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Lennon T, Kemal S, Heffernan ME, Bendelow A, Sheehan K, Davis MM, Macy ML. Childhood Exposure to Firearm Violence in Chicago and Its Impact on Mental Health. Acad Pediatr 2024; 24:982-986. [PMID: 38101617 DOI: 10.1016/j.acap.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/30/2023] [Accepted: 12/07/2023] [Indexed: 12/17/2023]
Abstract
OBJECTIVE To describe how often Chicago children are exposed to firearm violence, the types of exposure, and the parent-reported impact of these exposures on child mental health symptoms. METHODS Data were collected in May-July 2022 using the Voices of Child Health in Chicago Parent Panel Survey, administered to parents with children aged 2-17 years from all 77 Chicago neighborhoods. Firearm violence exposure was characterized as indirect (hearing gunshots or knowing someone who was shot) or direct (witnessing a shooting, being threatened with a firearm, being shot at but not injured, or being shot and injured). Parents indicated if children in their household had any of the following mental health symptoms associated with firearm violence exposure: fear, anxiety, sadness, isolation, difficulty concentrating, difficulty in school, or aggression. Chi-squared tests and multivariable logistic regression models were used for statistical analysis. RESULTS Responses were received from 989 Chicago parents. More than one third (37%) of children were exposed to firearm violence with an indirect exposure prevalence of 32% and a direct exposure prevalence of 10%. Mental health symptoms associated with firearm violence exposure were reported for 20% of children. Mental health symptoms were reported for 7% of children without firearm violence exposure compared to 31% with indirect exposure (aOR 6.2, 95% CI: 3.7, 10.6) and 68% with direct exposure (aOR 36.1, 95% CI: 16.6, 78.6) CONCLUSIONS: Chicago children with indirect and direct exposure to firearm violence had more parent-reported mental health symptoms than unexposed children. Trauma informed care approaches to mitigate the negative mental health effects of both direct and indirect firearm violence exposure are critical.
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Affiliation(s)
- Tyler Lennon
- Division of Emergency Medicine (T Lennon, S Kemal, K Sheehan, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Ill.
| | - Samaa Kemal
- Division of Emergency Medicine (T Lennon, S Kemal, K Sheehan, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Ill
| | - Marie E Heffernan
- Smith Child Health Outcomes, Research, and Evaluation Center (ME Heffernan and ML Macy), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Ill
| | - Anne Bendelow
- Data Analytics and Reporting (A Bendelow), Ann & Robert H. Lurie Children's Hospital of Chicago, Ill
| | - Karen Sheehan
- Division of Emergency Medicine (T Lennon, S Kemal, K Sheehan, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Ill
| | - Matthew M Davis
- Division of Advanced General Pediatrics and Primary Care (MM Davis), Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Ill
| | - Michelle L Macy
- Division of Emergency Medicine (T Lennon, S Kemal, K Sheehan, and ML Macy), Ann & Robert H. Lurie Children's Hospital of Chicago, Ill; Smith Child Health Outcomes, Research, and Evaluation Center (ME Heffernan and ML Macy), Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Ill
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2
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Onyeka OC, Spencer SD, Salloum A, Jiannetto K, Storch EA. The role of family accommodation in child posttraumatic stress symptoms and functional impairment in the context of cognitive behavioral therapy. J Affect Disord 2024; 346:252-259. [PMID: 37924982 PMCID: PMC10843667 DOI: 10.1016/j.jad.2023.10.144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/21/2023] [Accepted: 10/25/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Caregiver behaviors such as family accommodation (FA) are negatively reinforced by reduced distress in the short term, but ultimately maintain symptoms. It is important to explore the role of FA on symptoms and impairment. The current study examined the relationship among FA, posttraumatic stress symptoms (PTSS), and functional impairment in a sample of children and their caregivers who completed trauma treatment. METHOD Participants included 183 children and their caregivers (M age = 7.89; 55.19 % female; 73.22 % non-Hispanic; 51.37 % White). Data consisted of parent-reported measures collected at baseline, post-treatment, and 12-month follow-up from a randomized control trial (RCT) comparing Stepped Care CBT for Children after Trauma and Trauma-Focused Cognitive Behavior Therapy (TF-CBT). Correlational, mediation, and hierarchical linear regression analyses were conducted to test the interrelationships among FA, child PTSS, and child functional impairment. RESULTS FA was significantly, positively associated with total PTSS and functional impairment at baseline. Baseline FA partially mediated the relationship between baseline total PTSS and baseline functional impairment. Lastly, greater pre- to post-treatment changes in FA were mostly associated with relevant outcome variables at post-treatment and 12-month follow-up. LIMITATIONS Study limitations include use of a single informant, cross-sectional data analysis, lack of differentiation among trauma types, concerns regarding generalizability. CONCLUSION Assessing FA may be a helpful tool in better understanding how child PTSS relates to functional impairment following exposure to trauma. This study is clinically relevant it offers insight on the relationship among FA, PTSS, and functional impairment for families involved in trauma treatment.
