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Abstract
OBJECTIVE To investigate the prevalence of traumatic events and life events in relation to posttraumatic stress disorder (PTSD). METHOD In a Danish national representative sample of 390 eighth-grade students with a mean age of 14.5 years, 20 prevalent potential traumatizing and distressing events were described, along with the psychological impact of these events. RESULTS Eighty-seven percent of the females and 78% of the males were exposed to at least one event. The most common events were the death of a family member, threat of violence, or serious accidents. The most distressing subjective events were rape, suicide attempts, death in the family, serious illness, and childhood abuse. Gender, parents' education, and living with a single parent were associated with specific events. The estimated lifetime prevalence of PSTD was 9.0%, whereas another 14.1% reached a subclinical level of PTSD. After exposure, females suffered from PTSD twice as often as males. Being exposed to multiple traumatic events was associated with an increase in PTSD. CONCLUSION The findings in this study suggest substantial mental health problems in adolescents who are associated with various types of victimization.
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Affiliation(s)
- Ask Elklit
- Institute of Psychology, University of Aarhus, Denmark.
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252
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Steil R, Straube ER. Posttraumatische Belastungsstörung bei Kindern und Jugendlichen. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2002. [DOI: 10.1026/0084-5345.31.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Bislang liegen im Vergleich zur Forschung zur Posttraumatischen Belastungsstörung (PTB) bei Erwachsenen erst wenige Studien zur Epidemiologie und zur Behandlung der Störung bei Kindern und Jugendlichen vor. Ätiologische Modelle berücksichtigen bislang nur wenig entwicklungsbedingte Besonderheiten der Traumatisierung im frühen Lebensalter. Fragestellung: Überblick zum Stand der Forschung zu Häufigkeit, Entstehung, Aufrechterhaltung und Behandlung der PTB im Kindes- und Jugendalter. Methode: Analyse bislang vorliegender empirischer und theoretischer Arbeiten. Ergebnisse: Das Symptombild bei Kindern unterscheidet sich deutlich von dem der Erwachsenen, Unterschiede sowie diagnostische Instrumente werden beschrieben. Nach dem Erleben von Gewalt, besonders sexueller Art, erkranken Kinder und Jugendliche im Vergleich zu anderen Formen der Traumatisierung am häufigsten an einer PTB. Jungen sind insgesamt nach einer Traumatisierung weniger stark von posttraumatischer Symptomatik betroffen als Mädchen. Das Risiko, an PTB zu erkranken, steigt mit sinkendem Lebensalter bei Traumatisierung. Behandlungsprogramme beziehen diese besondere Vulnerabilität bislang nur wenig ein. Kontrollierte und randomisierte Studien zur Überprüfung ihrer Wirksamkeit fehlen. Schlussfolgerung: Kognitive Modelle, welche Besonderheiten der Wahrnehmung, Verarbeitung und Speicherung traumatischer Informationen in den Mittelpunkt stellen, liefern - durch die Berücksichtigung der Entwicklung kognitiver Fähigkeiten - Erklärungsmöglichkeiten für die negative Assoziation zwischen Lebensalter bei Traumatisierung und Vulnerabilität für PTB und Behandlungsansätze für die PTB im Kindes- und Jugendalter.
