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Marini A, Farmakopoulou I, Dritsas I, Gkintoni E. Clinical Signs and Symptoms of Anxiety Due to Adverse Childhood Experiences: A Cross-Sectional Trial in Adolescents. Healthcare (Basel) 2024; 12:1515. [PMID: 39120218 PMCID: PMC11311440 DOI: 10.3390/healthcare12151515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 06/12/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) are linked to the development of anxiety in adolescence. According to recent studies, the COVID-19 pandemic represents a novel ACE that is associated with anxiety among adolescents. This study investigates the relationship between ACEs, COVID-19, and anxiety in adolescents. METHODS A cross-sectional study was conducted using a community sample of 248 boys and girls ages 12 to 15 years (mean = 13.50 years) from five high schools in Eastern Attica. A total of four questionnaires were used: (1) Demographic Questionnaire, (2) State-Trait Anxiety Inventory for Children-STAIC, (3) Adverse Childhood Experiences Scale, and (4) COVID-19 Impact Scale. RESULTS The results demonstrated a moderate association between the total number of ACEs and anxiety (trait and state) in adolescence (trait anxiety: ρ = 0.37, p < 0.001; state anxiety: ρ = 0.29, p < 0.001). Girls scored significantly higher than boys on both trait anxiety (U = 4353, p < 0.001; mean difference = 5.5) and state anxiety (U = 5822.5, p = 0.014; mean difference = 2). The number of ACEs was found to be significantly related to the impact of COVID-19 (β = 0.025, p < 0.001). CONCLUSIONS This study highlights the significant link between ACEs and increased anxiety in adolescents, which is further exacerbated by the COVID-19 pandemic. The findings indicate that girls are more affected than boys. These results emphasize the need for targeted mental health interventions to enhance coping mechanisms, reduce stress, and address anxiety in adolescents, particularly during global crises like the pandemic. Developing such programs is essential for supporting the mental well-being of youth facing multiple stressors.
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Affiliation(s)
| | - Ignatia Farmakopoulou
- Department of Education and Social Work, University of Patras, 26504 Patras, Greece; (I.F.); (I.D.)
| | - Ioannis Dritsas
- Department of Education and Social Work, University of Patras, 26504 Patras, Greece; (I.F.); (I.D.)
| | - Evgenia Gkintoni
- Department of Psychiatry, University General Hospital of Patras, 26504 Patras, Greece
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Hooshyari Z, Mohammadi MR, Salmanian M, Ahmadi N, Khaleghi A, Garakani A. Lifetime prevalence, comorbidities, and Sociodemographic predictors of post-traumatic stress disorder (PTSD): the National Epidemiology of Iranian Children and adolescents Psychiatric disorders (IRCAP). Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02441-7. [PMID: 38656607 DOI: 10.1007/s00787-024-02441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVE The aims of this study were to (a) evaluate the lifetime prevalence of post-traumatic stress disorder (PTSD) according to sociodemographic characteristics, (b) determine sociodemographic factors associated with PTSD, (c) estimate the lifetime prevalence rates of comorbidities by age and gender, and (d) assess the proportion of traumatic events in the non-PTSD sample and the PTSD sample, according to gender. METHODS The data used for the present study were obtained from the IRCAP study which was a cross-sectional, community-based study on 29,250 children and adolescents aged 6-18 years from all provinces of Iran, which was done using multistage cluster sampling. Trained psychologists conducted diagnostic interviews with parents, children, and adolescents using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). RESULTS In this study, the prevalence of PTSD across the sample population was 0.6% (95% CI, 0.5-0.7%). Higher rates of PTSD were observed among girls (0.7%, CI 0.5-0.8%), adolescents aged 15-18 years (0.8%, CI 0.6-1.0%), and participants who had unemployed (1.5%, CI 0.8-2.8%), or farmer fathers (1.1%, CI 0.5-2.5%). Of the participants with PTSD, 65.1% met the criteria for at least one other psychiatric disorder. PTSD had a high rate of comorbidity with oppositional defiant disorder (22.9%, CI 17.5-29.4%), generalized anxiety disorder (20.8%, CI 15.7-27.1%), separation anxiety disorder (20.3%, CI 15.2-26.6%), and major depressive disorder (19.8%, CI 14.8-26.0%). We found 9.5% of non-PTSD sample experienced at least one traumatic event. Witness to domestic violence was the most common traumatic event experienced by 32.8% of PTSD sample. CONCLUSION Our results in the prevalence, comorbidities, and sociodemographic factors associated with PTSD supported findings of previous studies that used a structured diagnostic interview. It is recommended to use purposive sampling and to investigate comorbidities of PTSD and type of traumatic events in a large clinical population.
