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Wu W, Xie R, Ding W, Ding D, Tan D, Song S, Li W. A reciprocal relationship between parental maltreatment and child bullying perpetration in China. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2024; 34:127-140. [PMID: 38013604 DOI: 10.1111/jora.12902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/14/2023] [Accepted: 10/30/2023] [Indexed: 11/29/2023]
Abstract
This study aimed to examine the longitudinal reciprocal relationship between parental maltreatment and child bullying perpetration from middle childhood to early adolescence in China and the associated gender differences. Eight hundred ninety-one children completed a battery of questionnaires at four time points. A random-intercept cross-lagged model was established. The results indicated that at the between-person level, child bullying perpetration was positively associated with physical and psychological maltreatment. At the within-person level, there was a significant association between an increase in bullying perpetration and an increase in parental psychological and physical maltreatment across the four time points. Conversely, an increase in physical maltreatment led to an increase in child bullying perpetration from T1 to T2, while an increase in psychological maltreatment resulted in an increase in child bullying perpetration from T1 to T2 and T2 to T3. Furthermore, an increase in physical maltreatment increased boys' bullying perpetration but decreased that in girls from T2 to T3. These findings provide inspiration for future family education and anti-bullying interventions in schools.
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Affiliation(s)
- Wei Wu
- School of Psychology, Parent Education Research Center, The Intelligent Laboratory of Child and Adolescent Mental Health and Crisis Intervention of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Ruibo Xie
- School of Psychology, Parent Education Research Center, The Intelligent Laboratory of Child and Adolescent Mental Health and Crisis Intervention of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Wan Ding
- School of Psychology, Parent Education Research Center, The Intelligent Laboratory of Child and Adolescent Mental Health and Crisis Intervention of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Dan Ding
- Suzhou Borui School, Suzhou, China
| | - Deqin Tan
- School of Psychology, Parent Education Research Center, The Intelligent Laboratory of Child and Adolescent Mental Health and Crisis Intervention of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Shengcheng Song
- School of Psychology, Parent Education Research Center, The Intelligent Laboratory of Child and Adolescent Mental Health and Crisis Intervention of Zhejiang Province, Zhejiang Normal University, Jinhua, China
| | - Weijian Li
- School of Psychology, Parent Education Research Center, The Intelligent Laboratory of Child and Adolescent Mental Health and Crisis Intervention of Zhejiang Province, Zhejiang Normal University, Jinhua, China
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2
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Melamed DM, Botting J, Lofthouse K, Pass L, Meiser-Stedman R. The Relationship Between Negative Self-Concept, Trauma, and Maltreatment in Children and Adolescents: A Meta-Analysis. Clin Child Fam Psychol Rev 2024; 27:220-234. [PMID: 38386241 PMCID: PMC10920440 DOI: 10.1007/s10567-024-00472-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2024] [Indexed: 02/23/2024]
Abstract
Experiencing trauma in childhood is a global public health issue linked to worse physical and mental health outcomes, including Post-Traumatic Stress Disorder (PTSD). Self-concept is a transdiagnostic concept linked to various psychopathologies and understanding its unique relationship to trauma is important. This meta-analysis aimed to understand the size of the effect between trauma and maltreatment and self-concept in children and adolescents. The current meta-analysis searched PubMed, PILOTS, PsycINFO, and Web of Science databases. Inclusion criteria involved studies with defined trauma exposure, valid measures of self-concept, and participants' mean age under 18 years old. One-hundred-and-thirty-four studies were included in the meta-analysis (N = 255,334). A random-effects meta-analysis was performed. A small negative relationship was observed between trauma exposure and self-concept (r = - 0.20, 95% CI - 0.22, - 0.18). This relationship was significantly moderated by some variables (type and nature of trauma exposure) but not others (participant gender, type of self-concept measure, quality of studies, country economic status). A small relationship between trauma exposure and negative self-concept in children and adolescents was detected, with repeated trauma exposure and type of trauma exposure moderating this relationship. This provides important directions for clinical practice around providing support for those exposed or most vulnerable to experiencing trauma.
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Affiliation(s)
- Daniela M Melamed
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK
| | - Jessica Botting
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK
| | - Katie Lofthouse
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK
| | - Laura Pass
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich Research Park, Norwich, Norfolk, NR4 7TJ, UK.
