Posttraumatic stress symptom trajectories among children exposed to violence

Neuroimaging of posttraumatic stress disorder in adults and youth: progress over the last decade on three leading questions of the field

Almost three decades have passed since the first posttraumatic stress disorder (PTSD) neuroimaging study was published. Since then, the field of clinical neuroscience has made advancements in understanding the neural correlates of PTSD to create more efficacious treatment strategies. While gold-standard psychotherapy options are available, many patients do not respond to them, prematurely drop out, or never initiate treatment. Therefore, elucidating the neurobiological mechanisms that define the disorder can help guide clinician decision-making and develop individualized mechanisms-based treatment options. To this end, this narrative review highlights progress made in the last decade in adult and youth samples on three outstanding questions in PTSD research: (1) Which neural alterations serve as predisposing (pre-exposure) risk factors for PTSD development, and which are acquired (post-exposure) alterations? (2) Which neural alterations can predict treatment outcomes and define clinical improvement? and (3) Can neuroimaging measures be used to define brain-based biotypes of PTSD? While the studies highlighted in this review have made progress in answering the three questions, the field still has much to do before implementing these findings into clinical practice. Overall, to better answer these questions, we suggest that future neuroimaging studies of PTSD should (A) utilize prospective longitudinal designs, collecting brain measures before experiencing trauma and at multiple follow-up time points post-trauma, taking advantage of multi-site collaborations/consortiums; (B) collect two scans to explore changes in brain alterations from pre-to-post treatment and compare changes in neural activation between treatment groups, including longitudinal follow up assessments; and (C) replicate brain-based biotypes of PTSD. By synthesizing recent findings, this narrative review will pave the way for personalized treatment approaches grounded in neurobiological evidence.

Prevalence and associated factors of post-traumatic stress disorder in pediatric populations in Africa: a systematic review and meta-analysis

INTRODUCTION

Post-traumatic stress disorder (PTSD) is a prevalent challenge faced by individuals following traumatic events. Given the substantial impact of PTSD on the well-being of young people, comprehensive assessment of the available evidence can inform more effective prevention and intervention strategies to support the mental health and resilience of children in the African context. Despite its high incidence, there has been no up-to-date systematic synthesis of evidence to measure the magnitude of PTSD in pediatric populations in Africa. This systematic review and meta-analysis aim to quantify the prevalence of PTSD and identify associated factors in this vulnerable population.

METHODS

A systematic search was conducted across multiple databases, including PubMed, Embase, Scopus, Science Direct, and the search engines Google Scholar and Google, covering the period from 2014 up to May 15, 2024. The primary objective of this search was to identify relevant studies. Subsequently, a meta-analysis was performed using random-effects models to estimate the pooled effect size for each outcome of interest. Additionally, subgroup analysis was conducted to explore potential sources of heterogeneity, with study characteristics considered as covariates.

RESULTS

The pooled prevalence estimate for post-traumatic stress disorder (PTSD) among pediatric individuals was 36% (95% CI: 28-44%). Notably, significant heterogeneity existed among the studies (I2 = 98.41%, p value < 0.001), prompting us to employ a random effect model analysis. Furthermore, our meta-analysis revealed that children above 14 years of age and those who experienced family deaths due to traumatic events were significantly associated with PTSD.

CONCLUSION

This systematic review and meta-analysis revealed that the prevalence of PTSD among pediatric individuals aged 0-18 years in Africa was high. Notably, older children and those who experienced family deaths due to traumatic events were at a significantly higher risk of developing PTSD. These findings underscore the need for early intervention, age-specific support, and trauma-informed care to address the mental health challenges faced by pediatric populations.

The ripple effect of trauma: Evaluating vulnerability, post-traumatic stress symptoms, and aggression within a child and adolescent population

BACKGROUND

The deleterious effects of experiencing adverse childhood experiences (ACEs), especially those associated with child abuse and neglect (CM-ACEs), is well documented. Two common behavioral and emotional concerns observed in children following CM-ACEs is post-traumatic stress and aggression. While support for cognitive models explaining both of these outcomes exists, little is known about any shared cognitive vulnerabilities that may explain the presence of both.

OBJECTIVE

The purpose of the current study was to evaluate a cognitive model of vulnerability/safety as a shared underlying mechanism for the development of post-traumatic stress symptoms (PTSS) and aggression following the occurrence of CM-ACEs in children.

METHODS

Male youth between the ages of 6 and 14 attending school within a residential setting participated in a school-based performance improvement program. As a part of the program, data were collected on the child's history of abuse, PTSS, aggression, and feelings of safety and vulnerability.

RESULTS

The results of the SEM suggested that there was a significant serial indirect effect of vulnerability and PTSS on the relation between CM-ACEs and reactive aggression. This was not true for proactive aggression.

DISCUSSION

The current results suggest that that there may be a shared schema-based model in which feelings of vulnerability and cognitive models promoting the world as an unsafe place may contribute to the maintenance and development of both PTSS and reactive aggression among children who have experienced abuse/neglect.