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Affiliation(s)
- Regina Steil
- Institut für Psychologie, Friedrich-Schiller-Universität Jena
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253
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De Bellis MD, Broussard ER, Herring DJ, Wexler S, Moritz G, Benitez JG. Psychiatric co-morbidity in caregivers and children involved in maltreatment: a pilot research study with policy implications. CHILD ABUSE & NEGLECT 2001; 25:923-944. [PMID: 11523869 DOI: 10.1016/s0145-2134(01)00247-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE The purpose of this study was to determine the lifetime incidence of mental disorders in caregivers involved in maltreatment and in their maltreated child. METHODS Lifetime DSM-III-R and IV psychiatric diagnoses were obtained for 53 maltreating families, including at least one primary caregiver and one proband maltreated child or adolescent subject (28 males, 25 females), and for a comparison group of 46 sociodemographically, similar nonmaltreating families, including one proband healthy child and adolescent subject (22 males, 22 females). RESULTS Mothers of maltreated children exhibited a significantly greater lifetime incidence of anxiety disorders (especially post-traumatic stress disorder), mood disorders, alcohol and/or substance abuse or dependence disorder, suicide attempts, and comorbidity of two or more psychiatric disorders, compared to control mothers. Natural fathers or mothers' live-in mates involved in maltreatment exhibited a significantly greater lifetime incidence of an alcohol and/or substance abuse or dependence disorder compared to controls. The majority of maltreated children and adolescents reported anxiety disorders, especially post-traumatic stress disorder (from witnessing domestic violence and/or sexual abuse), mood disorders, suicidal ideation and attempts, and disruptive disorders. Most maltreated children (72%) suffered from comorbidity involving both emotional and behavioral regulation disorders. CONCLUSIONS Families involved in maltreatment manifest significant histories of psychiatric comorbidity. Policies which target identification and treatment of comorbidity may contribute to breaking the intergenerational transmission of maltreatment.
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Affiliation(s)
- M D De Bellis
- Department of Psychiatry, University of Pittsburgh, Medical Center, PA 15213, USA
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254
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Molnar BE, Buka SL, Kessler RC. Child sexual abuse and subsequent psychopathology: results from the National Comorbidity Survey. Am J Public Health 2001; 91:753-60. [PMID: 11344883 PMCID: PMC1446666 DOI: 10.2105/ajph.91.5.753] [Citation(s) in RCA: 701] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES This study examined the relationship between child sexual abuse (CSA) and subsequent onset of psychiatric disorders, accounting for other childhood adversities, CSA type, and chronicity of the abuse. METHODS Retrospective reports of CSA, other adversities, and psychiatric disorders were obtained by the National Comorbidity Survey, a nationally representative survey of the United States (n = 5877). Reports were analyzed by multivariate methods. RESULTS CSA was reported by 13.5% of women and 2.5% of men. When other childhood adversities were controlled for, significant associations were found between CSA and subsequent onset of 14 mood, anxiety, and substance use disorders among women and 5 among men. In a subsample of respondents reporting no other adversities, odds of depression and substance problems associated with CSA were higher. Among women, rape (vs molestation), knowing the perpetrator (vs strangers), and chronicity of CSA (vs isolated incidents) were associated with higher odds of some disorders. CONCLUSIONS CSA usually occurs as part of a larger syndrome of childhood adversities. Nonetheless, CSA, whether alone or in a larger adversity cluster, is associated with substantial increased risk of subsequent psychopathology.
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Affiliation(s)
- B E Molnar
- Department of Maternal and Child Health, Harvard School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA.
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255
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Flannery DJ, Singer MI, Wester K. Violence exposure, psychological trauma, and suicide risk in a community sample of dangerously violent adolescents. J Am Acad Child Adolesc Psychiatry 2001; 40:435-42. [PMID: 11314569 DOI: 10.1097/00004583-200104000-00012] [Citation(s) in RCA: 140] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine violence exposure, violent behaviors, psychological trauma, and suicide risk in a community sample of dangerously violent adolescents by comparison with a matched community sample of nonviolent adolescents. METHOD Anonymous self-report questionnaires were administered in the 1992-1993 school year to students in grades 9 through 12, in six public high schools located in Ohio and Colorado (N = 3,735). From this sample, 484 adolescents (349 males, 135 females) who reported attacking someone with a knife or shooting at someone within the past year (i.e., dangerously violent adolescents) were drawn. Four hundred eighty-four controls were also selected and matched on gender, age in years, ethnicity, area of residence, and family structure. RESULTS Dangerously violent adolescents reported higher levels of exposure to violence and victimization than did matched controls. Dangerously violent females were more likely to score in the clinical range of depression, anxiety, posttraumatic stress, anger, and dissociation than were control females and violent males; they also had significantly higher levels of suicide potential. CONCLUSIONS Students who have been known to commit violent acts should be adequately assessed for violence exposure and symptoms of psychological trauma, with special attention given to the suicide potential of violent females.