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3
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Davis RS, Halligan SL, Meiser-Stedman R, Elliott E, Ward G, Hiller RM. A Longitudinal Investigation of the Relationship Between Trauma-Related Cognitive Processes and Internalising and Externalising Psychopathology in Young People in Out-of-Home Care. Res Child Adolesc Psychopathol 2023; 51:485-496. [PMID: 36525227 PMCID: PMC10017561 DOI: 10.1007/s10802-022-01005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 12/23/2022]
Abstract
Young people in out-of-home care are at increased risk of developing a range of posttrauma mental health difficulties, including PTSD, but more commonly anxiety, depression and externalising symptoms. Cognitive models of PTSD indicate that trauma-related maladaptive appraisals, coping strategies and trauma memory qualities are key processes in the development and maintenance of PTSD, yet there has been limited investigation of the potential role of these processes in broader posttrauma psychopathology, particularly in young people who have been exposed to complex, rather than acute, trauma. We recruited 120 10-18 years olds in out-of-home care, and their caregivers, who completed assessments at two time points: baseline and 12-month follow-up. Young people completed self-report measures of trauma-related maladaptive appraisals, coping strategies and trauma-memory qualities, as well as reporting on PTSD, anxiety, depression and externalising symptoms. Carers also reported on internalising and externalising symptoms. We found that all three cognitive processes were associated with baseline self-reported internalising symptoms, with maladaptive appraisals most robustly associated with both anxiety and depression. Changes in all three processes over 12-months predicted a change in self-reported internalising and externalising symptoms, with maladaptive appraisals and coping predicting anxiety symptoms, and coping uniquely predicting depression and externalising symptoms. Effects remained after controlling for co-occurring PTSD symptoms. Findings were not replicated when using carer-reported symptoms. These findings suggest that existing cognitive models of PTSD may also usefully explain broader posttrauma depression, anxiety and externalising symptoms in young people who have experienced maltreatment and live in out-of-home care. Clinical implications are discussed.
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Affiliation(s)
| | - 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
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | | | - Georgina Ward
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Rachel M Hiller
- Department of Psychology, University of Bath, Bath, UK. .,Division of Psychology and Language Sciences, University College London, London, UK. .,Anna Freud National Centre for Children and Families, London, UK.
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4
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Vasileva M, Fegert JM, Rosner R, Witt A. Negative Posttraumatic Cognitions in 4- to 8-year-old Children following Maltreatment. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:1041-1050. [PMID: 35469337 PMCID: PMC9021828 DOI: 10.1007/s40653-022-00455-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Research has shown that children and adolescents suffering from posttraumatic stress often have negative posttraumatic cognitions such as negative appraisals of the trauma sequel that increase mental health problems. However, little is known about posttraumatic cognitions in young children. The aim of this study was to investigate negative posttraumatic cognitions in 4- to 8-year-old children following maltreatment. We also examined their association with child age and well-being as well as caregiver psychopathology. METHODS The study includes N = 112 caregiver-child dyads with children's mean age of M = 6.2 (SD = 1.1) years. Children had experienced physical abuse, emotional abuse, neglect, sexual victimization, and/or domestic violence prior to participation. Posttraumatic cognitions were assessed using a short child interview including four items adapted from the Child Posttraumatic Cognitions Inventory (CPTCI; Meiser-Stedman et al in Journal of Child Psychology and Psychiatry, 50(4), 432-440, 2009). RESULTS Completion of the interview about posttraumatic cognitions was independent from child's age. Higher levels of negative posttraumatic cognitions were significantly associated with a higher cumulative maltreatment score (r = .35) and higher scores of posttraumatic stress symptoms (r = .39). There was no significant correlation with parent variables. CONCLUSION These findings indicate that posttraumatic cognitions might be an important diagnostic and treatment target for 4- to 8-year-old children. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40653-022-00455-4.
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Affiliation(s)
- Mira Vasileva
- Child and Community Wellbeing Unit, School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Center for Clinical Psychology and Rehabilitation, University of Bremen, Bremen, Germany
| | - Jörg M. Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Andreas Witt
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany
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5
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Lower implicit self-esteem as a pathway linking childhood abuse to depression and suicidal ideation. Dev Psychopathol 2022; 34:1272-1286. [PMID: 33594963 PMCID: PMC9812227 DOI: 10.1017/s0954579420002217] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Identifying the potential pathways linking childhood abuse to depression and suicidal ideation is critical for developing effective interventions. This study investigated implicit self-esteem-unconscious valenced self-evaluation-as a potential pathway linking childhood abuse with depression and suicidal ideation. A sample of youth aged 8-16 years (N = 240) completed a self-esteem Implicit Association Test (IAT) and assessments of abuse exposure, and psychopathology symptoms, including depression, suicidal ideation, anxiety, and externalizing symptoms. Psychopathology symptoms were re-assessed 1-3 years later. Childhood abuse was positively associated with baseline and follow-up depression symptoms and suicidal ideation severity, and negatively associated with implicit self-esteem. Lower implicit self-esteem was associated with both depression and suicidal ideation assessed concurrently and predicted significant increases in depression and suicidal ideation over the longitudinal follow-up period. Lower implicit self-esteem was also associated with baseline anxiety, externalizing symptoms, and a general psychopathology factor (i.e. p-factor). We found an indirect effect of childhood abuse on baseline and follow-up depression symptoms and baseline suicidal ideation through implicit self-esteem. These findings point to implicit self-esteem as a potential mechanism linking childhood abuse to depression and suicidal ideation.
