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Abstract
The effects of trauma in children are amply documented. This paper investigated the relationship between children's age and posttraumatic clusters of symptoms 30 months after the end of the Gulf War and the mother's reaction to the trauma 6 and 30 months after the war. Fifty-one children aged 6 to 8 years (3 to 5 years during the war) and their mothers were interviewed. Results showed no age differences in the various posttraumatic symptoms of the children. Correlations between the children's posttraumatic symptoms and both the general and the specific posttraumatic symptoms of their mothers were positive and significant in the 6-year-olds, positive and nonsignificant in the 7-year-olds, and nonsignificant and mostly negative in the 8-year-olds. These findings may reflect the developmental changes that render the older child more autonomous and the younger child rigidly attached to the mother after a traumatic event.
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Affiliation(s)
- L Wolmer
- Tel-Aviv Community Mental Health Center and Sackler Faculty of Medicine, Tel-Aviv University, Israel
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252
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Abstract
This paper presents an overview of the psychological effects of trauma on children and adolescents with specific attention to the epidemiology of traumatic experiences, risk factors, developmental effects, the types of traumatic experiences albeit a single event trauma or a chronic process trauma, the spectrum of clinical presentations, psychiatric and psychological comorbidities as well as assessment and therapeutic principles. In addition to the child's psychological response to the traumatic stressor communities are often devastated by natural or man made disasters. The interactions between the child's response with the family and community response as well as community interventions are discussed.
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Affiliation(s)
- J A Shaw
- University of Miami School of Medicine, Beach, FL 33140, USA
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253
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Deering CG. A cognitive developmental approach to understanding how children cope with disasters. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2000; 13:7-16. [PMID: 11022467 DOI: 10.1111/j.1744-6171.2000.tb00070.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
TOPIC This paper applies cognitive developmental theory to explain how preschoolers, school-age children, and adolescents process and respond to disasters. PURPOSE To help clinicians understand the disaster experience from a child's point of view, recognize age-specific reactions, identify symptoms that may signal coping difficulties, and plan effective interventions. SOURCES Case examples from the author's work with flood victims illustrate typical reactions for children (preschool to adolescents) within a family context, along with developmentally appropriate interventions. CONCLUSIONS Children affected by disasters need nursing interventions geared toward their particular developmental level and sensitive to their perception of the disaster.
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Affiliation(s)
- C G Deering
- Clayton College and State University, Morrow, GA, USA.
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254
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McDermott BM, Palmer LJ. Post-disaster service provision following proactive identification of children with emotional distress and depression. Aust N Z J Psychiatry 1999; 33:855-63. [PMID: 10619212 DOI: 10.1046/j.1440-1614.1999.00611.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Proactive, school-based psychological testing for emotional distress and depression was employed 6 months after a bushfire disaster. The service provision aim was to provide children with the greatest emotional distress the relatively limited therapeutic resources available in the post-disaster environment. Specific hypotheses were tested: that the prevalence of emotional distress and depression would be elevated 6 months post disaster; that emotional distress would be correlated with traumatic events; and that depression would be related to experiences of loss. METHOD Six months after a bushfire disaster grade 4, 5, and 6 students (n = 601) participated in screening using a test battery measuring emotional distress, depressive symptoms and trait anxiety. RESULTS Twelve percent (n = 72) of children experienced severe emotional distress 6 months after the bushfire. Rates of depression were similar to rates in non-traumatised child community samples. Multivariate analysis suggested that emotional distress was significantly associated with trait anxiety, evacuation experience, the perception that parents may have died during the bushfire, and depressive symptoms. Depressive symptoms were associated with total distress score, trait anxiety and perception of threat to the parents. CONCLUSIONS Substantial mental health morbidity was identified 6 months after a bushfire disaster. The usefulness of post-disaster service provision influenced by proactive screening is discussed and reasons for further research highlighted.
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Affiliation(s)
- B M McDermott
- Department of Paediatrics, University of Western Australia, Perth, Australia.
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255
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Vila G, Porche LM, Mouren-Simeoni MC. An 18-month longitudinal study of posttraumatic disorders in children who were taken hostage in their school. Psychosom Med 1999; 61:746-54. [PMID: 10593625 DOI: 10.1097/00006842-199911000-00005] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of our investigation was to study the course of direct and indirect posttraumatic disorders over 18 months in children after they were taken hostage in their school. METHODS Twenty-six young hostages were evaluated by using standardized clinical interviews and self-administered questionnaires (State and Trait Anxiety Inventory for Children [STAIC]and Revised Impact of Event Scale [IES]) 2, 4, 7, and 18 months after the event. They were compared with 21 children from the same school who were not taken hostage (indirect exposure). RESULTS Symptoms of acute stress were observed in 25 (96%) of the children who were directly involved in the traumatic event. After 2 months, 18 children had developed disorders according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, including 7 cases of full posttraumatic stress disorder (PTSD), 11 cases of subclinical PTSD, 3 cases of separation anxiety, 1 case of specific phobia, and 2 cases of major depressive disorder. Anxiety scores (STAIC) decreased between 2 and 4 months and then stabilized, whereas symptoms of avoidance (IES-avoidance) decreased gradually throughout the follow-up period, and symptoms of repetition (IES-intrusion) decreased less markedly. Children who were indirectly exposed to the trauma also manifested protracted posttraumatic symptomatology (two full cases of PTSD and six cases of subclinical PTSD), but their IES-intrusion scores were significantly lower at 7 months than those of children who were directly exposed, and the severity of their symptoms diminished over time. Girls tended to show a higher level of anxiety and more features of intrusion than boys. Psychological debriefing did not prevent occurrence of the disorders, but children who were not debriefed had the worst outcomes. CONCLUSIONS Even after a short event and even if they are not directly exposed, children under the age of 9 years can develop high rates of posttraumatic disorders that follow a protracted course despite early intervention and careful monitoring.
