hum Dev 2020; 51:876-887. [PMID: 32026262 DOI: 10.1007/s10578-020-00965-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
This study aimed to examine the psychometric properties of the Child Post-Traumatic Cognitions Inventory (CPTCI) in a sample of Portuguese children and adolescents, following the exposition to a wildfire disaster. The sample included 533 children and adolescents living in regions exposed to the wildfire disaster (non-clinical sample: n = 483; clinical sample: n = 50). The short form of the instrument (CPTCI-SF) including two correlated factors ('Sense of Disturbing and Permanent Change' and 'Sense of Being a Fragile Person in a Scary World') showed good model fit and was invariant across gender and age-groups. Good internal consistency (> .70) was found, and higher CPTCI scores were associated with poorer adjustment indicators. The clinical sample presented significantly higher CPTCI scores than the non-clinical sample. These results contribute to the cross-cultural validation of the CPTCI and support the adequacy of its short form as a reliable and valid measure to be used with Portuguese children and adolescents.
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Affiliation(s)
- Ana Fonseca
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal.
| | - Paula Vagos
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal.,Portucalense University, Porto, Portugal
| | - Helena Moreira
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal
| | - Joana Pereira
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal
| | - Maria Cristina Canavarro
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal
| | - Daniel Rijo
- CINEICC - Center for Research in Neuropsychology and Cognitive Behavioral Intervention, Faculty of Psychology and Educational Sciences, University of Coimbra, Rua do Colégio Novo, 3001-802, Coimbra, Portugal
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Brown EJ, Cohen JA, Mannarino AP. Trauma-Focused Cognitive-Behavioral Therapy: The role of caregivers. J Affect Disord 2020; 277:39-45. [PMID: 32791391 DOI: 10.1016/j.jad.2020.07.123] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 06/06/2020] [Accepted: 07/27/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND Childhood trauma exposure is unfortunately common and is associated with the development of posttraumatic stress disorder (PTSD) as well as a number of other serious medical and mental and health disorders. After experiencing trauma, children depend on their non-offending parents to believe and support them, reframe the meaning of the trauma, and to keep them safe from future harm. Parents are often negatively impacted by their child's trauma which may contribute to the child's risk for developing PTSD and related problems. Including parents in treatment may enhance child outcomes. METHODS Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is an evidence-based child and adolescent trauma treatment model that integrally includes non-offending parents or caregivers throughout treatment (hereafter referred to as "caregivers"). This article describes TF-CBT's underlying concepts, principles and core components, as well as the role of caregiver inclusion in this model, and evaluates the extant evidence for caregiver factors in predicting TF-CBT outcomes. RESULTS Several studies suggest that inclusion of non-offending caregivers is associated with TF-CBT outcomes, and that this may occur through enhancing caregiver support of the child and/or reducing caregivers' trauma-related maladaptive cognitions. LIMITATIONS Few studies have evaluated whether caregiver factors served as formal treatment mediators. CONCLUSIONS Including non-offending caregivers in TF-CBT can improve youth outcomes.
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Affiliation(s)
- Elissa J Brown
- Professor of Psychology, St. John's University, 8000 Utopia Parkway, Queens, NY 11439, United States.
| | - Judith A Cohen
- Professor of Psychiatry, Drexel University College of Medicine, Allegheny Health Network/Allegheny General Hospital, 4 Allegheny Center, 8th Floor, Pittsburgh, PA 15212, United States.
| | - Anthony P Mannarino
- Professor and Vice ChairDepartment of Psychiatry, Allegheny General Hospital, Allegheny Health Network, Drexel University College of Medicine, 4 Allegheny Center, 8th Floor, Pittsburgh, PA 15212, United States.
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225
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Danese A, McLaughlin KA, Samara M, Stover CS. Psychopathology in children exposed to trauma: detection and intervention needed to reduce downstream burden. BMJ 2020; 371:m3073. [PMID: 33214140 PMCID: PMC7673907 DOI: 10.1136/bmj.m3073] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Andrea Danese
- King's College London, Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- King's College London, Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, London, UK
- South London and Maudsley NHS Foundation Trust, National and Specialist CAMHS Clinic for Trauma, Anxiety, and Depression, London, UK
| | | | | | - Carla S Stover
- Yale Early Stress and Adversity Consortium, Yale University Child Study Center, New Haven CT, USA
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226
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Denckla CA, Cicchetti D, Kubzansky LD, Seedat S, Teicher MH, Williams DR, Koenen KC. Psychological resilience: an update on definitions, a critical appraisal, and research recommendations. Eur J Psychotraumatol 2020; 11:1822064. [PMID: 33244362 PMCID: PMC7678676 DOI: 10.1080/20008198.2020.1822064] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 08/19/2020] [Indexed: 10/25/2022] Open
Abstract
Background: The ability to resist adverse outcomes, or demonstrate resilience after exposure to trauma is a thriving field of study. Yet ongoing debate persists regarding definitions of resilience, generalizability of the extant literature, neurobiological correlates, and a consensus research agenda. Objectives: To address these pressing questions, Drs. Christy Denckla and Karestan Koenen (co-chairs) convened a multidisciplinary panel including Drs. Dante Cicchetti, Laura Kubzansky, Soraya Seedat, Martin Teicher, and David Williams at the 2019 annual meeting of the International Society for Traumatic Stress Studies (ISTSS). Questions included (1) how have definitions of resilience evolved, (2) what are the best approaches to capture the complexity of resilience processes, and (3) what are the most important areas for future research? Methods: The proceedings of this panel are summarized in this report, and prominent themes are synthesized and integrated. Results: While different definitions emerged, all shared a focus on conceptualizing resilience at multiple levels, from the biological to the social structural level, a focus on the dynamic nature of resilience, and a move away from conceptualizing resilience as only an individual trait. Critical areas for future research included 1) focused efforts to improve assessment that has international and cross-cultural validity, 2) developing within-study designs that employ more intensive phenotyping strategies, 3) examining outcomes across multiple levels and domains, and 4) integrating conceptualizations of resilience from the individual-level to the larger social context at the population health level. Conclusion: Increasingly sophisticated and nuanced conceptual frameworks, coupled with research leveraging advances in genetics, molecular biology, increased computational capacity, and larger, more diverse datasets suggest that the next decade of research could bring significant breakthroughs.