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6
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Arslan G, Yıldırım M. Psychological Maltreatment and Loneliness in Adolescents: Social Ostracism and Affective Experiences. Psychol Rep 2021; 125:3028-3048. [PMID: 34396809 DOI: 10.1177/00332941211040430] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Psychological maltreatment is an important public health concern that has been linked with a variety of negative psychosocial consequences and adjustment problems in childhood to adulthood. The purpose of the current study sought to explore the direct and indirect associations between psychological maltreatment, social ostracism, affective experiences, and loneliness among high school Turkish adolescents. Participants were comprised of 791 adolescents attending three public high schools in Turkey. Students were mostly male with a mean age of 16.35 (SD = 1.09) years. Findings from the analyses indicated that social ostracism mediated the relationship between psychological maltreatment and both positive and negative affective experiences. Social ostracism and affective experiences mediated the effect of psychological maltreatment on adolescent feelings of loneliness. Results of the present study suggest that social ostracism and affective experiences are important mechanisms that may help to understand the impacts of psychological maltreatment on adolescent feelings of loneliness.
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Affiliation(s)
- Gökmen Arslan
- Department of Psychological Counseling and Guidance, Mehmet Akif Ersoy University, Burdur, Turkey.,Ağrı İbrahim Çeçen University, Turkey
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7
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Scharpf F, Mueller SC, Masath FB, Nkuba M, Hecker T. Psychopathology mediates between maltreatment and memory functioning in Burundian refugee youth. CHILD ABUSE & NEGLECT 2021; 118:105165. [PMID: 34171582 DOI: 10.1016/j.chiabu.2021.105165] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 06/06/2021] [Accepted: 06/09/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The detrimental impact of child maltreatment on children and adolescents' academic achievement and later socioeconomic wellbeing is well known. However, it is still unclear (1) whether maltreatment is actually linked to youth's long- and short-term memory deficits and (2) whether potential impairments are due to maltreatment per se or related psychopathology. OBJECTIVE Based on the Attentional Control Theory, we investigated a mediational model in which maltreatment would be related to psychopathology (internalizing symptoms, posttraumatic stress symptoms, posttraumatic cognitions), which would in turn be related to impaired memory functioning. PARTICIPANTS AND SETTING We drew on a sample of 155 Burundian refugee youth (aged 11 to 15) currently living in refugee camps in Tanzania and at high risk of experiencing ongoing maltreatment by parents. METHODS Youth reported on their experiences of maltreatment and psychopathology in structured clinical interviews and completed visuospatial memory tasks involving a short-term and a working memory component (Corsi Block Tapping Test) and delayed recall from long-term memory (Rey-Osterrieth Complex Figure). RESULTS Structural equation modeling showed that psychopathology mediated the association between increased maltreatment and reduced working memory capacity (β = -0.07, p = .02), with a trend towards mediation for short-term memory (β = -0.05, p = .06). Higher levels of maltreatment, but not psychopathology, were directly linked to long-term memory deficits (β = -0.20, p = .02). CONCLUSIONS Preventive efforts targeting maltreatment and interventions focusing on related psychopathology are needed to counter memory deficits and their potential negative implications for academic and socioeconomic outcomes.
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Affiliation(s)
| | - Sven C Mueller
- Department of Experimental Clinical and Health Psychology, Ghent University, Belgium; Department of Personality, Psychological Assessment and Treatment, University of Deusto, Bilbao, Spain
| | - Faustine Bwire Masath
- Department of Psychology, Bielefeld University, Germany; Department of Educational Psychology and Curriculum Studies, Dar es salaam University College of Education, Tanzania
| | - Mabula Nkuba
- Department of Educational Psychology and Curriculum Studies, Dar es salaam University College of Education, Tanzania
| | - Tobias Hecker
- Department of Psychology, Bielefeld University, Germany; Department of Psychology, University of Zurich, Switzerland
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8
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Gusler SK, Jackson Y, Brown S. The Impact of Maltreatment on Internalizing Symptoms for Foster Youth: an Examination of Spirituality and Appraisals as Moderators. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:455-467. [PMID: 33269045 PMCID: PMC7683671 DOI: 10.1007/s40653-019-00296-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Research shows that exposure to child maltreatment increases the risk of internalizing symptoms for youth, and that youth in foster care are at a particularly high risk of symptoms. However, not all youth who experience maltreatment evidence maladjustment, making the link between exposure and mental health outcomes unclear and creating a need to examine what factors buffer against symptomatology. A sample of youth in foster care was used to provide a new examination of the relation between child maltreatment exposure and internalizing symptoms, to test the possible moderating effects of both appraisals and spirituality, and examine differences between children and adolescents. Participants were 486 youth in foster care (M age = 13; 204 children; 282 adolescents). Youth completed self-report measures through the SPARK project (Studying Pathways to Adjustment and Resilience in Kids). Although appraisals and spirituality were not significant moderators, significant main effects emerged. For children, regression analyses showed that maltreatment exposure and lower scores on spiritual prosocial attitudes accounted for the majority of the 21% of the variance in internalizing symptoms. For adolescents 28% of the variance in internalizing symptoms was accounted for by greater maltreatment exposure, lower scores on spiritual prosocial attitudes, higher scores on relationship with a God/Higher Power, and more negative appraisals of stressful life events. The current study provides support for cognitive-based interventions for adolescents aimed at increasing appraisal flexibility and suggests that both children and adolescents could benefit from the development of prosocial attitudes often tied to spirituality but could be reinforced in additional settings.