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Affiliation(s)
- Zahra Hooshyari
- School of Psychology and Educational Sciences, University of Tehran, Tehran, Iran
| | - Mohammad Reza Mohammadi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Salmanian
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nastaran Ahmadi
- Yazd Cardiovascular Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Khaleghi
- Psychiatry and Psychology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Garakani
- Department of Psychiatry, Yale School of Medicine, New Haven, Connecticut, United States of America
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Wang N, Chung MC, Zhang J, Fang S. Network analysis on the relationship between posttraumatic stress disorder, psychiatric co-morbidity and posttraumatic growth among Chinese adolescents. J Affect Disord 2022; 309:461-470. [PMID: 35513114 DOI: 10.1016/j.jad.2022.04.148] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/14/2021] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND This study investigated the association between posttraumatic stress disorder (PTSD), psychiatric co-morbidity and posttraumatic growth (PTG) among Chinese adolescents using network analysis. METHODS 867 Chinese adolescents (male = 424, female = 443) were recruited from three secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Posttraumatic Growth Inventory, and the General Health Questionnaire-28. RESULTS Domains of each construct mainly clustered within their respective communities with several bridging edges identified. The prominent roles of bridging nodes and edges (positive and negative) were highlighted. Key bridging nodes were negative alterations in cognitions and mood for PTSD, anxiety and insomnia for psychiatric co-morbidity and appreciation of life for PTG. LIMITATIONS The cross-sectional nature of the present study may preclude the identification of real causal relationships between nodes. CONCLUSIONS Following a trauma, adolescents displayed posttraumatic stress along with general psychological disorder symptoms. These distress reactions could affect the way they appreciated life and their motivation to seek future life possibilities. Findings from the current study may provide some clue for the facilitation of posttraumatic growth among clinical patients.
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Affiliation(s)
- Na Wang
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong
| | - Man Cheung Chung
- Department of Psychology, Zayed University, Dubai, United Arab Emirates
| | - Jieting Zhang
- College of Psychology, Shenzhen University, Shenzhen, China
| | - Siqi Fang
- Department of Social and Behavioral Sciences, City University of Hong Kong, Hong Kong.
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Rasmussen A, Leon M, Elklit A. Cross-Cultural Measurement Invariance of the Harvard Trauma Questionnaire Across Nine Adolescent Samples. Assessment 2022:10731911221101912. [PMID: 35699448 DOI: 10.1177/10731911221101912] [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: 11/17/2022]
Abstract
Trauma researchers often make claims about the severity of posttraumatic stress disorder (PTSD) across populations, and yet cross-cultural measurement invariance (MI) is rarely assessed. Nine youth samples with Harvard Trauma Questionnaire (HTQ) responses were grouped based on sampling strategy used into two sets: representative (Denmark, the Faroe Islands, Iceland, and Lithuania, n = 1,457), and convenience (Greenland, India, Kenya, Malaysia, and Uganda, n = 2,036). Confirmatory factor analysis (CFA) was used to gauge whether configural, metric, scalar, and residual invariance of different models held between national samples within the two sets. Configural invariance held for most PTSD models in convenience samples, not in representative samples. Metric invariance was less common, and scalar and residual in general did not hold. Cultural similarity between samples seemed to be associated with invariance. Findings suggest that although PTSD symptoms may cluster similarly across culturally distal groups, comparisons of the severity of symptoms using the HTQ across adolescent samples are not likely valid.
