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Bilodeau-Houle A, Raymond C, Marin MF. It's all in the hair: Association between changes in hair cortisol concentrations in reaction to the COVID-19 pandemic and post-traumatic stress symptoms in children over time. Psychoneuroendocrinology 2024; 164:107019. [PMID: 38518705 DOI: 10.1016/j.psyneuen.2024.107019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 01/26/2024] [Accepted: 03/07/2024] [Indexed: 03/24/2024]
Abstract
After exposure to a stressful/traumatic event, some individuals will develop post-traumatic stress symptoms (PTSS). In adults, low cortisol levels appear to be a risk factor for the development of PTSS. Indeed, both lower pre-trauma cortisol levels and low cortisol levels in the aftermath of a traumatic event have been associated with greater PTSS. In contrast, studies conducted in children showed that elevated cortisol levels shortly after trauma exposure are associated with more severe post-traumatic stress symptomatology. The few studies that have examined how pre-trauma cortisol levels predict PTSS in children have found no effect. Given that a pandemic can induce PTSS in certain individuals, we investigated whether cortisol secretion prior to and in the early stages of the COVID-19 pandemic in Quebec (Canada) predicted PTSS in children. In June 2020, we collected a hair sample from 71 children (8-15 y/o, M = 11.65; 54.93% girls) without a history of psychopathology or exposure to previous traumatic events. Hair samples allowed us to derive cumulative measures of cortisol levels for the months prior to (from mid-December 2019 to mid-March 2020) and at the beginning of the pandemic (from mid-March 2020 to mid-June 2020). PTSS were assessed every 3 months between June 2020 (T1) and March 2021 (T4). The results showed that a greater increase in hair cortisol at the beginning of the pandemic predicted less PTSS at T1, with an increase in these symptoms over time. This study highlights the utility of using hair cortisol during future chronic stressful events to better understand its association with the evolution of distress.
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Affiliation(s)
- Alexe Bilodeau-Houle
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec H2X 3P2, Canada; Research Center of the Institut universitaire en santé mentale de Montréal, Montreal, Quebec H1N 3V2, Canada
| | - Catherine Raymond
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec H2X 3P2, Canada; Research Center of the Institut universitaire en santé mentale de Montréal, Montreal, Quebec H1N 3V2, Canada
| | - Marie-France Marin
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec H2X 3P2, Canada; Research Center of the Institut universitaire en santé mentale de Montréal, Montreal, Quebec H1N 3V2, Canada.
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Associations between HPA axis reactivity and PTSD and depressive symptoms: Importance of maltreatment type and puberty. Dev Psychopathol 2023; 35:130-141. [PMID: 34092276 PMCID: PMC8648873 DOI: 10.1017/s095457942100050x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The functioning of the hypothalamic-pituitary-adrenal (HPA) axis is implicated in the etiology and maintenance of depressive and posttraumatic stress disorder (PTSD) symptoms. However, different maltreatment experiences as well as the increased sensitivity of the HPA axis during puberty may alter associations between the HPA axis and mental health. To address these gaps, the current study examined the potential bidirectional associations between cortisol reactivity to a stressor, PTSD symptoms, and depressive symptoms among early adolescents across two time points, 1 year apart (n = 454; Mage = 10.98 at Time 1 and Mage = 12.11 at Time 2). Multiple-group path models tested the pathways between cortiol reactivity and mental health prior to and during puberty, for different types of maltreatment . Overall, the results showed that associations between cortisol output and symptoms of PTSD and depression were driven by those in the midst of puberty. Specifically, higher cortisol output at Time 1 was linked with higher levels of subsequent PTSD and depressive symptoms for neglected youth who had reached puberty. However, depressive symptoms predicted subsequent lower cortisol output for the physical abuse and emotional abuse groups. These findings demonstrate longitudinal links between cortisol, depressive symptoms, and PTSD symptoms among youth with different types of maltreatment histories and highlight the need to consider the reorganization of the stress system during puberty in order to advance our understanding of the HPA axis and mental health.
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Wiltshire CN, Wanna CP, Stenson AF, Minton ST, Reda MH, Davie WM, Hinrichs R, Winters S, France JM, Jovanovic T. Associations between children's trauma-related sequelae and skin conductance captured through mobile technology. Behav Res Ther 2022; 150:104036. [PMID: 35078028 PMCID: PMC8887191 DOI: 10.1016/j.brat.2022.104036] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 12/15/2022]
Abstract
Although many children experience trauma, few receive diagnoses and subsequent care despite experiencing trauma-related sequelae. At age nine (M = 9.11), children (N = 62; female = 46.4%) who predominantly identified as Black (78.7%) were enrolled in this first study examining how skin conductance as captured by mobile technology, eSense, related to children's traumatic experiences and trauma-related symptoms. Skin conductance measures were associated with degree of trauma exposure and PTSD hyperarousal symptoms. These findings suggest that physiological responses in addition to self-report measures may be easily used to assess children's trauma exposure and symptoms. Given eSense's ease-of-use, this technology could assist clinics and research institutions assess children's trauma-related needs.
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Affiliation(s)
- Charis N Wiltshire
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Cassandra P Wanna
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA.
| | - Anaïs F Stenson
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Sean T Minton
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Mariam H Reda
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - William M Davie
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Rebecca Hinrichs
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA
| | - Sterling Winters
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - John M France
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
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Siciliano RE, Anderson AS, Compas BE. Autonomic nervous system correlates of posttraumatic stress symptoms in youth: Meta-analysis and qualitative review. Clin Psychol Rev 2022; 92:102125. [PMID: 35078039 PMCID: PMC8858870 DOI: 10.1016/j.cpr.2022.102125] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Revised: 11/25/2021] [Accepted: 01/09/2022] [Indexed: 11/17/2022]
Abstract
Physiological dysregulation is a key diagnostic criterion for posttraumatic stress disorder (PTSD). While PTSD is defined by trauma exposure, symptom presentations are varied. Similarly, findings of autonomic nervous system (ANS), including parasympathetic (PNS) and sympathetic nervous system (SNS), function in youth exposed to trauma are mixed (e.g., hyporeactivity and hyperreactivity). The present meta-analysis quantitatively assesses the relation between ANS measures broadly, and PNS- and SNS-specific measures, and posttraumatic stress symptoms (PTSS) in youth (ages 4.98 to 19.55 years) across 38 cross-sectional and longitudinal studies (N = 3488). Findings demonstrate that heightened ANS activity is related to increased PTSS during stress tasks (r = 0.07), while decreased SNS activity at rest corresponded to increased PTSS (r = -0.09). The correlation between PNS measures and PTSS was non-significant. The moderation effect of age on the relation between PNS activity measured during stress tasks and PTSS approached significance, such that younger children showed a stronger negative relation between symptoms and PNS activity compared to older youth. Qualitative review of included studies revealed significant variability across sample and stressor characteristics and study methodology. Findings indicate the importance of autonomic dysregulation in youth with PTSS. Additional considerations for future research are discussed.