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Affiliation(s)
- Christy A. Denckla
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Dante Cicchetti
- Institute of Child Development, University of Minnesota, Minneapolis, USA
| | - Laura D. Kubzansky
- Department of Social and Behavioral Sciences, Lee Kum Sheung Center for Health and Happiness, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | | | - David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Sociology, Harvard University, Cambridge, MA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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227
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LIANG Y, ZHENG H, LIU Z. Changes in the network of posttraumatic stress disorder among children after the Wenchuan earthquake: A four-year longitudinal study. ACTA PSYCHOLOGICA SINICA 2020. [DOI: 10.3724/sp.j.1041.2020.01301] [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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228
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Griffin BA, Ayer L, Pane J, Vegetabile B, Burgette L, McCaffrey D, Coffman DL, Cefalu M, Funk R, Godley MD. Expanding outcomes when considering the relative effectiveness of two evidence-based outpatient treatment programs for adolescents. J Subst Abuse Treat 2020; 118:108075. [PMID: 32972649 PMCID: PMC7519172 DOI: 10.1016/j.jsat.2020.108075] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 06/08/2020] [Accepted: 06/28/2020] [Indexed: 11/27/2022]
Abstract
The current study seeks to advance understanding about how to address substance use and co-occurring mental health problems in adolescents. Specifically, we compared the effectiveness of two evidence-based treatment programs (Motivational Enhancement Treatment/Cognitive Behavior Therapy, 5 Sessions [MET/CBT5] and Adolescent Community Reinforcement Approach [A-CRA]) for both substance use and mental health outcomes (i.e., crossover effects). We used statistical methods designed to approximate randomized controlled trials when comparing nonequivalent groups using observational study data. Our methods also included an assessment of the potential impact of omitted variables. We found that after applying balancing weighting to ensure similarity of the baseline samples (given the nonrandomized study design), both groups significantly improved on the two substance use outcomes (days abstinent and percent of youth in recovery) and on the two mental health outcomes (post-traumatic stress disorder (PTSD) symptoms and general emotional problems). Youth in A-CRA were significantly more likely to be in recovery at the 3-month follow-up compared to youth in MET/CBT5, but the size of this effect was very small. Youth receiving MET/CBT5 appeared to show significantly more improvement in the two mental health measures compared to youth in A-CRA, though these effect sizes were also very small. The findings indicate that adolescents with co-occurring substance use and mental health problems improve on both substance use and mental health outcomes with both treatments even though they are not specifically targeting mental health problems.
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Affiliation(s)
| | - Lynsay Ayer
- RAND Corporation, 1200 South Hayes Street, Arlington, VA, USA.
| | - Joseph Pane
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, USA.
| | | | - Lane Burgette
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA 15213, USA.
| | | | - Donna L Coffman
- Temple University, 1301 Cecil B. Moore Ave, Ritter Annex, 9th floor, Philadelphia, PA 19122, USA.
| | - Matthew Cefalu
- RAND Corporation, 1776 Main St, Santa Monica, CA 90401, USA.
| | - Rod Funk
- Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761, USA.
| | - Mark D Godley
- Chestnut Health Systems, 448 Wylie Dr, Normal, IL 61761, USA.
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229
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Meneses E, Kinslow K, McKenney M, Elkbuli A. Post-Traumatic Stress Disorder in Adult and Pediatric Trauma Populations: A Literature Review. J Surg Res 2020; 259:357-362. [PMID: 33070994 DOI: 10.1016/j.jss.2020.09.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 08/25/2020] [Accepted: 09/22/2020] [Indexed: 01/30/2023]
Abstract
Each year, traumatic injuries affect 2.6 million adults in the United States leading to significant health problems. Although many sequelae stem directly from physical manifestations of one's sustained injuries, mental health may also be affected in the form of post-traumatic stress disorder (PTSD). PTSD can lead to decreased physical recovery, social functioning, and quality of life. Several screening tools such as the Injured Trauma Survivor Screen, PTSD CheckList, Primary Care PTSD, and Clinician-Administered PTSD Scale for DSM-5 have been used for initial PTSD screening of the trauma patient. Early screening is important as it serves as the first step in delivering the appropriate mental health care to those in need. Factors that increase the likelihood of developing PTSD include younger age, nonwhite ethnicity, and lower socioeconomic status. Current data on male or female predominance of PTSD in trauma populations is inconsistent. Cognitive behavioral therapy, hypnosis, and psychoeducation have been used to treat symptoms of PTSD. This review discusses the impact PTSD has on the trauma patient and the need for universal screening in this susceptible population. Ultimately, trauma centers should implement such universal screening protocols as to avoid absence, or undertreatment of PTSD, both of which having longstanding consequences.
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Affiliation(s)
- Evander Meneses
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida
| | - Kyle Kinslow
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida
| | - Mark McKenney
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida; Department of Surgery, University of South Florida, Tampa, Florida
| | - Adel Elkbuli
- Division of Trauma and Surgical Critical Care, Department of Surgery, Kendall Regional Medical Center, Miami, Florida.
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230
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Marusak HA, Hehr A, Bhogal A, Peters C, Iadipaolo A, Rabinak CA. Alterations in fear extinction neural circuitry and fear-related behavior linked to trauma exposure in children. Behav Brain Res 2020; 398:112958. [PMID: 33069739 DOI: 10.1016/j.bbr.2020.112958] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/12/2020] [Accepted: 10/05/2020] [Indexed: 01/12/2023]
Abstract
Exposure to childhood trauma is extremely common (>60 %) and is a leading risk factor for fear-based disorders, including anxiety and posttraumatic stress disorder. These disorders are characterized by deficits in fear extinction and dysfunction in underlying neural circuitry. Given the strong and pervasive link between childhood trauma and the development of psychopathology, fear extinction may be a key mechanism. The present study tests the impact of childhood trauma exposure on fear extinction and underlying neural circuitry. Children (N = 44, 45 % trauma-exposed; 6-11 yrs) completed a novel two-day virtual reality fear extinction experiment. On day one, participants underwent fear conditioning and extinction. Twenty-four hours later, participants completed a test of extinction recall during fMRI. Conditioned fear was measured throughout the experiment using skin conductance and fear-related behavior, and activation in fear-related brain regions was estimated during recall. There were no group differences in conditioned fear during fear conditioning or extinction learning. During extinction recall, however, trauma-exposed children kept more distance from both the previously extinguished and the safety cue, suggesting poor differentiation between threat and safety cues. Trauma-exposed youth also failed to approach the previously extinguished cue over the course of extinction recall. The effects on fear-related behavior during extinction recall were accompanied by higher activation to the previously extinguished cue in fear-relevant brain regions, including the dorsal anterior cingulate cortex and anterior insula, in trauma-exposed relative to control children. Alterations in fear-related brain regions and fear-related behavior may be a core mechanism through which childhood trauma confers heightened vulnerability to psychopathology.
