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Zhang T, Krysinska K, Alisic E, Andriessen K. Grief Instruments in Children and Adolescents: A Systematic Review. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231171188. [PMID: 37078181 DOI: 10.1177/00302228231171188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/21/2023]
Abstract
Many children and adolescents experience the death of a close person, such as a family member or a friend. However, there is a scarcity of literature on the assessment of grief in bereaved youth. The use of validated instruments is essential to advance our knowledge of grief in children and adolescents. We conducted a systematic review, adhering to PRISMA guidelines, to identify instruments that measure grief in this population and explore their characteristics. Searches in six databases (Medline, PsycINFO, Embase, Emcare, Scopus, and Web of Science) identified 24 instruments, encompassing three categories: general-purpose grief scales, maladaptive grief scales, and specialized grief scales. We extracted data using a predetermined list of descriptive and psychometric properties. Findings indicate a need to direct research towards more stringent validation of existing instruments and the design of new instruments in line with developments in the understanding of grief in this population.
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Affiliation(s)
- Toni Zhang
- Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - Karolina Krysinska
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Eva Alisic
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Karl Andriessen
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Kim HJ, Lee DH, Kim JH, Kang SE. Validation of the Dimensions of Anger Reactions Scale (the DAR-5) in non-clinical South Korean adults. BMC Psychol 2023; 11:74. [PMID: 36927713 PMCID: PMC10019409 DOI: 10.1186/s40359-023-01084-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 02/10/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Posttraumatic anger is a commonly reported emotion among people who have experienced traumatic events. The current study aimed to demonstrate the reliability and validity of the South Korean version of the DAR-5 (DAR-5-K). The DAR-5 is a single scale with 5 items which measures posttraumatic anger. The DAR-5 is composed of five items that measure anger frequency, intensity, duration, aggression, and its interference with social relations. METHODS Data were collected from 814 South Korean adults who had experienced traumatic events and participated in the study and analyzed via the combination of exploratory factor analysis (n = 405) and confirmatory factor analysis (n = 409). RESULTS Results supported the one-factor structure, as reported in previous validation studies. The scale demonstrated robust internal reliability and concurrent validity with measures of posttraumatic stress disorder (PTSD) symptoms, depression, anxiety, and self-esteem. The DAR-5 cut-off score of 12 that was established in the original validation study successfully differentiated high from low scorers with regard to PTSD symptoms, depression, anxiety, and self-esteem. CONCLUSION The results confirm that the DAR-5-K is a brief and psychometrically robust measure of anger that can be used to examine South Korean adults who have experienced traumatic events.
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Affiliation(s)
- Hae Jin Kim
- Traumatic Stress Center, Department of Education, Sungkyunkwan University, Seoul, Republic of Korea
| | - Dong Hun Lee
- Traumatic Stress Center, Department of Education, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Jeong Han Kim
- School of Rehabilitation Services and Counseling, University of Texas-Rio Grande Valley, Edinburg, TX, USA
| | - Su-Eun Kang
- Traumatic Stress Center, Department of Education, Sungkyunkwan University, Seoul, Republic of Korea
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3
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Lee SA, Jobe MC, Mathis AA, Gibbons JA. Persistent Complex Bereavement Disorder Symptoms Predict Grief Interview Emotions. OMEGA-JOURNAL OF DEATH AND DYING 2020; 84:856-869. [PMID: 32295480 DOI: 10.1177/0030222820919013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined persistent complex bereavement disorder (PCBD) symptoms' ability to predict emotional reactions of 69 bereaved adults who participated in grief interviews. The results supported the predictive validity of PCBD symptoms for both self-report and behavioral observation measures of sadness but with only one behavioral measure of happiness. Furthermore, PCBD symptoms uniquely predicted sadness in all but one measure of that emotion while accounting for symptoms of depression, posttraumatic stress, and separation anxiety. Because interviews are the primary method of psychological evaluation for clinicians, these findings collectively support the validity of the PCBD construct.
