Childhood Adversity and Associated Psychosocial Function in Adolescents with Complex Trauma

Caregivers on point: a randomized treatment-control prevention trial for foster and kinship caregivers to reduce behavior challenges among children in foster care

BACKGROUND

Children in foster care who are newly placed with licensed or kinship caregivers are often vulnerable to increased behavior problems associated with trauma and social disruptions. When those issues are not addressed, children are susceptible to placement disruptions that exacerbate behavior problems. Few preventive interventions are available for foster and kinship caregivers, and none are designed to be delivered at the time of a child's placement into the home. This study aims to examine the impact of the Chicago Parent Program adapted and customized for foster and kinship caregivers (CPP-FC), locally branded as Caregivers on Point, on caregiver stress, parenting confidence and strategies, children's behaviors, and placement stability.

METHODS

Caregivers (N = 300) are being recruited from a specialized foster care clinic that sees children and caregivers within five business days of a new placement. Upon completing baseline surveys and behavioral observation, caregiver-child dyads are randomized to receive CPP-FC (n = 150) or usual care (n = 150). Those in the treatment condition will complete 11 weekly sessions addressing child behavior management and caregiving approaches. A booster session will occur one month after the weekly sessions conclude. A mid-point assessment and behavioral observation will be collected four months after the baseline assessment for all participants, coinciding with the completion of the CPP-FC programming. At 6 months post-baseline, an end-of-study assessment will be collected. Administrative data will be extracted from the child welfare record to determine placement stability for the 12 months following enrolment. The primary outcome of interest is child behavior, indicated by changes in caregiver reports and objective ratings of behavior from observations, where raters are blinded to the treatment arm and timing of data collection. Secondary outcomes include placement stability and changes in caregiver stress and confidence in managing children's behavior.

DISCUSSION

If found to be effective, CPP-FC would be helpful for families involved with child welfare. It could be delivered by child welfare agencies, licensing and kinship navigator agencies, and foster care clinics and may be eligible for government reimbursement as a preventive intervention for children in foster care.

TRIAL REGISTRATION

This study was prospectively registered with ClinicalTrials.gov, NCT06170047 .

Assessment of adverse childhood experiences in adolescents from a rural agricultural community: Associations with depressive symptoms and psychosocial problems

The main goal of this study was to determine the prevalence of adverse childhood experiences (ACEs) among Latino adolescents from an agricultural community and to examine how it may impact their neuropsychiatric functioning. This research particularly assessed the association between ACEs and depression, as well as ACEs and psychosocial problems. The study sample consisted of 852 adolescents treated at a rural primary care clinic with a comprehensive ACE screening protocol that assesses for ACEs, depressed mood, and psychosocial functioning during every annual Well-Child Visit. Study results showed that ACEs were relatively common among participants with 64 % endorsing having experienced at least one ACE. Approximately 23 % of participants screened positive for depressed mood and 11 % for psychosocial problems. ACEs were found to have significant associations with both depression symptoms and with psychosocial problems. Males were found to have less depression symptoms than females among subjects with exposure to most ACE types, and older age was associated with lower psychosocial impairment. Study participants live in an agricultural community and are likely exposed to both chemical and non-chemical stressors. The exposure to ACEs and chemical environmental stressors may interact with pathological synergy to alter their biobehavioral development. Further research is needed to understand the "rules" for which stressors at what dose and at what stage of development place youth at greatest risk.

Evaluation of the association COMT Val158Met variant and childhood trauma on aggression in Turkish SCZ patients