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Affiliation(s)
- Hilary A Marusak
- Department of Psychiatry & Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, United States; Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, MI, United States.
| | - Aneesh Hehr
- Department of Psychiatry & Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Amanpreet Bhogal
- Department of Psychiatry & Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, United States
| | - Craig Peters
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, United States
| | - Allesandra Iadipaolo
- Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, United States
| | - Christine A Rabinak
- Department of Psychiatry & Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI, United States; Merrill Palmer Skillman Institute for Child and Family Development, Wayne State University, Detroit, MI, United States; Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, United States; Department of Pharmaceutical Sciences, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI, United States; Translational Neuroscience Program, School of Medicine, Wayne State University, Detroit, MI, United States
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231
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Solberg Ø, Nissen A, Vaez M, Cauley P, Eriksson AK, Saboonchi F. Children at risk: A nation-wide, cross-sectional study examining post-traumatic stress symptoms in refugee minors from Syria, Iraq and Afghanistan resettled in Sweden between 2014 and 2018. Confl Health 2020; 14:67. [PMID: 33024451 PMCID: PMC7531165 DOI: 10.1186/s13031-020-00311-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 09/18/2020] [Indexed: 12/19/2022] Open
Abstract
Background The objective of the present study was to assess nation-wide, representative prevalence estimates for symptom-defined posttraumatic stress disorder (PTSD) within populations of refugee minors from Afghanistan, Syria and Iraq resettled in Sweden. Methods A nation-wide, cross-sectional, questionnaire study with a stratified sample of refugee minors, aged 16–18 years, from Afghanistan, Iraq and Syria, resettled in Sweden between 2014 and 2018 (N = 5071) was conducted. The response rate was 22.3%, leaving n = 1129 refugee minors (boys 53.1% / girls 46.9%) in the final sample. Symptom-defined prevalences of PTSD were measured using CRIES-8 with ≥17 as cut-off. Data were analyzed using frequency distributions, and strata-specific PTSD prevalences with 95% confidence intervals (95% CIs), were estimated. The association between migratory status on arrival (unaccompanied vs. accompanied) and PTSD was estimated using crude and adjusted odds ratios (OR) utilizing logistic regression analyses with 95% CIs. Results Overall, the weighted PTSD prevalence was 42% (95% CI 38.9–45.1), with minors from Afghanistan presenting the highest prevalence (56.9, 95% CI 51.5–62.2), compared to minors from Iraq (36.8, 95% CI 28.9–45.4) and Syria (33.4, 95% CI 29.4–37.6). Unaccompanied minors from Afghanistan had higher odds of PTSD compared to accompanied minors from Afghanistan (OR = 1.92, 95% CI 1.08–3.40). Gender differences were non-significant. Conclusions High prevalences of symptom-defined PTSD among refugee minors in general and in unaccompanied minors from Afghanistan in particular, were revealed. Findings calls for continued efforts to support this especially vulnerable group.
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Affiliation(s)
- Øivind Solberg
- Division for Implementation and Treatment Research, Norwegian Centre for Violence and Traumatic Stress Studies, P.box 181, 0409 Oslo, Nydalen Norway.,Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden
| | - Alexander Nissen
- Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden.,Division for Forced migration and Refugee Health, Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Marjan Vaez
- Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Unit of Mental Health, Children and Youth, The Public Health Agency of Sweden, Solna, Sweden
| | - Prue Cauley
- Division for Implementation and Treatment Research, Norwegian Centre for Violence and Traumatic Stress Studies, P.box 181, 0409 Oslo, Nydalen Norway
| | - Anna-Karin Eriksson
- Unit of Mental Health, Children and Youth, The Public Health Agency of Sweden, Solna, Sweden
| | - Fredrik Saboonchi
- Department of Health Science, Swedish Red Cross University College, Stockholm, Sweden.,Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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232
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Liang Y, Zhou Y, Ruzek JI, Liu Z. Patterns of childhood trauma and psychopathology among Chinese rural-to-urban migrant children. CHILD ABUSE & NEGLECT 2020; 108:104691. [PMID: 32854057 DOI: 10.1016/j.chiabu.2020.104691] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 07/22/2020] [Accepted: 08/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Exposure to childhood trauma can cause psychopathology and negative psychosocial outcomes across the lifespan. Rural-to-urban migrant children are commonly exposed to traumatic experiences (TEs). However, no study has comprehensively examined patterns of childhood trauma in Chinese culture. The current study aimed to examine patterns of childhood trauma exposure among Chinese rural-to-urban migrant children. METHODS A large-scale (N = 15,890) cross-sectional survey of rural-to-urban migrant workers' children in grades 4 to 9 was conducted in Beijing. Childhood TEs, including accidents and injuries, interpersonal violence, and vicarious trauma, as well as demographics and internalizing and externalizing behaviors, were measured. RESULTS Four patterns of childhood trauma were found: low trauma exposure (60.4%), vicarious trauma exposure (23.9%), domestic violence exposure (10.5%), and multiple trauma exposure (5.3%). Age, gender, parents' marital status, father's education level, family support and peer support differentiated the four TE patterns. Both internalizing and externalizing behaviors were more severe in patterns with more types of TEs. CONCLUSIONS Our findings provide a better understanding of childhood trauma in Chinese culture and the relationship between TEs and mental health. Clinicians and policy makers should tailor prevention and treatment programs according to different patterns of victimization.