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Affiliation(s)
- D J Flannery
- Kent State University, Institute for the Study and Prevention of Violence, 191 MACC Annex (RAGS), Kent, OH 44242, USA
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256
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Sandler I. Quality and ecology of adversity as common mechanisms of risk and resilience. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2001; 29:19-61. [PMID: 11439827 DOI: 10.1023/a:1005237110505] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
This paper proposes common mechanisms to explain the effects of adversities and of resources that promote resilience. Adversities threaten the satisfaction of basic human needs and the acquisitions of competencies to carry out valued social roles. Adversities can also be characterized in terms of their ecological properties of occurrence in time, and place. Resilience resources at the individual, microsystem and macro levels reduce the negative effects of adversities through their effects on satisfaction of basic human needs and their effects on the occurrence of adversities. The effects of resilience resources are described as preventive, protective and promotive. Implications are presented for the development of interventions to promote resilience.
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Affiliation(s)
- I Sandler
- Department of Psychology, Arizona State University, Arizona, USA
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257
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Pfefferbaum B, Nixon SJ, Tivis RD, Doughty DE, Pynoos RS, Gurwitch RH, Foy DW. Television exposure in children after a terrorist incident. Psychiatry 2001; 64:202-11. [PMID: 11708044 DOI: 10.1521/psyc.64.3.202.18462] [Citation(s) in RCA: 217] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study examined the influence of bomb-related television viewing in the context of physical and emotional exposure on posttraumatic stress symptoms--intrusion, avoidance, and arousal--in middle school students following the 1995 Oklahoma City bombing. Over 2,000 middle school students in Oklahoma City were surveyed 7 weeks after the incident. The primary outcome measures were the total posttraumatic stress symptom score and symptom cluster scores at the time of assessment. Bomb-related television viewing in the aftermath of the disaster was extensive. Both emotional and television exposure were associated with posttraumatic stress at 7 weeks. Among children with no physical or emotional exposure, the degree of television exposure was directly related to posttraumatic stress symptomatology. These findings suggest that television viewing in the aftermath of a disaster may make a small contribution to subsequent posttraumatic stress symptomatology in children or that increased television viewing may be a sign of current distress and that it should be monitored. Future research should examine further whether early symptoms predict increased television viewing and/or whether television viewing predicts subsequent symptoms.
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Affiliation(s)
- B Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Blvd., WP-3470, Oklahoma City, OK 73104, USA.
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258
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Rusch MD, Grunert BK, Sanger JR, Dzwierzynski WW, Matloub HS. Psychological adjustment in children after traumatic disfiguring injuries: a 12-month follow-up. Plast Reconstr Surg 2000; 106:1451-8; discussion 1459-60. [PMID: 11129171 DOI: 10.1097/00006534-200012000-00001] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The psychological adjustment of 57 children (age range, 3 to 12 years) who sustained mutilating traumatic injuries to the face or upper or lower extremities was assessed over a 12-month interval. The injuries had occurred as a result of boating, lawn mower, or home accidents or dog bites. Within 5 days of the traumatic event, 98 percent of the children were symptomatic for posttraumatic stress disorder, depression, or anxiety. One month after the injury, 82 percent were symptomatic. Symptom frequency had declined by the time of the 3-month and 6-month evaluations, but 44 percent of the children continued to report symptoms at 12-month follow-up visits, and 21 percent met the diagnostic criteria for posttraumatic stress disorder. Typical symptoms included flashbacks, fear of re-injury, mood disorders, body-image changes secondary to disfigurement, sleep disturbances, and anxiety. These findings support the importance of psychological evaluation and treatment of children who suffer mutilating injuries that require the attention of plastic surgeons.