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Affiliation(s)
- Rachel E. Siciliano
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Allegra S. Anderson
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
| | - Bruce E. Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee, USA
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5
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Yun JA, Lee CH. Written Exposure Therapy for Korean Adolescents With PTSD: Four Case Studies. Clin Case Stud 2022. [DOI: 10.1177/15346501221074316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Research shows that cognitive behavioral therapy (CBT) is the most effective approach for treating children and adolescents with post-traumatic stress disorder (PTSD). However, evidence regarding CBT for adolescents with PTSD in Korea is lacking. Written Exposure Therapy (WET), which has the advantages of brevity and tolerability, has important clinical implications as an option for effective treatment of PTSD in the context of the Korean medical system. We aimed to examine the application of WET to adolescents through the cases of four Korean adolescents who underwent WET. The treatment experiences of the four adolescent participants with PTSD are presented, and insights based on their pre- and post-treatment research assessments are discussed. Although evidence is insufficient, our study suggests that WET can be considered a suitable treatment for adolescents who do not have a history of childhood abuse and have a relatively good support system.
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Affiliation(s)
- Ji-ae Yun
- Department of Neuropsychiatry, Daejeon Eulji Medical Center, Daejeon, Republic of Korea
| | - Chang-Hwa Lee
- Department of Neuropsychiatry, Daejeon Eulji Medical Center, Daejeon, Republic of Korea
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Horesh D, Milstein N, Tomashin A, Mayo O, Gordon I. Pre-pandemic electrodermal activity predicts current COVID-related fears: household size during lockdown as a moderating factor. Stress 2022; 25:22-29. [PMID: 34812098 DOI: 10.1080/10253890.2021.2006179] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Background: Despite the immense impact of COVID-19 on mental health, there is a lack of prospective studies examining physiological predictors of current risk factors. Moreover, although physiological processes evidently interact with socio-demographic factors to modulate individuals' response to a crisis, it remains largely unknown how these complex interactions shape people's mental responses to COVID-19. To fill these gaps of knowledge, we chose a potent physiological marker of distress - heightened baseline electrodermal activity (EDA) measured before the pandemic began - and hypothesized it would be related to greater COVID-related fears and worries as a function of individuals' household size.Method: 185 individuals (71% women), who had participated in our lab studies 2-3 years ago, in which we assessed their baseline EDA, completed several questionnaires online, including assessments of their current fears regarding COVID. Participants also reported the number of people in their household, with whom they had been together during a lockdown which was taking place at the time. We used pre-pandemic EDA measures in combination with their household size to predict participants' current fears.Results: Pre-pandemic EDA measures predicted current COVID-related fears and worries. Specifically for the EDA measure "number of skin conductance responses", we further found that the number of people in the household during the lockdown, moderated the abovementioned relationship, such that it occurred in individuals with average and larger households and not in those with small households.Conclusions: We provide a highly relevant and unique combination of physiological, socio-demographic, and psychological measures, which augments the potential to optimally target populations vulnerable to COVID-related distress, and subsequently offer them early mental health interventions.
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Affiliation(s)
- Danny Horesh
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Nir Milstein
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Alon Tomashin
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat-Gan, Israel
| | - Oded Mayo
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | - Ilanit Gordon
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
- The Gonda Multidisciplinary Brain Research Center, Bar Ilan University, Ramat-Gan, Israel
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Gervasio M, Beatty A, Kavanaugh B, Cancilliere MK, Holler K. The association between neurocognition and sexual abuse within a children's psychiatric inpatient program. Clin Neuropsychol 2020; 36:189-206. [PMID: 32613898 DOI: 10.1080/13854046.2020.1781932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: The aim of this study was to understand the detrimental effects of sexual abuse on neuropsychological variables including child's intelligence, executive functioning (EF), and learning/memory within a pediatric inpatient population.Method: This study examined the effect of sexual abuse on children's intelligence, EF, and learning/memory by conducting a retrospective chart review for 144 children (aged 7-12) who completed a neuropsychological assessment during a psychiatric inpatient hospitalization. Of the 144 children, participants were matched two to one by gender and age, with one group (n = 52) categorized by reported sexual abuse and the other group (n = 92) categorized by no reported sexual abuse. The neuropsychological measures included the Wechsler Abbreviated Scale of Intelligence (WASI-I/II) or Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV), Wide Range Assessment of Memory and Learning - Second Edition (WRAML-2): Story Memory Immediate/Delayed Recall and Delayed Recognition, Trail Making Test-B, Stroop Interference Test: Color-Word Condition, WRAML-2: Sentence Memory and Conners Continuous Performance Test-Second Edition.Results: Statistical analysis showed that participants with reported sexual abuse had significantly (p< .05) lower intelligence, EF, and learning/memory skills than those without reported sexual abuse. Only working memory and cognitive flexibility differences remained after controlling for clinical variables (e.g., PTSD, amount of total abuse types).Conclusions: These findings contributed to the limited research on the detrimental effects of sexual abuse in a pediatric inpatient population. They demonstrated a relationship between early sexual abuse and neuropsychological deficits, specifically executive function and IQ deficits.
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Affiliation(s)
- Maddi Gervasio
- Department of Psychiatry & Human Behavior, E. P. Bradley Hospital, East Providence, RI, USA
| | - Avery Beatty
- Department of Human Development and Family Studies, University of Rhode Island, Kingston, RI, USA
| | - Brian Kavanaugh
- Department of Psychiatry & Human Behavior, E. P. Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, East Providence, RI, USA
| | | | - Karen Holler
- Department of Psychiatry & Human Behavior, E. P. Bradley Hospital, East Providence, RI, USA.,Department of Psychiatry & Human Behavior, Alpert Medical School of Brown University, East Providence, RI, USA
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8
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A network analysis of posttraumatic stress disorder and dissociation in trauma-exposed adolescents. J Anxiety Disord 2020; 72:102222. [PMID: 32272318 DOI: 10.1016/j.janxdis.2020.102222] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 02/08/2020] [Accepted: 03/21/2020] [Indexed: 12/21/2022]
Abstract
Posttraumatic stress disorder (PTSD) and dissociation have long been recognized to co-occur, leading the DSM-5 to introduce a dissociative subtype of PTSD into its nomenclature. Most research to date on the dissociative subtype has focused on adults. The current study aimed to extend this research to an adolescent sample and to examine symptom-level associations between PTSD and dissociation using network analysis. The analysis was conducted with 448 trauma-exposed detained US adolescents (24.55% female; mean age 15.98 ± 1.25 years). A network consisting of 20 DSM-5 PTSD symptoms was constructed, followed by a network consisting of 20 PTSD symptoms and five dissociative items. Expected influence bridge centrality was estimated to examine items with the most/strongest cross-construct connections (i.e. between PTSD and dissociation). The PTSD symptoms concentration problems, amnesia and recurrent memories and the dissociative items depersonalization, derealisation and can't remember things that happened had the highest bridge centrality values. These symptom-level associations extend our understanding of the PTSD-dissociation relationship by pointing to specific symptoms of PTSD and dissociation that may drive the co-morbidity between the two constructs. These findings may inform future intervention efforts.