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Affiliation(s)
- Yiming Liang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, 19A Yuquan Road, Shijingshan District, Beijing 100049, China
| | - Yueyue Zhou
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, 19A Yuquan Road, Shijingshan District, Beijing 100049, China
| | - Josef I Ruzek
- Department of Psychiatry & Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA
| | - Zhengkui Liu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang District, Beijing 100101, China; Department of Psychology, University of Chinese Academy of Sciences, 19A Yuquan Road, Shijingshan District, Beijing 100049, China.
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233
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Dodd CG, Hill RM, Alvis LM, Rooney EE, Layne CM, Logsdon T, Sandler IN, Kaplow JB. Initial Validation and Measurement Invariance of the Active Inhibition Scale Among Traumatized and Grieving Youth. J Trauma Stress 2020; 33:843-849. [PMID: 32516471 DOI: 10.1002/jts.22529] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 12/16/2019] [Accepted: 01/07/2020] [Indexed: 01/08/2023]
Abstract
The Active Inhibition Scale (AIS; Ayers, Sandler, & Twohey, 1998) is an 11-item, self-report measure of emotional suppression among children and adolescents. Previous research with the AIS has linked emotional suppression to several clinically significant outcomes, such as posttraumatic stress symptoms (PTSS) and suicide, among trauma-exposed and bereaved youth; however, there are no published evaluations of its psychometric properties. We examined the factor structure and criterion validity of the AIS in two samples. Sample 1 included youth (M = 12.22 years, SD = 2.96, range: 6-18 years; 55.4% female) referred to an outpatient psychology clinic specializing in childhood trauma and grief. Sample 2 included youth (M = 13.18 years, SD = 2.58, range: 8-18 years; 61.8% female) referred to a community grief counseling center. Confirmatory factor analytic results supported a one-factor solution, Cronbach's α = .94. Additionally, AIS scores correlated positively with PTSS, depression, and maladaptive grief, rs = .43-.64. Evidence of factorial invariance was found across gender, race/ethnicity, and age group. Emotional suppression scores were higher among girls compared to boys, Black and Hispanic youth compared to White youth, and older compared to younger age groups. The magnitude of correlations between AIS and symptom measure scores was comparable across groups. These results support the reliability and criterion validity of the AIS with diverse youth populations and underscore the role that emotional suppression may play in explaining group differences in mental health symptoms.
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Affiliation(s)
- Cody G Dodd
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Lauren M Alvis
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Evan E Rooney
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Christopher M Layne
- UCLA-Duke University National Center for Child Traumatic Stress, Los Angeles, California, USA.,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles
| | - Tami Logsdon
- Children's Bereavement Center of South Texas, San Antonio, Texas, USA
| | - Irwin N Sandler
- Department of Psychology, Arizona State University, Tempe, Arizona, USA
| | - Julie B Kaplow
- Department of Pediatrics, Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
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234
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Makita K, Takiguchi S, Naruse H, Shimada K, Morioka S, Fujisawa TX, Shimoji K, Tomoda A. White matter changes in children and adolescents with reactive attachment disorder: A diffusion tensor imaging study. Psychiatry Res Neuroimaging 2020; 303:111129. [PMID: 32585578 DOI: 10.1016/j.pscychresns.2020.111129] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 02/23/2020] [Accepted: 06/12/2020] [Indexed: 01/02/2023]
Abstract
Childhood maltreatment is associated with altered brain structure and function and is a major risk factor for psychopathology, including reactive attachment disorder (RAD). However, whether changes to white matter microstructural integrity are associated with RAD is unclear. We used diffusion tensor imaging (DTI) to assess group differences in fractional anisotropy (FA) in patients with RAD (n = 25; mean age = 13.2) to typically developing (TD) controls (n = 33; mean age = 13.0). To further interpret differences in FA, additional parameters such as mean diffusivity (MD), axial diffusivity (AD) and radial diffusivity (RD) were assessed. We found that FA values in the body of corpus callosum (CC) and in the projection and thalamic pathways, including the posterior limb of the internal capsule and corona radiata (anterior, posterior, and superior), were significantly higher in the RAD than in the TD group. Additionally, RAD group showed significantly lower RD values in the body of the CC and abovementioned pathways than TD group. Our findings indicate that RAD is associated with altered structure of the CC and projection and thalamic pathways, which may play a role in emotion regulation. The aberrant development of these tracts in RAD may reflect stress-related psychophysiological responses.
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Affiliation(s)
- Kai Makita
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan
| | - Shinichiro Takiguchi
- Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan; Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
| | - Hiroaki Naruse
- Division of Physical Therapy and Rehabilitation, University of Fukui Hospital, Fukui, Japan
| | - Koji Shimada
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan; Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
| | - Shigemi Morioka
- Department of Pediatrics, Fukui Aiiku Hospital, Fukui, Japan
| | - Takashi X Fujisawa
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan; Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan
| | - Keigo Shimoji
- Department of Diagnostic Radiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Department of Radiology, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Akemi Tomoda
- Research Center for Child Mental Development, University of Fukui, Fukui, Japan; Department of Child and Adolescent Psychological Medicine, University of Fukui Hospital, Fukui, Japan; Division of Developmental Higher Brain Functions, United Graduate School of Child Development, University of Fukui, Fukui, Japan.