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Affiliation(s)
- Sherman A Lee
- Department of Psychology, Christopher Newport University, Newport News, Virginia, United States
| | - Mary C Jobe
- Department of Psychology, Christopher Newport University, Newport News, Virginia, United States
| | - Amanda A Mathis
- Department of Psychology, Christopher Newport University, Newport News, Virginia, United States
| | - Jeffrey A Gibbons
- Department of Psychology, Christopher Newport University, Newport News, Virginia, United States
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Kokou-Kpolou CK, Moukouta CS, Masson J, Bernoussi A, Cénat JM, Bacqué MF. Correlates of grief-related disorders and mental health outcomes among adult refugees exposed to trauma and bereavement: A systematic review and future research directions. J Affect Disord 2020; 267:171-184. [PMID: 32217217 DOI: 10.1016/j.jad.2020.02.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/02/2020] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND With conflict driving millions of refugees away from their homes worldwide, there has been an increase in interest in the field of refugee trauma. However, while trauma and bereavement interlink, prior studies have focused on trauma and its related disorders (PTSD) and predictive factors. This paper reviewed up-to-date literature on the prevalence rates of prolonged grief disorder (PGD), its comorbidities, and associated risk factors among adult refugees. METHOD We systematically reviewed the literature using five databases (PsycINFO, PsycARTICLES, Psychology and Behavioral Sciences Collection, Academic Search Elite, and PubMed). The process of study selection was designed according to PRISMA guidelines. RESULTS The initial search generated 126 articles, of which 12 met the inclusion criteria. The pooled prevalence of PGD was 33.2% (95% CI: 15.2-54.2%). Being an older refugee, traumatic and multiple losses implying the death of first-degree relatives appeared to be consistent risk factors for PGD, combined PTSD/PGD, depression, idioms of distress, and functional impairment. PGD, PTSD, and PTSD/PGD intersect on PTSD-intrusions and painful memories. LIMITATIONS All included studies adopted a cross-sectional design, thus limiting the understanding of causal pathways. CONCLUSIONS Our findings showed that the high prevalence of PGD and related comorbidities were influenced by the load of traumatic circumstances surrounding the death(s). The findings shed light on the current proposed grief-related diagnostic criteria . Psychopathological and transcultural aspects are discussed, and we provide concrete recommendations for improvements to future research in this field.
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Affiliation(s)
| | | | - Joanic Masson
- Department of Psychology, University of Picardy Jules Verne, Amiens, France
| | - Amal Bernoussi
- Department of Psychology, University of Picardy Jules Verne, Amiens, France
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Brown EJ, Goodman RF, Cohen JA, Mannarino AP, Chaplin WF. An Exploratory Trial of Cognitive-Behavioral vs Client-Centered Therapies for Child-Mother Dyads Bereaved from Terrorism. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:113-125. [PMID: 32318234 PMCID: PMC7163875 DOI: 10.1007/s40653-019-00264-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The study was an evaluation of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen et al. 2017) with child-caregiver dyads who experienced the death of a loved one from terrorism, using a hybrid efficacy/effectiveness design in which there were no required minimum symptom levels. Forty children ages 4-17 years old whose fathers died in the line of duty on 9/11/2001 and their mothers participated in an RCT comparing TF-CBT and Client-Centered Therapy (CCT). At baseline, mothers' PTSD, depression, and prolonged grief symptoms were highly elevated, whereas children's were at normative levels. Using intent-to-treat analysis, condition-by-time interactions showed significantly greater symptom reduction for mothers receiving CBT than those receiving CCT. For the children, both treatments led to significant symptom improvements.