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Affiliation(s)
- Ogechi Cynthia Onyeka
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Samuel D Spencer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Alison Salloum
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Katie Jiannetto
- School of Social Work, University of South Florida, Tampa, FL, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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3
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Kemal S, Nwabuo A, Hoffmann J. Mental Health and Violence in Children and Adolescents. Pediatr Clin North Am 2023; 70:1201-1215. [PMID: 37865440 DOI: 10.1016/j.pcl.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2023]
Abstract
This article examines the complex interplay between mental health and violence among children. Although children with mental illness are more likely to be victims of violence than perpetrators, this article describes the few mental health conditions associated with increased violent behavior among children. Next, the authors examine the spectrum of mental health sequelae among children following exposure to various forms of violence. Lastly, the authors discuss the underutilization of mental health services in this population and highlight screening and intervention tools available to pediatric clinicians caring for children exposed to violence.
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Affiliation(s)
- Samaa Kemal
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL 60611, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611, USA.
| | - Adaobi Nwabuo
- Department of Psychiatry and Behavioral Sciences, University of California Davis Health, 2230 Stockton Boulevard, Sacramento, CA 95817, USA
| | - Jennifer Hoffmann
- Division of Emergency Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 62, Chicago, IL 60611, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, 420 East Superior Street, Chicago, IL 60611, USA
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4
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Ramsli EG, Skar AMS, Skylstad V, Sjöblom D, Gread Z, Chiong W, Engebretsen IMS. Child and Caregiver Reporting on Child Maltreatment and Mental Health in the Philippines Before and After an International Child Development Program (ICDP) Parenting Intervention. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:247-258. [PMID: 37234832 PMCID: PMC10205937 DOI: 10.1007/s40653-022-00483-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2022] [Indexed: 05/28/2023]
Abstract
Child maltreatment is a serious problem affecting millions of children. Research on self-reporting of child maltreatment has shown a difference in reporting between caregivers and children. Increased understanding of this has implications for further evaluations of parenting programmes and assessment of violence and maltreatment. The purpose of this study was to explore caregiver-child reporting discrepancies on child maltreatment and emotional health before and after piloting of the International Child Development Program (ICDP) in the Philippines. Data was collected from caregivers and their children before and after caregiver participation in ICDP. Participants were selected from the Pantawid Pamilyang Pilipino Program in Leyte by Save the Children. Caregivers and children completed a questionnaire with some adapted items from the Conflict Tactics Scale Parent-Child version (CTSPC), some relevant complementary items on psychological aggression and items from the emotional problems subscale from the Strength and Difficulties Questionnaire (SDQ). Matching items, subscales and total count scores were compared using paired t-tests in STATA 14. Forty-six caregivers and 43 children aged from 5-13 years participated at baseline, and 44 caregivers and 42 children at endline. At baseline, children reported significantly more maltreatment than their caregivers. The groups reported similarly at baseline and endline on the items from the subscale on emotional problems. Both children and caregivers had lower scores on our harsh discipline scale at endline, indicating improved parenting strategies after the intervention. These results indicate a difference in reporting of child maltreatment between caregivers and children, with higher rates reported by the children before the intervention, but not after. This is important because it illustrates child and caregiver perspectives on maltreatment, and how they can differ. As such, our findings point towards a positive effect of ICDP on parenting.