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235
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Powell BJ, Patel SV, Haley AD, Haines ER, Knocke KE, Chandler S, Katz CC, Seifert HP, Ake G, Amaya-Jackson L, Aarons GA. 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 2020; 47:705-719. [PMID: 31813066 PMCID: PMC7275881 DOI: 10.1007/s10488-019-01003-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [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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Affiliation(s)
- Byron J Powell
- Brown School, Washington University in St. Louis, St. Louis, USA.
| | - Sheila V Patel
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
- RTI International, Durham, USA
| | - Amber D Haley
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
| | - Emily R Haines
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
- RTI International, Durham, USA
| | - Kathleen E Knocke
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
| | - Shira Chandler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, USA
| | - Colleen Cary Katz
- Silberman School of Social Work, Hunter College, City University of New York, New York, USA
| | | | - George Ake
- Duke University School of Medicine, Durham, USA
| | - Lisa Amaya-Jackson
- Center for Child and Family Health, Durham, USA
- Duke University School of Medicine, Durham, USA
| | - Gregory A Aarons
- Child and Adolescent Services Research Center, University of California at San Diego School of Medicine, San Diego, USA
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236
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Development and Preliminary Validation of the University of Minnesota's Traumatic Stress Screen for Children and Adolescents (TSSCA). J Behav Health Serv Res 2020; 48:50-62. [PMID: 32851563 DOI: 10.1007/s11414-020-09725-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Child and adolescent exposure to potential trauma experiences is pervasive. Given the prevalence, deleterious mental and physical effects, and economic cost of trauma exposure, child- and family-service systems are adopting trauma-informed approaches, including practices like trauma screening. Although a number of trauma-focused screening and assessment measures exist for youth, the majority are lengthy and inappropriate for universal administration. This study describes the development and preliminary validation of the Traumatic Stress Screen for Children and Adolescents (TSSCA), a six-item screening measure for trauma exposure and traumatic stress symptoms. Using two samples of youth presenting at community practice settings (n1 = 134, n2 = 137), reliability, discriminative validity, and criterion-related validity were calculated for the TSSCA. Results support the TSSCA as an empirically derived, reliable, and valid screening measure for exposure to trauma and symptoms of traumatic stress for youth ages 7 to 18.
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237
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Nahvi RJ, Sabban EL. Sex Differences in the Neuropeptide Y System and Implications for Stress Related Disorders. Biomolecules 2020; 10:biom10091248. [PMID: 32867327 PMCID: PMC7564266 DOI: 10.3390/biom10091248] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/16/2022] Open
Abstract
The neuropeptide Y (NPY) system is emerging as a promising therapeutic target for neuropsychiatric disorders by intranasal delivery to the brain. However, the vast majority of underlying research has been performed with males despite females being twice as susceptible to many stress-triggered disorders such as posttraumatic stress disorder, depression, anorexia nervosa, and anxiety disorders. Here, we review sex differences in the NPY system in basal and stressed conditions and how it relates to varied susceptibility to stress-related disorders. The majority of studies demonstrate that NPY expression in many brain areas under basal, unstressed conditions is lower in females than in males. This could put them at a disadvantage in dealing with stress. Knock out animals and Flinders genetic models show that NPY is important for attenuating depression in both sexes, while its effects on anxiety appear more pronounced in males. In females, NPY expression after exposure to stress may depend on age, timing, and nature and duration of the stressors and may be especially pronounced in the catecholaminergic systems. Furthermore, alterations in NPY receptor expression and affinity may contribute to the sex differences in the NPY system. Overall, the review highlights the important role of NPY and sex differences in manifestation of neuropsychiatric disorders.
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238
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Extinction Learning as a Potential Mechanism Linking High Vagal Tone with Lower PTSD Symptoms among Abused Youth. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2020; 47:659-670. [PMID: 30112595 DOI: 10.1007/s10802-018-0464-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Childhood abuse is a potent risk factor for psychopathology, including posttraumatic stress disorder (PTSD). Research has shown high resting vagal tone, a measure of parasympathetic nervous system function, protects abused youth from developing internalizing psychopathology, but potential mechanisms explaining this effect are unknown. We explored fear extinction learning as a possible mechanism underlying the protective effect of vagal tone on PTSD symptoms among abused youth. We measured resting respiratory sinus arrhythmia (RSA) and skin conductance responses (SCR) during a fear conditioning and extinction task in youth with variability in abuse exposure (N = 94; aged 6-18 years). High RSA predicted lower PTSD symptoms and enhanced extinction learning among abused youths. In a moderated-mediation model, extinction learning mediated the association of abuse with PTSD symptoms only among youth with high RSA. These findings highlight extinction learning as a possible mechanism linking high vagal tone to decreased risk for PTSD symptoms among abused youth.
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239
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Greene CA, Haisley L, Wallace C, Ford JD. Intergenerational effects of childhood maltreatment: A systematic review of the parenting practices of adult survivors of childhood abuse, neglect, and violence. Clin Psychol Rev 2020; 80:101891. [PMID: 32745835 PMCID: PMC7476782 DOI: 10.1016/j.cpr.2020.101891] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 06/22/2020] [Accepted: 07/20/2020] [Indexed: 12/21/2022]
Abstract
A history of maltreatment in childhood may influence adults' parenting practices, potentially affecting their children. This systematic review examines 97 studies investigating associations of parental childhood victimization with a range of parenting behaviors that may contribute to the intergenerational effects of abuse: abusive parenting, problematic parenting, positive parenting, and positive parental affect. Key findings include: (1) parents who report experiencing physical abuse or witnessing violence in the home during childhood are at increased risk for reporting that they engage in abusive or neglectful parenting; (2) a cumulative effect of maltreatment experiences, such that adults who report experiencing multiple types or repeated instances of victimization are at greatest risk for perpetrating child abuse; (3) associations between reported childhood maltreatment experiences and parents' problematic role reversal with, rejection of, and withdrawal from their children; (4) indirect effects between reported childhood maltreatment and abusive parenting via adult intimate partner violence; and (5) indirect effects between reported childhood maltreatment and lower levels of positive parenting behaviors and affect via mothers' mental health. Thus, childhood experiences of maltreatment may alter parents' ability to avoid negative and utilize positive parenting practices. Limitations of this body of literature include few prospective studies, an overreliance on adults' self-report of their childhood victimization and current parenting, and little examination of potentially differential associations for mothers and fathers.