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Affiliation(s)
- Elissa J. Brown
- Department of Psychology, St. John’s University, Queens, NY USA
- Child HELP Partnership, St. John’s University, 152-11 Union Turnpike, Flushing, NY 11367 USA
| | - Robin F. Goodman
- Department of Psychiatry, Allegheny General Hospital, Pittsburgh, PA USA
| | - Judith A. Cohen
- Department of Psychiatry, Allegheny General Hospital, Pittsburgh, PA USA
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Geronazzo-Alman L, Fan B, Duarte CS, Layne CM, Wicks J, Guffanti G, Musa GJ, Hoven CW. The Distinctiveness of Grief, Depression, and Posttraumatic Stress: Lessons From Children After 9/11. J Am Acad Child Adolesc Psychiatry 2019; 58:971-982. [PMID: 30877043 DOI: 10.1016/j.jaac.2018.12.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 10/30/2018] [Accepted: 11/13/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The clinical and nosological significance of grief reactions in youth exposed to a shared trauma (9/11, the September 11, 2001 terrorist attacks on the United States) was tested by examining whether the predictors (ie, non-loss-related trauma versus traumatic bereavement), clinical correlates, factorial structure, and phenomenology of grief reactions are distinct from those of major depressive disorder (MDD) and 9/11-related posttraumatic stress disorder (PTSD). METHOD In a representative sample of New York City schoolchildren (N = 8,236; grades 4-12; n = 1,696 bereaved), assessed 6 months post-9/11, multivariate regressions examined predictors of grief, PTSD, and MDD, as well as the incremental validity of grief in predicting health problems and functional impairment. Factor analysis and latent class analysis determined, respectively, the factorial and the syndromic distinctiveness of grief, PTSD, and MDD. RESULTS Four types of evidence supporting the distinctiveness of grief emerged. (1) Bereavement was associated with grief independently of PTSD and MDD, but not with PTSD and MDD after adjusting for grief; conversely, non-loss related trauma was associated primarily with PTSD. (2) Grief contributed uniquely to functional impairment. (3) Grief reactions loaded on a separate factor. (4) Youth with elevated grief reactions fell into two classes characterized by only moderate and negligible probability of co-occurring PTSD and MDD symptoms, respectively. CONCLUSION A multifaceted approach provided convergent evidence that grief reactions are independent of other common types of postdisaster child and adolescent psychopathology, and capture a unique aspect of bereavement-related distress. These findings suggest that grief reactions in traumatically bereaved youth merit separate clinical attention, informing tailored interventions.
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Affiliation(s)
- Lupo Geronazzo-Alman
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY.
| | - Bin Fan
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | - Cristiane S Duarte
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | - Christopher M Layne
- UCLA-Duke University National Center for Child Traumatic Stress, Los Angeles, CA
| | - Judith Wicks
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | | | - George J Musa
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
| | - Christina W Hoven
- New York State Psychiatric Institute, Columbia University Medical Center, New York, NY
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7
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Boelen PA, Spuij M, Lenferink LIM. Comparison of DSM-5 criteria for persistent complex bereavement disorder and ICD-11 criteria for prolonged grief disorder in help-seeking bereaved children. J Affect Disord 2019; 250:71-78. [PMID: 30836282 DOI: 10.1016/j.jad.2019.02.046] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 01/25/2019] [Accepted: 02/16/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Persistent complex bereavement disorder (PCBD) is a disorder of grief that newly entered DSM-5. Prolonged grief disorder (PGD) is a disorder of grief included in ICD-11. No prior studies examined and compared the dimensionality, prevalence, and concurrent validity of both conditions among bereaved children. METHODS With data from 291 help-seeking bereaved 8-18 year old children, we used confirmatory factor analysis to evaluate the fit of different factor models for PCBD and PGD. In addition, we determined diagnostic rates for probable PCBD and PGD and calculated associations of PCBD and PGD caseness with concurrently assessed symptoms of overall disturbed grief, depression, posttraumatic stress, and parent-rated problem behavior. RESULTS For PCBD and PGD, one-factor models-with all symptoms forming a unidimensional factor of disturbed grief-fit the data best. The prevalence of probable DSM-5 PCBD (3.4%) was significantly lower than ICD-11 PGD (12.4%). Both PCBD and PGD were significantly associated with concurrently assessed overall disturbed grief, depression, and posttraumatic stress; associations with parent-rated problems were moderate. LIMITATIONS Findings were based on self-reported ratings of symptoms, obtained from three different scales not specifically designed to assess PCBD and PGD. The use of a help-seeking sample limits the generalization of findings to bereaved children generally. CONCLUSIONS Findings support the validity of DSM-5 PCBD and ICD-11 PGD. Prevalence rates of both constructs differ. This needs further scrutiny.