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Affiliation(s)
- M D Rusch
- Department of Plastic and Reconstructive Surgery at the Medical College of Wisconsin, Milwaukee 53226, USA.
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259
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Cashel ML, Ovaert L, Holliman NG. Evaluating PTSD in incarcerated male juveniles with the MMPI-A: an exploratory analysis. J Clin Psychol 2000; 56:1535-49. [PMID: 11132569 DOI: 10.1002/1097-4679(200012)56:12<1535::aid-5>3.0.co;2-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This is a preliminary study examining the utility of the Minnesota Multiphasic Personality Inventory-Adolescent form (MMPI-A; Butcher, Williams, Graham, Archer, Tellegan, Ben-Porath, & Kaemmer, 1992) for identifying PTSD in incarcerated adolescents. Scores from the MMPI-A were compared with scores and diagnostic criteria from the Post-Traumatic Stress Disorder Reaction Index (PTSD-RI; Frederick, 1985) for a sample of 60 male juvenile delinquents. Results from a MANOVA indicated significant differences in mean scores for MMPI-A Scales 4, 6, and 8 for both PTSD and Non-PTSD groups. The MMPI Supplementary PK scale (Keane, Malloy & Fairbank, 1984), developed for identifying PTSD, was adapted and evaluated for applications with the MMPI-A. Finally, a discriminant function analysis successfully classified juveniles with and without PTSD symptomatology. In summary, the PK scale was moderately successful at identifying post-traumatic stress reactions. Our results suggest that the MMPI-A may serve as a useful screening measure, indicating the need for further evaluation of traumatic experiences in juveniles.
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Affiliation(s)
- M L Cashel
- Department of Psychology, Southern Illinois University at Carbondale, 62901-6502, USA
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260
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Reebye P, Moretti MM, Wiebe VJ, Lessard JC. Symptoms of posttraumatic stress disorder in adolescents with conduct disorder: sex differences and onset patterns. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2000; 45:746-51. [PMID: 11086558 DOI: 10.1177/070674370004500808] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine sex differences in the rate and symptoms of posttraumatic stress disorder (PTSD), trauma exposure, and onset patterns in youth with conduct disorder (CD). METHOD Youth admitted to a clinical facility for severe behaviour problems completed the Diagnostic Interview for Children and Adolescents--Revised (DICA-R) to assess the presence of CD and PTSD. RESULTS Over one-half of CD youth reported exposure to trauma, yet only 17% met criteria for PTSD. PTSD was more frequent in CD girls (28%) than in boys (10%), and girls experienced greater symptom intensity and anhedonia, difficulty feeling love or affection, and disturbance of sleep and concentration. Girls more frequently reported sexual assault, while boys were more likely to report accidents, physical assaults, and witnessing the death of a loved one. Retrospective reports indicated that PTSD tended to develop subsequent to CD. CONCLUSIONS Exposure to trauma is common among CD youth; however, diagnostic procedures should be adapted for increased sensitivity to PTSD. The development of CD may increase the risk for PTSD, particularly in girls, by exposing youth to situations in which they are traumatized. The role of trauma in CD should be routinely examined by clinicians and warrants further research.
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Affiliation(s)
- P Reebye
- Department of Child & Adolescent Psychiatry, BC's Children's Hospital, Vancouver
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261
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Lipschitz DS, Rasmusson AM, Anyan W, Cromwell P, Southwick SM. Clinical and functional correlates of posttraumatic stress disorder in urban adolescent girls at a primary care clinic. J Am Acad Child Adolesc Psychiatry 2000; 39:1104-11. [PMID: 10986806 DOI: 10.1097/00004583-200009000-00009] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify clinical and functional correlates of posttraumatic stress disorder (PTSD) in trauma-exposed urban adolescent girls. METHOD Ninety female adolescents aged 12 to 21 years (mean 17.3 years) who presented for routine medical care at an adolescent primary care clinic were assessed with self-report questionnaires and interviews for trauma exposure, posttraumatic stress symptoms, other psychopathology, and psychosocial, family, and school function. RESULTS Ninety-two percent (n = 83) endorsed at least one trauma. Witnessing community violence (85.6%) and hearing about a homicide (67.8%) were the most common traumatic events endorsed. Twelve (14.4%) and 10 (11.6%) traumatized girls met DSM-IV symptom criteria for full and partial PTSD, respectively. Compared with traumatized girls without PTSD, girls with PTSD were significantly more depressed, used more cigarettes and marijuana, and were more likely to have failed a school grade, been suspended from school, or been arrested. CONCLUSIONS Urban adolescent girls are exposed to multiple types of trauma. Whereas most develop at least one posttraumatic stress symptom, girls who meet full symptom criteria for PTSD show evidence of other psychopathology, increased cigarette and marijuana use, and poorer school performance. Further research is needed to identify and treat inner-city girls with PTSD.