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9
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Zantvoord JB, Ensink JBM, Op den Kelder R, Wessel AMA, Lok A, Lindauer RJL. Pretreatment cortisol predicts trauma-focused psychotherapy response in youth with (partial) posttraumatic stress disorder. Psychoneuroendocrinology 2019; 109:104380. [PMID: 31352130 DOI: 10.1016/j.psyneuen.2019.104380] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/01/2019] [Accepted: 07/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Despite availability of effective trauma-focused psychotherapies, treatment non-response in youth with (partial) posttraumatic stress disorder remains substantial. Studies in adult PTSD have suggested that cortisol is associated with treatment outcome. Furthermore, cortisol prior to treatment could be used to predict treatment success. However, there is a lack of comparable studies in youth with (partial) PTSD. The objective of the current study was therefore to test whether cortisol prior to treatment would differ between treatment responders and non-responders and would positively predict the extent of clinical improvement in youth with (partial) PTSD. METHODS Youth aged 8-18 with PTSD (79.2%) or partial PTSD (20.8%) were treated with 8 sessions of either trauma-focused cognitive behavioral therapy (TF-CBT) or eye movement desensitization and reprocessing (EMDR). Prior to treatment initiation, salivary cortisol was measured in treatment responders (n = 23) and treatment non-responders (n = 30) at 10 and 1 min before and 10, 20 and 30 min after personalized trauma script driven imagery (SDI). The cortisol stress response (>1.5 nmol/L increase from baseline) and basal cortisol secretion was assessed during the SDI procedure. We hypothesized that treatment responders would display higher cortisol levels caused by increased cortisol reactivity prior to trauma-focused psychotherapy relative to psychotherapy non-responders and higher cortisol levels would positively predict the extent of clinical improvement. RESULTS Script driven imagery did not induce a cortisol stress response in all but two participants. Prior to treatment responders showed significantly higher basal cortisol secretion during SDI compared to treatment non-responders. This effect remained significant after controlling for gender. Higher pre-treatment basal cortisol secretion further positively predicted the extent of clinical improvement during trauma-focused psychotherapy. CONCLUSION Because SDI failed to provoke a cortisol stress response in our sample, the question if cortisol reactivity differs between treatment responders and non-responders remains inconclusive. However, our results do suggest that higher pretreatment basal cortisol secretion forms a potential indicator of prospective trauma-focused psychotherapy response in youth with (partial) PTSD. Although, the amount of uniquely explained variance in clinical improvement by pre-treatment cortisol secretion is limited and still renders insufficient basis for clinical applicability, these findings do suggest directions for future studies to delineate the mechanisms of treatment success in youth with (partial) PTSD.
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Affiliation(s)
- Jasper B Zantvoord
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands; Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands.
| | - Judith B M Ensink
- The Bascule, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, the Netherlands; Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Rosanne Op den Kelder
- The Bascule, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, the Netherlands; Department of Child Development and Education, University of Amsterdam, the Netherlands; Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - Aimy M A Wessel
- The Bascule, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, the Netherlands
| | - Anja Lok
- Department of Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Ramon J L Lindauer
- The Bascule, Academic Centre for Child and Adolescent Psychiatry, Amsterdam, the Netherlands; Department of Child and Adolescent Psychiatry, Amsterdam University Medical Center, Amsterdam, the Netherlands
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10
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Haag K, Hiller R, Peyk P, Michael T, Meiser-Stedman R, Fearon P, Ehlers A, Halligan SL. A Longitudinal Examination of Heart-Rate and Heart Rate Variability as Risk Markers for Child Posttraumatic Stress Symptoms in an Acute Injury Sample. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2019; 47:1811-1820. [PMID: 31073881 PMCID: PMC6805807 DOI: 10.1007/s10802-019-00553-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Heart rate (HR) alterations in the immediate aftermath of trauma-exposure have been proposed to be potentially useful markers for child and adolescent posttraumatic stress disorder (PTSD). However, it is not yet clear if this holds true for measures taken more distal to the trauma, and no studies have investigated the predictive validity of more sensitive HR variability (HRV) indices. We recruited 76 parent-child pairs (child age 6 to 13 years) after the child experienced a traumatic event leading to presentation at a hospital emergency department. At 1-month post trauma (T1), HR recordings were obtained at rest, and while children verbally recounted their traumatic experience, both alone and together with a parent. Child post-traumatic stress symptoms (PTSS) were assessed concurrently (T1), and at 3 (T2) and 6-month (T3) follow-ups. We found that for T1, elevated mean HR during trauma narratives, but not at baseline, was positively associated with PTSS, with some evidence that HRV-indices were negatively cross-sectionally associated with PTSS. Furthermore, T1 HR indices predicted PTSS at T2 and partially at T3, although these effects did not hold when T1 PTSS were added to the model. Findings suggest that, consistent with the adult literature, HR indices in children may be a concurrent marker of higher PTSS and may be predictive of longer term distress. The findings encourage further investigations that track child HR and HRV in relation to PTSS over time after trauma, in order to examine how biological profiles evolve in those with persistent symptoms.
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Affiliation(s)
| | - Rachel Hiller
- Department of Psychology, University of Bath, Bath, UK
| | - Peter Peyk
- Department of Consultation-Liaison-Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zürich, Switzerland
| | - Tanja Michael
- Department for Clinical Psychology and Psychotherapy, University of Saarland, Saarbrücken, Germany
| | | | - Pasco Fearon
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Anke Ehlers
- Department of Psychology, University of Oxford, Oxford, UK
| | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK.
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
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Iffland B, Klein F, Rosner R, Renneberg B, Steil R, Neuner F. Cardiac reactions to emotional words in adolescents and young adults with PTSD after child abuse. Psychophysiology 2019; 57:e13470. [PMID: 31456251 DOI: 10.1111/psyp.13470] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 07/09/2019] [Accepted: 08/08/2019] [Indexed: 01/31/2023]
Abstract
Post-traumatic stress disorder (PTSD) is associated with alterations in cardiac reactivity to threat cues. Meta-analyses have summarized that adults with PTSD have increased heart rates in response to trauma-related stimuli. However, the opposite effect (i.e., cardiac hyporeactivity) has recently been reported in subgroups of PTSD patients. In children and adolescents with PTSD, reports of cardiac alterations are rare and ambiguous. So far, most studies in adolescents and young adults are restricted to victims of accidents, even though PTSD is highly prevalent in victims of child maltreatment. The present study aimed at investigating cardiac reactions in adolescents and young adults with PTSD after child abuse. Cardiac responses to standardized emotional words were studied in 39 adolescent and young adult PTSD patients after childhood sexual and/or physical abuse as compared to 39 healthy control subjects (age range: 15-20 years). The experimental paradigm consisted of a passive reading task with neutral, positive, physically threatening, and socially threatening (swear) words. Results showed that cardiac reactions to negative stimuli, particularly physically threatening stimuli, were less pronounced in PTSD patients than in controls. Moreover, cardiac reactions in response to socially threatening words were less variable in the PTSD group. No differences between and within groups were present in reaction to neutral or positive stimuli. Findings suggest that a physiologically blunted subtype of PTSD may already manifest during adolescence and young adulthood. Moreover, the results of the present study emphasize the relevance of individual trauma history for physiological reactions.