Childhood trauma is a serious form of stress that makes individuals more vulnerable to developing Schizophrenia (SCZ). Many studies have predicted the association between the catechol-O-methyltransferase (COMT) gene Val158Met variant and aggressive attack. We aimed to investigate the association the COMT variant and childhood trauma on aggression in Turkish SCZ patientsThis study included 89 patients diagnosed with SCZ. Childhood Trauma Questionnaire (CTS) and Overt Aggression Scale (OAS) were used to assess childhood trauma and aggression. COMT Val158Met variant was analyzed by PCR-RFLP method from isolated DNAs.There was no statistically significant difference in comparing the COMT genotype distribution and clinical characteristics including suicide attempts, self-destructive behavior, crime history, substance, alcohol and tobacco use. When we evaluate Spearman's rank correlation coefficients between CTQ and OAS, the correlation between the OAS and CTQ scores of the patients was statistically significant except for the sexual abuse subgroup of the CTQ. In the univariate logistic regression analysis, in which the dichotomized OAS score was accepted as the dependent variable, it was found that age, suicide attempt, substance abuse, and CTQ total score significantly predicted the higher OAS scores. In the multivariate logistic regression analysis, which included the variables that predicted OAS significantly, age, suicide attempt, and total CTQ score were determined as independent variables predicting OAS.Because of the phenotypic complexity in SCZ, it is difficult to draw strong conclusions about COMT and to highlight a definitive relationship. Larger-scale studies are needed to examine the multifactorial inheritance pattern of schizophrenia in different dimensions.

A longitudinal study of childhood maltreatment, subcortical development, and subcortico-cortical structural maturational coupling from early to late adolescence

BACKGROUND

Examining neurobiological mechanisms that may transmit the effects of childhood maltreatment on mental health in youth is crucial for understanding vulnerability to psychopathology. This study investigated associations between childhood maltreatment, adolescent structural brain development, and mental health trajectories into young-adulthood.

METHODS

Structural magnetic resonance imaging data was acquired from 144 youth at three time points (age 12, 16, and 18 years). Childhood maltreatment was reported to occur prior to the first scan. Linear mixed models were utilized to examine the association between total childhood maltreatment, neglect, abuse and (i) amygdala and hippocampal volume development, and (ii) maturational coupling between amygdala/hippocampus volume and the thickness of prefrontal regions. We also examined whether brain development mediated the association between maltreatment and depressive and anxiety symptoms trajectories from age 12 to 28.

RESULTS

Total maltreatment, and neglect, were associated with positive maturational coupling between the amygdala and caudal anterior cingulate cortex (cACC), whereby at higher and lower levels of amygdala growth, maltreatment was associated with lower and higher PFC thinning, respectively. Neglect was also associated with maturational coupling of the hippocampus with prefrontal regions. While positive amygdala-cACC maturational coupling was associated with greater increases in anxiety symptoms, it did not significantly mediate the association between maltreatment and anxiety symptom trajectories.

CONCLUSION

We found maltreatment to be associated with altered patterns of coupling between subcortical and prefrontal regions during adolescence, suggesting that maltreatment is associated with the development of socio-emotional neural circuitry. The implications of these findings for mental health require further investigation.

Profile and mental health characterization of childhood overprotection/overcontrol experiences among Chinese university students: a nationwide survey

Introduction

The childhood experiences of being overprotected and overcontrolled by family members have been suggested to be potentially traumatic. However, the possible associated factors of these experiences among young people are still not well studied. This study aimed to partly fill such gaps by a relatively large, nationwide survey of Chinese university students.

Methods

A total of 5,823 university students across nine different provinces in China were included by the convenience sampling method in the data analyses. All participants completed the overprotection/overcontrol (OP/OC) subscale in a recently developed 33-item childhood trauma questionnaire (CTQ- 33). Data were also collected on all participants' socio-demographic profiles and characterization of mental health. Binary logistic regression was conducted to investigate the associated socio-demographic and psychological factors of OP/ OC.

Results

The prevalence of childhood OP/OC was estimated as 15.63% (910/5,823) based on a cutoff OP/OC subscale score of  ≥ 13. Binary logistic regression suggested that being male, being a single child, having depression, having psychotic-like experiences, lower family functioning, and lower psychological resilience were independently associated with childhood OP/OC experiences (all corrected-p < 0.05). The OP/OC was also positively associated with all the other trauma subtypes (abuses and neglects) in the CTQ-33, while there are both shared and unique associated factors between the OP/OC and other trauma subtypes. Post-hoc analyses suggested that OP/OC experiences were associated with depression in only females and associated with anxiety in only males.

Discussion

Our results may provide initial evidence that childhood OP/OC experiences would have negative effects on young people's mental health which merits further investigations, especially in clinical populations.