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Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, the Netherlands; Arq Psychotrauma Expert Group, Diemen, the Netherlands.
| | - Mariken Spuij
- Department of Child and Adolescent Studies, Utrecht University, the Netherlands
| | - Lonneke I M Lenferink
- Department of Clinical Psychology, Utrecht University, PO Box 80140, 3508 TC, Utrecht, the Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
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8
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Hill RM, Kaplow JB, Oosterhoff B, Layne CM. Understanding grief reactions, thwarted belongingness, and suicide ideation in bereaved adolescents: Toward a unifying theory. J Clin Psychol 2019; 75:780-793. [DOI: 10.1002/jclp.22731] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 10/23/2018] [Accepted: 11/04/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Ryan M. Hill
- Section of Psychology, Department of Pediatrics; Baylor College of Medicine and Texas Children's Hospital; Houston Texas
| | - Julie B. Kaplow
- Section of Psychology, Department of Pediatrics; Baylor College of Medicine and Texas Children's Hospital; Houston Texas
| | | | - Christopher M. Layne
- UCLA/Duke University National Center for Child Traumatic Stress, Department of Psychiatry and Biobehavioral Sciences; University of California; Los Angeles California
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Boelen PA, Lenferink LIM, Nickerson A, Smid GE. Evaluation of the factor structure, prevalence, and validity of disturbed grief in DSM-5 and ICD-11. J Affect Disord 2018; 240:79-87. [PMID: 30059938 DOI: 10.1016/j.jad.2018.07.041] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/01/2018] [Accepted: 07/14/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Persistent complex bereavement disorder (PCBD) is a disorder of grief included in DSM-5 Section 3. Prolonged Grief Disorder (PGD) is a disorder of grief that will enter the forthcoming ICD-11. This study evaluated the factor structure, prevalence, and validity of disturbed grief as per DSM-5 and ICD-11. METHODS With data from a community sample (N =512), we used confirmatory factor analysis (CFA) to evaluate the fit of different factor models for PCBD and PGD, determined diagnostic rates for probable PCBD and PGD, and used sensitivity/specificity analyses to evaluate the performance of individual items as indicators of PCBD and PGD. We calculated associations of PCBD-caseness and PGD-caseness with concurrently assessed symptoms of posttraumatic stress disorder (PTSD) and depression and, in a subset of 280 participants, with these same symptoms assessed one year later, to examine concurrent and predictive validity of PCBD and PGD. RESULTS For PCBD-symptoms, a three-factor model with distinct factors of separation distress, reactive distress, and social/identity disruption fit the data well; for PGD-symptoms a two-factor model with distinct separation distress symptoms and additional symptom (e.g., guilt, anger, blame) yielded acceptable model fit. Overall, items evidenced strong sensitivity and negative predictive power, and relatively poor specificity and positive predictive power. The prevalence of probable DSM-5 PCBD (6.4%) was significantly lower than the prevalence of ICD-11 PGD (18.0%). Both PCBD and PGD were significantly associated with concurrent overall grief, depression, and PTSD; PCBD but not PGD was associated with symptoms one year beyond baseline. LIMITATIONS Limitations include our reliance on self-reported data and symptoms of PCBD and PGD being derived from two questionnaires. CONCLUSIONS Findings provide preliminary evidence for the validity of both the PCBD and PGD constructs, albeit that prevalence rates of both constructs and predictive validity differ-which needs further scrutiny.