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Affiliation(s)
- Benjamin Iffland
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Fabian Klein
- Department of Psychology, Bielefeld University, Bielefeld, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Babette Renneberg
- Clinical Psychology and Psychotherapy, Freie Universitaet Berlin, Berlin, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt, Germany
| | - Frank Neuner
- Department of Psychology, Bielefeld University, Bielefeld, Germany
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12
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Kerig PK. Polyvictimization and Girls' Involvement in the Juvenile Justice System: Investigating Gender-Differentiated Patterns of Risk, Recidivism, and Resilience. JOURNAL OF INTERPERSONAL VIOLENCE 2018; 33:789-809. [PMID: 29411692 DOI: 10.1177/0886260517744843] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A recent dramatic rise in girls' arrests has increased our need to examine whether our models of youth justice system involvement need to be differentiated by gender. Polyvictimization, in particular, has been implicated as a powerful predictor of youth problem behavior. However, recent research suggests that polyvictimization is associated with youth involvement in the justice system in ways that differ for girls at the levels of the independent variables (i.e., the sources of risk), the dependent variables (i.e., youth outcomes), and the mediators of these associations (i.e., the purported mechanisms that account for these relations). The present critique describes growth points in the current research with the goal of suggesting promising directions for future investigations. In particular, gaps are noted regarding our understanding of the specific forms of polyvictimization that affect traumatized girls' development, especially given the highly disproportionate prevalence of sexual abuse among justice-involved girls. In addition, increased attention is needed to gender differences in the timing of victimization and the onset of risky behavior, as well as the nature of trauma-linked youth offenses and recidivism, which research also suggests may differ for boys and girls. Furthermore, a new body of research on psychophysiological reactivity promises to shed light on gender differences in trauma response, resilience, and risk. Finally, the importance acknowledging the intersection of polyvictimization, gender, and race is noted. The article ends with a discussion of the ways in which understanding gender differences and similarities can inform gender-responsive approaches to prevention and intervention efforts.
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13
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Straub J, Klaubert LM, Schmiedgen S, Kirschbaum C, Goldbeck L. Hair cortisol in relation to acute and post-traumatic stress symptoms in children and adolescents. ANXIETY STRESS AND COPING 2017; 30:661-670. [PMID: 28745078 DOI: 10.1080/10615806.2017.1355458] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND We report on the preliminary results of two independent studies that (1) compare the hair cortisol concentrations (HCC) of healthy controls with patients displaying post-traumatic stress symptoms (PTSS, study 1+2), (2) investigate whether pre-trauma HCC are predictive for the development of acute stress symptoms (ASS) and PTSS (study 1) and (3) determine whether HCC correlate with PTSS in a clinical sample of children (study 2). METHODS In study 1, the clinical symptoms of 35 minors were examined one (T1) and seven weeks (T2) after surgery following an accident. Hair samples were taken after the accident that reflect cortisol secretion over the past three months before the accident (healthy controls). In study 2, HCC and PTSS symptoms were cross-sectionally assessed in 22 minors who had experienced a psychological trauma. RESULTS The HCC of patients with PTSS were lower than the HCC of healthy controls (study 1+2). Secondary analyses showed that HCC were significantly lower in male PTSS patients than in male healthy controls, whereas the HCC in females were comparably low in both groups. Pre-trauma HCC did not predict the total ASS and PTSS scores (study 1) and HCC were not directly related to the total PTSS scores (study 2).
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Affiliation(s)
- Joana Straub
- a Department of Child and Adolescent Psychiatry and Psychotherapy , University of Ulm , Ulm , Germany
| | - Lena Marie Klaubert
- a Department of Child and Adolescent Psychiatry and Psychotherapy , University of Ulm , Ulm , Germany
| | - Susann Schmiedgen
- b Institute of Biological Psychology, Technische Universität Dresden , Dresden , Germany
| | - Clemens Kirschbaum
- b Institute of Biological Psychology, Technische Universität Dresden , Dresden , Germany
| | - Lutz Goldbeck
- a Department of Child and Adolescent Psychiatry and Psychotherapy , University of Ulm , Ulm , Germany
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Morris MC, Hellman N, Abelson JL, Rao U. Cortisol, heart rate, and blood pressure as early markers of PTSD risk: A systematic review and meta-analysis. Clin Psychol Rev 2016; 49:79-91. [PMID: 27623149 PMCID: PMC5079809 DOI: 10.1016/j.cpr.2016.09.001] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Revised: 07/27/2016] [Accepted: 09/02/2016] [Indexed: 11/28/2022]
Abstract
Individuals with posttraumatic stress disorder (PTSD) typically exhibit altered hypothalamic-pituitary-adrenal (HPA) function and sympathetic nervous system (SNS) activity. The goals of this study were to determine whether HPA and SNS alterations in the immediate aftermath of trauma predict subsequent PTSD symptom development and whether inconsistencies observed between studies can be explained by key demographic and methodological factors. This work informs secondary prevention of PTSD by identifying subgroups of trauma survivors at risk for PTSD. This meta-analysis (26 studies, N=5186 individuals) revealed that higher heart rate measured soon after trauma exposure was associated with higher PTSD symptoms subsequently (r=0.13). Neither cortisol (r=-0.07) nor blood pressure (diastolic: r=-0.01; systolic: r=0.02) were associated with PTSD symptoms which may be influenced by methodological limitations. Associations between risk markers (heart rate, cortisol, systolic blood pressure) and PTSD symptoms were in the positive direction for younger samples and negative direction for older samples. These findings extend developmental traumatology models of PTSD by revealing an age-related shift in the presentation of early risk markers. More work will be needed to identify risk markers and pathways to PTSD while addressing methodological limitations in order to shape and target preventive interventions.