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Affiliation(s)
- Stephanie K. Gusler
- Clinical Child Psychology, Human Development Center, University of Kansas, Sunnyside Avenue, Room 2015, Lawrence, KS 66045 USA
| | - Yo Jackson
- Department of Psychology, Child Maltreatment Solutions Network, The Pennsylvania State University, State College, PA 16801 USA
| | - Shaquanna Brown
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48109 USA
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9
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Humphreys KL, LeMoult J, Wear JG, Piersiak HA, Lee A, Gotlib IH. Child maltreatment and depression: A meta-analysis of studies using the Childhood Trauma Questionnaire. CHILD ABUSE & NEGLECT 2020; 102:104361. [PMID: 32062423 PMCID: PMC7081433 DOI: 10.1016/j.chiabu.2020.104361] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 05/18/2023]
Abstract
BACKGROUND Researchers have documented that child maltreatment is associated with adverse long-term consequences for mental health, including increased risk for depression. Attempts to conduct meta-analyses of the association between different forms of child maltreatment and depressive symptomatology in adulthood, however, have been limited by the wide range of definitions of child maltreatment in the literature. OBJECTIVE We sought to meta-analyze a single, widely-used dimensional measure of child maltreatment, the Childhood Trauma Questionnaire, with respect to depression diagnosis and symptom scores. PARTICIPANTS AND SETTING 192 unique samples consisting of 68,830 individuals. METHODS We explored the association between total scores and scores from specific forms of child maltreatment (i.e., emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect) and depression using a random-effects meta-analysis. RESULTS We found that higher child maltreatment scores were associated with a diagnosis of depression (g = 1.07; 95 % CI, 0.95-1.19) and with higher depression symptom scores (Z = .35; 95 % CI, .32-.38). Moreover, although each type of child maltreatment was positively associated with depression diagnosis and scores, there was variability in the size of the effects, with emotional abuse and emotional neglect demonstrating the strongest associations. CONCLUSIONS These analyses provide important evidence of the link between child maltreatment and depression, and highlight the particularly larger association with emotional maltreatment in childhood.
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Affiliation(s)
| | | | - John G Wear
- Western University of Health Sciences, United States
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10
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de Haan A, Keller F, Ganser HG, Münzer A, Witt A, Goldbeck L. Longitudinal Associations Between Dysfunctional Maltreatment-Related Cognitions and Psychopathology in Children and Adolescents. J Trauma Stress 2019; 32:496-505. [PMID: 31291484 DOI: 10.1002/jts.22422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 02/08/2019] [Accepted: 02/18/2019] [Indexed: 12/19/2022]
Abstract
Dysfunctional posttraumatic cognitions seem to play an important role in adjustment after traumatic experiences. However, little research has been done on maltreated children and adolescents. Furthermore, possible causal associations between cognitions, posttraumatic stress symptoms, and internalizing and externalizing problems have rarely been investigated. In the current study, 263 maltreated children and adolescents (8-17 years of age) were assessed at baseline and again at time points 6 and either 12 or 18 months later. Cross-lagged panel analyses were used to gain a better understanding of the course of and associations among dysfunctional maltreatment-related cognitions, posttraumatic stress symptoms, and internalizing and externalizing problems. Ratings of all variables significantly decreased over time. Moderate to strong autoregressive paths emerged for all variables, denoting stability. Furthermore, the variables showed moderate to high correlations at every assessment. Posttraumatic stress symptoms moderately predicted dysfunctional maltreatment-related cognitions as well as internalizing and externalizing problems 6 months after baseline. Cross-lagged paths from the cognitions as well as from internalizing and externalizing problems to all other variables were not significant. Age, gender, and maltreatment characteristics did not play a relevant role in these cross-lagged associations when they were included as covariates. Our results underline the cognitive scar model, in which preceding posttraumatic stress symptoms adversely impact cognitions. Posttraumatic stress symptoms appear to be an important target for treatment as their reduction may help decrease internalizing and externalizing problems as well.