Individual and Social Risk and Protective Factors as Predictors of Trajectories of Post-traumatic Stress Symptoms in Adolescents

The present study elucidates heterogeneity in post-traumatic stress symptoms (PTSS) across adolescence in a sample of youth who have experienced myriad types and combinations of potentially traumatic events (PTEs), including substantiated physical abuse, sexual abuse, neglect and/or at least one other self-reported PTE. A machine learning technique was used to assess a multivariate set of variables (e.g., PTEs, individual risk and protective factors, social risk and protective factors, and racial and ethnic minority status) as predictors of PTSS trajectory group membership. The sample included 498 maltreated (n = 275) and comparison (n = 223) 14-19-year-old female adolescents (M = 15.27, SD = 1.06 at Time 1) assessed annually until age 19. 45.7% of participants were White, 45.3% Black, 0.4% Native American, 0.8% Hispanic, and 7.7% other. Growth mixture modeling identified three distinct trajectories of PTSS: (1) recovery (56%); (2) moderate, chronic (25%); and (3) high, chronic (19%). An elastic net model was used to test predictors of membership in the recovery versus the high, chronic PTSS trajectory groups. Results demonstrated that the recovery trajectory was characterized by the absence of sexual abuse, physical abuse, and other traumas, higher self-esteem, less affective dysregulation, less risky peers, lower levels of parent depression, and being of racial/ethnic minority status. Findings help to characterize individual variation in trajectories of PTSS following PTEs by underscoring the unique trauma responses of racial and ethnic minority youth and offering possible targets of interventions to promote recovery from PTSS.

Understanding posttraumatic stress trajectories in adolescent females: A strength-based machine learning approach examining risk and protective factors including online behaviors

Heterogeneity in the course of posttraumatic stress symptoms (PTSS) following a major life trauma such as childhood sexual abuse (CSA) can be attributed to numerous contextual factors, psychosocial risk, and family/peer support. The present study investigates a comprehensive set of baseline psychosocial risk and protective factors including online behaviors predicting empirically derived PTSS trajectories over time. Females aged 12-16 years (N = 440); 156 with substantiated CSA; 284 matched comparisons with various self-reported potentially traumatic events (PTEs) were assessed at baseline and then annually for 2 subsequent years. Latent growth mixture modeling (LGMM) was used to derive PTSS trajectories, and least absolute shrinkage and selection operator (LASSO) logistic regression was used to investigate psychosocial predictors including online behaviors of trajectories. LGMM revealed four PTSS trajectories: resilient (52.1%), emerging (9.3%), recovering (19.3%), and chronic (19.4%). Of the 23 predictors considered, nine were retained in the LASSO model discriminating resilient versus chronic trajectories including the absence of CSA and other PTEs, low incidences of exposure to sexual content online, minority ethnicity status, and the presence of additional psychosocial protective factors. Results provide insights into possible intervention targets to promote resilience in adolescence following PTEs.

Co-development of traumatic stress symptoms and externalising behaviour problems among foster children and the effect of complex trauma: a latent growth curve model

OBJECTIVES

Foster children are disproportionately exposed to complex trauma, which may lead to multifaceted impairments that manifest in comorbid emotional and behavioural problems. As little is known about the interactions between comorbid disorders over time, the present study aims to explore the co-development of traumatic stress (TS) symptoms and externalising behaviour problems (EBP), as well as the influence of complex trauma operationalised as cumulative child maltreatment (CM).

SETTING

As part of a 3-year longitudinal study, children from six foster care facilities in Lower Austria were interviewed at three measurement points.

PARTICIPANTS

Of, in total, 263 participating children, the data of 124 children aged 10-18 years (M=13.5, 28% female) could be analysed.

PRIMARY AND SECONDARY OUTCOME MEASURES

Latent growth curve models were used to examine the co-development of TS symptoms (International Trauma Questionnaire) and EBP (Child Behaviour Checklist) over time; gender, age and cumulative CM (Childhood Trauma Questionnaire) acted as time-invariant covariates.

RESULTS

While average TS symptoms decreased over time, EBP remained stable. Findings revealed that the initial severity of EBP was both related to the initial severity of TS symptoms and predictive of their rate of change. Cumulative CM was a significant predictor of initial TS symptoms and EBP even after controlling for age and gender, but not for the rates of change.

CONCLUSIONS

Taken together, our results indicate that EBP and TS symptoms are not only cross-sectionally associated but interact with each other over time. Furthermore, an underlying complex trauma could at least partly determine the severity of the two symptom groups. In accordance with a trauma-informed care approach, our study highlights the importance of trauma-specific screening of high-risk children with complex or diffuse symptoms and argues for the benefits of treatments that focus on improving emotion regulation and social skills in addition to addressing trauma.

Child Anxiety, Depression, and Post-traumatic Stress Disorder Following Orthopedic Trauma

BACKGROUND

Many children and adolescents are exposed to different types of trauma, e.g., abuse or various disasters. Trauma can cause severe and long-term impairment and consequences, the most studied of which are post-traumatic stress disorder (PTSD) and PTSD symptoms (PTSS). PTSD is highly prevalent in clinical practice (with a frequency of about 7%) and is a debilitating consequence of trauma.

AIM

The current study aimed to assess childhood injuries and their associated anxiety, depression, and post-traumatic stress disorder following orthopedic trauma.

METHODS

A descriptive cross-sectional study was conducted, including all pediatric patients with trauma at Abha Maternity and Children Hospital in the Seer region of Saudi Arabia, as well as pediatric patients with trauma at Abha Maternity and Children Hospital during the period from January 1, 2021 to December 31, 2022. Data were collected from the children's caregivers using a direct interview questionnaire to assess the children's personal data, depression, anxiety, and post-traumatic stress disorder. Children's trauma-related data were extracted from their medical records using a pre-structured data extraction sheet.