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Affiliation(s)
- Carolyn A Greene
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA.
| | | | - Cara Wallace
- University of Hartford, 200 Bloomfield Avenue, West, Hartford, CT 06117, USA
| | - Julian D Ford
- University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT 06030, USA
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240
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Clinical correlates of socioeconomic status in adolescent bipolar disorder. Compr Psychiatry 2020; 101:152186. [PMID: 32504872 DOI: 10.1016/j.comppsych.2020.152186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 04/21/2020] [Accepted: 05/22/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lower socioeconomic status (SES) is associated with symptomatic severity, comorbidity, and functional impairment in adults with bipolar disorder (BD). Little is known about clinical correlates of SES in adolescents with BD. METHODS Participants included 195 adolescents, 13-20 years old, with BD type I, II or not otherwise specified (NOS). Diagnoses were determined by standardized semi-structured interviews. Based on the Hollingshead scale, participants were divided into "low" (SES 1-3) and the "high" (SES 4-5) SES groups. Demographic and clinical correlates of SES were evaluated in univariate analyses; significant variables were evaluated in a logistic regression model. RESULTS Compared to participants in the high SES group (n = 150), participants in the low SES group (n = 45) were significantly younger, less likely to be of Caucasian race and living with natural parents. In the logistic regression model, controlling for age and race, the low SES group had higher risk of police contact or arrest (OR = 2.41, 95% CI:1.14-5.11, p = 0.022), less treatment with stimulants(OR = 0.20 95% CI: 0.06-0.67, p = 0.009), and more post-traumatic stress disorder (PTSD) (OR = 4.08, 95% CI:1.33-12.46, p = 0.014) compared to the high SES group. In sensitivity analyses that further controlled for intact family, the finding of higher rates of police contact or arrest was no longer significant. LIMITATIONS Cross-sectional design; higher-skewed SES sample. CONCLUSIONS Lower SES in adolescent BD is associated with higher legal risk, increased PTSD, and under-treatment of attention-deficit/hyperactivity disorder (ADHD). Future studies are needed to evaluate the inter-relationships of these correlates, using prospective designs that can evaluate the direction of these associations. Further studies incorporating neurobiological markers are also needed to explore mechanisms underlying SES-related differences in BD.
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241
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Folayan MO, Oginni O, Arowolo O, El Tantawi M. Internal consistency and correlation of the adverse childhood experiences, bully victimization, self-esteem, resilience, and social support scales in Nigerian children. BMC Res Notes 2020; 13:331. [PMID: 32650832 PMCID: PMC7350627 DOI: 10.1186/s13104-020-05174-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Accepted: 07/04/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES We evaluated the internal consistencies and the correlation between measures of adverse childhood experiences (ACE), bully victimization, self-esteem, resilience, and social support in children/adolescents in Nigeria. RESULTS The Cronbach's alphas were 0.67 for the ACE Questionnaire; 0.79 for the victimization subscale of the Illinois Bully Scale; 0.60 for Rosenberg's self-esteem scale; 0.81 for Connor-Davidson resilience scale; and 0.93 for multidimensional perceived social support scale. Social support was negatively correlated with ACE (r = - 0.21) and bully victimization (r = - 0.16) and was associated with higher self-esteem (r = - 0.29) and higher resilience (r = 0.15). Likewise, higher resilience was associated with fewer ACE (r = - 0.07), higher self-esteem (r = - 0.21), and higher bully victimization (r = 0.13). Higher self-esteem was associated with fewer ACE (r = 0.25) and lower bully victimization (r = 0.16), whereas bully victimization was positively correlated with ACE (r = 0.20). The correlations were all statistically significant.
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Affiliation(s)
- Morenike Oluwatoyin Folayan
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olakunle Oginni
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
- Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Olaniyi Arowolo
- Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria
| | - Maha El Tantawi
- Faculty of Dentistry, Alexandria University, Alexandria, Egypt
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242
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Basu A, Farkas DK, Jiang T, Koenen KC, Lash TL, Sørensen HT, Gradus JL. Incident psychiatric comorbidity following stress disorder diagnoses in Danish school-aged children: prospective population-based study. Br J Psychiatry 2020; 217:377-382. [PMID: 31755399 PMCID: PMC7242129 DOI: 10.1192/bjp.2019.247] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Prospective population-based studies of psychiatric comorbidity following trauma and severe stress exposure in children are limited. AIMS To examine incident psychiatric comorbidity following stress disorder diagnoses in Danish school-aged children using Danish national healthcare system registries. METHOD Children (6-15 years of age) with a severe stress or adjustment disorder (ICD-10) between 1995 and 2011 (n = 11 292) were followed prospectively for an average of 5.8 years. Incident depressive, anxiety and behavioural disorder diagnoses were examined relative to an age- and gender-matched comparison cohort (n = 56 460) using Cox proportional hazards regression models. Effect modification by gender was examined through stratified analyses. RESULTS All severe stress and adjustment disorder diagnoses were associated with increased rates for all incident outcome disorders relative to the comparison cohort. For instance, adjustment disorders were associated with higher rates of incident depressive (rate ratio RR = 6.8; 95% CI 6.0-7.7), anxiety (RR = 5.3; 95% CI 4.5-6.4), and behavioural disorders (RR = 7.9; 95% CI 6.6-9.3). Similarly, PTSD was also associated with higher rates of depressive (RR = 7.4; 95% CI 4.2-13), anxiety (RR = 7.1; 95% CI 3.5-14) and behavioural disorder (RR = 4.9; 95% CI 2.3-11) diagnoses. There was no evidence of gender-related differences. CONCLUSIONS Stress disorders varying in symptom constellation and severity are associated with a range of incident psychiatric disorders in children. Transdiagnostic assessments within a longitudinal framework are needed to characterise the course of post-trauma or severe stressor psychopathology.