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Affiliation(s)
- Anke de Haan
- Department of Psychology, Division of Child and Adolescent Health Psychology, University of Zurich, Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Ferdinand Keller
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Helene G Ganser
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Annika Münzer
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Andreas Witt
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Lutz Goldbeck
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
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11
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de Haan A, Tutus D, Goldbeck L, Rosner R, Landolt MA. Do dysfunctional posttraumatic cognitions play a mediating role in trauma adjustment? Findings from interpersonal and accidental trauma samples of children and adolescents. Eur J Psychotraumatol 2019; 10:1596508. [PMID: 31069022 PMCID: PMC6493315 DOI: 10.1080/20008198.2019.1596508] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/07/2019] [Accepted: 03/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background: Trauma adjustment varies in children and adolescents. Studies on objective risk factors of posttraumatic stress symptoms (PTSS) yielded inconsistent results. Dysfunctional posttraumatic cognitions (PTCs) might play a mediating role between risk factors and posttraumatic symptomatology. Objective: To investigate the interplay of the characteristics of the trauma (e.g. trauma type), the characteristics of the individual (e.g. age, sex), and the characteristics of the social environment (e.g. parental distress, marital status) on PTSS and depression, taking the child's dysfunctional PTCs into account as a possible mediator. Method: Structural equation modelling was used to better understand trauma adjustment in two heterogeneous samples of children and adolescents: a sample of 114 participants aged 7-16 after accidental trauma and a sample of 113 participants aged 6-17 after interpersonal trauma. Results: In the accidental trauma sample, dysfunctional PTCs mediated the positive associations of younger age and lower parental educational level on child PTSS, but not on depression. In the interpersonal trauma sample, being female positively predicted child depression. Furthermore, parental dysfunctional PTCs positively predicted both child PTSS and depression. No mediation effect of child dysfunctional PTCs was found in the interpersonal trauma sample. Child dysfunctional PTCs moderately to strongly predicted child PTSS and depression in both trauma samples. Conclusions: The impact of the characteristics of the individual and the characteristics of the social environment on child PTSS and depression might depend on the type of trauma experienced. Dysfunctional PTCs mediated between the characteristics of the individual and the characteristics of the social environment and the severity of PTSS in the aftermath of accidental trauma, but not of interpersonal trauma.
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Affiliation(s)
- Anke de Haan
- Department of Psychology - Division of Child and Adolescent Health Psychology, University of Zurich, Zurich, Switzerland.,Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland
| | - Dunja Tutus
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Lutz Goldbeck
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Markus A Landolt
- Department of Psychology - Division of Child and Adolescent Health Psychology, University of Zurich, Zurich, Switzerland.,Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland
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12
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Hiller RM, Creswell C, Meiser-Stedman R, Lobo S, Cowdrey F, Lyttle MD, Ehlers A, Halligan SL. A Longitudinal Examination of the Relationship between Trauma-Related Cognitive Factors and Internalising and Externalising Psychopathology in Physically Injured Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018; 47:683-693. [PMID: 30264278 PMCID: PMC6439173 DOI: 10.1007/s10802-018-0477-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cognitive models of posttraumatic stress disorder (PTSD) highlight maladaptive posttrauma appraisals, trauma memory qualities, and coping strategies, such as rumination or thought suppression, as key processes that maintain PTSD symptoms. Anxiety, depression and externalising symptoms can also present in children in the aftermath of trauma, yet there has been little empirical investigation of the potential relevance of posttrauma cognitive processes for such difficulties. Here, we examined whether: a) acute maladaptive cognitive processes (specifically, maladaptive appraisals, memory qualities, and cognitive coping) were associated with symptoms of PTSD, internalising, and externalising at 1-month posttrauma (T1); and b) changes in these cognitive processes predicted symptom change at a follow-up assessment 6 months later (T2). We recruited 132 6–13 year old children and their parents from emergency departments following the child’s experience of an acute trauma. Children self-reported on their maladaptive appraisals, trauma-memory and cognitive coping strategies, along with symptoms of PTSD, anxiety and depression. Parents also rated children’s internalising and externalising symptoms. We found each cognitive process to be robustly associated with PTSD and non-PTSD internalising symptoms at T1, and change in each predicted change in symptoms to T2. Maladaptive appraisals and cognitive coping were unique predictors of children’s posttrauma internalising. Effects were partially retained even controlling for co-occurring PTSD symptoms. There was less evidence that trauma-specific cognitive processes were associated with externalising symptoms. Findings suggest aspects of cognitive models of PTSD are applicable to broader posttrauma psychopathology, and have implications for how we understand and target children’s posttrauma psychological adjustment.
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Affiliation(s)
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | | | - Sarah Lobo
- Department of Psychology, University of Bath, Bath, UK
| | - Felicity Cowdrey
- Department of Psychology, University of Bath, Bath, UK.,Oxford Health NHS Foundation Trust, Cotswold House, Specialist Eating Disorder Service, Savernake Hospital, Marlborough, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Applied Sciences, University of West England, Bristol, UK
| | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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13
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de Haan A, Ganser HG, Münzer A, Witt A, Goldbeck L. Dysfunctional maltreatment-related cognitions in children and adolescents. Child Adolesc Psychiatry Ment Health 2017; 11:31. [PMID: 28652862 PMCID: PMC5483269 DOI: 10.1186/s13034-017-0168-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 05/24/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Dysfunctional trauma-related cognitions correlate highly with chronic stress. Studies on maltreatment-related cognitions and their predictors in children and adolescents are rare. METHODS The study sample consisted of 231 children aged 8-17 years who had experienced maltreatment including domestic violence, emotional abuse, neglect, physical, and sexual abuse. Using multiple linear regression analysis, gender, age, index-event, multi-type maltreatment, out-of-home-care, and migration background were investigated as possible predictors of dysfunctional maltreatment-related cognitions. Additionally, the associations between dysfunctional cognitions and posttraumatic stress symptoms (PTSS) as well as further internalizing and externalizing symptoms were calculated. RESULTS Gender emerged as a significant predictor of dysfunctional maltreatment-related cognitions. Moreover, there was an interaction effect of gender and age, with female adolescents showing most dysfunctional cognitions. Furthermore, experiencing five different maltreatment types had an impact, leading to more dysfunctional cognitions compared to single-type maltreatment. Dysfunctional maltreatment-related cognitions correlated highly with PTSS and internalizing symptoms, and moderately with externalizing symptoms. CONCLUSIONS Dysfunctional maltreatment-related cognitions are associated with psychological symptoms after maltreatment and, therefore, need to be addressed in assessment and treatment. Trial registration DRKS00003979. Registered 03 July 2012.