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Affiliation(s)
| | | | - Ask Elklit
- University of Southern Denmark, Odense, Denmark
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5
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Parenting revisited: Profiles and associations with psychological distress among traumatized Chinese adolescents. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01411-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Chung MC, Chen ZS. The Interrelationship Between Child Abuse, Emotional Processing Difficulties, Alexithymia And Psychological Symptoms Among Chinese Adolescents. J Trauma Dissociation 2021; 22:107-121. [PMID: 32673192 DOI: 10.1080/15299732.2020.1788689] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This study examined the interrelationship between child abuse, emotional processing difficulties, alexithymia, and psychological symptoms with posttraumatic stress disorder (PTSD) symptoms from past traumas adjusted among Chinese adolescents. Eight hundred adolescents completed questionnaires measuring the preceding psychological constructs. After controlling for PTSD from past trauma, structural equation modeling showed that child abuse correlated with emotional processing difficulty which correlated with alexithymia. In turn, alexithymia correlated with psychological symptom severity. To conclude, child abuse can affect psychological health among Chinese adolescents. This relationship, however, is influenced by the degree to which processing distressing emotions and getting in touch with internal feelings is avoided.
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Affiliation(s)
- Man Cheung Chung
- Department of Educational Psychology, Ho Tim Building, Faculty of Education, The Chinese University of Hong Kong , Shatin, Hong Kong
| | - Zhuo Sheng Chen
- China University of Political Science and Law , Beijing, China
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Wang N, Chung MC, Wang Y. The relationship between posttraumatic stress disorder, trauma centrality, posttraumatic growth and psychiatric co-morbidity among Chinese adolescents. Asian J Psychiatr 2020; 49:101940. [PMID: 32065961 DOI: 10.1016/j.ajp.2020.101940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/09/2020] [Accepted: 02/08/2020] [Indexed: 10/25/2022]
Abstract
This study examined the inter-relationship between posttraumatic stress disorder (PTSD) from past trauma, psychiatric co-morbidity, trauma centrality and posttraumatic growth (PTG) among Chinese adolescents. Nine hundred and forty-eight Chinese adolescents (M = 462, F = 486) were recruited from two secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Centrality of Events Scale, the Posttraumatic Growth Inventory, the General Health Questionnaire-28, and the Educational Stress Scale for Adolescents. After controlling for demographic variables and levels of academic stress, structural equation modeling showed that PTSD was positively associated with trauma centrality and psychiatric co-morbidity but negatively associated with posttraumatic growth. Trauma centrality mediated the impacts of PTSD on posttraumatic growth and psychiatric co-morbidity. To conclude, PTSD from past trauma could impact adolescents' ways of perceiving positive aspects of their trauma and psychological well-being. Such impact, however, was influenced by the changes in their self-concept.
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Affiliation(s)
- Na Wang
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Man Cheung Chung
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong.
| | - Yabing Wang
- Department of Educational Psychology, The Chinese University of Hong Kong, Hong Kong.