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Affiliation(s)
- Matthew C Morris
- Department of Family and Community Medicine, Meharry Medical College, Nashville, TN, United States; Center for Molecular and Behavioral Neuroscience, Meharry Medical College, Nashville, TN, United States; Department of Psychology, Vanderbilt University, Nashville, TN, United States.
| | - Natalie Hellman
- Department of Psychology, The University of Tulsa, Tulsa, OK, United States
| | - James L Abelson
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Uma Rao
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States; Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, United States; Center for Behavioral Health Research, University of Tennessee, Knoxville, TN, United States
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15
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Babel KA, Jambroes T, Oostermeijer S, van de Ven PM, Popma A, Vermeiren RRJM, Doreleijers TAH, Jansen LMC. Do post-trauma symptoms mediate the relation between neurobiological stress parameters and conduct problems in girls? Child Adolesc Psychiatry Ment Health 2016; 10:42. [PMID: 27822302 PMCID: PMC5088655 DOI: 10.1186/s13034-016-0129-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Attenuated activity of stress-regulating systems has consistently been reported in boys with conduct problems. Results in studies of girls are inconsistent, which may result from the high prevalence of comorbid post-trauma symptoms. Therefore, the aim of the present study is to investigate post-trauma symptoms as a potential mediator in the relation between stress-regulation systems functioning and conduct problems in female adolescents. METHODS The sample consisted of 78 female adolescents (mean age 15.4; SD 1.1) admitted to a closed treatment institution. The diagnosis of disruptive behaviour disorder (DBD) was assessed by a structured interview-the diagnostic interview schedule for children version IV (DISC-IV). To assess post-trauma symptoms and externalizing behaviour problems, self-report questionnaires, youth self report (YSR) and the trauma symptom checklist for Children (TSCC) were used. The cortisol awakenings response (CAR) measured hypothalamic-pituitary-adrenal (HPA) axis activity, whereas autonomous nervous system (ANS) activity was assessed by heart rate (HR), pre-ejection period (PEP) and respiratory sinus arrhythmia (RSA). Independent t-tests were used to compare girls with and without DBD, while path analyses tested for the mediating role of post- trauma symptoms in the relation between stress regulating systems and externalizing behaviour. RESULTS Females with DBD (n = 37) reported significantly higher rates of post-trauma symptoms and externalizing behaviour problems than girls without DBD (n = 39). Path analysis found no relation between CAR and externalizing behaviour problems. With regard to ANS activity, positive direct effects on externalizing behaviour problems were present for HR (standardized β = 0.306, p = 0.020) and PEP (standardized β = -0.323, p = 0.031), though not for RSA. Furthermore, no relation-whether direct or indirect-could be determined from post-trauma symptoms. CONCLUSIONS Present findings demonstrate that the neurobiological characteristics of female externalizing behaviour differ from males, since girls showed heightened instead of attenuated ANS activity. While the prevalence of post-trauma symptoms was high in girls with DBD, it did not mediate the relation between stress parameters and externalizing behaviour. Clinical implications and future directions are discussed.
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Affiliation(s)
- Kimberly A. Babel
- Department of Child and Adolescent Psychiatry, VU University Medical Center, p/a De Bascule, P.O. Box 303, 1115 Duivendrecht, The Netherlands
| | - Tijs Jambroes
- Department of Child and Adolescent Psychiatry, VU University Medical Center, p/a De Bascule, P.O. Box 303, 1115 Duivendrecht, The Netherlands
| | - Sanne Oostermeijer
- Department of Child and Adolescent Psychiatry, VU University Medical Center, p/a De Bascule, P.O. Box 303, 1115 Duivendrecht, The Netherlands
| | - Peter M. van de Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Arne Popma
- Department of Child and Adolescent Psychiatry, VU University Medical Center, p/a De Bascule, P.O. Box 303, 1115 Duivendrecht, The Netherlands ,Department of Criminal Law and Criminology, Leiden University, Leiden, The Netherlands
| | - Robert R. J. M. Vermeiren
- Department of Child and Adolescent Psychiatry, VU University Medical Center, p/a De Bascule, P.O. Box 303, 1115 Duivendrecht, The Netherlands ,Department of Child and Adolescent Psychiatry, Curium-Leiden University Medical Center, Leiden, The Netherlands
| | - Theo A. H. Doreleijers
- Department of Child and Adolescent Psychiatry, VU University Medical Center, p/a De Bascule, P.O. Box 303, 1115 Duivendrecht, The Netherlands
| | - Lucres M. C. Jansen
- Department of Child and Adolescent Psychiatry, VU University Medical Center, p/a De Bascule, P.O. Box 303, 1115 Duivendrecht, The Netherlands
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Ben-Amitay G, Kimchi N, Wolmer L, Toren P. Psychophysiological Reactivity in Child Sexual Abuse. JOURNAL OF CHILD SEXUAL ABUSE 2016; 25:185-200. [PMID: 26934544 DOI: 10.1080/10538712.2016.1124309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Sexual abuse has physiological and emotional implications. The purpose of this study is to evaluate the neurobiological sequels of childhood sexual trauma by monitoring physiological variables among sexually abused girls and women compared to controls. We assessed posttrauma and traumatic life events of 35 females sexually abused in their childhood (age range 7-51 years) and 25 control females (age range 7-54 years). Electroencephalography, frontalis electromyography, electrodermal activity, and heart rate parameters were recorded while watching sets of pictures representing neutral and trauma-suggestive stimuli. A minority of participants met the Diagnostic and Statistical Manual of Mental Disorders criteria for post-traumatic stress disorder. Abused females displayed significant elevations in heart rate, electromyography, and electroencephalography while viewing allusive stimuli and elevated heart rate while viewing neutral stimuli. The dysfunctional regulation of the physiological stress system associated with child sexual abuse may endanger the victims with various stress and anxiety disorders.
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Affiliation(s)
- Galit Ben-Amitay
- a Tel Aviv Brull Community Mental Health Center , Clalit Health Services , Tel Aviv , Israel
- b The Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
| | - Nir Kimchi
- a Tel Aviv Brull Community Mental Health Center , Clalit Health Services , Tel Aviv , Israel
- c Cohen-Harris Resilience Center , the Association for Children at Risk , Tel Aviv , Israel
| | - Leo Wolmer
- c Cohen-Harris Resilience Center , the Association for Children at Risk , Tel Aviv , Israel
- d Baruch Ivcher School of Psychology , Herzlyia Interdisciplinary Center , Herzliya , Israel
| | - Paz Toren
- a Tel Aviv Brull Community Mental Health Center , Clalit Health Services , Tel Aviv , Israel
- b The Sackler Faculty of Medicine , Tel Aviv University , Tel Aviv , Israel
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17
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Ardizzi M, Martini F, Umiltà MA, Evangelista V, Ravera R, Gallese V. Impact of Childhood Maltreatment on the Recognition of Facial Expressions of Emotions. PLoS One 2015; 10:e0141732. [PMID: 26509890 PMCID: PMC4624998 DOI: 10.1371/journal.pone.0141732] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/11/2015] [Indexed: 11/30/2022] Open
Abstract
The development of the explicit recognition of facial expressions of emotions can be affected by childhood maltreatment experiences. A previous study demonstrated the existence of an explicit recognition bias for angry facial expressions among a population of adolescent Sierra Leonean street-boys exposed to high levels of maltreatment. In the present study, the recognition bias for angry facial expressions was investigated in a younger population of street-children and age-matched controls. Participants performed a forced-choice facial expressions recognition task. Recognition bias was measured as participants’ tendency to over-attribute anger label to other negative facial expressions. Participants’ heart rate was assessed and related to their behavioral performance, as index of their stress-related physiological responses. Results demonstrated the presence of a recognition bias for angry facial expressions among street-children, also pinpointing a similar, although significantly less pronounced, tendency among controls. Participants’ performance was controlled for age, cognitive and educational levels and for naming skills. None of these variables influenced the recognition bias for angry facial expressions. Differently, a significant effect of heart rate on participants’ tendency to use anger label was evidenced. Taken together, these results suggest that childhood exposure to maltreatment experiences amplifies children’s “pre-existing bias” for anger labeling in forced-choice emotion recognition task. Moreover, they strengthen the thesis according to which the recognition bias for angry facial expressions is a manifestation of a functional adaptive mechanism that tunes victim’s perceptive and attentive focus on salient environmental social stimuli.