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Affiliation(s)
- G Vila
- Department of Child and Adolescent Psychiatry, Necker-Enfants-Malades Hospital, Paris, France
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256
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Pfefferbaum B, Nixon SJ, Krug RS, Tivis RD, Moore VL, Brown JM, Pynoos RS, Foy D, Gurwitch RH. Clinical needs assessment of middle and high school students following the 1995 Oklahoma City bombing. Am J Psychiatry 1999; 156:1069-74. [PMID: 10401454 DOI: 10.1176/ajp.156.7.1069] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This clinical assessment was designed to identify middle and high school students in need of formal evaluation for posttraumatic response symptoms following the 1995 bombing of the Alfred P. Murrah Federal Building in Oklahoma City. METHOD A clinical needs assessment instrument was developed and administered to grade 6 through 12 students 7 weeks after the bombing (N = 3,218). RESULTS More than 40% of the students reported knowing someone injured, and more than one-third reported knowing someone killed in the blast. Posttraumatic stress symptoms at 7 weeks significantly correlated with gender, exposure through knowing someone injured or killed, and bomb-related television viewing. CONCLUSIONS This study documents the intensity of community exposure to the bombing and the lingering symptoms of stress. The assessment was used in planning for clinical service delivery, training professional responders, and supporting funding requests.
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Affiliation(s)
- B Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City 73190-3048, USA.
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257
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Scheeringa MS. Treatment for Posttraumatic Stress Disorder in Infants and Toddlers. ACTA ACUST UNITED AC 1999. [DOI: 10.1521/jsyt.1999.18.2.20] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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258
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Korol M, Green BL, Gleser GC. Children's responses to a nuclear waste disaster: PTSD symptoms and outcome prediction. J Am Acad Child Adolesc Psychiatry 1999; 38:368-75. [PMID: 10199107 DOI: 10.1097/00004583-199904000-00008] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the psychological impact of living near a nuclear waste disaster that involved ongoing threat of radioactive contamination. METHOD Participants were an exposed sample (residence within a 5-mile radius of the nuclear plant) of 120 children (7-15 years old) and their parents and a nonexposed comparison sample of 60 children and their parents. Parent and self-ratings of the children's psychological functioning and posttraumatic stress disorder (PTSD) symptoms were obtained, along with cognitive variables. RESULTS Minimal differences between the 2 samples were found. In the exposed sample, stress responses for the child self-reports showed several age group by gender interactions. Girls' PTSD symptoms tended to increase with age while boys' symptoms decreased, with intrusion showing the strongest effects. While child and parent PTSD symptom ratings were correlated, children reported approximately twice as many symptoms. Cognitive understanding increased with age and was greater in boys. Exposure and parent functioning significantly predicted outcome. CONCLUSIONS Age and gender effects after disaster might best be explored as an interaction. While disaster effects were mild, the psychological health of the parents may be an important determinant of psychological health in children in this type of disaster.
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Affiliation(s)
- M Korol
- Mount Saint Mary's College, Emmitsburg, MD 21727, USA
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259
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Melançon G, Boyer R. [How to prevent post-traumatic stress disorder before traumatization occurs?]. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1999; 44:253-8. [PMID: 10225126 DOI: 10.1177/070674379904400305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To provide an update on methods of preventing the onset of posttraumatic stress disorder (PTSD) before trauma occurs. METHOD Survey and analysis of the literature (mainly articles) found in the Medline, Psychinfo, and Pilot databases. RESULTS Most research focuses on identifying risk factors and reinforcing individual resistance as the prime means of preventing PTSD. The severity of the trauma is by far the most serious risk factor. To reinforce resistance and prevent the onset of PTSD, the army has favoured psychoeducational approaches. However, the literature survey has found no pretrauma prevention program for other high-risk occupations. CONCLUSION The usefulness of identified risk factors for the primary prevention of PTSD is limited, since with the exception of the trauma itself, they play a minor role on the onset of severe-trauma PTSD. Psychoeducational approaches aimed at reinforcing the resistance of individuals at risk are promising, but their potential has to be further explored in individuals in high-risk trades. Finally, it has been suggested that other avenues of research in the primary prevention (pretrauma) of PTSD be explored. These include the identification of possible protection factors, the influence of genetic make-up and of biological variables, the cumulative effects of exposure to stressors, and the presence of chronic stressors.
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Affiliation(s)
- G Melançon
- Institut universitaire de gériatrie de Montréal.
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260
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Essau C, Conradt J, Petermann F. Häufigkeit der Posttraumatischen Belastungsstörung bei Jugendlichen: Ergebnisse der Bremer Jugendstudie. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 1999. [DOI: 10.1024//1422-4917.27.1.37] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: In diesem Artikel werden Häufigkeit, Komorbidität und psychosoziale Beeinträchtigung bei der Posttraumatischen Belastungsstörung an 1035 Jugendlichen im Alter von zwölf bis 17 Jahren dargestellt. Die Posttraumatische Belastungsstörung sowie andere psychische Störungen wurden nach DSM-IV-Kriterien anhand des computergestützten Interviews der Münchener Version des Composite International Diagnostic Interview kodiert. Insgesamt hatten 17 Jugendliche (1,6%) irgendwann in ihrem Leben die DSM-IV-Kriterien der Posttraumatischen Belastungsstörung erfüllt. Etwas mehr Mädchen als Jungen erfüllten die diagnostischen Kriterien dieser Störung, deren Häufigkeit mit dem Alter zunahm. Die Lebenszeit-Häufigkeit traumatischer Ereignisse lag weitaus höher. 233 (22,5%) aller Jugendlichen berichteten von mindestens einem traumatischen Ereignis in ihrem Leben. Am häufigsten wurden körperliche Angriffe, Verletzungen und schwerwiegende Unfälle von den Jugendlichen erlebt. Traumatische Ereignisse waren bei Jungen signifikant häufiger als bei Mädchen. Das Auftreten eines traumatischen Ereignisses war meist verbunden mit Hypervigilanz sowie wiederholter und eindringlicher psychischer Belastung bei Konfrontation mit Hinweisreizen, die einen Aspekt des Ereignisses symbolisieren oder ihm ähneln. Die Posttraumatische Belastungsstörung trat in hohem Maße komorbid mit Depressiven und Somatoformen Störungen sowie mit Störungen durch Substanzkonsum auf. Über 90% der Jugendlichen waren in ihrem Alltagsleben stark beeinträchtigt. Trotz des hohen Grades psychosozialer Beeinträchtigung nahm nur ein kleiner Teil der Fälle professionelle Hilfe in Anspruch.