Pediatric ACEs and related life event screener (PEARLS) latent domains and child health in a safety-net primary care practice

BACKGROUND

Research examining the connections between individual adverse childhood experiences (ACEs) and how groupings of interrelated adversities are linked with subsequent health is scarce, limiting our understanding of risk during a period of rapid expansion of ACE screening in clinical practice. The study objective was to conduct a psychometric analysis to derive latent domains of ACEs and related life events and assess the association between each domain and health outcome.

METHODS

Participants (3 months-11 years) were recruited from the University of California San Francisco Benioff's Children Hospital Oakland Primary Care Clinic. Children were screened with the Pediatric ACEs and Related Life Events Screener (PEARLS) (n = 340), which assessed 17 total ACEs and related life events, including forms of abuse, household challenges, and social risks. Domains were constructed using confirmatory factor analysis and associations between the three identified domains and 14 health outcomes were assessed using multivariable linear and logistic regression models.

RESULTS

Three PEARLS domains were identified: Maltreatment (ω = 0.73, ɑ=0.87), Household Challenges (ω = 0.70, ɑ=0.82), and Social Context (ω = 0.55, ɑ=0.70). Measurement invariance was supported across both gender and screening format. All domains were associated with poorer general and behavioral health and stomachaches. Maltreatment and Social Context were additionally associated with eczema while only Social Context was associated with increased odds of reporting headaches and somatic symptoms.

CONCLUSION

In an underserved, urban west-coast pediatric population, the PEARLS found three adversity domains of Maltreatment, Household Challenges, and Social Context that all had an independent statistically significant association with poorer child health. The results provide a timely and more nuanced representation of risk that can inform clinical practice and policy using more targeted resources and interventions.

General and Specific Factors of Environmental Stress and Their Associations With Brain Structure and Dimensions of Psychopathology

Background

Early-life stressors can adversely affect the developing brain. While hierarchical modeling has established the existence of a general factor of psychopathology, no studies have modeled a general factor of environmental stress and related this factor to brain development. Using a large sample of children from the ABCD (Adolescent Brain Cognitive Development) Study, the current study aimed to identify general and specific factors of environmental stress and test their associations with brain structure and psychopathology.

Methods

In a sample of 11,878 children, bifactor modeling and higher-order (second-order) modeling identified general and specific factors of environmental stress: family dynamics, interpersonal support, neighborhood socioeconomic status deprivation, and urbanicity. Structural equation modeling was performed to examine associations between these factors and regional gray matter volume (GMV) and cortical thickness as well as general and specific factors of psychopathology.

Results

The general environmental stress factor was associated with globally smaller cortical and subcortical GMV as well as thinner cortices across widespread regions. Family dynamics and neighborhood socioeconomic status deprivation were associated with smaller GMV in focal regions. Urbanicity was associated with larger cortical and subcortical GMV and thicker cortices in frontotemporal regions. The environmental factors were associated with psychopathology in the expected directions. The general factors of environmental stress and psychopathology were both predictors of smaller GMV in children, while remaining distinct from each other.

Conclusions

This study reveals a unifying model of environmental influences that illustrates the inherent organization of environmental stressors and their relationship to brain structure and psychopathology.

Association of childhood trauma, and resilience, with quality of life in patients seeking treatment at a psychiatry outpatient: A cross-sectional study from Nepal

Quality of life is defined by the World Health Organization as "Individuals’ perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns". It is a comprehensive measure of health outcome after trauma. Childhood maltreatment is a determinant of poor mental health and quality of life. Resilience, however, is supposed to be protective. Our aim is to examine childhood trauma and resilience in patients visiting psychiatry outpatient and investigate their relations with quality of life. A descriptive cross-sectional study was conducted with a hundred patients with trauma and visiting psychiatry outpatient. Standardized tools were applied to explore childhood trauma, resilience, quality of life and clinical diagnoses and trauma categorization. Sociodemographic and relevant clinical information were obtained with a structured proforma. Bivariate followed by multivariate logistic regressions were conducted to explore the relation between childhood trauma, resilience, and quality of life. Poor quality of life was reported in almost one third of the patients. Upper socioeconomic status, emotional neglect during childhood, current depression and low resilience were the determinants of poor quality of life in bivariate analysis. Final models revealed that emotional neglect during childhood and low resilience had independent associations with poor quality of life. Efforts should be made to minimize childhood maltreatment in general; and explore strategies to build resilience suited to the cultural context to improve quality of life.