RESULTS

A total of 100 children with trauma were included. Children ranged in age from eight to 12 years, with a mean age of 7.3 ± 3.4 years. In all, 67 (67.0%) children were males, and only 6 (6.0%) had chronic health problems. The vast majority of the children with trauma had a low-severity experience of depression and anxiety following trauma (97.1% for each), and only one child had a high-severity experience of depression and anxiety. In all, 5 (4.9%) children with trauma experienced clinically significant PTSD, and the vast majority of them showed a low likelihood of the disorder. Multiple fractures and undergoing surgery were significant predictors of developing PTSD (P < 0.05).

CONCLUSION

In conclusion, the current study revealed that bone trauma was frequent among children, mainly due to playing accidents. Also, a low prevalence of post-traumatic stress disorders and their mental consequences was estimated.

A systematic literature review of protective factors mitigating intimate partner violence exposure on early childhood health outcomes

AIM

The objective of this integrative review was to critically synthesize the evidence on protective factors in early childhood that buffer the effects of exposure to intimate partner violence (IPV) on young children's health outcomes.

METHODS

Studies were eligible for inclusion in this review if the article was (a) in English, (b) title or abstract discussed protective factors, buffering, resilience or mitigating factors in early childhood for young children who experienced IPV.

RESULTS

A total of 23 articles of 492 manuscripts identified from the search from peer-reviewed journals from 2010 to 2022 were included. Individual-level protective factors for young children exposed to IPV and include emotional self-regulation, child temperament and child self-esteem. Family-level protective factors were maternal physical and mental health; warm, responsive parenting; knowledge of child development; socioeconomic advantage; caregiver employment; and maternal education.

CONCLUSION

The results of this integrative review highlight the critical importance of a dyadic approach to early childhood intervention. Health and legal systems should not only focus solely on pathology of family violence but also conceptualize treatment and courses of action from a strength-based perspective in order to empower victims of IPV, and promote the safety, health and well-being of children. Future research should examine the role of system-level protective factors.

IMPACT

This review adds to the growing body of the evidence of positive relational health as a key social determinant of health for children. This will be foundational to design interventions that shield children from further harm and promote health, flourishing and recovery from violence and trauma.

Parallel Process of Posttraumatic Stress and Externalizing Problems Among Youth at High Risk for Victimization

Research shows comorbidity between posttraumatic stress symptoms (PTSS) and externalizing problems among polyvictimized youth. However, the impact of polyvictimization on the longitudinal co-development of PTSS and distinct forms of externalizing problems remains unclear. Growth trajectory modeling was used to address this gap. At ages 8, 12, and 16, polyvictimization was measured using youth, caregiver, and official records; whereas youth self-reported PTSS and caregivers reported aggression and delinquency. Results demonstrate that changes in PTSS and each externalizing domain were independent. Further, polyvictimization and PTSS/aggression were only associated at concurrent time points. In contrast, polyvictimization and delinquency were generally associated at concurrent and distal time points, suggesting that polyvictimization may have a more enduring impact on youths' delinquent behaviors than other symptoms.

Impact of hormonal contraceptives on sex differences in fear conditioning and fear extinction in PTSD

Sex differences in the neurobiological mechanisms involved in fear conditioning and extinction have been suggested to contribute to differential vulnerability for the development of posttraumatic stress disorder (PTSD) in women compared with men. Reproductive hormones, such as estradiol, have been shown to facilitate fear conditioning and extinction learning and may explain some of these differences. However, the effect of commonly used hormonal contraceptives on the neurobiological mechanisms of fear conditioning and extinction is poorly understood. A laboratory study was conducted in trauma-exposed men and women with and without full or partial PTSD to examine effects of sex and use of hormonal birth control on fear conditioning, fear extinction learning, and extinction retention. Participants underwent fear conditioning with stimuli that were paired (CS+) or unpaired (CS−) with shock. Extinction learning occurred 72 h later, and extinction retention was tested 1 wk after extinction. Women on hormonal contraceptives (HCs) demonstrated enhanced acquisition of fear conditioning and enhanced extinction of fear as compared with women off hormonal birth control and men. While clinical implications have yet to be determined, these results suggest that hormonal contraceptives may facilitate learning during both fear acquisition and extinction. Understanding the impact of sex and hormones on fear conditioning and extinction processes may lead to new insights into the pathophysiology of PTSD and result in advancements in treatment that may vary by sex.

Impact of mothers' IPV-PTSD on their capacity to predict their child's emotional comprehension and its relationship to their child's psychopathology

BACKGROUND

Previous studies demonstrated that when the violence-exposed child becomes a mother and interacts with her own child during early sensitive periods for social-emotional development, she may have difficulties providing sensitive responsiveness to the child's emotional communication. Such difficulties place the child's development of emotional comprehension (EC) and related self-regulation at risk. The aim of this study was to examine how mothers' interpersonal violence-related posttraumatic disorder (IPV-PTSD) would affect their children's EC and their own ability to predict their children's EC. We also investigated how mothers' predictive ability would correlate with child psychopathology.

METHODS

Sixty-one mother-child dyads (36 with IPV-PTSD) participated in this study. Children's (mean age = 7.0 years, SD = 1.1) EC was assessed with the Test of Emotion Comprehension (child TEC) and their psychopathology as reported by the mother was assessed with the Child Behaviour Checklist (CBCL) and as evaluated by a clinician using selected modules of the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS). Mothers were measured for IPV-PTSD with the Clinician Administered PTSD Scale (CAPS) and for their capacity to predict their child's emotional comprehension (mother-responding-as-child TEC; mTEC).