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Affiliation(s)
- C.A. Essau
- Zentrum für Rehabilitationsforschung, Universität Bremen (Direktor: Prof. Dr. F. Petermann)
| | - J. Conradt
- Zentrum für Rehabilitationsforschung, Universität Bremen (Direktor: Prof. Dr. F. Petermann)
| | - F. Petermann
- Zentrum für Rehabilitationsforschung, Universität Bremen (Direktor: Prof. Dr. F. Petermann)
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261
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Practice parameters for the assessment and treatment of children and adolescents with posttraumatic stress disorder. J Am Acad Child Adolesc Psychiatry 1998; 37:4S-26S. [PMID: 9785726 DOI: 10.1097/00004583-199810001-00002] [Citation(s) in RCA: 239] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
These practice parameters review the current state of knowledge about posttraumatic stress disorder (PTSD) in children and adolescents. The parameters were written to aid clinicians in the assessment and treatment of children and adolescents with PTSD symptoms. A literature search and extensive review were conducted in order to evaluate the existing empirical and clinical information in this regard. Expert consultation was also solicited. The main findings of this process were that a wide variety of stressors can lead to the development of PTSD symptoms in this population; that the specific PTSD symptoms manifested may vary according to the developmental stage of the child and the nature of the stressor, and for this reason, the diagnostic criteria for PTSD in adults may not adequately describe this disorder in children and adolescents; that several factors seem to mediate the development of childhood PTSD following a severe stressor; and that most of the therapeutic interventions recommended for children with PTSD are trauma-focused and include some degree of direct discussion of the trauma. Controversies and unresolved issues regarding PTSD in children are also addressed.
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262
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Lonigan CJ, Anthony JL, Shannon MP. Diagnostic efficacy of posttraumatic symptoms in children exposed to disaster. JOURNAL OF CLINICAL CHILD PSYCHOLOGY 1998; 27:255-67. [PMID: 9789186 DOI: 10.1207/s15374424jccp2703_3] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Examined 5 conditional probability indices to determine the diagnostic efficacy of 48 symptoms associated with posttraumatic stress disorder (PTSD) in 5,687 children exposed to Hurricane Hugo, of whom 5.5% had a diagnosis of posttraumatic stress syndrome (PTSS). Moderate levels of sensitivity and high levels of specificity were obtained for most symptoms. Odds ratios more precisely demonstrated that some Diagnostic and Statistical Manual of Mental Disorders (DSM) symptoms of PTSD, especially when combined, were useful for identifying children with PTSS but that anxiety symptoms and some DSM symptoms of PTSD had poor diagnostic utility. Satisfying criteria for the DSM-III-R numbing/avoidance cluster and symptoms from the numbing/avoidance cluster had the highest diagnostic efficacy, suggesting that avoidance may be the hallmark of severe posttraumatic reactions. These results suggest which symptoms should be conceptualized as central versus peripheral to the disorder and which symptoms and symptom combinations clinicians should attend to most when diagnosing or screening PTSD in children.
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Affiliation(s)
- C J Lonigan
- Department of Psychology, Florida State University, Tallahassee 32306-1270, USA.
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263
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Psychometric properties of the impact of events scale in traumatized Cambodian refugee youth. PERSONALITY AND INDIVIDUAL DIFFERENCES 1998. [DOI: 10.1016/s0191-8869(98)00030-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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264
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Pelcovitz D, Libov BG, Mandel F, Kaplan S, Weinblatt M, Septimus A. Posttraumatic stress disorder and family functioning in adolescent cancer. J Trauma Stress 1998; 11:205-21. [PMID: 9565912 DOI: 10.1023/a:1024442802113] [Citation(s) in RCA: 119] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Twenty three adolescents with a history of cancer, 27 physically abused adolescents, and 23 healthy, nonabused adolescents were administered structured posttraumatic stress disorder (PTSD) interviews and self-report questionnaires regarding family functioning. Thirty five percent of adolescent cancer subjects met criteria for lifetime PTSD as compared to only 7% of the abused adolescents: 17% of the cancer subjects and 11% of the abuse subjects met criteria for current PTSD. Adolescents with cancer viewed their mothers and fathers as significantly more caring and more protective than the comparison and abused adolescents. Cancer subjects who met criteria for lifetime PTSD saw their families as significantly more chaotic than those who did not have PTSD. Eighty three percent of cancer subjects who had lifetime PTSD also had mothers who had PTSD.
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Affiliation(s)
- D Pelcovitz
- North Shore University Hospital-NYU School of Medicine, New York 14853, USA
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265
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Abstract
PROBLEM To understand the life experiences of gunshot-injured children to obtain information about predisposing factors to injury. METHODS A pilot study of 16 hospitalized children (14 males, 2 females) between the ages of 11 and 15 who sustained gunshot injuries. Each child was psychiatrically assessed on a medical inpatient unit after sustaining a gunshot injury to assess the rate of acute stress disorder and other comorbid psychiatric diagnoses. FINDINGS Findings showed gunshot-injured children had a 56% rate of acute stress disorder, and 68% had a past psychiatric history. CONCLUSIONS Gunshot-injured children require psychiatric intervention to minimize the long-term effects of acute stress disorder. Further research is needed to clarify the relationship of gunshot-injury and dysfunctional behavior and develop effective treatment options.
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Affiliation(s)
- V Hamrin
- Department of Child and Adolescent Psychiatry, Children's Memorial Medical Center, Chicago, IL, USA
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266
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Cuffe SP, Addy CL, Garrison CZ, Waller JL, Jackson KL, McKeown RE, Chilappagari S. Prevalence of PTSD in a community sample of older adolescents. J Am Acad Child Adolesc Psychiatry 1998; 37:147-54. [PMID: 9473910 DOI: 10.1097/00004583-199802000-00006] [Citation(s) in RCA: 137] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine prevalence and correlates of trauma and posttraumatic stress disorder (PTSD) symptoms and diagnosis in older adolescents aged 16 through 22 years. METHOD The second cycle of a longitudinal epidemiological study in the Southeast included a semistructured interview assessing PTSD symptomatology administered to 490 adolescents. RESULTS Approximately 3% of female subjects and 1% of male subjects satisfied the DSM-IV criteria for PTSD. Females reported more traumatic events than males, and black subjects reported more events than white subjects. Being female (odds ratio = 12.32), experiencing rape or child sexual abuse (odds ratio = 49.37), and witnessing an accident or medical emergency (odds ratio = 85.02) were associated with increased risk of PTSD. CONCLUSIONS While relatively few adolescents satisfy the criteria for PTSD, most subjects who experienced a traumatic event reported some PTSD symptoms. Specific types of traumatic events were associated with occurrence of PTSD.