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Affiliation(s)
- Paul A Boelen
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, The Netherlands; Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands.
| | - Lonneke I M Lenferink
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, P.O. Box 80140, 3508 TC, Utrecht, The Netherlands; Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Grote Kruisstraat 2/1, 9712 TS, Groningen, The Netherlands
| | | | - Geert E Smid
- Arq Psychotrauma Expert Group, Nienoord 5, 1112 XE, Diemen, The Netherlands; Foundation Centrum '45, Nienoord 5, 1112 XE, Diemen, The Netherlands
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10
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Lee SA. Persistent complex bereavement symptoms explain impairments above depression, posttraumatic stress, and separation anxiety: an incremental validity study. DEATH STUDIES 2018; 43:634-638. [PMID: 30235066 DOI: 10.1080/07481187.2018.1509909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 02/19/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
The present study examined the incremental validity of persistent complex bereavement disorder (PCBD) symptoms using an on-line survey of 255 bereaved college students. A series of hierarchical multiple regression analyses examined the extent to which PCBD symptoms explained unique variance in different domains of life impairment, beyond symptoms of depression, posttraumatic stress, and separation anxiety. The results supported the incremental validity of PCBD symptoms for fear of future losses, sleep impairment, and work/social impairment. However, PCBD symptoms did not account for loneliness scores. These findings collectively support the validity and clinical utility of the DSM-5's PCBD construct.
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Affiliation(s)
- Sherman A Lee
- Department of Psychology, Christopher Newport University , Newport News , Virginia , USA
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Kaplow JB, Wardecker BM, Layne CM, Kross E, Burnside A, Edelstein RS, Prossin AR. Out of the Mouths of Babes: Links Between Linguistic Structure of Loss Narratives and Psychosocial Functioning in Parentally Bereaved Children. J Trauma Stress 2018; 31:342-351. [PMID: 29870081 PMCID: PMC6026046 DOI: 10.1002/jts.22293] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 11/06/2022]
Abstract
This study examined links between the language bereaved children use to describe the death of their caregiver and children's psychological/behavioral functioning and coping strategies. Participants included 44 children (54.5% male) aged 7 to 12 (M = 9.05) years who were bereaved by the death of a caregiver. Children were assessed via self- and caregiver-report measures and an in-person interview regarding the loss of their caregiver. Children's loss narratives gathered through in-person interviews were transcribed and subjected to textual analysis. Linguistic categories included pronouns and verb tense. Drawing from linguistic and self-distancing theories, we hypothesized that children's use of language reflecting self-distancing (third-person pronouns and past tense) or social connectedness (first-person plural pronouns) would be negatively associated with psychological/behavioral distress and avoidant coping. Similarly, we expected that children's use of self-focused language (first-person singular pronouns and present tense) would be positively associated with psychological/behavioral distress and avoidant coping. As hypothesized, preliminary findings suggest that children who employed more self-distancing language and used more social connectedness words reported less avoidant coping, rs = .40-.42. Also as hypothesized, children who employed more self-focused language had higher levels of self-reported posttraumatic stress symptoms, r = .54, and avoidant coping, r = .54, and higher parent-reported psychological/behavioral distress, r = .43. Implications for theory-building, risk screening, and directions for future research with bereaved youth are discussed.