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Affiliation(s)
- Archana Basu
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Kresge Building, Boston, MA, USA 02115
| | | | - Tammy Jiang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Karestan C. Koenen
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Timothy L. Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | | | - Jaimie L. Gradus
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
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243
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Selitsky L, Markowitz N, Baxa DM, Kaljee L, Miree CA, Islam N, Burse C, Newaz R, Dankerlui D, Jacobsen G, Joseph C. Self-report of domestic violence and forced sex are related to sexual risk behaviors in a sample of juvenile detainees. HEALTH & JUSTICE 2020; 8:15. [PMID: 32577955 PMCID: PMC7313184 DOI: 10.1186/s40352-020-00116-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Accepted: 06/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Justice-involved youth have higher rates of sexually transmitted infections (STIs), and a higher prevalence of the associated sexual risk behaviors. Sexual risk behaviors are also associated with alcohol and drug use. Research suggests that a history of trauma is an important predictor of alcohol and drug use in youth offenders, and therefore is a likely contributor to sexual risk behavior in this population. The objective of this analysis is to determine the association of trauma, specifically, domestic violence and forced sex, to six sexual risk behaviors and a history of chlamydia among detained youth. METHODS The analysis uses data from a convenience sample of detainees assenting to HIV testing conducted December 2016 - August 2017 using the state-certified Voluntary Counseling Testing and Referral (VCTR) process. RESULTS Of the 379 youth that received VCTR at the facility, 308 (81.3%) were used in this analysis. Report of domestic violence was significantly associated with sex under the influence of alcohol and was also significantly associated with sex under the influence of marijuana. Forced sex was associated with a sexual partner of unknown HIV status. CONCLUSIONS Traumatic experiences were related to sexual risk behaviors in this analysis, and substance use was strongly implicated in the association. Trauma is known to be a catalyst to sexual risk behaviors, substance use, and delinquency in adolescence. Results support the findings of other investigators and re-iterate the need for trauma-informed interventions that can improve the life trajectories of detained youth.
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Affiliation(s)
- Lea Selitsky
- Internal Medicine, Johns Hopkins Hospital, Baltimore, USA
| | - Norman Markowitz
- Division of Infectious Diseases, Henry Ford Health System and School of Medicine, Wayne State University, Detroit, USA
| | - Dwayne M. Baxa
- William Beaumont School of Medicine, Oakland University, Rochester, USA
- Division of Infectious Diseases, Henry Ford Health System, Detroit, USA
| | - Linda Kaljee
- Global Health Initiative, Henry Ford Health System, Detroit, USA
| | - Cheryl A. Miree
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, Michigan USA
| | - Nishat Islam
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, Michigan USA
| | - Chez Burse
- Global Health Initiative, Henry Ford Health System, Detroit, USA
| | - Rehnuma Newaz
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, Michigan USA
| | - Doreen Dankerlui
- Global Health Initiative, Henry Ford Health System, Detroit, USA
| | - Gordon Jacobsen
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, Michigan USA
| | - Christine Joseph
- Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, Michigan USA
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244
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When Do Posttraumatic Stress and Related Problems Abate During School-Based Group Therapy for Elementary Students? SCHOOL MENTAL HEALTH 2020. [DOI: 10.1007/s12310-020-09377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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245
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Parker J, Olson S, Bunde J. The Impact of Trauma-Based Training on Educators. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:217-227. [PMID: 32549933 PMCID: PMC7289915 DOI: 10.1007/s40653-019-00261-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
An extensive literature establishing the prevalence of Adverse Childhood Experiences (ACEs) and their destructive impact over the lifespan has motivated recent efforts to fundamentally alter the educational milieu. One such initiative, entitled "Compassionate Schools," involves the training of educators in trauma-informed and trauma-sensitive practices, in the hopes of creating scholastic environments more conducive to widespread resilience. Despite encouraging initial reports, few studies have empirically evaluated the impact of Compassionate Schools training on attendees. The current investigation reports the results of two studies. In Study 1, participants completed a questionnaire 6 months after their Compassionate Schools trainings, including items relevant to mindset and behavior change. In Study 2, participants completed the Attitudes Relevant to Trauma Informed Care (ARTIC) scale before and after a Compassionate Schools training. The majority of participants in Study 1 reported enduring changes in mindset and behavior as a result of their trainings, and described those changes in terms consistent with the Compassionate Schools model. ARTIC responses in Study 2 suggested marked trauma-informed attitudinal improvements between pre- and post-training assessments. These data, although preliminary, are consistent with the Compassionate Schools paradigm, and empirically support its promise as a ACEs-informed intervention for educators.
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Affiliation(s)
- Jennifer Parker
- Child Protection Training Center, University of South Carolina Upstate, 160 E. St. John Street, Spartanburg, SC 29306 USA
| | - Stacey Olson
- Child Protection Training Center, University of South Carolina Upstate, 160 E. St. John Street, Spartanburg, SC 29306 USA
| | - James Bunde
- Psychology Department, University of South Carolina Upstate, Spartanburg, SC USA
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247
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Unterhitzenberger J, Sachser C, Rosner R. Posttraumatic Stress Disorder and Childhood Traumatic Loss: A Secondary Analysis of Symptom Severity and Treatment Outcome. J Trauma Stress 2020; 33:208-217. [PMID: 32216150 DOI: 10.1002/jts.22499] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 07/30/2019] [Accepted: 07/30/2019] [Indexed: 11/08/2022]
Abstract
Loss is a commonly experienced traumatic event among children. Although the experience of loss can potentially lead to posttraumatic stress symptoms (PTSS), little is known about PTSS levels after traumatic loss versus other traumatic events. We investigated data from a randomized controlled trial (RCT) on trauma-focused cognitive behavioral therapy (TF-CBT) versus a waitlist condition for children with PTSS. In a secondary analysis, we compared participants who reported traumatic loss as their index event (n = 23) to those who reported the two most frequently reported index events in the RCT: sexual abuse (SA; n = 59) and physical violence (PV; n = 55). The index event was rated according to the participants' most distressing traumatic event reported on the Clinician-Administered PTSD Scale for Children and Adolescents. Participants who experienced traumatic loss reported fewer PTSS and better general functioning than those who reported SA. A subgroup RCT (n = 19) revealed TF-CBT to be highly effective in reducing PTSS in cases of traumatic loss, d = 1.69. The effect sizes for PTSS indicated that all three trauma groups benefited from TF-CBT. In the waitlist group, PTSS symptoms improved for SA and PV, ds = 0.76 and 0.98, respectively, but not for traumatic loss, d = 0.23. These findings suggest that TF-CBT is a feasible and promising treatment for children who experience PTSS after traumatic loss. The results are limited by the post hoc quality of the analyses and lack of a measure of grief in the RCT.