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Affiliation(s)
- S P Cuffe
- Department of Neuropsychiatry and Behavioral Science, University of South Carolina, Columbia, USA
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267
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Abstract
This study examined a stratified random sample of 233 Kuwaiti 8- to 12-year-old boys and girls, in order to assess their level of exposure to violence during the Iraqi occupation of Kuwait and its relation to psychological and cognitive performance 1 year after the crisis. Children were assessed on intelligence, posttraumatic stress, and depression, and were interviewed about their crisis experience. No significant decline in intelligence scores was detected after the crisis. A difference in level of parental depression was found between those who stayed in Kuwait as compared to those who were out for all or part of the crisis. Depression in children was low but associated with the level of exposure to violence as reported in the interview, and greater levels of posttraumatic stress. The results support the hypothesis that acute trauma resulting from exposure to violence is related to posttraumatic stress in children.
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Affiliation(s)
- F A Hadi
- Educational Psychology Department, Kuwait University, Kuwait
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268
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Abstract
OBJECTIVE To review current knowledge about the clinical presentation, assessment, and treatment of posttraumatic stress disorder (PTSD) in children. METHOD The literature on PTSD in children is examined. RESULTS Over the past 10 years, PTSD has been described in children exposed to a variety of traumatic experiences. Little is known about the epidemiology of the disorder in children. Partial symptomatology and comorbidity are common. A variety of factors influence response to trauma and affect recovery. They include characteristics of the stressor and exposure to it; individual factors such as gender, age and developmental level, and psychiatric history; family characteristics; and cultural factors. Since the condition is likely to occur after disaster situations, much of the literature describes the child's response to disaster and interventions tend to include efforts within schools and/or communities. A number of clinical approaches have been used to treat the condition. CONCLUSIONS While assessment has been studied extensively, the longitudinal course of PTSD and treatment effectiveness have not been. Biological correlates of the condition also warrant greater attention.
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Affiliation(s)
- B Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, University of Oklahoma Health Sciences Center, Oklahoma City 73190-3048, USA
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269
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Rossman BR, Bingham RD, Emde RN. Symptomatology and adaptive functioning for children exposed to normative stressors, dog attack, and parental violence. J Am Acad Child Adolesc Psychiatry 1997; 36:1089-97. [PMID: 9256588 DOI: 10.1097/00004583-199708000-00016] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To examine and identify predictors of posttraumatic symptomatology and adaptive functioning of children exposed to single and repetitive adverse events that varied in severity. METHOD A sample of 86 patients and their children, aged 4 to 9 years, were interviewed after three types of adverse experiences; repetitive exposure to parental violence, a dog attack, or a milder stressor. The PTSD Reaction Index, Child Dissociative Checklist, and Child Behavior Checklist were used. RESULTS Trauma symptoms were greater for the first two groups, younger children, and girls. Gender effects were most evident in the dog attack group and depended on type of symptoms and informant. Supportiveness in the parenting relationship aided prediction of both trauma symptoms and adjustment. CONCLUSIONS Children appear to experience elevated posttraumatic stress disorder symptomatology after both single and repetitive adverse events that are potentially life-threatening. A positive parental relationship is associated with fewer symptoms and better adaptive functioning. The mechanisms through which this support interacts with behavioral and physiological systems to facilitate better regulation await further research.
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Affiliation(s)
- B R Rossman
- Department of Psychology, University of Denver, CO 80208, USA
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270
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Wintgens A, Boileau B, Robaey P. Posttraumatic stress symptoms and medical procedures in children. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 1997; 42:611-6. [PMID: 9288423 DOI: 10.1177/070674379704200607] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To focus on posttraumatic stress symptoms after childhood diseases such as cancer, organ transplantation, and severe burns. METHODS Differential diagnoses, risk factors, and treatment aspects (psychological and pharmacological) are discussed. RESULTS The concept of adjustment problems in chronic or severe illnesses is widely used in pediatrics. Many aspects of severe childhood diseases are traumatic, as defined by the DSM-IV: severe illnesses are life-threatening, medical procedures threaten the child's physical integrity, and disorganized behaviour periods are common. CONCLUSION This concept, which remains insufficiently investigated, is a promising area of investigation for prospective and prevention studies.
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Affiliation(s)
- A Wintgens
- Cognitive Psychophysiology and Neuropsychiatry Laboratory, Hôpital Sainte-Justine and Université de Montréal, Quebec
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271
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March JS, Amaya-Jackson L, Terry R, Costanzo P. Posttraumatic symptomatology in children and adolescents after an industrial fire. J Am Acad Child Adolesc Psychiatry 1997; 36:1080-8. [PMID: 9256587 DOI: 10.1097/00004583-199708000-00015] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE This investigation evaluated the extent and nature of posttraumatic symptomatology (PTS) in children and adolescents 9 months after an industrial fire at the imperial Foods chicken-processing plant in Hamlet, North Carolina, caused extensive loss of life. METHOD Using a PTS self-report measure plus self- and teacher reports of comorbid symptoms the authors surveyed 1,019 fourth- to ninth-grade students in the community where the fire occurred. RESULTS Three factors comprising PTS were identified: reexperiencing, avoidance and hyperarousal. Reexperiencing and avoidance were positively correlated; hyperarousal proved weakly correlated with reexperiencing, perhaps because exposure was largely indirect. Using a T score cutoff of 65 on the reexperiencing factor as indicative of PTS 9.7% of subjects met criteria for PTS; 11.9% met criteria for posttraumatic stress disorder (PTSD) using DSM-III-R PTSD criteria. Degree of exposure was the most powerful predictor of PTS. Race (African-American) and gender (female) posed significant risk factors for PTS. Self-reported internalizing symptoms and teacher-reported externalizing symptoms were positively predicted by intercurrent PTS, and independently of PTS, by degree of exposure. Comorbid symptoms showed interesting interactions with exposure, race, and gender. Lack of self-attributed personal efficacy predicted PTS but did not moderate the effects of race or gender on PTS risk. CONCLUSIONS This study, which used a population-based sampling strategy, strengthens and extends findings from earlier literature on pediatric PTSD in showing that (1) PTS and comorbid internalizing and externalizing symptoms rise in direct proportion to degree of exposure; (2) gender and race show variable effects on risk for PTS and comorbid symptoms; and (3) comorbid symptoms are positively correlated with PTS and may represent primary outcomes of traumatic exposure in their own right.