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Affiliation(s)
- Emil Graff Ramsli
- Centre for International Health (CIH), Department of Global Public Health and Primary Care (IGS), Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Ane-Marthe Solheim Skar
- Centre for International Health (CIH), Department of Global Public Health and Primary Care (IGS), Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
- The Norwegian Centre for Violence and Traumatic Stress Studies (NKVTS), Oslo, Norway
| | - Vilde Skylstad
- Centre for International Health (CIH), Department of Global Public Health and Primary Care (IGS), Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Disa Sjöblom
- Save the Children Finland (SCF), Helsinki, Finland
| | - Zenona Gread
- Save the Children Philippines (SCP), Manila, Philippines
| | - Wayomi Chiong
- Save the Children Philippines (SCP), Manila, Philippines
| | - Ingunn Marie S. Engebretsen
- Centre for International Health (CIH), Department of Global Public Health and Primary Care (IGS), Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
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Skandsen A, Sand L, Teicher MH, Heradstveit O, Bøe T. Exposure to potentially traumatic events and PTSD symptomatology in Norwegian 11-13-year-olds: results from the Bergen Child Study. Child Adolesc Psychiatry Ment Health 2023; 17:32. [PMID: 36870995 PMCID: PMC9985863 DOI: 10.1186/s13034-023-00578-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 02/13/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Exposure to potentially traumatic experiences (PTEs) is common among children and adolescents, but relatively little is known about the epidemiology of trauma and trauma-related psychopathology in children and youth. The present cross- sectional epidemiological study aimed to explore factors that is associated with posttraumatic stress symptoms (PTSS) in children. METHOD Data stem from the Bergen Child Study, a series of cross-sectional multi-phase surveys of children born between 1993 and 1995 in Bergen, Norway. The sample used is from the second wave of the Bergen Child Study (BCS) conducted in 2006, a two-phase study. The study entailed a detailed psychiatric evaluation using the Development and well-being assessment (DAWBA). The DAWBA was administered to parents or caregivers and covered diagnostic areas, child and family background, and child strengths. A total of 2043 parents participated. RESULTS Out of the total sample, parents reported that 4.8% children had experienced PTEs at some point in their lives. The findings revealed current PTSS in 30.9% of children exposed to PTE, which was 1.5% of the total sample. None of the parents reported PTSS in their children over the threshold for diagnosing posttraumatic stress disorder (PTSD). The most common PTSS cluster was arousal reactivity (90.0%), followed by negative cognitions and mood (80%). The least frequent symptom cluster was intrusions (63.3%) and avoidance (60%). Children with PTSS were reported to live in families with significantly more family stressors (p = 0.001, d = 0.8) and had utilized significantly more sources for help relative to those without PTSS (p = 0.001, d = 0.75). CONCLUSION The present population study on children revealed a lower prevalence rate of PTEs and PTSD than previous studies. It provided findings in the field of trauma on parent- reported PTSS and PTSD symptom clusters not restricted to the clinical level of PTSD. Lastly, it highlighted how family-life stressors and support differed between those who had PTSS and those with no PTSS.
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Affiliation(s)
- Annika Skandsen
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway. .,Stavanger University Hospital, Gerd Ragna Bloch Thorsens Gate 25, Stavanger, Norway.