RESULTS

We found no significant between-group differences in children's level of EC. Maternal PTSD was associated with lower scores on the mTEC, however. Reduced maternal scores on the mTEC were significantly associated with maternal report of increased aggressive child behaviour and with depression symptoms on the K-SADS. Further, scores on the mTEC interacted with maternal report of child aggression on child oppositional defiant disorder (ODD) symptoms on the K-SADS.

CONCLUSION

These findings support that improving maternal emotional comprehension may help reduce child risk for psychiatric morbidity in this population.

Look After Yourself: Students Consistently Showing High Resilience Engaged in More Self-Care and Proved More Resilient During the COVID-19 Pandemic

The COVID-19 pandemic has prompted severe restrictions on everyday life to curb the spread of infections. For example, teaching at universities has been switched to an online format, reducing students' opportunities for exchange, and social interaction. Consequently, their self-reported mental health has significantly decreased and there is a pressing need to elucidate the underlying mechanisms-ideally considering not only data collected during the pandemic, but also before. One hundred seventeen German university students aged 18-27 were assessed for known resilience factors (optimism, self-care, social support, generalized self-efficacy) and subsequently completed surveys on stress experiences and mental health every 3 months over a period of 9 months before the outbreak of the pandemic and once during the first lockdown in Germany. For each timepoint before the pandemic, we regressed participants' mental health against the reported stressor load, such that the resulting residuals denote better or worse than expected outcomes, i.e., the degree of resilient functioning. We then tested whether different expressions in the resilience factors were predictive of distinct resilient functioning trajectories, which were identified through latent class growth analysis. Finally, we investigated whether trajectory class, resilience factors, and perceived stress predicted resilience during the pandemic. Results show rather stable resilient functioning trajectories, with classes differing mainly according to degree rather than change over time. More self-care was associated with a higher resilient functioning trajectory, which in turn was linked with the most favorable pandemic response (i.e., lower perceived stress and more self-care). Although findings should be interpreted with caution given the rather small sample size, they represent a rare examination of established resilience factors in relation to resilience over an extended period and highlight the relevance of self-care in coping with real-life stressors such as the pandemic.

Resilience in Development and Psychopathology: Multisystem Perspectives

Resilience science in psychology and related fields emerged from clinical research on risk for psychopathology in the 1970s and matured over the ensuing decades with advances in theory, methods, and knowledge. Definitions and models of resilience shifted to reflect the expanding influence of developmental systems theory and the growing need to integrate knowledge about resilience across levels and disciplines to address multisystem threats. Resilience is defined for scalability and integrative purposes as the capacity of a dynamic system to adapt successfully through multisystem processes to challenges that threaten system function, survival, or development. Striking alignment of resilience factors observed in human systems, ranging from individuals to communities, suggests the possibility of networked, multisystem protective factors that work in concert. Evidence suggests that there may be resilience factors that provide transdiagnostic protection against the effects of adverse childhood experiences on risk for psychopathology. Multisystem studies of resilience offer promising directions for future research and its applications to promote mental health and positive development in children and youth at risk for psychopathology.

Risk and Resilience Factors for Psychobehavioral Symptom Trajectories Among Child Welfare-Involved Youth

The primary aim of the study was to investigate the development of psychobehavioral symptoms (internalizing, externalizing, and posttraumatic stress [PTS]) of child welfare-involved adolescents over a 3-year period and to identify predictors of the trajectories. Using three waves of data from the National Survey of Child and Adolescent Well-Being (NSCAW-II), latent growth curve modeling was conducted on a sample of 350 adolescents who were between 11 and 13 years of age at baseline. Findings indicated that adolescents' internalizing symptoms decreased over time, whereas externalizing symptoms remained stable over time. PTS symptoms decreased over time in girls, but not boys. Physical abuse predicted higher levels of externalizing behaviors and sexual abuse predicted a slower decrease in PTS symptoms. Greater child prosocial skills and higher quality of caregiver-child relationship were associated with lower initial levels of externalizing symptoms. In addition, a higher quality caregiver-child relationship and greater satisfaction with peer relationships were associated with lower initial levels of internalizing and PTS symptoms. Findings suggest that intervention strategies should consider gender, maltreatment type, and interpersonal and social skills to effectively prevent the development of psychobehavioral symptoms among child welfare-involved youth.

Violence, Adolescence, and Canadian Religious Communities: A Quantitative Study

Exposure to violence is recognized as a major health concern among adolescent populations. The evidence base that links religious involvement with risks for child violence is inconsistent. In a national analysis involving a weighted sample of 24,307 young people, we studied the perpetration of violence (fighting and bullying), as well as victimization by violence (bullying only), among young people who were affiliated with religious groups. One in four young Canadians reported involvement in such groups. Study findings confirmed some unique patterns among this group. First, these religiously involved children reported the same or greater levels of perpetration of violence than other children. Second, religiously involved children reported the same or greater levels of experiencing victimization from violence. Third, religious involvement appeared to protect against engagement in certain overt risk-taking behaviors, but not violence. These patterns were consistent even after adjustment for family, community, socioeconomic, and school-related determinants. If religious communities are to fulfill mandates that foster the protection and nurturing of children into healthy relationships, violence is best addressed using evidence-based strategies. Development of such effective preventive strategies requires the incorporation of contemporary evidence about the distribution, determinants, and possible effects of violence in such groups. Findings from our study suggest that a silence around the issue of violence may in fact be true in the context of some Canadian religious communities. Yet, if these communities make an intentional commitment to protecting children from violence and promoting healthy relationships, and are willing to learn from evidence-based practices that have shown to protect children from participating in and experiencing violent and victim behaviors, perhaps these disturbing trends could be reversed. This message is germane for all levels of leadership in Canadian religious communities.