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Affiliation(s)
- J S March
- Department of Psychiatry, Duke University, Durban, NC 27710, USA
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272
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Almqvist K, Brandell-Forsberg M. Refugee children in Sweden: post-traumatic stress disorder in Iranian preschool children exposed to organized violence. CHILD ABUSE & NEGLECT 1997; 21:351-366. [PMID: 9134264 DOI: 10.1016/s0145-2134(96)00176-7] [Citation(s) in RCA: 98] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Fifty preschool children from 47 Iranian families living as refugees in Sweden were assessed individually, simultaneously with parental interviews focusing on exposure to organized violence and post-traumatic stress symptomatology in the children. Information given by the children increased the prevalence of a Post-Traumatic Stress Disorder (PTSD) diagnosis (DSM-III-R) from 2% to 21% in the 42 children with traumatic exposure through war and political persecution. The amount of traumatic exposure was strongly related to the prevalence of PTSD. The stability of prevalence was high in a follow-up 2 and 1/2 years later; 23% of the children with traumatic exposure still met the full criteria of PTSD according to DSM-III-R.
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Affiliation(s)
- K Almqvist
- Department of Psychology, Góteborg University, Karlstad, Sweden
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273
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Laor N, Wolmer L, Mayes LC, Gershon A, Weizman R, Cohen DJ. Israeli preschool children under Scuds: a 30-month follow-up. J Am Acad Child Adolesc Psychiatry 1997; 36:349-56. [PMID: 9055515 DOI: 10.1097/00004583-199703000-00013] [Citation(s) in RCA: 150] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Longitudinal studies of children exposed to traumatic events show contrasting findings regarding their symptomatic change over time. The present study reports on a 30-month follow-up of preschool children and their mothers who had been exposed to Scud missile attacks. METHOD Families displaced during the Gulf War after their homes had been damaged by the missile attack and a control group whose homes remained intact were interviewed about posttraumatic and general symptomatology, the mothers' capacity to control images, and the children's adaptive behavior. RESULTS Stress symptoms decreased in the displaced children but not in their mothers. Both reported more posttraumatic symptoms than did the control group. No differences in the children's adaptive behavior were observed. Posttraumatic symptoms of the displaced children correlated with the mothers' avoidant symptoms. The mothers' avoidant symptoms at follow-up were statistically explained by the mothers' symptoms during the war and their capacity for image control, the duration of displacement, and the cohesion of the family. CONCLUSIONS The maternal stress-buffering capacity constitutes a central element in children's protective matrix and is crucial in minimizing long-term internal suffering of traumatized preschool children.
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Affiliation(s)
- N Laor
- Tel Aviv Brull Community Mental Health Center, Israel
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274
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Saylor CF, Belter R, Stokes SJ. Children and Families Coping with Disaster. ISSUES IN CLINICAL CHILD PSYCHOLOGY 1997. [DOI: 10.1007/978-1-4757-2677-0_13] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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275
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Portraits of Survival: A 20-year Follow-up of the Children of Buffalo Creek. Prehosp Disaster Med 1996. [DOI: 10.1017/s1049023x00042461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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276
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Warheit GJ, Zimmerman RS, Khoury EL, Vega WA, Gil AG. Disaster related stresses, depressive signs and symptoms, and suicidal ideation among a multi-racial/ethnic sample of adolescents: a longitudinal analysis. J Child Psychol Psychiatry 1996; 37:435-44. [PMID: 8735443 DOI: 10.1111/j.1469-7610.1996.tb01424.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Longitudinal findings are presented on the relationships between disaster related stresses, depression scores, and suicidal ideation among a multi-racial/ethnic sample of adolescents (N = 4,978) all of whom have been exposed to Hurricane Andrew. Regression analysis showed that being female, hurricane generated stresses, low levels of family support, pre-hurricane suicidal ideation, and post-hurricane depression scores were significant predictors of post-hurricane suicidal ideation. Path analysis revealed that being female, low socioeconomic status, pre- and post-hurricane depression, high stress scores, low family support, and pre-hurricane suicidal ideation had significant direct/indirect effects on post-hurricane suicidal ideation.
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Affiliation(s)
- G J Warheit
- Department of Sociology, University of Miami, Coral Gables, FL 33124, USA
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277
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Pelcovitz D, Goldenberg B, Kaplan S, Weinblatt M, Mandel F, Meyers B, Vinciguerra V. Posttraumatic stress disorder in mothers of pediatric cancer survivors. PSYCHOSOMATICS 1996; 37:116-26. [PMID: 8742539 DOI: 10.1016/s0033-3182(96)71577-3] [Citation(s) in RCA: 102] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Prevalence of posttraumatic stress disorder (PTSD) in 24 mothers of pediatric cancer survivors was compared with its prevalence among 23 mothers of healthy children. Significantly more mothers of pediatric cancer survivors were diagnosed with lifetime PTSD. Significant differences were also found in lifetime arousal, as well as current and lifetime reexperience and avoidance symptom clusters. Significant difference existed in the distribution of the number of prediagnosis high-magnitude events experienced by the mothers diagnosed with current PTSD as compared with the prediagnosis experience of the mothers who were not diagnosed with current PTSD. Illness severity, level of perceived family and extrafamilial social support, and Symptom Checklist-90-Revised global severity index scores did not significantly differ in the PTSD-positive and PTSD-negative groups.
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Affiliation(s)
- D Pelcovitz
- Department of Psychiatry, North Shore University Hospital, Cornell University Medical College, USA
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278
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Shaw JA, Applegate B, Schorr C. Twenty-one-month follow-up study of school-age children exposed to Hurricane Andrew. J Am Acad Child Adolesc Psychiatry 1996; 35:359-64. [PMID: 8714325 DOI: 10.1097/00004583-199603000-00018] [Citation(s) in RCA: 120] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To explore the 21-month course of posttraumatic stress symptomatology (PTSS) and psychological morbidity in 30 school-age children (7 to 13 years) after exposure to Hurricane Andrew. METHOD Pynoos' Posttraumatic Stress Disorder Reaction Index and Achenbach's Teacher's Report Form were administered at 8 and 21 months after Hurricane Andrew. RESULTS At 21 months 70% of the children endorsed moderate-severe PTSS. The reduction in PTSS was greater for boys than girls. Psychopathology as measured by the Teacher's Report Form increased over the 19-month period. Boys demonstrated significant increases in internalizing symptoms and in Withdrawn, Anxious/Depressed, Social Problems, and Attention Problems scales, and girls showed a significant increase in the Anxious/Depressed scale. CONCLUSIONS Twenty-one months after exposure to Hurricane Andrew, there were continuing high levels of PTSS and evidence of increasing emotional and behavioral problems. While girls sustained higher levels of PTSS, boys demonstrated higher indices of other psychopathology. The enduring effects of disaster associated with secondary stressors and "traumatic reminders" continue to be etiologically important for continuing psychological morbidity.