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Affiliation(s)
- Martina Ardizzi
- Department of Neuroscience, University of Parma, Parma, Italy
- Ravera Children Rehabilitation Centre (RCRC), Lakka, Freetown, Sierra Leone
- * E-mail:
| | - Francesca Martini
- Department of Health Psychology, Hospital of Sanremo, Sanremo, Italy
| | | | | | - Roberto Ravera
- Ravera Children Rehabilitation Centre (RCRC), Lakka, Freetown, Sierra Leone
- Department of Health Psychology, Hospital of Sanremo, Sanremo, Italy
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18
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Fan F, Long K, Zhou Y, Zheng Y, Liu X. Longitudinal trajectories of post-traumatic stress disorder symptoms among adolescents after the Wenchuan earthquake in China. Psychol Med 2015; 45:2885-2896. [PMID: 25990926 DOI: 10.1017/s0033291715000884] [Citation(s) in RCA: 116] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND This study examines the patterns and predictors of post-traumatic stress disorder (PTSD) symptom trajectories among adolescent survivors following the Wenchuan earthquake in China. METHOD A total of 1573 adolescent survivors were followed up at 6, 12, 18 and 24 months post-earthquake. Participants completed the Posttraumatic Stress Disorder Self-Rating Scale (PTSD-SS), Adolescent Self-Rating Life Events Checklist, Social Support Rate Scale, and the Simplified Coping Style Questionnaire. Distinct patterns of PTSD symptom trajectories were established through grouping participants based on time-varying changes of developing PTSD (i.e. reaching the clinical cut-off on the PTSD-SS). Multivariate logistic regressions were used to examine predictors for trajectory membership. RESULTS PTSD prevalence rates at 6, 12, 18 and 24 months were 21.0, 23.3, 13.5 and 14.7%, respectively. Five PTSD symptom trajectories were observed: resistance (65.3% of the sample), recovery (20.0%), relapsing/remitting (3.3%), delayed dysfunction (4.2%) and chronic dysfunction (7.2%). Female gender and senior grade were related to higher risk of developing PTSD symptoms in at least one time point, whereas being an only child increased the possibility of recovery relative to chronic dysfunction. Family members' injury/loss and witness of traumatic scenes could also cause PTSD chronicity. More negative life events, less social support, more negative coping and less positive coping were also common predictors for not developing resistance or recovery. CONCLUSIONS Adolescents' PTSD symptoms showed an anniversary reaction. Although many adolescents remain euthymic or recover over time, some adolescents, especially those with the risk factors noted above, exhibit chronic, delayed or relapsing symptoms. Thus, the need for individualized intervention with these adolescents is indicated.
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Affiliation(s)
- F Fan
- School of Psychology,South China Normal University,Guangzhou,Guangdong,People's Republic of China
| | - K Long
- School of Psychology,South China Normal University,Guangzhou,Guangdong,People's Republic of China
| | - Y Zhou
- School of Psychology,South China Normal University,Guangzhou,Guangdong,People's Republic of China
| | - Y Zheng
- School of Psychology,South China Normal University,Guangzhou,Guangdong,People's Republic of China
| | - X Liu
- School of Psychology,South China Normal University,Guangzhou,Guangdong,People's Republic of China
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19
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Tatsuta N, Nakai K, Satoh H, Murata K. Impact of the Great East Japan Earthquake on Child's IQ. J Pediatr 2015; 167:745-51. [PMID: 26168771 DOI: 10.1016/j.jpeds.2015.06.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 05/26/2015] [Accepted: 06/16/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the neurodevelopmental effects of the Great East Japan Earthquake in resident children. STUDY DESIGN The disaster on March 11, 2011, caused severe damage to the Sanriku coastal area, where we had been conducting a birth cohort study since 2003. It occurred in the middle of our 7-year-old examination. Approximately 500 mother-child pairs were compulsorily divided into 2 groups: 123 children finished the examination in the predisaster period, and 289 did in the postdisaster period. The remainder died or moved from that area. At the time of 7-year-old examination, we administered the Wechsler Intelligence Scale for Children-Third Edition and electrocardiography to assess autonomic function. According to the Child Behavior Checklist for ages 2-3 years and the Kaufman Assessment Battery for Children that had been administered at 30 months and 42 months of age, respectively, there were no significant differences in them between the 2 groups. RESULTS Verbal IQ, including information, arithmetic, and vocabulary subscores of the Wechsler Intelligence Scale for Children-Third Edition, at 7 years of age was significantly lower in the postdisaster group than in the predisaster group. However, there were no significant differences in performance IQ, full-scale IQ, or autonomic nervous indicators between the 2 groups. CONCLUSIONS Since many schools were utilized as primary refuges after the disaster, the deficits in verbal IQ of 7-year-old children may have been due to the interrupted schooling. Further follow-up and more specific posttraumatic stress disorder testing will be required to determine the cause and long-term implications.
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Affiliation(s)
- Nozomi Tatsuta
- Department of Development and Environmental Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi Prefecture, Japan
| | - Kunihiko Nakai
- Department of Development and Environmental Medicine, Tohoku University Graduate School of Medicine, Sendai, Miyagi Prefecture, Japan.