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Affiliation(s)
- Julie B Kaplow
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Britney M Wardecker
- Center for Healthy Aging, Penn State University, University Park, Pennsylvania, USA
| | - Christopher M Layne
- Department of Psychiatry, University of California, Los Angeles, Los Angeles, California, USA
| | - Ethan Kross
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Amanda Burnside
- Department of Psychology, Loyola University, Chicago, Illinois, USA
| | - Robin S Edelstein
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Alan R Prossin
- Department of Psychiatry, University of Texas Health Science Center, Houston, Texas, USA
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Kaplow JB, Layne CM, Oosterhoff B, Goldenthal H, Howell KH, Wamser-Nanney R, Burnside A, Calhoun K, Marbury D, Johnson-Hughes L, Kriesel M, Staine MB, Mankin M, Porter-Howard L, Pynoos R. Validation of the Persistent Complex Bereavement Disorder (PCBD) Checklist: A Developmentally Informed Assessment Tool for Bereaved Youth. J Trauma Stress 2018; 31:244-254. [PMID: 29669184 PMCID: PMC5922782 DOI: 10.1002/jts.22277] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 12/17/2017] [Accepted: 01/05/2018] [Indexed: 11/08/2022]
Abstract
The inclusion of Persistent Complex Bereavement Disorder (PCBD) in the DSM-5 appendix signifies a call for research regarding the distinguishing features and clinical utility of proposed PCBD criteria. Rigorously constructed tools for assessing PCBD are lacking, especially for youth. This study evaluated the validity and clinical utility of the PCBD Checklist, a 39-item measure designed to assess PCBD criteria in youth aged 8 to18 years. Test construction procedures involved: (a) reviewing the literature regarding developmental manifestations of proposed criteria, (b) creating a developmentally informed item pool, (c) surveying an expert panel to evaluate the clarity and developmental appropriateness of candidate items, (d) conducting focus groups to evaluate the comprehensibility and acceptability of items, and (e) evaluating psychometric properties in 367 bereaved youth (Mage = 13.49, 55.0% female). The panel, clinicians, and youth provided favorable content validity and comprehensibility ratings for candidate items. As hypothesized, youth who met full PCBD criteria, Criterion B (e.g., preoccupation with the deceased and/or circumstances of the death), or Criterion C (e.g., reactive distress and/or social/identity disruption) reported higher posttraumatic stress and depressive symptoms than youth who did not meet these criteria, ηp2 = .07-.16. Youth who met Criterion C reported greater functional impairment than youth who did not, ηp2 = .08-.12. Youth who qualified for the "traumatic bereavement specifier" reported more frequent posttraumatic stress symptoms than youth who did not, ηp2 = .04. Findings support the convergent, discriminant, and discriminant-groups validity, developmental appropriateness, and clinical utility of the PCBD Checklist.
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Affiliation(s)
- Julie B. Kaplow
- Department of Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas, USA
| | - Christopher M. Layne
- Department of Psychiatry, University of California, Los Angeles, California, USA
| | - Benjamin Oosterhoff
- Department of Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas, USA
| | - Hayley Goldenthal
- Department of Psychology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kathryn H. Howell
- Department of Psychiatry, University of Memphis, Memphis, Tennessee, USA
| | - Rachel Wamser-Nanney
- Department of Psychological Sciences, University of Missouri-St. Louis, Missouri, USA
| | - Amanda Burnside
- Department of Psychology, Loyola University, Chicago, Illinois, USA
| | - Karen Calhoun
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Daphne Marbury
- St. John Providence Health System, Detroit, Michigan, USA
| | | | | | | | | | | | - Robert Pynoos
- Department of Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, Houston, Texas, USA
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13
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Perkins JD, Ajeeb M, Fadel L, Saleh G. Mental health in Syrian children with a focus on post-traumatic stress: a cross-sectional study from Syrian schools. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1231-1239. [PMID: 30083987 PMCID: PMC6208941 DOI: 10.1007/s00127-018-1573-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 07/30/2018] [Indexed: 12/27/2022]
Abstract
PURPOSE Studies show that conflict can negatively affect psychological health. The Syrian crisis is 8 years old and yet little is known about the impact of the conflict on the well-being of Syrians who remain. This gap was addressed by conducting an empirical study on the mental health burden of Syrian children in two areas of the country. METHODS 492 children between 8 and 15 years were randomly selected from schools in Damascus and Latakia. The incidence of psychological disorder symptoms was measured using self-report screening instruments, the Children's Revised Impact of Event Scale (CRIES-8) and the Revised Children's Anxiety and Depression Scale (RCADS-25). Simultaneously, sociodemographic and traumatic event information was collected. Binary logistic regression was used to identify factors that influence the development of post-traumatic stress disorder (PTSD) symptoms. RESULTS In our sample, 50.2% of students were internally displaced and 32.1% reported a negative experience. 60.5% of those tested had at least one probable psychological disorder with PTSD the most common (35.1%), followed by depression (32.0%), and anxiety (29.5%). Binary logistic regression indicated that PTSD symptoms were predicted by: living in Damascus [odds ratio (OR) 2.36, 95% confidence interval (CI) 1.51-3.69], being female (1.54, 1.02-2.34), having depression and anxiety (2.55, 1.48-4.40), and the negative experiences; displacement and daily warzone exposure (1.84, 1.02-3.30 and 2.67, 1.08-6.60). CONCLUSIONS Syrian children are experiencing traumatic events and war-associated daily stresses that are hugely impacting psychological well-being. Our data offer guidance for mental health providers regarding risk factors and highlights the use of the school system to reach suffering children.