Developmental trauma: Conceptual framework, associated risks and comorbidities, and evaluation and treatment

Children exposed to adverse childhood experiences (ACEs) and pervasive interpersonal traumas may go on to develop PTSD and, in most cases, will further undergo a significant shift in their developmental trajectory. This paper examines contemporary research on Developmental Trauma (DT), which is inextricably linked to disruptions in social cognition, physiological and behavioral regulation, and parent-child attachments. Developmental trauma associated with early experiences of abuse or neglect leads to multi-faceted and longstanding consequences and underscores critical periods of development, complex stress-mediated adaptations, and multilevel, trans-theoretical influences in the diagnostic formulation and treatment of traumatized children, adolescents, and adults. Psychological and medical correlates of Developmental Trauma Disorder are considered, and directions for future research are discussed.

Childhood trauma and food addiction: The role of emotion regulation difficulties and gender differences

OBJECTIVE

Childhood trauma has been associated with substance use disorders (SUDs), but less research has investigated its association with food addiction (i.e., compulsive intake of highly processed foods containing refined carbohydrates and/or added fat). Existing research on childhood trauma and food addiction has focused primarily on women from restricted samples. Further, emotion dysregulation difficulties are implicated in both childhood trauma and food addiction, but research has not explored whether it may play a mediating role.

METHOD

Thus, the current study utilizes a sample of 310 participants recruited from Amazon Mechanical Turk (mean age = 41.3 years old, 47.4% men, 78.7% white) to investigate the mediating role of emotion dysregulation in the association between childhood trauma and food addiction. We also conducted exploratory analyses to investigate for gender differences in these associations. Gender-stratified correlational matrixes were conducted to investigate association between childhood trauma, food addiction, and emotional dysregulation. Moderated mediation models and multilevel regressions were also conducted to identify the role of gender in the association between childhood trauma, food addiction, and emotion dysregulation.

RESULTS

Emotion dysregulation was found to partially mediate the associations between food addiction and childhood trauma and gender was found to moderate associations between childhood trauma and emotion dysregulation, as well as childhood trauma and food addiction. Both moderating pathways were significantly stronger for men compared to women.

DISCUSSION

Results suggests that emotion dysregulation may be one important mediator in the association between childhood trauma and food addiction, particularly for men. The identification of other potential mechanisms contributing to the association between childhood trauma and food addiction and the use of longitudinal measurement strategies will be important in future research.

Modeling changes in adolescent health risk behaviors approaching and just after the time of emancipation from foster care

BACKGROUND

Emancipated foster youth frequently engage in behaviors that contribute to poor health. Whether health risk behaviors increase following emancipation or are established while in foster care remains unclear.

OBJECTIVE

This secondary data analysis examined substance use and attitudes toward sexual risk behaviors to understand continuity in risk behaviors among foster youth before emancipation and following emancipation.

PARTICIPANTS AND SETTING

Youth ages 16-20 (N = 151) who had been in foster care for at least 12 months and were expected to emancipate were recruited. The urban county where the study was conducted allowed youth to remain in foster care until 21 years of age.

METHODS

Participants completed surveys assessing substance use and attitudes toward sexual risk behaviors at baseline, 6 and 12 months. Multilevel models estimated trajectories of health behaviors and attitudes, with emancipation timing as the primary predictor. Individual and child welfare characteristics were included as covariates.

RESULTS

Substance use did not change with emancipation (B_s = 0.01, p = 0.81) and positive attitudes about risky sexual behavior significantly decreased as youth approached emancipation (B_s = 1.67, p < 0.01). Placement instability and adversity were not associated with either outcome (ps > 0.08). Females reported more positive attitudes about higher-risk sexual behavior than males (B = 3.09, p < 0.01) and less substance use (B = -1.15, p = 0.03).

CONCLUSIONS

Substance use and attitudes about sexual risk behaviors are established before emancipation; interventions prior to emancipation are necessary to improve health outcomes.