PTSD and complex PTSD in adolescence: discriminating factors in a population-based cross-sectional study

Background: Chronic and repeated trauma are well-established risk factors for complex posttraumatic stress disorder (CPTSD) in adult samples. Less is known about how trauma history and other factors contribute to the development of CPTSD in adolescence. Objective: The aim of this study was to assess the potential contribution of trauma history and social factors to CPTSD in adolescents. Method: In a cross-sectional community study of 1299 adolescents aged 12-16 years, PTSD (n = 97) and CPTSD (n = 108) was assessed with the Child and Adolescent version of the International Trauma Questionnaire (ITQ-CA). Trauma exposure, family functioning, school problems, and social support as potential discriminating factors between the PTSD and CPTSD groups were investigated. Results: Cumulative trauma exposure did not discriminate between PTSD and CPTSD in this sample. CPTSD was associated with family problems (such as financial difficulties and conflicts in the home), school problems (bullying and learning difficulties), and lack of social support. Conclusions: Our study indicates that factors other than cumulative trauma are important for the development of CPTSD in adolescence. Interventions targeting adolescent's social environment both at home and at school may be beneficial.

Who Reports What? A Comparison of Child and Caregivers´ Reports of Child Trauma Exposure and Associations to Post-Traumatic Stress Symptoms and Functional Impairment in Child and Adolescent Mental Health Clinics

Identifying trauma-related symptoms is important for treatment planning at child and adolescent mental health services (CAMHS), and routine trauma screening may be a first step to ensure appropriate treatment. Studies with community samples have found modest agreement between children’s and caregivers´ report of exposure to potentially traumatizing events (PTEs). However, studies from clinical populations are scarce and the evidence base for screening recommendations is insufficient. The current study explores child and caregiver agreement on the child’s exposure to PTEs and its relationship with the child’s post-traumatic stress symptoms (PTSS) and functional impairment. The sample consist of 6653 caregiver-child dyads referred to Norwegian CAMHS between 2012–2017. The children were 6 to 18 years of age (M = 12.03, SD = 3.14) and 47% were boys and 45% were girls (8% missing). Children reported significantly more exposure to accidents or illness, community violence, and sexual abuse than their caregiver, but there were no differences for reports of domestic violence. Kappa results were fair to moderate, with the highest agreement rate for reports of sexual abuse, followed by domestic violence, community violence, and lowest agreement for accidents or illnesses. There were higher agreement rates among caregivers and older children, and caregivers and girls. In general, the child had higher PTSS and functional impairment scores when child exposure to PTEs were reported by both the caregiver and the child. Both children and caregivers should be included in trauma screening procedures at CAMHS to collect a more complete picture of the child’s experiences and treatment needs.

Violence against children and adolescents by nursing staff: prevalence rates and implications for practice

BACKGROUND

International studies show that child maltreatment is a widespread but often underestimated problem that causes high individual, social and economic costs. Child maltreatment is an important topic for the medical sector as well. On the one hand, affected persons often seek support and help from healthcare professionals, but on the other hand, assaults can also occur in medical institutions by healthcare professionals. Surprisingly, there is hardly any data on the frequency of child maltreatment by healthcare professionals in general and particularly by nursing staff.

METHODS

Therefore, in a large representative survey of the German population of 2,516 subjects aged between 14 and 91, the experience of child maltreatment in medical institutions by nursing staff was assessed retrospectively.

RESULTS

Of the 46 subjects who had an inpatient stay in a child and adolescent psychiatry before the age of 18, 33.3% reported to have experienced maltreatment by nursing staff, while 17.3% of the 474 persons who had an inpatient stay in general or pediatric hospitals experienced maltreatment by nursing staff. All forms of maltreatment were significantly more frequent in psychiatric compared to general and pediatric hospitals.

CONCLUSIONS

The results of our representative retrospective survey demonstrate that maltreatment by nursing staff are not rare individual cases, but that medical facilities bear systemic risks for assault. Therefore, it is necessary that all medical institutions, in particular psychiatric hospitals, address this issue. In order to reduce the risk for assaults, it is important not only to implement structural measures but also to develop an attitude that emphasizes zero tolerance for violence against children and adolescents.

Pathways of Internalizing and Posttraumatic Stress Symptoms Across Childhood and Adolescence

Research in adult populations has suggested a number of possible explanations for the high co-morbidity between posttraumatic stress symptoms (PTSS) and internalizing symptoms, including shared risk factors and reciprocal causation. Little research has examined these hypotheses in children or has considered the separation of between- and within-person effects. The objective of this study was to examine pathways between PTSS and internalizing symptoms using two samples drawn from the Longitudinal Studies on Child Abuse and Neglect (LONGSCAN, n = 1221) and the first National Survey of Child and Adolescent Well-Being (NSCAW-I, n = 309). Each sample included three waves of data (LONGSCAN: ages 8, 12, and 16; NSCAW: ages 8, 11, 15). It was hypothesized: (1) PTSS would predict future internalizing symptoms; (2) the strength of the relationship between internalizing symptoms and PTSS would increase over time; and (3) childhood trauma would be associated with higher levels of internalizing symptoms and PTSS. The hypotheses were examined using traditional cross-lagged panel models (CLPMs) as well as a CLPM with random intercepts (RI-CLPM), which has the advantage of separating within-person effects from between-person stability in symptoms. Results from both CLPMs and RI-CLPM support rising symptom comorbidity from late childhood to mid-adolescence. Results between the models, however, suggest that the reciprocal influence between symptom complexes over time may not hold after separating between- and within-persons effects, lending stronger support to the shared risk factors hypothesis and highlighting the need for future research to explore other possible explanatory mechanisms for the rising comorbidity of these symptom complexes over development.