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Affiliation(s)
- Anke de Haan
- 0000 0004 1937 0650grid.7400.3Department of Child and Adolescent Health Psychology, University of Zurich, Zurich, Switzerland ,grid.410712.1Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Helene G. Ganser
- grid.410712.1Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Annika Münzer
- grid.410712.1Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Andreas Witt
- grid.410712.1Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Lutz Goldbeck
- grid.410712.1Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
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14
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Arslan G. Psychological maltreatment, coping strategies, and mental health problems: A brief and effective measure of psychological maltreatment in adolescents. CHILD ABUSE & NEGLECT 2017; 68:96-106. [PMID: 28427000 DOI: 10.1016/j.chiabu.2017.03.023] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 03/28/2017] [Accepted: 03/29/2017] [Indexed: 05/05/2023]
Abstract
Psychological maltreatment is an important social and public health problem and associated with a wide range of short and long-term outcomes in childhood to adulthood. Given the importance of investigating mitigating factors on its effect, the purpose of the present study is to investigate the mediating effect of active and avoidant coping strategies on the association between psychological maltreatment and mental health- internalizing and externalizing- problems in adolescents. Participants of the study consisted of 783 adolescents, ranging in age from 14 to 18 years (M=15.57, SD=0.88), with 52.9% female and 47.1% male. Several structural equation models were conducted to investigate the mediating role of coping strategies on the effect of psychological maltreatment on adolescents' internalizing and externalizing problems. Findings from mediation analyses demonstrated the mediating effect of active and avoidant coping strategies on the association between psychological maltreatment and mental health problems. The outcomes support adolescents use more avoidant coping strategies and fewer active coping strategies in the face of psychological maltreatment experiences, and this affects their mental health. Taken together, these results should contribute to the design of prevention and intervention services in order to promote mental health.
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Affiliation(s)
- Gökmen Arslan
- Department of Psychological Counseling and Guidance, Süleyman Demirel University, Isparta, Turkey.
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15
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Kangaslampi S, Punamäki RL, Qouta S, Diab M, Peltonen K. Psychosocial Group Intervention Among War-Affected Children: An Analysis of Changes in Posttraumatic Cognitions. J Trauma Stress 2016; 29:546-555. [PMID: 27859680 DOI: 10.1002/jts.22149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/08/2022]
Abstract
Cognitive theories point to reduction in dysfunctional posttraumatic cognitions (PTCs) as one mechanism involved in recovery from posttraumatic stress symptoms (PTSS), yet research findings have shown individual differences in the recovery process. We tested the cognitive mediation hypothesis above in a previously published psychosocial group intervention among war-affected children. We also examined heterogeneity in children's PTCs during the intervention. We used a cluster randomized trial of Smith et al.'s (2002) teaching recovery techniques (TRT) intervention among 482 Palestinians 10-13 years of age (n = 242 for intervention group, n = 240 for control group). Children reported PTSS, PTCs, and depressive symptoms at baseline, midpoint, postintervention, and at 6-month follow-up. Path analysis results showed that TRT was not effective in reducing dysfunctional PTCs, and the reductions did not mediate intervention effects on PTSS. Using latent class growth analysis, we chose the model with 3 differing trajectories in the intervention group: high, decreasing, moderate, downward trending, and severe, stable levels of PTCs. Higher PTSS and depressive symptoms at baseline were associated with membership in the severe, stable trajectory. The intervention did not produce the kind of beneficial cognitive change needed in the cognitive mediation conceptualization. Nevertheless, cognitive changes differed substantially across children during the intervention, and were associated with their preintervention mental health status. These findings call for more detailed examination of the process of cognitive mediation.