| | - Hiroshi Satoh
- Department of Environmental Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Miyagi Prefecture, Japan
| | - Katsuyuki Murata
- Department of Environmental Health Sciences, Akita University Graduate School of Medicine, Akita City, Japan
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20
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Kirsch V, Wilhelm FH, Goldbeck L. Psychophysiological characteristics of pediatric posttraumatic stress disorder during script-driven traumatic imagery. Eur J Psychotraumatol 2015; 6:25471. [PMID: 25660044 PMCID: PMC4320135 DOI: 10.3402/ejpt.v6.25471] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 12/22/2014] [Accepted: 01/05/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Psychophysiological alterations such as elevated baseline levels and hyperresponsivity in cardiac, electrodermal, and facial muscle activity have been observed in adults with posttraumatic stress disorder (PTSD). There are only few, inconclusive studies investigating psychophysiological responses in children and adolescents with PTSD. OBJECTIVE This cross-sectional study sought to examine if autonomic variables, facial electromyography (EMG), and self-reported anxiety at baseline, while listening to neutral and idiosyncratic trauma scripts, differ between minors with a trauma history and PTSD, and a traumatized control (TC) group without PTSD. A better understanding of psychophysiological reactions in trauma-exposed children and adolescents could improve differential assessment and treatment decisions. METHOD PTSD was assessed using the Clinician Administered PTSD Scale for Children and Adolescents in 6- to 17-year-old trauma-exposed children, resulting in a group with PTSD according to DSM-IV (n=16) and a TC group without PTSD (n=18). Facial EMG, (para-)sympathetic measures (heart rate, electrodermal activity, respiratory sinus arrhythmia), and self-reported anxiety were measured during 5-min baseline, 3-min neutral script, and 3-min idiosyncratic trauma script. Baseline, reactivity (trauma minus baseline), and script contrast (trauma minus neutral) were analyzed by multivariate analyses of variance. RESULTS Children and adolescents with PTSD reported more anxiety compared to TC for baseline, reactivity, and script contrast (ps<0.021, ds>0.59), and showed elevated corrugator supercilii muscle activity for script contrast (p<0.05, d=0.79). No group differences emerged for sympathetic or parasympathetic measures. CONCLUSIONS Children and adolescents with PTSD experienced elevated anxiety at baseline and elevated anxiety and facial corrugator muscle response to an idiosyncratic trauma narrative. Autonomic hyperreactivity, typical for adult PTSD samples, did not figure prominently.
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Affiliation(s)
- Veronica Kirsch
- Clinic for Child and Adolescence Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany;
| | - Frank H Wilhelm
- Department of Psychology, Division of Clinical Psychology, Psychotherapy, and Health Psychology, University of Salzburg, Salzburg, Austria
| | - Lutz Goldbeck
- Clinic for Child and Adolescence Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
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21
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Tsavoussis A, Stawicki SPA, Stoicea N, Papadimos TJ. Child-witnessed domestic violence and its adverse effects on brain development: a call for societal self-examination and awareness. Front Public Health 2014; 2:178. [PMID: 25346927 PMCID: PMC4193214 DOI: 10.3389/fpubh.2014.00178] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 09/20/2014] [Indexed: 11/13/2022] Open
Abstract
There is substantial evidence indicating that children who witness domestic violence (DV) have psychosocial maladaptation that is associated with demonstrable changes in the anatomic and physiological make up of their central nervous system. Individuals with these changes do not function well in society and present communities with serious medical, sociological, and economic dilemmas. In this focused perspective, we discuss the psychosocially induced biological alterations (midbrain, cerebral cortex, limbic system, corpus callosum, cerebellum, and the hypothalamic, pituitary, and adrenal axis) that are related to maladaptation (especially post-traumatic stress disorder) in the context of child-witnessed DV, and provide evidence for these physical alterations to the brain. Herein, we hope to stimulate the necessary political discourse to encourage legal systems around the world to make the act of DV in the presence of a child, including a first time act, a stand-alone felony.
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Affiliation(s)
- Areti Tsavoussis
- Lucas County Prosecutor's Office, Victim Witness Assistance Program , Toledo, OH , USA
| | - Stanislaw P A Stawicki
- Department of Research and Innovation, St. Luke's University Health Network, Temple University School of Medicine , Bethlehem, PA , USA
| | - Nicoleta Stoicea
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Thomas J Papadimos
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
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22
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Kavanaugh B, Holler K. Brief report: Neurocognitive functioning in adolescents following childhood maltreatment and evidence for underlying planning & organizational deficits. Child Neuropsychol 2014; 21:840-8. [DOI: 10.1080/09297049.2014.929101] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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23
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Zhu Z, Wang R, Kao HS, Zong Y, Liu Z, Tang S, Xu M, Liu IC, Lam SP. Effect of calligraphy training on hyperarousal symptoms for childhood survivors of the 2008 China earthquakes. Neuropsychiatr Dis Treat 2014; 10:977-85. [PMID: 24940061 PMCID: PMC4051712 DOI: 10.2147/ndt.s55016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study investigated the treatment effects of calligraphy therapy on childhood survivors of the 2008 Sichuan earthquakes in the People's Republic of China. METHODS In experiment 1, 129 children participated in a 30-day calligraphic training, and 81 children were controls. The Children's Revised Impact of Event Scale was adopted to assess behavioral effects. Experiment 2 involved 41 treatment subjects and 39 controls, with the same procedure as in experiment 1 except that salivary cortisol level was also measured as a physiological indicator. RESULTS After 30 days of calligraphy treatment, the arousal symptoms and salivary cortisol levels in the experimental group decreased from 5.72±0.31 and 13.34±2.88 to 4.98±0.31 and 9.99±2.81, respectively. In the control group, there was not a significant decrease from pretest to post-test. In addition, the arousal scores in posttest (4.98±4.39) were significantly lower than midtest (5.71±4.14) for girls; in contrast, for boys, posttest (4.90±4.24) showed little change compared with midtest (5.04±4.36), but both were significantly lower than pretest (6.42±4.59). CONCLUSIONS Calligraphy therapy was effective in reducing hyperarousal symptoms among child survivors.
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Affiliation(s)
- Zhuohong Zhu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Richu Wang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Henry Sr Kao
- Department of Psychology, University of Hong Kong, Hong Kong
| | - Yan Zong
- Sichuan Judicial and Police Officers Professional College, Deyang, Sichuan, People's Republic of China
| | - Zhengkui Liu
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Shan Tang
- Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Min Xu
- Department of Linguistics, University of Hong Kong, Hong Kong
| | - Ivy Cy Liu
- Department of Psychology, Fu Jen Catholic University, New Taipei, Taiwan
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24
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[Child sexual abuse. Epidemiology, clinical diagnostics, therapy, and prevention]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2013; 56:199-207. [PMID: 23361204 DOI: 10.1007/s00103-012-1598-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The article provides an overview of the research on sexual abuse and the current political developments in Germany. First, the terminology of sexual child abuse is discussed, followed by the presentation of epidemiological data. The section on diagnostics and therapy shows that--because of mostly nonspecific indicators--the diagnosis of child sexual abuse is very difficult to define. Child sexual abuse is discussed as a traumatic experience for children and adolescents with different psychiatric and physical diseases. Current studies have shown that especially cognitive behavioral therapeutic-oriented approaches are effective in curing posttraumatic stress disorders. Based on the new German Child Protection Act, the focus lies on the clarification of confidentiality for medical professionals and their right to consulting services for child protection. In conclusion, guidelines and minimum standards for a child prevention and protection model are presented as well as institutional recommendations addressed to all institutions (also clinical) that take care of or treat children and adolescents.