The relationship between multiple exposures to violence and war trauma, and mental health and behavioural problems among Palestinian children and adolescents

The current study aims to investigate the effect of cumulative exposure to violence on mental health amongst children and adolescents living in the Gaza Strip. The sample consists of 1029 children and adolescents aged 11-17 years. Of them, 533 (51.8%) were female and 496 (48.2%) were male. War-traumatic events were measured using the War-Traumatic Events Checklist (W-TECh). Violence was derived from the Multicultural Events Schedule for Adolescents (M.E.S.A.) containing three domains: violence at home, violence in the neighbourhood, and violence at school. Emotional and behavioural problems were measured using the Strengths and Difficulties Questionnaire (SDQ). Posttraumatic Stress Disorder was measured using the Post-Traumatic Stress Disorders Symptoms Scale (PTSDSS). Finally, depression symptoms were measured by the Depression scale. Around two thirds of the children (64.5%, N = 665) reported that they were exposed to violence at home, 48.2% (N = 497) to violence in the neighbourhood, 78.2% (N = 806) to violence at school. In addition, boys significantly showed more exposure to violence compared to girls. Moreover, the prevalence of PTSD according to DSM-5 is 53.5% (N = 549). The results also showed that cumulative effect of exposure to violence in more contexts (political war trauma, violence at home, neighbourhood and/or school) predicted higher levels of PTSD, social and emotional problems, depression, and overall mental health problems amongst children. Cumulative exposure to violence may increase the propensity of developing mental health problems such as PTSD, emotional and behavioural problems, and depression symptoms and thus interventions should be targeted to these populations.

Psychobiology of Attachment and Trauma-Some General Remarks From a Clinical Perspective

Attachment refers to a psychobiological principle that is deeply rooted in evolutionary development; it is thought to contribute a major advantage in the survival of the social group. Within individual development it indicates a primary motivational system that guides the initial transactions between mother and baby and furthermore mediates affective attunement and regulation. Psychosocial learning, in close interaction with genetics and epigenetics, also develops a decisive foundation for further brain development of the infant. Finally, the attachment pattern established forms an enduring, relational context for later affective, cognitive, and social development of the child. As an unconsciously active matrix for future personal relationships it has a particular impact on the comprehensive psychological functions of empathy and mentalization. Early adverse and traumatic experiences or major emotional neglect may lead to different levels of security versus insecurity or disorientation-disorganization of the attachment pattern that corresponds to characteristic features of neurobiological regulation.

Psychopathology among adult survivors of child pornography

BACKGROUND

The majority of studies investigating child pornography have focused on conceptualizing the problem and the harm of the crime, evaluating the risk for child pornography offending, or discuss preventive measures. Little is known about survivors of this type of crime.

OBJECTIVE

This research explores the relationship between child pornography victimization and psychopathology in adulthood. Specifically, we examined the contribution of emotional reactions at the time of the crime and shortly after (guilt, embarrassment and avoidance) on psychopathology among adult survivors of child pornography.

PARTICIPANTS AND SETTING

The study was conducted among 107 child pornography adult survivors, aged 18-63 (M = 39.48, SD = 12.31). All participants were sexually molested during the crime.

METHODS

An online survey was completed by a convenience sample of adult survivors of child pornography.

RESULTS

Findings indicate survivor's current age predicted current psychopathology symptoms. Survivor's emotional reactions of guilt and embarrassment at the time of the crime and shortly after were significantly associated with elevated psychopathology, above and beyond demographic characteristics and features of the crime.

CONCLUSIONS

The present results suggest the way survivors of child pornography react to the crime might shape their mental health in the long term.

Commentary: I thought I was going to die and the world is not safe-how to help children recover after trauma? Reflections on Meiser-Stedman et al. (2019)

Children all over the world experience exposure to trauma. Why do only some young people have significant traumatic stress symptoms in the days and weeks immediately post-trauma while others do not, and why do some youth then recover without treatment while others go on to suffer from persistent PTSD? This important question is examined in a comprehensive study by Meiser-Stedman et al., (2019). In a sample of single-event trauma exposed youth, they investigate the role cognitive processes may have in shaping early reactions and in maintaining post-traumatic stress symptoms (PTSS) over time. For the onset of PTSS, perceived threat and feeling overwhelmed and confused during the traumatic event was associated with significant PTSS. For the maintenance of PTSS, poorly elaborated, sensory-based memories, dissociation, rumination, and negative appraisals were associated with higher PTSS. The newly revised International Society for Traumatic Stress Studies' guidelines for the prevention and treatment of PTSS found no strong evidence to recommend any of the evaluated preventive or early intervention programs. This commentary highlights how understanding different trajectories for the onset and maintenance of post-traumatic stress may inform our development of prevention and early intervention strategies. Cognitive processes seem to play an important role in the development of PTSS but these may play out differently in youth exposed to single events and youth with interpersonal trauma experiences. Knowledge on memory processing, meaning making, the role of social support and maladaptive cognitions need to be implemented in systems of trauma-informed care.