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Affiliation(s)
- J A Shaw
- Department of Psychiatry, University of Miami School of Medicine, FL 33101, USA
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279
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The history and prevalence of posttraumatic stress disorder with special reference to children and adolescents. J Sch Psychol 1996. [DOI: 10.1016/0022-4405(96)00002-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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280
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Alleviating posttraumatic stress in children following hurricane Andrew. JOURNAL OF APPLIED DEVELOPMENTAL PSYCHOLOGY 1996. [DOI: 10.1016/s0193-3973(96)90004-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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281
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Etiologic factors in the development of posttraumatic stress disorder in children and adolescents. J Sch Psychol 1996. [DOI: 10.1016/0022-4405(96)00003-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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282
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Horowitz K, Weine S, Jekel J. PTSD symptoms in urban adolescent girls: compounded community trauma. J Am Acad Child Adolesc Psychiatry 1995; 34:1353-61. [PMID: 7592273 DOI: 10.1097/00004583-199510000-00021] [Citation(s) in RCA: 180] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To describe the assessments for exposure to violent events and posttraumatic stress disorder (PTSD) symptoms in a population of urban adolescent girls. METHOD Seventy-nine urban adolescent girls attending an adolescent medicine clinic were assessed via clinician-assisted self-report measures called the Adolescent Self-Report Trauma Questionnaire. The questionnaire gathered information on demographics, exposure to community and domestic violent events, and PTSD symptoms. RESULTS The adolescents experienced between 8 and 55 different types of community and domestic violent events, with the mean number of violent events being 28. Hyperarousal cluster symptoms were present in 90%, reexperiencing clusters symptoms in 89%, and avoidance cluster symptoms in 80%, while 67% met symptom criteria for PTSD. Increased number of types of violent events was positively correlated with meeting PTSD criteria (p = .01) and with increased PTSD severity scores (p = .001). CONCLUSIONS These urban adolescent girls have experienced prolonged and repeated exposure to multiple types of community as well as domestic violent events, via multiple modalities of contact, over time. They reported a high percentage of PTSD symptoms across all three symptom clusters. The authors propose the concept of "compounded community trauma" and discuss its marked impact on female adolescent development.
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Affiliation(s)
- K Horowitz
- Yale University School of Medicine, New Haven, CT, USA
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283
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Sack WH, Clarke GN, Seeley J. Posttraumatic stress disorder across two generations of Cambodian refugees. J Am Acad Child Adolesc Psychiatry 1995; 34:1160-6. [PMID: 7559310 DOI: 10.1097/00004583-199509000-00013] [Citation(s) in RCA: 149] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine the expression of war-related trauma as manifested by DSM-III-R rates of posttraumatic stress disorder (PTSD) and major depressive disorder in two generations of Cambodian refugees living in the western United States. METHOD A probability sample of 209 Khmer adolescents and one of their parents were interviewed using portions of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version and the PTSD section of the Diagnostic Interview for Children and Adolescents. Interviews were conducted in English by a master's-level clinician with a Khmer interpreter. RESULTS PTSD was found to be significantly related across parent-child generations. A nonsignificant generational trend was also found for depressive disorders. A number of environmental variables measured in the study (amount of reported war trauma, loss, living arrangements, treatment received, socioeconomic status) were not related to these findings. Parents were more likely to report an earlier onset of PTSD symptoms. CONCLUSIONS This study suggests that PTSD in refugees may cluster in families. Whether this phenomenon is caused by a genetic susceptibility to trauma awaits further research. PTSD and depressive disorders in refugee populations, while often comorbid, appear to follow different courses over time.
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Affiliation(s)
- W H Sack
- Division of Child and Adolescent Psychiatry, Oregon Health Sciences University, Portland 97201, USA
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284
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Goenjian AK, Pynoos RS, Steinberg AM, Najarian LM, Asarnow JR, Karayan I, Ghurabi M, Fairbanks LA. Psychiatric comorbidity in children after the 1988 earthquake in Armenia. J Am Acad Child Adolesc Psychiatry 1995; 34:1174-84. [PMID: 7559312 DOI: 10.1097/00004583-199509000-00015] [Citation(s) in RCA: 298] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To determine current rates of posttraumatic stress disorder (PTSD), depressive disorder, and separation anxiety disorder (SAD) among children 1 1/2 years after the 1988 earthquake in Armenia; to determine current rates of comorbid PTSD and depressive disorder; and to assess the contribution of exposure, gender, loss of family members, and loss of residence. METHOD Two hundred eighteen school-age children from three cities at increasing distances from the epicenter were evaluated using the Child Posttraumatic Stress Disorder Reaction Index, the Depression Self-Rating Scale, and the section on SAD from the Diagnostic Interview for Children and Adolescents. RESULTS On the basis of these evaluations, high rates of current PTSD, depressive disorder, and their co-occurrence were found among victims residing in the two heavily impacted cities. SAD was comparatively less frequent, although symptoms of SAD had been pervasive throughout the region. Severity of posttraumatic stress and depressive reactions were highly correlated. Extent of loss of family members was independently correlated with each. CONCLUSION After a catastrophic natural disaster, children are at risk for comorbid PTSD and secondary depression. Based on the findings, an interactive model is proposed of postdisaster psychopathology. Early clinical intervention is recommended to prevent chronic posttraumatic stress reactions and secondary depression.
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Affiliation(s)
- A K Goenjian
- Western United States Armenian Relief Society Clinics of Armenia
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285
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Shaw JA, Applegate B, Tanner S, Perez D, Rothe E, Campo-Bowen AE, Lahey BL. Psychological effects of Hurricane Andrew on an elementary school population. J Am Acad Child Adolesc Psychiatry 1995; 34:1185-92. [PMID: 7559313 DOI: 10.1097/00004583-199509000-00016] [Citation(s) in RCA: 104] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To explore the prevalence and progression of posttraumatic symptomatology (PTS), using emotional and behavioral indices of psychopathology in school-age children in the pathway of Hurricane Andrew (HI-IMPACT) and in a comparison group north of Miami (LO-IMPACT). METHOD Pynoos' Posttraumatic Stress Disorder Reaction Index and Achenbach's Teacher's Report Form (TRF) were administered 8 weeks and 32 weeks after the hurricane. In addition, 21 measures of disruptive behavior cataloged by Dade County Public Schools were aggregated and compared by grading period between pre- and posthurricane school years. RESULTS There were no statistically significant differences between the two schools in PTS at 8 weeks after the hurricane, although the children in the HI-IMPACT school were more likely to have severe PTS. TRF findings at 8 weeks revealed that children in the HI-IMPACT school evidenced lower means on the eight TRF scales and on the broader Internalizing and Externalizing measures. Analysis of the disruptive behavior revealed a drop in the marking period immediately after the hurricane in the HI-IMPACT area, but an opposite effect was observed in the LO-IMPACT area. CONCLUSIONS After the hurricane there was an initial increase in PTS and a concomitant decrease in other measures of behavior and psychopathology. PTS remained relatively high throughout the school year, but there was a rebound and subsequent normalization of the measures of disruptive behavior.