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Affiliation(s)
- Samuli Kangaslampi
- School of Social Sciences and Humanities / Psychology, University of Tampere, Tampere, Finland
| | - Raija-Leena Punamäki
- School of Social Sciences and Humanities / Psychology, University of Tampere, Tampere, Finland
| | - Samir Qouta
- Faculty of Education, Islamic University of Gaza, Gaza City, Palestine
| | - Marwan Diab
- Gaza Community Mental Health Programme, Gaza City, Palestine
| | - Kirsi Peltonen
- School of Social Sciences and Humanities / Psychology, University of Tampere, Tampere, Finland
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16
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Liu ST, Chen SH. A Community Study on the Relationship of Posttraumatic Cognitions to Internalizing and Externalizing Psychopathology in Taiwanese Children and Adolescents. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2016; 43:1475-1484. [PMID: 25957269 DOI: 10.1007/s10802-015-0030-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A growing number of studies indicate that posttraumatic cognitions play a crucial role in the development and maintenance of posttraumatic stress disorder (PTSD). However, the effects of posttraumatic cognitions on general psychopathology beyond PTSD remain unclear. The current study aimed to validate the Chinese version of the Child Posttraumatic Cognitions Inventory (CPTCI-C) and to investigate the relationship between posttraumatic cognitions and psychopathology. A community sample of 285 school-aged children and adolescents (aged 9-17, 160 [56.1 %] female) reported their trauma-related cognitions on the CPTCI-C and completed measures of symptoms of PTSD, depression, and generalized anxiety. Parents reported their children's internalizing and externalizing problems. We validated a revised version of the CPTCI-C based on the results of confirmatory factor analyses. The resulting evidence suggests that this revised CPTCI-C possesses good internal consistency, fair 6-week temporal stability, and good concurrent validity. In addition to significant correlations between posttraumatic cognitions and internalizing and externalizing psychopathology, after controlling for age, gender, and trauma types, both the revised CPTCI-C subscale scores conveyed unique contributions to psychological distress while only the maladaptive appraisals of the trauma remained weakly associated with externalizing problems. Structural equation modeling analysis showed that maladaptive appraisals of the trauma had a direct longitudinal impact on chronic PTSD severity. No mediation effect of posttraumatic cognitions on the relationship between acute and chronic PTSD activity was observed. The implications of our findings are discussed for the specificity of posttraumatic cognitions to posttraumatic internalizing psychopathology and cognitive interventions that target negative trauma-related cognitions.
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Affiliation(s)
- Shu-Tsen Liu
- Department of Psychology, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei, 106, Taiwan.,Department of Psychiatry, National Taiwan University Hospital Yunlin Branch, No.579, Sec. 2, Yunlin Rd., Douliou City, Yunlin County, 640, Taiwan
| | - Sue-Huei Chen
- Department of Psychology, National Taiwan University, No. 1, Sec. 4, Roosevelt Road, Taipei, 106, Taiwan.
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17
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McKinnon A, Smith P, Bryant R, Salmon K, Yule W, Dalgleish T, Dixon C, Nixon RDV, Meiser-Stedman R. An Update on the Clinical Utility of the Children's Post-Traumatic Cognitions Inventory. J Trauma Stress 2016; 29:253-8. [PMID: 27191657 DOI: 10.1002/jts.22096] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2015] [Revised: 01/15/2016] [Accepted: 02/29/2016] [Indexed: 11/06/2022]
Abstract
The Children's Post-Traumatic Cognitions Inventory (CPTCI) is a self-report questionnaire that measures maladaptive cognitions in children and young people following exposure to trauma. In this study, the psychometric properties of the CPTCI were examined in further detail with the objective of furthering its utility as a clinical tool. Specifically, we investigated the CPTCI's discriminant validity, test-retest reliability, and the potential for the development of a short form of the measure. Three samples (London, East Anglia, Australia) of children and young people exposed to trauma (N = 535; 7-17 years old) completed the CPTCI and a structured clinical interview to measure posttraumatic stress disorder (PTSD) symptoms between 1 and 6 months following trauma. Test-retest reliability was investigated in a subsample of 203 cases. The results showed that a score in the range of 46 to 48 on the CPTCI was indicative of clinically significant appraisals as determined by the presence of PTSD. The measure also had moderate-to-high test-retest reliability (r = .78) over a 2-month period. The Children's Post-Traumatic Cognitions Inventory-Short Form (CPTCI-S) had excellent internal consistency (α = .92), and moderate-to-high test-retest reliability (r = .78). The examination of construct validity showed the model had an excellent fitting factor structure (Comparative Fit index = 0.95, Tucker-Lewis index = 0.91, Root Mean Square Error of Approximation = .07). A score ranging from 16 to 18 was the best cutoff point on the CPTCI-S, in that it was indicative of clinically significant appraisals as determined by the presence of PTSD. Based on these results, we concluded that the CPTCI is a useful tool to support the practice of clinicians and that the CPTCI-S has excellent psychometric properties.