The Role of Childhood Trauma in Psychosis and Schizophrenia: A Systematic Review

Schizophrenia (SCZ) is a prevalent cause of disability worldwide. Distinguished mainly by psychosis, behavioral alterations could range from hallucinations to delusions. This systematic review examines evidence of a relationship between childhood trauma/adverse life events and psychosis, especially in SCZ. A methodical search provided reproducible results using these five databases: PubMed, ScienceDirect, Semantic Scholar, JSTOR, and Cochrane Library. The systematic search focused on articles published between July 2016 and July 2021. The search strategy utilized specific keywords relevant to SCZ, psychosis, and childhood trauma. The formulation of specified inclusion and exclusion criteria was necessary to ensure a comprehensive narrowed-down search, such as the inclusion of free full-text articles published or translated in English and exclusion of irrelevant subject areas. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a strategic search initially identified 741 articles; three additional articles were identified from citation searching. After relevance screening, duplicate removal, and quality appraisal, 12 studies from databases/registers and three from citation searching met the criteria proving relevance to our review with minimal evidence of bias. The final selected 15 studies included observational studies and reviews. A review of relevant data unveiled findings on childhood adversity, individual lived experiences, and their involvement in SCZ. Evidence suggests that certain neurobiological processes occur in brain after trauma. The inflammation and dysregulation from oxidative stress predispose patients to an at-risk-mental state, facilitating the progression to SCZ. This review encourages further evaluation of early trauma detection and the potential benefits of early intervention.

Internalizing Symptoms Among Youth in Foster Care: Prevalence and Associations with Exposure to Maltreatment

Among youth in foster care (N = 303, aged 11-17 years), we investigated prevalence of internalizing symptoms; associations between symptom level and maltreatment types and numbers; and the interaction between gender and maltreatment, on internalizing symptoms. Youth completed Spence Children Anxiety Scale, Short Mood Feelings Questionnaire, and Child and Adolescent Trauma Screen. Compared to community samples, symptom levels above clinical cut-off was more frequent, with social- and generalized anxiety (ES = 0.78-0.88) being most prevalent among youth in foster care. Girls reported more internalizing symptoms (ES = 0.59-0.93). Sexual abuse and neglect were associated with a broader range of internalizing symptoms (ES = 0.35-0.64). Increased incidence of maltreatment was associated with increased levels of symptoms (ES = 0.21-0.22). Associations between maltreatment and symptom level were stronger for girls. This study stresses the importance of broad screening of maltreatment and internalizing symptoms to meet the needs of youth in foster care.

Patterns of adverse childhood experiences and depressive symptom trajectories in young adults: A longitudinal study of college students in China

BACKGROUND

Adverse childhood experiences (ACEs) tend to cluster together in daily life, and most studies focus on the level of depression at certain points, but the dynamic process of depression is often neglected. Thus, research is urgently needed to explore the relationship between ACEs pattern and trajectory of depressive symptom levels at multiple time points in order to provides early targeted interventions to those who are most at risk.

OBJECTIVE

We aimed to explore patterns of ACEs, including types and timing, associated with depression trajectories in college students.

METHODS

A school-based health survey was used to collect data as part of a longitudinal study in two medical college in Anhui province, China. Questionnaires were issued to 3,662 participants aged 17-22 and recorded details of ACEs (types and timing) and depression. Latent class analysis (LCA) was used to identify "patterns" of ACEs type and timing. Depressive symptom trajectories employed latent class growth analysis (LCGA). Multiple logistic regressions were employed to evaluate the relationships between ACEs patterns and depressive symptom trajectories.

RESULTS

We identified five ACEs patterns: "High neglect/emotional abuse/community violence," "High neglect/emotional abuse," "High neglect/family dysfunction," "High neglect," "Low ACEs." We traced three depression trajectories: "High depressive symptom" "Moderate depressive symptom," "Low depressive symptom." "High neglect/emotional abuse/community violence," "High neglect/emotional abuse" and "High neglect/family dysfunction" demonstrated a high risk for "High depressive symptom" and "Moderate depressive symptom." "High neglect" showed a high risk for "Moderate depressive symptom" but not for "High depressive symptom" (P < 0.05).

