Exposure to traumatic events and health-related quality of life in preschool-aged children

Putative juvenile terrorists: the relationship between multiple traumatization, mental health, and expectations for reintegration among Islamic State recruited adolescent and young adult fighters

Background

In several conflicts worldwide children are recruited as fighters in irregular forces. These children need to be reintegrated into the society after the conflict. However, concurrent to various reservations in the communities, the reintegration of former child soldiers is challenged by the fact that many of the affected children were indoctrinated by the armed group and traumatized through war events. Even several years after the defeat of the terrorist organization ISIS in Iraq, systematic efforts towards the reintegration of children who had been recruited by ISIS are notably absent.

Methods

we conducted clinical interviews with a sample of N = 59 adolescents and young adults who were incarcerated for terrorism in the prisons of the Kurdistan Region of Iraq to assess levels and types of trauma exposure, PTSD, depression, readiness to reintegrate and ongoing identification with ISIS.

Results

We found high levels of PTSD and depression that were associated with trauma exposure. The subjective readiness to reintegrate into the communities was associated with trauma exposure and was mediated by depression, even after controlling for the influence of ongoing identification with the armed group.

Conclusion

The study indicates that trauma-related mental ill-health should be considered in efforts to reintegrate young former terrorists.

The relationship between negative life events and quality of life in adolescents: Mediated by resilience and social support

Background

Quality of life has become an important indicator for assessing the health care of adolescents. This study aimed to explore the relationship between negative life events and quality of life in adolescents and the potential mediating roles of resilience and social support.

Methods

A stratified cluster sampling technique was used to select 3,860 adolescents as study participants. The Adolescent Self-Rating Life Events Checklist, the Resilience Scale for Chinese Adolescents, the Social Support Rating Scale, and the Adolescent Quality of Life Scale were used by participants to rate their negative life events, resilience, social support, quality of life, respectively. The correlations between study variables were analyzed by the Pearson correlation analyses. The AMOS 26.0 software was used to explore the mediating roles of resilience and social support in negative life events and quality of life.

Results

There was a negative correlation between negative life events and quality of life (β=-0.745, P < 0.05); resilience and social support played an important mediating role in the relationship between negative life events and quality of life (β_Resilience = -0.287, P < 0.05; β_{Social support} = -0.124, P < 0.05). The emotional adjustment dimension of resilience (β = -0.285, P < 0.05) and the subjective support dimension of social support (β = -0.100, P < 0.05) played the largest mediating roles, respectively.

Conclusion

Negative life events were negatively correlated with adolescents' quality of life. Strengthening resilience and social support is expected to weaken and reduce the adverse effects of negative life events on adolescents and further maintain and improve their quality of life.

Sleep as a Moderator of Young Children's Traumatic Stress and Behavior Problems: a Treatment-Referred Sample

Empirical evidence suggests young children who have experienced trauma are at risk of developing sleep problems and behavior difficulties, but it is unclear of the specific relation between these behavioral health concerns. The primary purpose of the study is to determine whether sleep problems moderate the relation between traumatic stress and behavior problems in a sample of young children referred for treatment. A secondary purpose is to explore if sleep problems also moderate the relation between specific domains of traumatic stress (i.e., intrusion, avoidance, arousal) and behavior problems. Data from 170 preschoolers ages 3 through 5 referred for treatment were gathered at intake and utilized in this study. Results indicate sleep problems moderate the effect of overall traumatic stress on behavior problems. This statistical finding also was found with intrusive symptoms, and the moderation analyses approached significance with avoidance and arousal. Our findings highlight the importance for clinicians to assess for sleep problems when young children who have experienced trauma are referred to them for treatment, particularly if a low level of overall traumatic stress is present.

Association between Maltreatment, Positive Parent-Child Interaction, and Psychosocial Well-Being in Young Children

OBJECTIVES

To explore the prevalence of maltreatment and the combined effect of maltreatment and frequency of positive parent-child interaction on psychosocial well-being in young children in China.

STUDY DESIGN

A retrospective study was conducted in 2016 in a representative sample of 20 324 children aged 3-4 years who were newly enrolled in kindergartens in Shanghai, China. All data were collected through online platforms. Parents reported the maltreatment history of their children and completed the Strengths and Difficulties Questionnaire and the Chinese Parent-Child Interaction Scale.

RESULTS

The prevalence of parent-reported child maltreatment in Shanghai was 2.70% (95% CI, 2.38-3.05). A history of maltreatment increased the risk of total difficulties (aOR, 2.36; 95% CI, 1.39-4.03) and prosocial problems (aOR, 2.31; 95% CI, 1.37-3.91). A high frequency of positive parent-child interaction had a moderating effect on the correlation between maltreatment and prosocial problems.

CONCLUSIONS

Maltreated children had an increased risk of developing psychosocial problems, particularly those with a low frequency of positive parent-child interactions. A higher frequency of positive parent-child interactions may be associated with fewer adverse outcomes in maltreated children.

Determination of psychosocial conditions of refugee children living in society

PURPOSE

This study aims to determine the psychosocial conditions of refugee children living in society.