Trajectories of traumatic stress reactions in children exposed to intimate partner violence

BACKGROUND

Understanding different longitudinal patterns of traumatic stress reactions in children exposed to intimate partner violence (IPV) can promote early identification of at-risk children.

OBJECTIVE

Our study aims to explore trajectories of traumatic stress reactions following childhood IPV exposure, and their relation with parental traumatic stress and child emotional security in the interparental subsystem.

PARTICIPANTS AND SETTING

The sample comprised 303 children (age 3-10, M = 6.20) from families referred to institutions for IPV. Data were collected at home.

METHODS

Three waves of parent-reported questionnaire data were analyzed using latent class growth analysis and linear regression.

RESULTS

Five trajectories were identified: 'resilient', 'moderate stable', 'struggling', 'improving', and 'elevated adjusting'. Only the 'struggling' trajectory had dysfunctional symptom levels at the final wave. Higher parental traumatic stress predicted 'improving' trajectory membership (β = 0.17, p =  .033), whereas lower parental traumatic stress (β = -0.20, p =  .003) and child emotional insecurity (β = -0.45, p = < .001) predicted 'resilient' trajectory membership. Higher child emotional insecurity predicted membership in trajectories with higher initial traumatic stress (improving: β = 0.26, p <  .001; struggling: β = 0.31, p <  .001; elevated adjusting: β = 0.27, p <  .001). Child emotional security did not buffer the effect of parental traumatic stress on likelihood of dysfunctional trajectory membership (β = 0.04, p =.380).

CONCLUSIONS

Children exposed to IPV show different trajectories of traumatic stress reactions, partly corresponding to trajectories identified in other populations. Child emotional security and parental traumatic stress predict trajectory membership.

"Violence is Everywhere": Childhood Polyvictimization, Perceptions of the Prevalence of Victimization, and Posttraumatic Stress Symptoms

Childhood polyvictimization is related to a heightened risk for mental health and functional problems in young adulthood, including posttraumatic stress symptoms, but little research has examined how perceptions of the prevalence of victimization may contribute to specific symptoms of posttraumatic stress. The primary aims of the current study were to (a) evaluate the accuracy of young adults' beliefs about the prevalence of multiple types of childhood victimization and (b) determine how inaccurate appraisals of victimization prevalence are associated with posttraumatic stress symptoms. College students (n = 369) drawn from two geographic regions of the United States responded to an online survey assessing their experiences of childhood victimization, perceptions about the prevalence of victimization, emotion regulation skills, and mental health. Childhood polyvictimization was significantly and positively related to distorted appraisals of the prevalence of victimization overall (r = .26, p < .001), and emotion regulation was associated with symptoms of posttraumatic stress in all domains. Distorted perceptions of the prevalence of victimization were linked to higher symptoms of hyperarousal, but not to higher symptoms of reexperiencing, avoidance, or negative mood/cognition. Results suggest that emotion regulation skills training is likely to be beneficial for many individuals experiencing posttraumatic stress, and intervention around perceptions of the prevalence of victimization may be useful for addressing symptoms of hyperarousal.

Trajectories of birth family contact in domestic adoptions

Emotional distance regulation theory (Broderick, 1993; Grotevant, 2009) guided this examination of the changes in family structure and process in adoptive kinship networks experiencing different arrangements of contact between birth and adoptive family members. Group-based trajectory modeling was used to reveal four trajectories of postadoption contact experienced between adoptive and birth family members in adoptive kinship networks of same-race, domestic infant adoptions. Data were drawn from the Minnesota Texas Adoption Research Project, a study of 190 adoptive families and 169 birth mothers followed across four longitudinal waves (middle childhood, adolescence, emerging adulthood, young adulthood). Three aspects of the birth family adoptive family relationship measured at four times were used to create the groups: frequency of contact between the adopted person and birth mother, satisfaction of the adopted person with the openness arrangements, and number of adoptive and birth family members involved in the contact. Four trajectory groups emerged: no contact (41.6% of sample), stopped contact (13.7%), limited contact (26.3%), and extended contact (18.4%). Group membership was validated by coders who matched interview transcripts with group descriptions at levels significantly above chance. Knowledge of trajectories will assist professionals providing postadoption services. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The effects of recurrent physical abuse on the co-development of behavior problems and posttraumatic stress symptoms among child welfare-involved youth

The primary aim of the current study was to examine the longitudinal effects of ongoing physical abuse on the co-development of externalizing behavior problems and posttraumatic stress (PTS) symptoms among child welfare-involved adolescents. Using three waves of data from the National Survey of Child and Adolescent Well-Being, we performed unconditional and conditional parallel process latent growth curve modeling in a structural equation modeling framework. The study sample included 491 adolescents who were between 11 and 13 years of age at baseline. Higher levels of initial PTS symptoms were associated with higher levels of externalizing behavior problems, but the rate of change in PTS symptoms were not significantly associated with the rate of change in externalizing behavior problems over time. Although physical abuse was concurrently associated with both externalizing behavior problems and PTS symptoms at all assessment points, there were no lagged effects. Additionally, we found that physical abuse indirectly affects subsequent development of externalizing behavior problems and PTS symptoms through ongoing physical abuse. Findings highlight the comorbidity of externalizing behaviors and PTS symptoms among early adolescents in the child welfare system, underlining the importance of screening for and addressing these problems simultaneously. Findings also point to the need for continued assessment of and protection from ongoing physical abuse during adolescence.