CONCLUSIONS

The findings address the need for a comprehensive consideration of exposure to childhood adversity associated with the risk of depression in young adults through identifying more problematic ACEs patterns amongst exposed children.

Executive functions as a mediator of childhood maltreatment on adult psychopathology: A longitudinal mediation analysis comparing maltreatment factor models

BACKGROUND

Childhood maltreatment (CM), executive functions (EFs), and psychiatric disorders all correlate highly. Changes in EFs during adolescence related to CM present a possible mediating mechanism for the development of psychiatric disorders, yet no study has analyzed this longitudinally while comparing predictive capacity of different CM factor structures. We hypothesized that changes in EFs from adolescence to adulthood would mediate, in part, associations between CM, internalizing disorders (INT), and anti-social personality disorder (ASPD) while different subtypes of CM would differentially predict INT and ASPD.

OBJECTIVE

This study longitudinally examined the mediating effects of EFs on associations between CM, INT, and ASPD while comparing prediction of two CM factor structures.

PARTICIPANTS

High-risk subjects selected for drug use in adolescence (N = 658) from mean ages 16 to 23.

METHODS

A Bayesian structural equation model was deployed to analyze change in EFs as a mediator of the relationship between CM and adult INT and ASPD. CM was measured using two factor structures: a single overall factor and four correlated factors representing CM subtypes.

RESULTS

CM significantly predicted INT and ASPD but there was no evidence that the relationship was substantially mediated through EFs. High correlations among subtypes of CM limited the unique predictions of each subtype on INT and ASPD.

CONCLUSION

In this high-risk sample, the collinearity of CM subtypes obscured their predictions of outcome measures supporting the use of one CM factor. EFs did not significantly mediate associations between CM and psychiatric disorders, but further research on these relationships is warranted.

Characteristics and Service Needs of Maltreated Children Referred for Mental Health Services at a Child Advocacy Centre in Canada

OBJECTIVE

There is a dearth of Canadian-based literature on children referred to treatment services following maltreatment exposure. In order to inform assessment, intervention, and program development to improve outcomes, insight into the demographics and mental health needs of this population is required.

METHODS

A retrospective file review of 176 children and youth who were referred for assessment and treatment at a mental health partner agency within a Canadian Child Advocacy Centre was conducted from January 2016 to June 2017. A standardized protocol was developed to extract data on family and child demographic characteristics, type of maltreatment, other adversity exposure, presenting concerns of the child, and mental health service utilization.

RESULTS

The majority of children were female (66.5%), 4.5% were 0 to <5 years, 66.5% were 5 to <13 years, and 29.0% were 13 to <18 years of age. More than half of the children (53.4%) had multiple forms of maltreatment, with 67% exposed to sexual abuse. Exposure to other forms of adversity was also common, including domestic violence (53.4%) and parental mental health difficulties (52.3%). Most children had more than five presenting concerns at the time of referral, and most went on to receive intervention services. Sixty-nine percent of families had not previously received child mental health treatment, although 41.5% had prior child welfare involvement. Thirty percent of families ended treatment prematurely.

CONCLUSIONS

The current study illustrates the complex profile and mental health needs of children referred for treatment following maltreatment exposure. Results may have implications for clinical care improvement that support maltreated children.

The Tern Programme Study protocol for an implementation trial of a flexible, long-term psychosocial intervention for complex posttraumatic stress in young people

BACKGROUND

Complex Trauma (CT) is a term used to refer to multiple or prolonged traumatic experiences. Such experiences are often first encountered during childhood and may impact key developmental periods. CT is a risk for a broad range of deleterious physical, psychological, social, and occupational outcomes. The diagnosis of Complex Posttraumatic Stress Disorder (C-PTSD) has been proposed to capture the symptomatology resulting from CT exposure.In Australia, there are few publicly funded services that target, and are purposely designed to support, the mental health needs of young people with symptoms of complex post-traumatic stress (C-PTSD). The Tern Programme has been designed as a purpose-built model of care for providing mental health support to young people with C-PTSD.