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Affiliation(s)
| | - Cedric Sachser
- Clinic for Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
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248
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Eskander N, Vadukapuram R, Zahid S, Ashraf S, Patel RS. Post-traumatic Stress Disorder and Suicidal Behaviors in American Adolescents: Analysis of 159,500 Psychiatric Hospitalizations. Cureus 2020; 12:e8017. [PMID: 32528756 PMCID: PMC7279690 DOI: 10.7759/cureus.8017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Objectives Our main goal is to understand the demographics and psychiatric comorbidities and to evaluate the risk of suicidal behaviors in post-traumatic stress disorder (PTSD) adolescents. Methods We included 159,500 adolescents (age, 12 to 18 years) with a primary psychiatric diagnosis from the Nationwide Inpatient Sample from January to December 2014 and grouped them by a diagnosis of PTSD (N = 21,230 [13.3%]). A logistic regression model was used to measure the odds ratio (OR) for suicidal behaviors in PTSD versus non-PTSD cohorts. Results A higher proportion of PTSD adolescents were females (75.7%) and whites (63.6%). The most prevalent psychiatric comorbidities in PTSD inpatients (vs. non-PTSD) were anxiety disorders (100% vs. 31.9%) and mood disorders (89.4% vs. 84.7%). About 48.7% of PTSD inpatients had suicidal behaviors and had a higher risk (OR 1.23; 95% CI: 1.19-1.26; P < 0.001) compared to that seen in 43.6% of the non-PTSD cohort. Conclusions Diagnosis of PTSD is prevalent in adolescents, especially females and whites, with anxiety and mood disorders being the most prevalent comorbidities. There exists a significant association between PTSD and suicidal behaviors, with an increased risk of 23% in adolescents.
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Affiliation(s)
- Noha Eskander
- Psychiatry, Ain Shams University Hospital, Cairo, EGY
| | - Ramu Vadukapuram
- Psychiatry, State University of New York Upstate Medical University, Syracuse, USA
| | - Shaheer Zahid
- Psychiatry, Saint James School of Medicine, Park Ridge, USA
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249
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Bender AK, Bucholz KK, Edenberg HJ, Kramer JR, Anokhin AP, Meyers JL, Kuperman S, Hesselbrock V, Hesselbrock M, McCutcheon VV. Trauma Exposure and Post-Traumatic Stress Disorder Among Youth in a High-Risk Family Study: Associations with Maternal and Paternal Alcohol Use Disorder. JOURNAL OF FAMILY TRAUMA, CHILD CUSTODY & CHILD DEVELOPMENT 2020; 17:116-134. [PMID: 38827930 PMCID: PMC11142461 DOI: 10.1080/26904586.2020.1751016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
This study presents findings regarding the prevalence of trauma exposure and Posttraumatic Stress Disorder (PTSD) based on discrete types of trauma (physical, sexual, witnessed violence, and non-assaultive trauma) among 3404 youth in a family study of Alcohol Use Disorder (AUD). Data from the Collaborative Study on the Genetics of Alcoholism (COGA) were used to examine associations of parent AUD with offspring's childhood trauma exposure, and with lifetime diagnosis of DSM-IV PTSD among White and Black participants aged 12-35. Of 3404 youth, 59.7% had parents affected by AUD and 78% experienced ≤1 traumatic events before age 18. AUD in one or both parents was associated with physical, sexual, and witnessed violence among Whites. Among African Americans, maternal AUD was associated with sexual assault. The lifetime PTSD rate among youth exposed to childhood trauma was 8.6%, and mother-only AUD was significantly associated with lifetime PTSD among participants in both groups. PTSD among youth in this study were somewhat higher (7.9% to 8.83%) than those found in general population studies of the same demographic (5% to 6.8%). Maternal AUD appears to be a salient risk factor for sexual assault before age 18 among Black and development of lifetime PTSD among White youth.
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Affiliation(s)
- Annah K Bender
- School of Social Work, University of Missouri-St. Louis, St. Louis, MO
| | - Kathleen K Bucholz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Howard J Edenberg
- Department of Biochemistry and Molecular Biology, Indiana University School of Medicine, Indianapolis, IN
| | - John R Kramer
- Psychiatry, Department of Psychiatry, Carver College of Medicine, University of Iowa
| | - Andrey P Anokhin
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
| | - Jacquelyn L Meyers
- Assistant Professor, State University of New York Downstate Health Sciences University, Brooklyn, NY
| | - Samuel Kuperman
- Carver College of Medicine, University of Iowa, Iowa City, IA
| | | | | | - Vivia V McCutcheon
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO
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250
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Olsavsky AK, Stoddard J, Erhart A, Tribble R, Kim P. Neural processing of infant and adult face emotion and maternal exposure to childhood maltreatment. Soc Cogn Affect Neurosci 2020; 14:997-1008. [PMID: 31680141 PMCID: PMC7058929 DOI: 10.1093/scan/nsz069] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 08/07/2019] [Accepted: 08/19/2019] [Indexed: 01/26/2023] Open
Abstract
Face processing in mothers is linked to mother–infant social communication, which is critical for parenting and in turn for child development. Neuroimaging studies of child maltreatment-exposed (CME) mothers are sparse compared to studies of mothers with postpartum depression, which have suggested blunted amygdala reactivity to infant stimuli. We expected to see a similar pattern in CME mothers. Based on broader studies in trauma-exposed populations, we anticipated increased amygdala reactivity to negative adult face stimuli in a comparison task in CME mothers given heightened evaluation of potential threat. We examined Neuroimaging studies of mothers with childhood maltreatment exposure (CME) (18–37 years old), who performed infant (N = 45) and/or adult (N = 46) face processing tasks. CME mothers exhibited blunted bilateral amygdala reactivity to infant faces. There was no between-group difference in amygdala reactivity to adult faces. In infant and adult face processing tasks regardless of CME, superior temporal gyrus activation was increased for negative-valence stimuli. Our preliminary findings suggest that childhood maltreatment alters maternal processing of infant social cues, a critical skill impacting infant socioemotional development.
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Affiliation(s)
- Aviva K Olsavsky
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus.,Pediatric Mental Health Institute, Children's Hospital Colorado
| | - Joel Stoddard
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus.,Pediatric Mental Health Institute, Children's Hospital Colorado
| | | | | | - Pilyoung Kim
- Department of Psychiatry, School of Medicine, University of Colorado Anschutz Medical Campus.,Department of Psychology, University of Denver
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