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Affiliation(s)
- J A Shaw
- Department of Psychiatry, University of Miami School of Medicine, FL, USA
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286
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Weine S, Becker DF, McGlashan TH, Vojvoda D, Hartman S, Robbins JP. Adolescent survivors of "ethnic cleansing": observations on the first year in America. J Am Acad Child Adolesc Psychiatry 1995; 34:1153-9. [PMID: 7559309 DOI: 10.1097/00004583-199509000-00012] [Citation(s) in RCA: 77] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To describe the psychiatric assessments and trauma testimonies of 12 Bosnian adolescents newly resettled in America. METHOD Twelve Bosnian adolescents who experienced the massive psychic trauma of "ethnic cleansing" were assessed during the first year after their resettlement in the United States. Assessments consisted of systematic, trauma-focused, clinical interviews that included standard assessment scales of posttraumatic stress disorder (PTSD) and depression, as well as the opportunity to give testimony about their experiences. RESULTS PTSD was diagnosed in 25% of subjects and depressive disorders in 17%. Reexperiencing cluster symptoms were present in 50%, avoidance cluster symptoms in 31%, and hyperarousal cluster symptoms in 29%. CONCLUSIONS The relatively low rate of PTSD in this sample (in comparison with adult survivors of "ethnic cleansing" and with Cambodian adolescent survivors) may be attributable to normal prior development, time-limited adversity, lack of physical or sexual traumas, rejoining nuclear families, or insufficient time for the development of delayed-onset PTSD. It may also be a reflection of the resiliency of adolescence.
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Affiliation(s)
- S Weine
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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287
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Garrison CZ, Bryant ES, Addy CL, Spurrier PG, Freedy JR, Kilpatrick DG. Posttraumatic stress disorder in adolescents after Hurricane Andrew. J Am Acad Child Adolesc Psychiatry 1995; 34:1193-201. [PMID: 7559314 DOI: 10.1097/00004583-199509000-00017] [Citation(s) in RCA: 138] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine rates and correlates of posttraumatic stress disorder (PTSD) in adolescents after Hurricane Andrew. METHOD A random-digit dialing sample of 158 Hispanic, 116 black, and 104 white adolescent-parent pairs were surveyed in high- and low-impact areas within Dade County, Florida, 6 months after Hurricane Andrew. Subjects completed a structured telephone interview focused on within-disaster experiences and emotional reaction, disaster-related losses, lifetime exposure to violent or traumatic events, recent stressful experiences, and psychiatric symptomatology. RESULTS Approximately 3% of males (95% confidence interval 0.4 to 5.3) and 9% of females (95% confidence interval 4.6 to 13.7) met the criteria for PTSD. Rates were highest among blacks (8.3%, 95% confidence interval 2.3 to 14.2) and Hispanics (6.1%, 95% confidence interval 2.2 to 9.9) and increased with age (odds ratio of 1.34, 95% confidence interval 1.04 to 1.72) and the number of undesirable events reported (odds ratio of 1.38, 95% confidence interval 1.21 to 1.57). CONCLUSIONS While only a relatively small percentage of adolescents reported symptoms consistent with a diagnosis of PTSD, most reported some posttraumatic symptoms. Postdisaster planning should recognize that common stressful events occurring after disasters may be more strongly associated with PTSD than magnitude of contact with the actual disaster.
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Affiliation(s)
- C Z Garrison
- Department of Epidemiology and Biostatistics, School of Public Health, University of South Carolina, Columbia 29208, USA
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288
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Greenberg MR, Schneider DF. Gender differences in risk perception: effects differ in stressed vs. non-stressed environments. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 1995; 15:503-511. [PMID: 7480950 DOI: 10.1111/j.1539-6924.1995.tb00343.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Contrary to previous reports that women are more concerned about environmental risks than men, we hypothesized that men and women residing in neighborhoods stressed by multiple hazards would demonstrate similar concerns about local environmental conditions. Analysis of a national data base and an aggregate of ten local data bases found greater female than male concern about local technological, behavioral, and land use hazards in good neighborhoods, but, as expected, not in stressed ones. We urge analysts to conduct more studies in stressed neighborhoods in order to better understand the perspective of those who live with environmental risks.
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Affiliation(s)
- M R Greenberg
- Department of Urban Studies and Community Health, Bloustein School, Livingston College, Rutgers University, New Brunswick, New Jersey 08903, USA
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289
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Miller TW. Stress adaptation in children: Theoretical models. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 1995. [DOI: 10.1007/bf02308665] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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290
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Brent DA, Perper JA, Moritz G, Liotus L, Richardson D, Canobbio R, Schweers J, Roth C. Posttraumatic stress disorder in peers of adolescent suicide victims: predisposing factors and phenomenology. J Am Acad Child Adolesc Psychiatry 1995; 34:209-15. [PMID: 7896654 DOI: 10.1097/00004583-199502000-00016] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To examine the factors predisposing to posttraumatic stress disorder (PTSD) in peers of adolescent suicide victims. METHOD One hundred forty-six adolescents who were the friends of 26 suicide victims were studied. Five percent (n = 8) developed PTSD after exposure to suicide. These 8 subjects with PTSD were compared to the remainder of the exposed subjects (n = 138). RESULTS Subjects with PTSD were more likely than those without PTSD to have had a history of substance abuse, agoraphobia, and suicide attempts. Subjects who developed PTSD were more likely to have developed a new-onset depression, to have more severe grief, and to have been closer to the suicide victim. Subjects with PTSD tended to have more severe exposure to suicide and came from discordant households with a history of disruptions in key relationships. The 8 subjects who developed PTSD were compared to 38 subjects who developed new-onset depression but not PTSD. Those with PTSD were more likely to have had past substance abuse, prior suicide attempts, family history of panic disorder, a history of parent-child disruption, and a history of loss. Symptoms of intrusive visual images, hypervigilance, and avoidance of reminders discriminated subjects who had PTSD from new-onset depressives without PTSD. CONCLUSIONS PTSD is an expectable outcome in youth exposed to suicide. Further work is required to differentiate symptoms of depression from PTSD.