METHODS

This implementation trial will involve a longitudinal examination of Tern participants for a fixed 24-month period. Participants will be recruited from the young people referred to Tern at headspace centres in regional Australia where Tern operates. Eligible participants will have reported a history of complex trauma, and present with symptoms of C-PTSD. All participants will be invited to complete a series of surveys during their participation in the programme. Survey items will assess C-PTSD symptom change, quality of life and occupational functioning.The Tern model of care is delivered in a semi-structured format to accommodate a person-centred flexible approach. Fidelity will be monitored through the completion of a clinician post-session checklist and through group supervision.

DISCUSSION

This study will provide the first quantitative data on the new Tern model of care and evaluate mental health and functional outcomes of its participants. If effective, Tern may be suitable for replication in other Australian or international youth mental health services where complex post-traumatic stress is prevalent.

TRIAL REGISTRATION

Australia and New Zealand Clinical Trials Registry (ANZCTR): ACTRN12621000079842p. Prospectively registered on 29 January 2021.

ABBREVIATIONS

CT = Complex Trauma; C-PTSD = Complex Posttraumatic Stress Disorder.

Predictors of quality of life among youths in foster care-a 5-year prospective follow-up study

PURPOSE

Few studies have investigated possible predictors of positive outcomes for youths in foster care. The aim of this prospective follow-up study was to examine quality of life (QoL) among youths in foster care and to assess whether contextual and child factors predicted QoL.

METHODS

Online questionnaires were completed by carers in Norway in 2012 (T1, n = 236, child age 6-12 years) and by youths and carers in 2017 (T2, n = 405, youth age 11-18 years). We received responses on 116 of the youths at both T1 and T2, and our final sample consisted of 525 youths with responses from T1 and/or T2. Child welfare caseworkers reported preplacement maltreatment and service use at T1. We assessed mental health and prosocial behavior at T1 by having carers complete the Strength and Difficulties Questionnaire and QoL at T2 with youth-reported KIDSCREEN-27. We analyzed the data using descriptive statistics, t-tests and multiple linear regressions, and we used multiple imputation to handle missing data.

RESULTS

Youths in foster care had lower QoL across all dimensions compared to a Swedish general youth sample. QoL scores among our sample were similar to Norwegian youths with ill or substance abusing parents and to European norm data. Youths reported the highest QoL scores on the parent relations and autonomy dimension. Male gender, younger age, kinship care and prosocial behavior five years earlier predicted higher QoL.

CONCLUSION

Similar to other at-risk youths, youths in foster care seem to have lower QoL than the general Scandinavian population. Despite early adversities, they had good relations with their current carers. Adolescent girls seem especially vulnerable to low QoL and might need extra support to have good lives in foster care.

Child maltreatment and substance-use-related negative consequences: Longitudinal trajectories from early to mid adolescence

BACKGROUND

Child maltreatment is associated with adult substance use disorders (i.e. alcohol and/or illicit drug use). Little is known about the behavioral pathways characterizing adolescent substance users who were subjected to childhood maltreatment. Here, we investigate the longitudinal trajectories of substance-use-related negative consequences (SURNCs) in adolescence in relation to childhood maltreatment.

METHOD

We drew the data (N = 1515) from the longitudinal multidisciplinary research program LoRDIA (Longitudinal Research on Development In Adolescence), of which 406 reported substance use and were included in the presented analyses. The data were collected via self-report questionnaires in classroom settings at three time points (mean age: 13.5, 14.4 and 15.0). We obtained information for childhood maltreatment using the Childhood Trauma Questionnaire-Short Form (CTQ-SF) and data of frequencies of SURNC with a questionnaire scale.

RESULTS

Estimates from zero-inflated Poisson growth curve model revealed no baseline differences in SURNCs across children reporting none, single, or multiple maltreatment before the age of twelve. However, children experiencing multiple maltreatment displayed a greater increase in the frequency of SURNCs during the transition from early to mid adolescence than did those reporting no maltreatment. These estimates were only partly influenced by the inclusion of frequency of alcohol and substance drug use to the model.

CONCLUSIONS

These findings imply that children suffering maltreatment are at a higher risk of experiencing SURNCs, a factor known to elevate the risk of substance use disorders later in life, as they transition from early to mid adolescence.