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Affiliation(s)
- D S Lipschitz
- National Center for PTSD, VA Connecticut, West Haven 06516, USA.
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262
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Ford JD, Racusin R, Ellis CG, Daviss WB, Reiser J, Fleischer A, Thomas J. Child maltreatment, other trauma exposure, and posttraumatic symptomatology among children with oppositional defiant and attention deficit hyperactivity disorders. CHILD MALTREATMENT 2000; 5:205-217. [PMID: 11232267 DOI: 10.1177/1077559500005003001] [Citation(s) in RCA: 154] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Consecutive child psychiatric outpatient admissions with disruptive behavior or adjustment disorders were assessed by validated instruments for trauma exposure and posttraumatic stress disorder (PTSD) symptoms and other psychopathology. Four reliably diagnosed groups were defined in a retrospective case-control design: Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), comorbid ADHD-ODD, and adjustment disorder controls. ODD and (although to a lesser extent) ADHD were associated with a history of physical or sexual maltreatment. PTSD symptoms were most severe if (a) ADHD and maltreatment co-occurred or (b) ODD and accident/illness trauma co-occurred. The association between ODD and PTSD Criterion D (hyperarousal/hypervigilance) symptoms remained after controlling for overlapping symptoms, but the association of ADHD with PTSD symptoms was largely due to an overlapping symptom. These findings suggest that screening for maltreatment, other trauma, and PTSD symptoms may enhance prevention, treatment, and research concerning childhood disruptive behavior disorders.
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Affiliation(s)
- J D Ford
- Center for the Study of High Utilizers of Health Care, University of Connecticut School of Medicine, USA
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263
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MacKinaw-Koons B, Vasey MW. Considering sex differences in anxiety and its disorders across the life span: A construct-validation approach. ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s0962-1849(05)80004-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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264
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Daviss WB, Mooney D, Racusin R, Ford JD, Fleischer A, McHugo GJ. Predicting posttraumatic stress after hospitalization for pediatric injury. J Am Acad Child Adolesc Psychiatry 2000; 39:576-83. [PMID: 10802975 DOI: 10.1097/00004583-200005000-00011] [Citation(s) in RCA: 150] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the prevalence and predictors of posttraumatic stress disorder (PTSD) in children after hospitalizations for accidental injuries. METHOD Forty-eight children (aged 7-17 years) and their parents were assessed during hospitalization with measures of children's prior traumatization, prior psychopathology, injury severity, parental acute distress, and child acute distress. At outpatient follow-up at least 1 month later, children were evaluated for current PTSD diagnosis and PTSD symptomatology (PTSDS) by a child structured interview and for PTSDS by a parent questionnaire. RESULTS A total of 12.5% had the full syndrome of PTSD at follow-up, and an additional 16.7% had partial (sub-syndromal) PTSD. Full PTSD was associated with a higher level of prior psychopathology, higher parental acute distress, and higher rates of prior sexual abuse, compared with partial or no PTSD. Prior psychopathology, parental distress, and, to a lesser extent, children's acute distress as reported by parents and breadth of prior traumatization, predicted subsequent PTSDS. CONCLUSIONS Full or partial PTSD is relatively common in youths 1 month or more after hospitalization for injuries. Parents' acute distress as well as children's prior psychopathology, prior traumatization, and acute distress may be useful predictors of such injured children's subsequent PTSD or PTSDS.