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Affiliation(s)
- D A Brent
- Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213
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291
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Stokes SJ, Saylor CF, Swenson CC, Daugherty TK. A comparison of children's behaviors following three types of stressors. Child Psychiatry Hum Dev 1995; 26:113-23. [PMID: 8565647 DOI: 10.1007/bf02353235] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
One purpose of this study was to examine the differences in behavior of children exposed to trauma versus no trauma. Another goal was to compare different types of traumatic events in terms of their effects on behaviors. Our analysis indicated significant differences between trauma and no trauma groups. Additional analyses indicated that those children who were allegedly sexually abused were rated as exhibiting higher levels of symptomatology on all three factors of the Pediatric Emotional Distress Scale (PEDS) as well as the Total PEDS score than the other three groups.
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Affiliation(s)
- S J Stokes
- Charleston/Dorchester Mental Health Center, SC, USA
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292
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Stuber ML, Meeske K, Gonzalez S, Houskamp BM, Pynoos R. Post-traumatic stress after childhood cancer I: The role of appraisal. Psychooncology 1994. [DOI: 10.1002/pon.2960030407] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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293
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Ownby DR, Adinoff AD. The appropriate use of skin testing and allergen immunotherapy in young children. J Allergy Clin Immunol 1994; 94:662-5. [PMID: 7930297 DOI: 10.1016/0091-6749(94)90171-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Immunotherapy is clearly effective in the treatment of allergic rhinitis and Hymenoptera sensitivity and probably effective in the treatment of asthma. Few studies evaluate the risks and benefits of immunotherapy in young children. Current evidence suggests that young children are at increased risk for systemic reactions from immunotherapy. Furthermore, immunotherapy or adverse reactions resulting from immunotherapy may result in significant psychologic problems. The potential risks of immunotherapy would be justified if immunotherapy were demonstrated to be safe and additive to other therapies. Immunotherapy might be particularly effective in treating or helping to prevent house dust mite- or cockroach-associated asthma. Until the efficacy of immunotherapy is demonstrated in young children, we agree with the European Academy of Allergology and Clinical Immunology position that immunotherapy in young children is relatively contraindicated.
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Affiliation(s)
- D R Ownby
- Division of Allergy and Clinical Immunology, Henry Ford Health System, Detroit, MI 48202
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294
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Affiliation(s)
- N J King
- Faculty of Education, School of Graduate Studies, Monash University, Clayton, Victoria, Australia
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295
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296
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Elliott DM. Assessing adult victims of interpersonal violence. NEW DIRECTIONS FOR MENTAL HEALTH SERVICES 1994:5-16. [PMID: 7870016 DOI: 10.1002/yd.23319946403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The assessment of the impacts of interpersonal violence on the client is an important therapeutic process that is likely to improve the quality of care provided by the clinician. Such assessment must, however, be based on an understanding of the logical consequences of violence on the victim's psyche. Additionally, the evaluator must be aware of the theoretical orientation, item content, intended use, and normative data available for the instruments used in any evaluation process. Based on available clinical and research data, trauma-specific measures are likely to be more helpful in providing relevant clinical information on the psychological status of victims of violence than are more generic measures of psychological distress.
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297
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298
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Green BL, Grace MC, Vary MG, Kramer TL, Gleser GC, Leonard AC. Children of disaster in the second decade: a 17-year follow-up of Buffalo Creek survivors. J Am Acad Child Adolesc Psychiatry 1994; 33:71-9. [PMID: 8138524 DOI: 10.1097/00004583-199401000-00011] [Citation(s) in RCA: 154] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To conduct a long-term follow-up of child survivors of a devastating human-caused disaster. METHOD Child survivors (2-15) of the Buffalo Creek dam collapse, first evaluated in 1974, 2 years postdisaster, were reevaluated 17 years postdisaster when they were adults. Of the original 207 children, 99 were located and reevaluated using ratings on the Psychiatric Evaluation Form, the Impact of Event Scale, and the SCL-90 and lifetime and current diagnoses from the Structured Clinical Interview for DSM-III-R. RESULTS Ratings of psychiatric symptoms at the two points in time showed significant decreases in overall severity ratings and in anxiety, belligerence, somatic concerns, and agitation. A few symptoms, not present in the child sample, increased over time (substance abuse, suicidal ideation). The current rate of disaster-related post-traumatic stress disorder (PTSD) was 7%, down from a postflood rate of 32%. There were no differences by age group in current psychological status; however, women evidenced more PTSD-related symptoms than did men. All current PTSD cases were women. Comparisons with similar subjects from a nonexposed community showed no differences. CONCLUSIONS The findings indicated that the children studied, although having shown earlier effects, had "recovered" from the event by the time of long-term follow-up.
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Affiliation(s)
- B L Green
- Department of Psychiatry, Georgetown University, Washington, DC 20007
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Brent DA, Perper J, Moritz G, Friend A, Schweers J, Allman C, McQuiston L, Boylan MB, Roth C, Balach L. Adolescent witnesses to a peer suicide. J Am Acad Child Adolesc Psychiatry 1993; 32:1184-8. [PMID: 8282663 DOI: 10.1097/00004583-199311000-00011] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVE This case-control study attempts to evaluate the psychological impact of witnessing a suicide on high school students. METHOD Twenty-eight high school students witnessed a firearms suicide and the serious injury of another student while riding a school bus. They were assessed 2 months after the event, and their responses were compared with 28 demographically similar adolescents from another community who had not been exposed to suicide. RESULTS The exposed students, when compared with the controls, had higher rates of new-onset anxiety disorder and a trend for increased rates of new-onset post-traumatic stress disorder (PTSD). Within the exposed group, measures of the closeness of the relationship to both the suicide victim and the student who was injured were correlated with the severity of PTSD symptomatology. Within the exposed group, other factors that predisposed to new-onset disorder included family history of affective illness, family history of suicide attempt, and stressful life events occurring in the year before exposure. CONCLUSIONS In combination with the extant literature, this study demonstrates that adolescents who witness a traumatic suicidal death are at risk for the development of psychopathology, specifically, anxiety disorders and PTSD.
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Affiliation(s)
- D A Brent
- Western Psychiatric Institute and Clinic, Pittsburgh, PA 15213
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