DESIGNS AND METHODS

This descriptive cross-sectional research which used the Socio-demographic Information Form for Children, Child Posttraumatic Stress Reaction Index (CPTS-RI), and Children's Depression Inventory (CDI) included 738 children.

RESULTS

Social factors like the educational levels and professions of their parents, as well as economic status could affect the children's level of posttraumatic stress disorder, depression, and anxiety. The regression analysis revealed that depression and anxiety explained 72% of posttraumatic stress disorder in the children studied.

PRACTICE IMPLICATIONS

Nurses should be aware that the effects of trauma on children who were exposed to war and migration can continue even after much time has passed since the war started.

Predictors of Intrusive Sexual Behaviors in Preschool-Aged Children

Intrusive sexual behaviors (ISBs) are a specific type of problematic sexual behavior characterized by the invasive nature of the acts (e.g., touching others' private parts, attempting intercourse; Friedrich, 1997). The limited amount of research on ISBs has focused on sexual abuse history as the primary predictor. However, Friedrich, Davies, Feher, and Wright (2003) found that ISBs in children up to age 12 were related to four broad conceptual factors: (a) exposure to sexual content, (b) exposure to violent behavior, (c) family adversity, and (d) child vulnerabilities. The current study sought to replicate Friedrich's study using a clinical sample of 217 preschool-aged children (ages two to six). Results supported variables from within the child vulnerabilities construct (externalizing behaviors, β_EXT = 0.032, p = 0.001), post-traumatic stress disorder (PTSD) criteria met (β_PTSD = 0.177, p = 0.02), and an inverse relationship with age (β_AGE = -0.206, p = 0.024). These results highlight the importance of considering childhood behavioral patterns and reactivity to traumatic events as correlates of ISBs in young children.

„Seefahrercamp“ – Effektivität eines kognitiv-behavioralen Behandlungsprogramms für Kinder mit Traumafolgestörungen von 5 bis 13 Jahren

Zusammenfassung. Ein traumafokussiertes kognitiv-behaviorales Behandlungsprogramm mit spielerischen Therapiebausteinen wurde für Kinder mit Traumafolgestörungen und ihre Bezugspersonen entwickelt. Untersucht wurde, ob eine Verminderung der posttraumatischen und phobischen Symptomatik sowie weiterer Verhaltensauffälligkeiten erreicht werden konnte. Die Daten von 47 Kindern im Alter von 5 bis 13 Jahren (61.7 % männlich) wurden vor und nach der Therapie sowie sechs Monate im Anschluss erhoben. Nach der Behandlung waren die selbstbeurteilten posttraumatischen und fremdbeurteilten phobischen Symptome, sowie die fremdbeurteilten Auffälligkeiten signifikant verbessert. Die Effektstärken fielen erwartungsgemäß moderat bzw. hoch aus; die Responseraten für die posttraumatischen und phobischen Symptome betrugen 70.4 % bzw. 19.2 %. Alle Kinder wiesen am Behandlungsende eine Remission der posttraumatischen Symptome auf. Das Behandlungsprogramm sollte zukünftig in randomisiert-kontrollierten Studien untersucht werden.

Childhood Abuse, Religious Involvement, and Substance Abuse Among Latino-American Men in the United States

PURPOSE

Childhood abuse/victimization and subsequent substance abuse are significant behavioral health problems among developed countries. In the United States (U.S.), however, few studies have examined whether this early trauma exacerbates adulthood substance abuse, viewed as a negative coping strategy, among Latino-American men. Furthermore, little is known about how collectivist cultural factors (i.e., ethnic identity, social support, and religious involvement), indicating potentially positive coping resources, were related to substance abuse in this largest minority-male population.

METHOD

We investigated Latino-American men (N = 1127) in a nationally representative U.S. sample, using logistic regression analysis adjusting known demographic and acculturation correlates.

RESULTS

The results identified considerably elevated rates of childhood physical abuse/victimization (35.7 %) and lifetime substance abuse (17.3 %). Childhood physical (not sexual) abuse/victimization was positively associated with lifetime substance abuse, alongside age, being U.S.-born, and perceived discrimination. Latino-American men with lifetime substance abuse reported more religious coping.

CONCLUSION

Findings may contribute to the design of culturally competent behavioral care.

HRQoL impact of stressful life events in children beginning primary school: results of a prospective study in Poland

Purpose

To evaluate the relationship between recent stressful life events (SLEs), stress-related symptoms (SRSs), and health-related quality of life (HRQoL) in children beginning primary school.

Methods

A community-based sample of 6- to 8-year-old children (176 boys and 175 girls at baseline) participated in a prospective longitudinal study with three waves of data collection and 1-year interval between subsequent surveys, conducted in the Wielkopolska Province, Poland. Main exposures included nine recent stressful life events and psychosomatic and behavioural symptoms related to stress (SRSs), both self-reported by children. The outcome was total HRQoL assessed by a Polish version of the PedsQL™ 4.0 (Pediatric Quality of Life Inventory) Generic Core Scales questionnaire, 5- to 7-year-old version. To evaluate the relationship between total HRQoL and predictor variables, a latent growth curve (LGC) model using multiple group design (boys and girls) with three waves and two time-varying covariates, the SLEs and SRSs, was applied.