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Doric A, Stevanovic D, Stupar D, Vostanis P, Atilola O, Moreira P, Dodig-Curkovic K, Franic T, Davidovic V, Avicenna M, Noor M, Nussbaum L, Thabet A, Ubalde D, Petrov P, Deljkovic A, Antonio ML, Ribas A, Oliveira J, Knez R. UCLA PTSD reaction index for DSM-5 (PTSD-RI-5): a psychometric study of adolescents sampled from communities in eleven countries. Eur J Psychotraumatol 2019; 10:1605282. [PMID: 31105904 PMCID: PMC6507911 DOI: 10.1080/20008198.2019.1605282] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Children and adolescents are often exposed to traumatic events, which may lead to the development of posttraumatic stress disorder (PTSD). It is therefore important for clinicians to screen for potential symptoms that can be signs of PTSD onset. PTSD in youth is a worldwide problem, thus congruent screening tools in various languages are needed. Objective: The aim of this study was to test the general psychometric properties of the Traumatic Stress Disorder Reaction Index for children and adolescents (UCLA PTSD) Reaction Index for DSM-5 (PTSD-RI-5) in adolescents, a self-report instrument intended to screen for trauma exposure and assess PTSD symptoms. Method: Data was collected from 4201 adolescents in communities within eleven countries worldwide (i.e. Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestine-Gaza, Philippines, Portugal, Romania, and Serbia). Internal consistency, discriminant validity, and a confirmatory factor analysis of a four-factor model representing the main DSM-5 symptoms of the PTSD-RI-5 were evaluated. Results: The PTSD-RI-5 total score for the entire sample shows very good reliability (α = .92) as well as across all countries included (α ranged from .90 to .94). The correlations between anxiety/depressive symptoms and the PTSD-RI-5 scores were below .70 indicating on good discriminant validity. The four-factor structure of the scale was confirmed for the total sample and data from six countries. The standardized regression weights for all items varied markedly across the countries. The lack of a common acceptable model across all countries prevented us from direct testing of cross-cultural measurement invariance. Conclusions: The four-factor structure of the PTSD-RI-5 likely represents the core PTSD symptoms as proposed by the DSM-5 criteria, but there could be items interpreted in a conceptually different manner by adolescents from different cultural/regional backgrounds and future cross-cultural evaluations need to consider this finding.
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Affiliation(s)
- Ana Doric
- Department of Psychology (Center for Applied Psychology), Faculty of Humanities and Social Sciences, University of Rijeka, Rijeka, Croatia
| | - Dejan Stevanovic
- Child Psychiatry, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Dusko Stupar
- Child Psychiatry, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Panos Vostanis
- School of Psychology, Leicester University, Leicester, UK
| | - Olayinka Atilola
- Department of Behavioural Medicine, Lagos State University College of Medicine Ikeja, Lagos, Nigeria
| | | | - Katarina Dodig-Curkovic
- Medical Faculty Osijek, Faculty for Dental Medicine and Health, University Health Center Osijek, Osijek, Croatia
| | - Tomislav Franic
- Child and Adolescent Psychiatry, School of Medicine, University of Split, Split, Croatia
| | - Vrljicak Davidovic
- Department of Psychiatry, Clinical Hospital Centre Split, Split, Croatia
| | - Mohamad Avicenna
- Faculty of Psychology, State Islamic University Syarif Hidayatullah, Jakarta, Indonesia
| | - Multazam Noor
- Psychiatry department, Dr Soeharto Heerdjan Mental Hospital Jakarta, Jakarta, Indonesia
| | - Laura Nussbaum
- Department of Child and Adolescent Psychiatry, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Abdelaziz Thabet
- School of Public Health, Al Quds University, Gaza Branch, Palestine
| | - Dino Ubalde
- Department of Psychology, St. Dominic College of Asia, City of Bacoor, Philippines
| | - Petar Petrov
- Department of Child and Adolescent Psychiatry, University Hospital St. Marina, Varna, Bulgaria
| | | | | | - Adriana Ribas
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rajna Knez
- Department of Women´s and Children´s health, Skaraborgs Hospital, Skövde, Sweden.,Department of Psychiatry and Psychological Medicine, Medical School, University of Rijeka, Rijeka, Croatia.,University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Göteborg, Sweden
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Ghazali SR, Chen YY, Aziz HA. Childhood Maltreatment and Symptoms of PTSD and Depression Among Delinquent Adolescents in Malaysia. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2018; 11:151-158. [PMID: 32318145 PMCID: PMC7163867 DOI: 10.1007/s40653-017-0196-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Adolescents in the juvenile justice system are known to suffer from various psychological disorders. Less is known about how childhood psychological trauma is related to psychological disorders among delinquent adolescents in Malaysia. This study investigated the relationship between childhood maltreatment and depressive and Posttraumatic Stress Disorder (PTSD) symptoms. Of 327 adolescents 96% were exposed to at least one childhood victimization. Significant differences were found for all types of victimization (i.e. maltreatment, sexual abuse, severe assault, neglect, and family victimization) between delinquent and non-delinquent adolescents. Females were more likely to be involved in family victimization, while males were more likely to experience severe assault and crime victimization. Delinquent adolescents reported depressive and PTSD symptoms significantly more than non-delinquent adolescents. The prevalence of PTSD and depressive symptoms among delinquents was 20.8 and 52.7% respectively. Highly victimized delinquent adolescents and/or those victimized in family-related events were at significantly higher risk to develop psychiatric symptoms.