| | - Liv Sand
- Stavanger University Hospital, Gerd Ragna Bloch Thorsens Gate 25, Stavanger, Norway
| | - Martin H Teicher
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.,Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, MA, USA
| | - Ove Heradstveit
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway.,Alcohol & Drug Research, Stavanger University Hospital, Stavanger, Norway
| | - Tormod Bøe
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway.,Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
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6
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Berman IS, McLaughlin KA, Tottenham N, Godfrey K, Seeman T, Loucks E, Suomi S, Danese A, Sheridan MA. Measuring early life adversity: A dimensional approach. Dev Psychopathol 2022; 34:499-511. [PMID: 35314009 PMCID: PMC7613038 DOI: 10.1017/s0954579421001826] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Exposure to adversity in childhood is associated with elevations in numerous physical and mental health outcomes across the life course. The biological embedding of early experience during periods of developmental plasticity is one pathway that contributes to these associations. Dimensional models specify mechanistic pathways linking different dimensions of adversity to health and well-being outcomes later in life. While findings from existing studies testing these dimensions have provided promising preliminary support for these models, less agreement exists about how to measure the experiences that comprise each dimension. Here, we review existing approaches to measuring two dimensions of adversity: threat and deprivation. We recommend specific measures for measuring these constructs and, when possible, document when the same measure can be used by different reporters and across the lifespan to maximize the utility with which these recommendations can be applied. Through this approach, we hope to stimulate progress in understanding how particular dimensions of early environmental experience contribute to lifelong health.
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Affiliation(s)
- Ilana S. Berman
- Frank Porter Graham Child Development Institute, University of North Carolina at Chapel Hill
| | | | | | - Keith Godfrey
- MRC Lifecourse Epidemiology Centre and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust
| | - Teresa Seeman
- David Geffen School of Medicine, University of California Los Angeles
| | - Eric Loucks
- School of Public Health, Mindfulness Center, Brown University
| | - Stephen Suomi
- Eunice Kennedy Shriver National Institute of Child Health & Human Development
| | - Andrea Danese
- Department of Child and Adolescent Psychiatry, King’s College London
| | - Margaret A. Sheridan
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
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7
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Gindt M, Fernandez A, Zeghari R, Ménard ML, Nachon O, Richez A, Auby P, Battista M, Askenazy F. A 3-year retrospective study of 866 children and adolescent outpatients followed in the Nice Pediatric Psychotrauma Center created after the 2016 mass terror attack. Front Psychiatry 2022; 13:1010957. [PMID: 36569628 PMCID: PMC9772007 DOI: 10.3389/fpsyt.2022.1010957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 11/22/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The mass terrorist attack in Nice, France, in July 2016 caused deaths and injuries in a local population, including children and adolescents. The Nice Pediatric Psychotrauma Center (NPPC) was opened to provide mental health care to the pediatric population (0-18 years) who experienced traumatic events. OBJECTIVES This study describes the specificity of the care pathway for young trauma victims, with an explanation of how the NPPC works during the first three years. METHODS In this retrospective study, we conducted quantitative and qualitative data collection about new and follow-up consultations, primary and comorbid diagnoses, and the kind of trauma (terrorist attack versus other kinds of trauma). Ethics approval was obtained from the local Ethics committee. RESULTS 866 children and adolescents were followed in the NPPC. We found a high rate of Post-Traumatic Stress Disorder (PTSD; 71%) in this population with a high rate of comorbidities (67%), mainly sleep disorders (34.7%) and mood and anxiety disorders (16.2%). A high number of children and adolescents impacted by the terrorist attack required follow-up consultations after exposure to the mass terrorist attack, the first care-seeking requests continued to occur three years later, although at a slower rate than in the first and second years. New consultations for other kinds of trauma were observed over time. DISCUSSION This study supports previous findings on the significant impact of mass trauma in the pediatric population showing even a higher level of PTSD and a high rate of comorbidities. This may be explained by the brutality of the traumatic event, particularly for this age group. The findings of this study have implications for early interventions and long-term care for children and adolescents to prevent the development of chronic PTSD into adulthood.
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Affiliation(s)
- Morgane Gindt
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Arnaud Fernandez
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Radia Zeghari
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Marie-Line Ménard
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Ophelie Nachon
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Aurélien Richez
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Philippe Auby
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France
| | - Michele Battista
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
| | - Florence Askenazy
- Service Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, Hôpitaux Pédiatriques de Nice Centre Hospitalier Universitaire-Lenval, Nice, France.,Université Côte d'Azur, CoBTek, Fédération de Recherche Interventions en Santé, Nice, France.,Centre Expert du Psychotrauma Provence Alpes Côte d'Azur Corse, Nice, France
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