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Affiliation(s)
- Jon Davis Perkins
- PMARC, University of Edinburgh, St Leonard's Land, Holyrood Road, Edinburgh, EH8 8AQ, UK.
| | - Maiss Ajeeb
- 0000 0001 2353 3326grid.8192.2Department of Counselling, Damascus University, Damascus, Syria
| | - Lina Fadel
- 0000000106567444grid.9531.eSchool of Social Sciences, Heriot-Watt University, Edinburgh, UK
| | - Ghassan Saleh
- 0000 0001 2353 3326grid.8192.2Department of Counselling, Damascus University, Damascus, Syria
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Prolonged grief and posttraumatic stress in bereaved children: A latent class analysis. Psychiatry Res 2017; 258:518-524. [PMID: 28958457 DOI: 10.1016/j.psychres.2017.09.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 09/01/2017] [Accepted: 09/01/2017] [Indexed: 11/21/2022]
Abstract
Few studies have yet examined subgroups among children (aged 8-18) confronted with the death of a close loved one, characterized by different profiles of symptoms of prolonged grief disorder (PGD) and symptoms of bereavement-related posttraumatic stress disorder (PTSD). This study sought to identify such subgroups and socio-demographic and loss-related variables associated with subgroup membership. We used data from 332 children, most of whom (> 80%) were confronted with the death of a parent, mostly (> 50%) due to illness. Latent class analysis revealed three classes of participants: a resilient class (38.6%), a predominantly PGD class (35.2%), and a combined PGD/PTSD class (26.2%). Class membership was associated with self-rated levels of depression and functional impairment, and parent-rated behavioural problems. No significant between-class differences on demographics or loss-related variables were found. The current findings of distinct classes of PGD, and PGD plus PTSD attest to the construct validity of PGD as a distinct disorder, and can inform theory building and the development of diagnostic instruments relevant to children with pervasive distress following loss.
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Addressing the Needs of Children and Youth in the Context of War and Terrorism: the Technological Frontier. Curr Psychiatry Rep 2017; 19:30. [PMID: 28447296 DOI: 10.1007/s11920-017-0786-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
This paper reviews recent literature on the mental health needs of youth in the context of war and terrorism. A human rights lens is used to explore issues of accessibility and sustainability in service utilization during times of crisis. The authors present the evolution of services over the last several decades, progressing through individual, school-based, and community-wide interventions by exploring models that focus on symptom reduction and building resilience. This paper highlights the benefits and limitations of traditional intervention methods and proposes a new frontier of intervention development and research. The authors focus on the emerging field of e-mental health services and specifically highlight the utility of virtual reality games in treating trauma-exposed youth. The rapid and easily accessible nature of e-mental health models is presented as one potential solution to barriers in accessibility that can help promote the human rights of youth exposed to war and terrorism.