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Affiliation(s)
- Siti Raudzah Ghazali
- Department of Psychological Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, 94300 Sarawak Malaysia
| | - Yoke Yong Chen
- Department of Psychological Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, 94300 Sarawak Malaysia
| | - Hafizah Abdul Aziz
- Department of Psychological Medicine, Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Kota Samarahan, 94300 Sarawak Malaysia
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Marthoenis, Meutia I, Sofyan H, Schouler-Ocak M. Exposure to Traumatic Events and PTSD in a Postconflict and Disaster-Prone Area. JOURNAL OF LOSS & TRAUMA 2018. [DOI: 10.1080/15325024.2018.1423867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Marthoenis
- Department of Psychiatry and Mental Health Nursing, Syiah Kuala University, Banda Aceh, Indonesia
| | - Inong Meutia
- Master Program of Disaster Management, Syiah Kuala University, Banda Aceh, Indonesia
| | - Hizir Sofyan
- Department of Statistics, Syiah Kuala University, Banda Aceh, Indonesia
| | - Meryam Schouler-Ocak
- University Psychiatric Clinic of Charité at St. Hedwig’s Hospital, Berlin, Germany
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Child Abuse and Psychiatric Co-morbidity Among Chinese Adolescents: Emotional Processing as Mediator and PTSD from Past Trauma as Moderator. Child Psychiatry Hum Dev 2017; 48:610-618. [PMID: 27704299 DOI: 10.1007/s10578-016-0687-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This study investigated whether child abuse was associated with psychiatric co-morbidity in a group of Chinese adolescents, and whether this association would be mediated by emotional processing difficulties and moderated by the severity of PTSD from other traumas in the past. Four hundred seventy-four adolescents participated in the study. They completed the Childhood Trauma Questionnaire-Short Form, General Health Questionnaire-28, the Posttraumatic Stress Diagnostic Scale, and Emotional processing scale-25. The results showed that after adjusting for the total number of traumatic events and how long ago the most traumatic event occurred, child abuse was associated with psychiatric co-morbidity. This association was not moderated by the severity of PTSD from past traumas but mediated by emotion processing difficulties. To conclude, adolescents who experience child abuse can develop emotional processing difficulties which in turn impact on psychiatric symptoms. Experience of past trauma does not influence these psychological processes.
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The Relationship Between Gender, Posttraumatic Stress Disorder from Past Trauma, Alexithymia and Psychiatric Co-morbidity in Chinese Adolescents: A Moderated Mediational Analysis. Psychiatr Q 2016; 87:689-701. [PMID: 26875103 DOI: 10.1007/s11126-016-9419-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study focused on a group of Chinese adolescents and examined whether the degree of alexithymia would mediate the effect of PTSD from past trauma onto psychiatric co-morbidities and whether gender differences would moderate the mediational effects of alexithymia. Three hundred and twenty-six adolescents were recruited from two schools and completed the Posttraumatic Stress Diagnostic Scale, General Health Questionnaire-28 and Toronto Alexithymia Scale-20. The results showed that 54 % had no trauma in their lives; 10, 21 and 15 % met the criteria for full, partial and no-PTSD respectively. After adjusting the number of traumatic events, difficulty identifying feelings mediated the path between PTSD from past trauma and psychiatric co-morbidity. Gender moderated the mediational effect of difficulty identifying feelings. To conclude, adolescents can develop PTSD symptoms and psychiatric co-morbidity following exposure to a traumatic event. For both males and females, difficulty getting in touch with feelings can influence the impact of PTSD onto psychiatric co-morbidity.
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