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25
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Kavanaugh B, Holler K, Selke G. A neuropsychological profile of childhood maltreatment within an adolescent inpatient sample. APPLIED NEUROPSYCHOLOGY-CHILD 2013; 4:9-19. [PMID: 24156759 DOI: 10.1080/21622965.2013.789964] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Recent research has begun to identify the neurocognitive and psychological effects of childhood maltreatment, although information is limited on the neuropsychological presentation of maltreatment in psychiatrically hospitalized adolescents. This study examined the executive-functioning and language abilities as well as psychopathological presentation of childhood maltreatment victims in an adolescent psychiatric inpatient setting. The sample consisted of adolescent inpatients (ages 13-19 years old) who completed a neuropsychological/psychological assessment during hospitalization (n = 122). The sample was grouped based on childhood maltreatment history, with one group categorized by maltreatment history (n = 49) and the other group characterized by no maltreatment history (n = 73). Analyses revealed statistically significant differences (p < .01) between maltreatment groups on executive functioning, as well as on measures of self-reported depression and anxiety symptoms. No group differences remained after controlling for posttraumatic stress disorder. Further, distinct neuropsychological profiles were identified for specific types of maltreatment experienced. These findings suggest that while childhood maltreatment is associated with a range of neuropsychological impairments, the specific type of maltreatment experienced may have a significant influence on the type and severity of impairments. These findings contribute to the growing body of research on the significant consequences of childhood maltreatment.
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Affiliation(s)
- Brian Kavanaugh
- a Department of Clinical Psychology , Antioch University New England , Keene , New Hampshire
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26
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Abstract
Das Gedächtnis spielt eine wichtige Rolle bei der Entstehung und Behandlung von Posttraumatischer Belastungsstörung (PTBS). Die vorliegende Überblicksarbeit beschäftigt sich mit der Frage nach dem empirischen Nachweis von traumabezogenen Gedächtnisstörungen im Kindesalter. Die bisherigen Untersuchungen zeigen ein heterogenes Bild. Es gibt Hinweise auf eine Beeinträchtigung der Hirnreifungsprozesse sowie der Erinnerungsqualität bei Kindern und Jugendlichen mit PTBS. Jedoch im Gegensatz zu Befunden im Erwachsenenalter wiesen traumatisierte Kinder ein größeres Hippocampusvolumen im Vergleich zur Kontrollgruppe auf. Die Zusammenschau der Befunde macht den großen Bedarf an weiterführenden Untersuchungen deutlich.
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Affiliation(s)
- Elvira Lorenz
- Klinik für Kinder- und Jugendpsychiatrie, -psychotherapie und -psychosomatik, Universitätsklinikum Hamburg-Eppendorf
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27
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Kirsch V, Goldbeck L. Traumafokussierte kognitive Verhaltenstherapie mit Kindern und Jugendlichen. KINDHEIT UND ENTWICKLUNG 2013. [DOI: 10.1026/0942-5403/a000104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In diesem Beitrag wird die traumafokussierte kognitive Verhaltenstherapie zunächst mit ihrem theoretischen Hintergrund und ihrer umfangreichen Evidenzbasis dargestellt. Dann erfolgt ein Überblick über den Aufbau und die praktische Umsetzung dieser multimodalen ambulanten Therapie mit ihren zentralen Elementen Psychoedukation, Aufbau von Bewältigungsstrategien, graduierte Exposition und Sicherheitsplan. Schließlich werden erste Erfahrungen mit der Implementierung in der Versorgungspraxis berichtet und Maßnahmen zur weiteren Verbreitung evidenzbasierter Traumatherapien diskutiert.
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Affiliation(s)
- Veronica Kirsch
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie
| | - Lutz Goldbeck
- Universitätsklinikum Ulm, Klinik für Kinder- und Jugendpsychiatrie/Psychotherapie
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Steinberg AM, Brymer MJ, Kim S, Briggs EC, Ippen CG, Ostrowski SA, Gully KJ, Pynoos RS. Psychometric properties of the UCLA PTSD reaction index: part I. J Trauma Stress 2013; 26:1-9. [PMID: 23417873 DOI: 10.1002/jts.21780] [Citation(s) in RCA: 246] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article presents psychometric characteristics of the UCLA PTSD Reaction Index for DSM IV (PTSD-RI) derived from a large sample of children and adolescents (N = 6,291) evaluated at National Child Traumatic Stress Network centers. Overall mean total PTSD-RI score for girls was significantly higher as compared with boys. Age-related differences were found in that overall mean total PTSD-RI scores and within sex groups were higher among those aged 7-9 years and 16-18 years. There were no significant differences in mean total PTSD-RI scores across racial/ethnic groups. The PTSD-RI total scale displayed good to excellent internal consistency reliability across age ranges, sex, and racial/ethnic groups (α = .88-.91). Correlations of PTSD-RI scores with PTS subscale scores on the TSCC-A for the entire sample and within sex, age, and ethnic/racial groups provided evidence of convergent validity, although not discriminant validity. In contradistinction to previously reported 4-factor models, an exploratory factor analysis revealed 3 factors that mostly reflected the underlying dimensions of PTSD in DSM IV. PTSD-RI scores were associated with increased odds ratios for functional/behavior problems (odds ratio [OR] = 1-1.80). These findings are striking in light of the wide range of trauma exposures, age, and race/ethnicity among subjects.
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Affiliation(s)
- Alan M Steinberg
- Department of Psychiatry and Biobehavioral Sciences, UCLA/Duke University National Center for Child Traumatic Stress, University of California, Los Angeles, CA 90064, USA
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Viviani D, Haegler P, Strasser DS, Steiner MA. Sex comparison on long-lasting behavioral and physiological disturbances induced by single shock experience in rats. Physiol Behav 2012; 107:243-51. [PMID: 22776621 DOI: 10.1016/j.physbeh.2012.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Revised: 06/01/2012] [Accepted: 06/29/2012] [Indexed: 01/29/2023]
Abstract
Enhanced female vulnerability and symptom severity are described in post-traumatic stress disorder (PTSD). It remains largely unknown whether females present with more pronounced PTSD-like symptoms than males in rodent models of PTSD. A model of single electric foot-shock followed by situational reminders was used to investigate in rats the impact of sex on potential long-lasting changes in anxiety-like behavior, and in endocrine and physiological responses to stress and fearful situations. Three weeks after single shock exposure (in the dark side of a shuttle box) both male and female rats spent less time in the dark compartment of a dark-light box and in the closed arms of an elevated plus maze than non-shocked controls. Both behaviors were likely due to avoidance of places reminiscent of the initial shock context. The shock exposure had no long-term impact on social interaction behavior or on basal and restraint stress-induced increases in plasma corticosterone. Shock exposure increased sudden silence-induced freezing responses and hyperthermia during novelty stress and fear to a similar extent in both males and females and left heart rate responses unaffected. Non-shocked females generally showed a reduced response or faster recovery to baseline under stress- or fearful test conditions as compared to non-shocked males, which was likely due to differential sex-specific coping strategies. Taken together, our results suggest that, despite some baseline sex differences, both male and female rats are similarly affected in the long-term by the initial foot-shock exposure used in this particular simulation of PTSD.
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Affiliation(s)
- Daniele Viviani
- Research and Development, Actelion Pharmaceuticals Ltd., Allschwil, Switzerland.
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