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Silove D, Tay AK, Kareth M, Rees S. The Relationship of Complex Post-traumatic Stress Disorder and Post-traumatic Stress Disorder in a Culturally Distinct, Conflict-Affected Population: A Study among West Papuan Refugees Displaced to Papua New Guinea. Front Psychiatry 2017; 8:73. [PMID: 28620322 PMCID: PMC5449451 DOI: 10.3389/fpsyt.2017.00073] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 04/13/2017] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Controversy continues about the validity of the construct of complex post-traumatic stress disorder (C-PTSD). In particular, questions remain whether C-PTSD can be differentiated from post-traumatic stress disorder (PTSD) and, secondarily, other common mental disorders. The examination of these issues needs to be expanded to populations of diverse cultural backgrounds exposed to prolonged persecution. We undertake such an inquiry among a community sample of West Papuan refugees exposed to extensive persecution and trauma. METHODS We interviewed over 300 West Papuan refugees using the Refugee-Mental Health Assessment Package to record symptoms of PTSD, C-PTSD, major depressive disorder (MDD), and complex grief (CG). We used first- and second-order confirmatory factor analysis (CFA) to test aspects of the convergent and discriminant validity of C-PTSD. RESULTS The CFA analysis supported both a one-factor and two-factor model of PTSD and C-PTSD. Nested model comparison tests provide support for the parsimonious one-factor model solution. A second-order CFA model of PTSD and C-PTSD produced a poor fit. The modified three-factor multi-disorder solution combining a traumatic stress (TS) factor (amalgamating PTSD and C-PTSD), MDD, and CG yielded a good fit only after removing three CG domains (estrangement, yearning, and behavioral change), a model that produced large standardized residuals (>0.20). CONCLUSION The most parsimonious model yielded a single TS factor combining symptom domains of C-PTSD and PTSD in this culturally distinct community exposed to extensive persecution and conflict-related trauma. There may be grounds for expanding the scope of psychological treatments for refugees to encompass this wider TS response. Our findings are consistent with theoretical frameworks focusing on the wider TS reaction of refugees exposed to human rights-related traumas of mass conflict, persecution, and displacement.
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Affiliation(s)
- Derrick Silove
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Alvin Kuowei Tay
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Moses Kareth
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Susan Rees
- Psychiatry Research and Teaching Unit, Academic Mental Health Unit, Liverpool Hospital, School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
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Xu X, Hu ML, Song Y, Lu ZX, Chen YQ, Wu DX, Xiao T. Effect of Positive Psychological Intervention on Posttraumatic Growth among Primary Healthcare Workers in China: A Preliminary Prospective Study. Sci Rep 2016; 6:39189. [PMID: 27995960 PMCID: PMC5171914 DOI: 10.1038/srep39189] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 11/18/2016] [Indexed: 12/20/2022] Open
Abstract
Posttraumatic growth (PTG) is defined as positive psychological change in the wake of highly challenging circumstances. Healthcare workers in particular are more vulnerable to stressors and trauma than the general population. The current study examined the use and effectiveness of a novel positive psychological intervention based on Chinese traditional culture to improve PTG in hospital healthcare workers. The intervention was provided to 579 healthcare workers at hospitals in Guilin, Shenzhen and Xiangtan. Scores on the Posttraumatic Growth Inventory (PTGI) and its subscales were significantly higher after intervention than before (p < 0.001). Of the five aspects of PTG, the aspect of "new possibilities" benefited the most from intervention (Cohen's d = 0.45). PTG in women, nurses and college graduates increased to a greater extent than other participants after intervention. It was concluded that our novel intervention is effective at improving PTG in medical staff.
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Affiliation(s)
- Xin Xu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Mu-Li Hu
- Research Office, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Yu Song
- Research Office, People's Hospital of Hunan Province, Changsha, P. R. China
| | - Zhang-Xiu Lu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - You-Qiao Chen
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Da-Xing Wu
- Medical Psychological Center, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
| | - Tao Xiao
- Research Office, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, China
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