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Affiliation(s)
- W B Daviss
- Dartmouth Medical School, Lebanon, NH 03756-0001, USA.
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265
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Crimmins SM, Cleary SD, Brownstein HH, Spunt BJ, Warley RM. Trauma, drugs and violence among juvenile offenders. J Psychoactive Drugs 2000; 32:43-54. [PMID: 10801067 DOI: 10.1080/02791072.2000.10400211] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Trauma typically occurs when one experiences a situation where life has been threatened or lost. If the trauma is not resolved, negative residual effects may result in alcohol and drug use, involvement in violent activities as well as the development of mental health problems such as posttraumatic stress disorder (PTSD). Findings from a National Institute on Drug Abuse-funded study examining the link between trauma, drug use and violence among youth are presented. Results from interviews with 414 juveniles remanded to the Office of Children and Family Services (formerly New York State Division For Youth) for assault, sexual assault, robbery or homicide, document the trauma experienced by these youth, as well as how it correlated with their drug usage and participation in violent, illegal activities. Discussion of these findings, their implications for understanding and intervening, and recommendations for future research are highlighted.
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Affiliation(s)
- S M Crimmins
- National Development and Research Institutes, Inc., New York, New York 10048, USA
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266
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Seedat S, van Nood E, Vythilingum B, Stein DJ, Kamlner D. SCHOOL SURVEY OF EXPOSURE TO VIOLENCE AND POSTTRAUMATIC STRESS SYMPTOMS IN ADOLESCENTS. ACTA ACUST UNITED AC 2000. [DOI: 10.1080/16826108.2000.9632366] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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267
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de Vries AP, Kassam-Adams N, Cnaan A, Sherman-Slate E, Gallagher PR, Winston FK. Looking beyond the physical injury: posttraumatic stress disorder in children and parents after pediatric traffic injury. Pediatrics 1999; 104:1293-9. [PMID: 10585980 DOI: 10.1542/peds.104.6.1293] [Citation(s) in RCA: 159] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Traffic crashes are the leading health threat to children in the United States, resulting in nearly 1 million injuries annually. The psychological consequences of these injuries are primarily unknown. The aims of this study were to estimate the prevalence of posttraumatic stress disorder (PTSD) in traffic-injured children and their parents and to identify risk factors for PTSD development. METHODS A prospective cohort study of traffic-injured children between 3 and 18 years of age was conducted at a level 1 Pediatric Trauma Center. The children were enrolled as part of an ongoing surveillance system of traffic-related injuries. Presence and severity of PTSD were determined in the children and their parents through a validated diagnostic questionnaire 7 to 12 months after child injury. RESULTS Twenty-five percent of the children and 15% of the parents suffered diagnostic PTSD, but only 46% of the parents of affected children sought help of any form (including from friends) for their child and only 20% of affected parents sought help for themselves. Child PTSD was associated with older child age and parent PTSD. Parent PTSD was associated with younger child age, child PTSD, and parent witnessing the event. Injury severity was not predictive of PTSD. CONCLUSIONS PTSD in children and their parents is a common, yet overlooked, consequence of pediatric traffic-related injury with prevalence rates similar to those found in children exposed to violence. Physicians managing the pediatric trauma patient, regardless of injury severity or whether the injury was intentional, should screen for PTSD and refer for treatment where appropriate.