Direct and Indirect Effects of Maltreatment and Social Support on Children's Social Competence Across Reporters

Children's social competence is a key characteristic of resilience, yet little research has assessed contributing factors to this construct. The objectives of this study were to examine direct and indirect effects of maltreatment on children's social competence, the promotive role of child and caregiver social support, and factors contributing to reports of child social competence across informants. Structural equation modeling evaluated the influence of CPS report history, child adjustment, and child and caregiver social support on child social competence in n = 783 caregiver-child dyads. CPS report history (age 0-8) was indirectly related to low social competence through child adjustment problems. Social support was a significant promotive factor of child social competence, with caregiver social supports predicting higher levels of parent-reported child social competence. Child social support predicted self-reported child social competence. Findings reinforce the assertion that both caregiver and child social support networks are critical to promoting child well-being after adversity.

Posttraumatic symptom profiles among adult survivors of childhood sexual abuse: A longitudinal study

In the present study, our aim was to examine longitudinal posttraumatic stress symptom (PTSS) trajectories in a Norwegian sample of adults who had experienced sexual abuse during childhood, and to identify predictors of PTSS-trajectory belongingness. The sample consisted of 138 adult survivors of childhood sexual abuse (96.4% women, mean age=42.9years, mean age at the first abuse=5.9 years), recruited from support centers for sexual abuse survivors. The majority (78.3%) reported penetrative abuse, and a large proportion of the sample reported that the perpetrator was a biological parent (38.4%) or someone they trusted (76.1%), reflecting a high severity level of the abusive experiences. Latent Profile Analyses revealed the best overall fit for a two PTSS-trajectories model; one trajectory characterized by sub-clinical and decreasing level of PTSS (54.9%), and the other by high and slightly decreasing level of PTSS (45.1%). Increased odds for belonging to the trajectory with clinical level symptoms was found among those who reported higher levels of exposure to other types of childhood maltreatment (OR=3.69, p=0.002), sexual abuse enforced by physical violence (OR=3.04, p=0.003) or threats (OR=2.56, p=0.014), very painful sexual abuse (OR=2.73, p=0.007), or who had experienced intense anxiety, helplessness or fear during the abuse (OR=2.97, p=0.044). Those in the trajectory with clinical level PTSS reported lower levels of perceived social support and more relational difficulties compared to those in the sub-clinical PTSS trajectory. In conclusion, different longitudinal PTSS trajectories can be found among adult survivors of childhood sexual abuse. Significant predictors of PTSS-trajectory belongingness are discussed alongside their potential implications for preventive efforts and clinical interventions.

Resilience Mediates Impact of Some Childhood Maltreatment on Post-Traumatic Stress Symptoms in Conscripted Marines in the Republic of Korea

Although it is known that post-traumatic stress symptoms (PTSS) can result from military service, the variance in PTSS unexplained by military service warrants further investigation, and no researchers have investigated South Korean Marines' vulnerability during their 2-year conscripted service as the first line of national defense against threats from North Korea. This study was designed to examine whether resilience mediated the relationship between childhood maltreatment and PTSS in 169 Korean conscripts into the Marine Corps. In a cross-sectional study design, the Childhood Trauma Questionnaire-Short Form was used to measure childhood maltreatment, including abuse and neglect. The Impact of Event Scale-Revised and the Connor-Davidson Resilience Scale were used to measure PTSS and resilience. Structural equation modeling was used for data analysis. Half the conscripts reported at least one type of childhood maltreatment, and 22.3% had high PTSS, even in a short period of service. Childhood abuse was significantly associated with PTSS during military service, a relationship that was not mediated by resilience. However, resilience mediated the relationship between childhood neglect and PTSS during military service. Assessment of childhood maltreatment and resilience prior to military service is crucial for identifying conscripts at increased risk for PTSS during even brief military service. In addition to direct interventions for abuse effects among all Marines, interventions enhancing resilience may benefit conscripts who experienced childhood neglect. © 2016 Wiley Periodicals, Inc.

PTSD, cyberbullying and peer violence: prevalence and correlates among adolescent emergency department patients

OBJECTIVE

Posttraumatic stress disorder (PTSD) is often underdiagnosed and undertreated among adolescents. The objective of this analysis was to describe the prevalence and correlates of symptoms consistent with PTSD among adolescents presenting to an urban emergency department (ED).

METHODS

A cross-sectional survey of adolescents aged 13-17 years presenting to the ED for any reason was conducted between August 2013 and March 2014. Validated self-report measures were used to measure mental health symptoms, violence exposure and risky behaviors. Multivariate logistic regression analysis was performed to determine adjusted differences in associations between symptoms consistent with PTSD and predicted correlates.

RESULTS

Of 353 adolescents, 23.2% reported current symptoms consistent with PTSD, 13.9% had moderate or higher depressive symptoms and 11.3% reported past-year suicidal ideation. Adolescents commonly reported physical peer violence (46.5%), cyberbullying (46.7%) and exposure to community violence (58.9%). On multivariate logistic regression, physical peer violence, cyberbullying victimization, exposure to community violence, female gender and alcohol or other drug use positively correlated with symptoms consistent with PTSD.

CONCLUSIONS

Among adolescents presenting to the ED for any reason, symptoms consistent with PTSD, depressive symptoms, physical peer violence, cyberbullying and community violence exposure are common and interrelated. Greater attention to PTSD, both disorder and symptom levels, and its cooccurring risk factors is needed.