Results

An unconditional multi-group LGC model revealed that the total HRQoL changed over time in a linear trajectory. After incorporating to the model, two time-varying covariates, SLEs and SRSs, the first predictor for HRQoL was only significant at the last wave in girls and at two subsequent waves, except for baseline, in boys. The second predictor revealed significant negative impacts on HRQoL over the entire period of time in both boys and girls suggesting that the pathway underlying the association of SLEs with HRQoL may be mediated by SRSs. Mean values of HRQoL at each time points did not show gender differences.

Conclusions

The findings of the present study may help to develop and implement a health and safety protection training programmes addressed to parents, caregivers, and practitioners to make children’s lives easier.

Stepped care versus standard trauma-focused cognitive behavioral therapy for young children

BACKGROUND

To compare the effectiveness and cost of stepped care trauma-focused cognitive behavioral therapy (SC-TF-CBT), a new service delivery method designed to address treatment barriers, to standard TF-CBT among young children who were experiencing posttraumatic stress symptoms (PTSS).

METHODS

A total of 53 children (ages 3-7 years) who were experiencing PTSS were randomly assigned (2:1) to receive SC-TF-CBT or TF-CBT. Assessments by a blinded evaluator occurred at screening/baseline, after Step One for SC-TF-CBT, posttreatment, and 3-month follow-up.

TRIAL REGISTRATION

ClinicalTrials.gov: https://www.clinicaltrials.gov/ct2/show/NCT01603563.

RESULTS

There were comparable improvements over time in PTSS and secondary outcomes in both conditions. Noninferiority of SC-TF-CBT compared to TF-CBT was supported for the primary outcome of PTSS, and the secondary outcomes of severity and internalizing symptoms, but not for externalizing symptoms. There were no statistical differences in comparisons of changes over time from pre- to posttreatment and pre- to 3-month follow-up for posttraumatic stress disorder diagnostic status, treatment response, or remission. Parent satisfaction was high for both conditions. Costs were 51.3% lower for children in SC-TF-CBT compared to TF-CBT.

CONCLUSIONS

Although future research is needed, preliminary evidence suggests that SC-TF-CBT is comparable to TF-CBT, and delivery costs are significantly less than standard care. SC-TF-CBT may be a viable service delivery system to address treatment barriers.

A preliminary examination of child well-being of physically abused and neglected children compared to a normative pediatric population

Federal mandates require state child welfare systems to monitor and improve outcomes for children in three areas: safety, permanency, and well-being. Research across separate domains of child well-being indicates maltreated children may experience lower pediatric health-related quality of life (HRQL). This study assessed well-being in maltreated children using the Pediatric Quality of Life Inventory (PedsQL 4.0), a widely used measure of pediatric HRQL. The PedsQL 4.0 was used to assess well-being in a sample of children (N = 129) receiving child welfare services following reports of alleged physical abuse or neglect. We compared total scores and domain scores for this maltreated sample to those of a published normative sample. Within the maltreated sample, we also compared well-being by child and family demographic characteristics. As compared with a normative pediatric population, maltreated children reported significantly lower total, physical, and psychosocial health. We found no significant differences in total and domain scores based on child and parent demographics within the maltreated sample. This preliminary exploration indicates children receiving child welfare services have significantly lower well-being status than the general child population and have considerable deficits in social and emotional functioning. These findings support continued investment in maltreatment prevention and services to improve the well-being of victims of maltreatment.

Health, emergency department use, and early identification of young children exposed to trauma

BACKGROUND

Childhood trauma is an important public health problem with financial, physical health, and mental health repercussions. Emergency departments (EDs) are often the first point of contact for many young children affected by emotionally or psychologically traumatic events (e.g., neglect, separation from primary caregiver, maltreatment, witness to domestic violence within the family, natural disasters).

STUDY OBJECTIVES

Describe the prevalence of physical health symptoms, ED use, and health-related problems in young children (birth through 5 years) affected by trauma, and to predict whether or not children experiencing trauma are more likely to be affected by health-related problems.

METHODS

Community-based, cross-sectional survey of 208 young children. Traumatic events were assessed by the Traumatic Events Screening Inventory - Parent Report Revised. Child health symptoms and health-related problems were measured using the Caregiver Information Questionnaire, developed by ORC Macro (Atlanta, GA).

RESULTS

Seventy-two percent of children had experienced at least one type of traumatic event. Children exposed to trauma were also experiencing recent health-related events, including visits to the ED (32.2%) and the doctor (76.9%) for physical health symptoms, and recurring physical health problems (40.4%). Children previously exposed to high levels of trauma (four or more types of events) were 2.9 times more likely to report having had recently visited the ED for health purposes.

CONCLUSIONS

Preventing recurrent trauma or recognizing early trauma exposure is difficult, but essential if long-term negative consequences are to be mitigated or prevented. Within EDs, there are missed opportunities for identification and intervention for trauma-exposed children, as well as great potential for expanding primary and secondary prevention of maltreatment-associated illness, injury, and mortality.