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Affiliation(s)
- A P de Vries
- University of Groningen, Faculty of Medical Sciences, Groningen, The Netherlands
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268
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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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269
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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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270
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Lipschitz DS, Winegar RK, Hartnick E, Foote B, Southwick SM. Posttraumatic stress disorder in hospitalized adolescents: psychiatric comorbidity and clinical correlates. J Am Acad Child Adolesc Psychiatry 1999; 38:385-92. [PMID: 10199109 DOI: 10.1097/00004583-199904000-00010] [Citation(s) in RCA: 114] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To describe the diagnostic comorbidity and clinical correlates of posttraumatic stress disorder (PTSD) in adolescent psychiatric inpatients. METHOD Seventy-four adolescent inpatients were given a structured diagnostic interview, the revised version of the Diagnostic Interview for Children and Adolescents, and a battery of standard self-report measures to assess general trauma exposure, posttraumatic stress symptoms, suicidal behavior, dissociation, and depression. RESULTS Ninety-three percent of subjects reported exposure to at least one traumatic event such as being a witness/victim of community violence, witnessing family violence, or being the victim of physical/sexual abuse. Thirty-two percent of subjects met diagnostic criteria for current PTSD, with sexual abuse cited as the most common traumatic stressor in 69% of PTSD cases. Girls were significantly more likely to develop PTSD than boys, although the total number of types of trauma did not differ by gender. Compared with psychiatric controls, male youngsters with PTSD were significantly more likely to have comorbid diagnoses of eating disorders, other anxiety disorders, and somatization disorder. Furthermore, male and female youngsters with PTSD were significantly more likely to have attempted suicide and report greater depressive and dissociative symptoms. CONCLUSION In clinical populations of hospitalized adolescents exposed to multiple forms of trauma, PTSD is a common, but highly comorbid disorder. Specific multimodal assessments and treatments targeted to both PTSD and its comorbidity profile are warranted.
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Affiliation(s)
- D S Lipschitz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
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271
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Wozniak J, Crawford MH, Biederman J, Faraone SV, Spencer TJ, Taylor A, Blier HK. Antecedents and complications of trauma in boys with ADHD: findings from a longitudinal study. J Am Acad Child Adolesc Psychiatry 1999; 38:48-55. [PMID: 9893416 DOI: 10.1097/00004583-199901000-00019] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVE To examine the relationship between trauma and attention-deficit hyperactivity disorder (ADHD), evaluating whether ADHD increases the risk for trauma, the risk for posttraumatic stress disorder (PTSD), or the risk for trauma-associated psychopathology. METHOD Data from a longitudinal sample of 260 children and adolescents with and without ADHD were examined. All were evaluated comprehensively with assessments in multiple domains of functioning including systematic assessments of trauma and PTSD. Comparisons were made between traumatized and nontraumatized youths with and without ADHD. RESULTS No meaningful differences were detected in comparisons between ADHD and control children, either in the rate of trauma exposure or in the development of PTSD. Although trauma was associated with the development of major depression, this effect was independent of ADHD status. In contrast, bipolar disorder at baseline assessment was a significant risk factor for subsequent trauma exposure. CONCLUSIONS ADHD was not found to be a risk factor for either trauma exposure or PTSD, but childhood mania was. If confirmed, this finding stresses the potential severe clinical sequelae of childhood mania in children.
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Affiliation(s)
- J Wozniak
- Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA
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272
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Abstract
The common biopsychosocial sequelae of violence exposures are reviewed, with a focus on post-traumatic stress disorder in developmental, clinical, and familial contexts. Challenges to assessment are reviewed, and implications for prevention and treatment are presented. Pediatricians have an essential role to play in secondary and tertiary prevention through the use of anticipatory guidance and victimization as a marker of developmental risk.