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Affiliation(s)
- Anna McKinnon
- Centre for Emotional Health, Macquarie University, Sydney, New South Wales, Australia
| | - Patrick Smith
- Institute of Psychiatry, Kings College London, Denmark Hill, London, United Kingdom
| | - Richard Bryant
- Department of Psychology, University of New South Wales, Sydney, New South Wales, Australia
| | - Karen Salmon
- School of Psychology, Victoria University of Wellington, Wellington, North Island, New Zealand
| | - William Yule
- Institute of Psychiatry, Kings College London, Denmark Hill, London, United Kingdom
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge, Cambridgeshire, United Kingdom
| | - Clare Dixon
- Department of Psychology, University of Bath, Bath, Somerset, United Kingdom
| | - Reginald D V Nixon
- School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Richard Meiser-Stedman
- Department of Clinical Psychology, University of East Anglia, Norwich, East Anglia, United Kingdom
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18
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Palosaari E, Punamäki RL, Peltonen K, Diab M, Qouta SR. Negative Social Relationships Predict Posttraumatic Stress Symptoms Among War-Affected Children Via Posttraumatic Cognitions. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 44:845-57. [DOI: 10.1007/s10802-015-0070-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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19
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Padilla Paredes P, Calvete E. Cognitive vulnerabilities as mediators between emotional abuse and depressive symptoms. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2015; 42:743-53. [PMID: 24292965 DOI: 10.1007/s10802-013-9828-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
This study tested whether childhood parental emotional abuse and peer emotional bullying serve as antecedents of depression in adolescence and identified the cognitive mechanisms involved in this process. It was hypothesized that the experience of emotional abuse would predict depressive symptoms via development of rumination and negative inferences. A 3-wave longitudinal study was carried out with 998 adolescents (471 girls and 526 boys) between 13 and 17 years of age. Results showed that emotional abuse by parents and peers at Time 1 predicted a worsening of several cognitive vulnerabilities at Time 2. In addition, brooding mediated between the experiences of abuse and the increase of depressive symptoms at Time 3. Thus, findings suggest that the experiences of childhood emotional abuse by parents and peers serve as antecedents to develop a negative cognitive style, vulnerability that, once developed, is a risk factor for the onset of depressive symptoms in adolescence.
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Affiliation(s)
- Patricia Padilla Paredes
- Department of Personality, Psychological Assessment and Treatment, University of Deusto, Apdo. 1, 48080, Bilbao, Spain,
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20
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Diehle J, de Roos C, Meiser-Stedman R, Boer F, Lindauer RJL. The Dutch version of the Child Posttraumatic Cognitions Inventory: validation in a clinical sample and a school sample. Eur J Psychotraumatol 2015; 6:26362. [PMID: 25724364 PMCID: PMC4344547 DOI: 10.3402/ejpt.v6.26362] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 12/17/2014] [Accepted: 01/26/2015] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND With the inclusion of trauma-related cognitions in the DSM-5 criteria for posttraumatic stress disorder (PTSD), the assessment of these cognitions has become essential. Therefore, valid tools for the assessment of these cognitions are warranted. OBJECTIVE The current study aimed at validating the Dutch version of the Child Posttraumatic Cognitions Inventory (CPTCI). METHOD We included children aged 8-19 years in our study and assessed the factor structure, reliability and validity of the CPTCI in a clinical sample (n=184) and a school sample (n=318). RESULTS Our results supported the two-factor structure of the CPTCI and showed good internal consistency for the total scale and the two subscales. We found significant positive correlations between the CPTCI and measures of PTSD, depression, and anxiety disorder. The CPTCI correlated negatively with a measure of quality of life. Furthermore, we found significantly higher scores in the clinical sample than in the school sample. For children who received treatment, we found that a decrease in CPTCI scores was accompanied by a decrease in posttraumatic stress symptoms and comorbid problems indicating that the CPTCI is able to detect treatment effects. CONCLUSION Overall, our results suggest that the Dutch CPTCI is a reliable and valid instrument.
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Affiliation(s)
- Julia Diehle
- Department of Child and Adolescent Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands;
| | - Carlijn de Roos
- Psychotrauma Center for Children and Adolescents, MHI Rivierduinen, Leiden, The Netherlands
| | | | - Frits Boer
- Department of Child and Adolescent Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands.,Academic Center for Child and Adolescent Psychiatry de Bascule, Amsterdam, The Netherlands
| | - Ramón J L Lindauer
- Department of Child and Adolescent Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands.,Academic Center for Child and Adolescent Psychiatry de Bascule, Amsterdam, The Netherlands
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Abstract
PURPOSE OF REVIEW We review recent evidence regarding risk factors for childhood posttraumatic stress disorder (PTSD) and treatment outcome studies from 2010 to 2012 including dissemination studies, early intervention studies and studies involving preschool children. RECENT FINDINGS Recent large-scale epidemiological surveys confirm that PTSD occurs in a minority of children and young people exposed to trauma. Detailed follow-up studies of trauma-exposed young people have investigated factors that distinguish those who develop a chronic PTSD from those who do not, with recent studies highlighting the importance of cognitive (thoughts, beliefs and memories) and social factors. Such findings are informative in developing treatments for young people with PTSD. Recent randomized controlled trials (RCTs) confirm that trauma-focused cognitive behaviour therapy (TF-CBT) is a highly efficacious treatment for PTSD, although questions remain about effective treatment components. A small number of dissemination studies indicate that TF-CBT can be effective when delivered in school and community settings. One recent RCT shows that TF-CBT is feasible and highly beneficial for very young preschool children. Studies of early intervention show mixed findings. SUMMARY Various forms of theory-based TF-CBT are highly effective in the treatment of children and adolescents with PTSD. Further work is needed to replicate and extend initial promising outcomes of TF-CBT for very young children. Dissemination studies and early intervention studies show mixed findings and further work is needed.
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22
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Sawyer C, Judd RG. Counselors and Bikers Collaborate to Empower Abused Children. JOURNAL OF CREATIVITY IN MENTAL HEALTH 2012. [DOI: 10.1080/15401383.2012.661243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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