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Affiliation(s)
- W H Davies
- Child Protection Center, Children's Hospital of Wisconsin, USA
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273
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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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274
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Olsson G. Adolescent depression. Epidemiology, nosology, life stress and social network. Minireview based on a doctoral thesis. Ups J Med Sci 1998; 103:77-145. [PMID: 9923068 DOI: 10.3109/03009739809178946] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The study engaged a total population of 16-17-year-old urban high-school students and 2300 (93%) were screened for depression and previous suicide attempts. Adolescents with high depression scores in self-evaluation (12.3%) or reporting previous suicide attempts (2.4%) were diagnostically interviewed together with one control for each, matched for gender and educational program. After the interview self-ratings were completed regarding social network, family climate, and life events. Major depression was prevalent during the last year in 5.8% and during life time in 11.4%, 4 girls for every boy. A depression with remaining symptoms for a year or more was the most common type. Dysthymia without major depressive episodes was diagnosed in 1.1%, two girls for every boy. Short hypomanic episodes had been experienced by 13.2% of those with major depressive disorder. Anxiety disorder was comorbid to depression in one half and conduct disorder in one forth of the depressed adolescents. Alcohol was abused by 6.5% and used regularly by another 12%. Other drugs were used by 6.5% of depressed adolescents and not at all by controls. The depressed used tobacco twice as frequently as non-depressed. Social network and family climate were compared within the originally matched pairs. Adolescents with long-lasting depressions had a smaller and unsatisfying social network. They also had experienced many stressful life events related to family adversities, while those with shorter depressive episodes had stress related to the peer group. Depressed adolescents with comorbid conduct disorder reported insufficient support from the close network and a more negative family climate.
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Affiliation(s)
- G Olsson
- Departement of Neuroscience, Child and Adolescent Psychiatry, University Hospital, Uppsala, Sweden
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275
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Hastings TL, Kelley ML. Development and validation of the Screen for Adolescent Violence Exposure (SAVE). JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 1997; 25:511-20. [PMID: 9468111 DOI: 10.1023/a:1022641916705] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Empirical evidence was provided on the utility of the Screen for Adolescent Violence Exposure (SAVE) in assessing adolescent exposure to school, home, and community violence. The SAVE was empirically developed on 1,250 inner-city adolescents, and obtained excellent reliability and validity. Both exploratory and confirmatory factor analyses identified three factors: Traumatic Violence, Indirect Violence, and Physical/Verbal Abuse. The SAVE demonstrated utility in classifying high- and low-violence participants, and correlated significantly with both objective crime data and theoretically relevant constructs (anger, posttraumatic stress symptoms, and internalizing/externalizing problems). Thus, the SAVE provides measurement of the stressor criterion associated with posttraumatic stress disorder, and allows quantification of severity of violence exposure by setting.
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Affiliation(s)
- T L Hastings
- University of Washington School of Medicine, Dept. of Psychiatry and Behavioral Sciences, Seattle, USA
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276
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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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277
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Steiner H, Garcia IG, Matthews Z. Posttraumatic stress disorder in incarcerated juvenile delinquents. J Am Acad Child Adolesc Psychiatry 1997; 36:357-65. [PMID: 9055516 DOI: 10.1097/00004583-199703000-00014] [Citation(s) in RCA: 283] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the prevalence of posttraumatic stress disorder (PTSD) in severely delinquent subjects and to measure associated personality characteristics. METHOD Eighty-five incarcerated boys (mean age 16.6, SD = 1.2) with mostly violent offenses were studied. The sample was representative of the California Youth Authority population. They received a standard psychiatric screen, a semistructured interview for PTSD, and self-report questionnaires measuring personality traits and defenses. A nonclinical sex- and age-matched group was used for comparing psychometrics. RESULTS Subjects suffered from PTSD at higher rates than other adolescent community samples and at higher rates than those found in county probation camps. Thirty-two percent fulfilled criteria for PTSD, 20% partial criteria. One half of the subjects described the witnessing of interpersonal violence as the traumatizing event. Psychometric results converged in the predicted way: Subjects with PTSD showed elevated distress, anxiety, depression, and lowered restraint, impulse control, and suppression of aggression; they had high levels of immature defenses such as projection, somatization, conversion, dissociation, and withdrawal. CONCLUSIONS PTSD occurs at high rates in delinquents, and this finding has implications for management and treatment. Personality characteristics that might put individuals at risk for the development of PTSD were identified.
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Affiliation(s)
- H Steiner
- Division of Child Psychiatry and Child Development, Stanford University School of Medicine, CA 94305-5540, USA
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