When social support is not enough: Trauma and PTSD symptoms in a risk-sample of adolescents

Socio-economic factors associated with post-traumatic stress symptoms among adolescents and young people during the first wave of the COVID-19 pandemic

This study assessed the association between sociodemographic factors and post-traumatic stress symptoms (PTSS) among 18-24-year-olds during the first wave of the COVID-19 pandemic. This was a secondary analysis of data from 4508 individuals collected through an online survey conducted between June and January 2021. PTSS was measured as a dependent variable using the checklist for post-traumatic stress disorder in civilians. Age, birth sex, sexual, level of education, access to emotional and social support, and emotional distress were the independent variables. A multivariate logistic regression analysis was conducted to determine the associations between the dependent and independent variables while controlling for the country related confounding variables. Females (AOR:2.023), sexual minority individuals (AOR:1.868), those who did not disclose their sexual identify (AOR:1.476), those with poor access to emotional and social support (AOR:4.699) and individuals with no formal education (AOR:13.908), and only primary level education (AOR:4.521) had higher odds of PTSS. The study highlights the multifaceted nature of PTSS during the pandemic and suggests the importance of promoting access of young people, especially females, sexual minority individuals and those with low educational status, to emotional/social support to mitigate the probability of PTSS, especially among sexual minority individuals.

Depression and Substance Use as Consequences of Exposure to Family Violence: A Moderation Mediation and Self-Medication Hypothesis Study

Ample evidence exists suggesting that exposure to family violence leads to substance use and this relationship is moderated by gender; however, much is still unknown of the underlying mechanism of this relationship. Thus, the current study first examined whether exposure to family violence was associated with substance use. Then consistent with the self-medication hypothesis, we tested whether depressive symptoms mediated the relations between exposure to family violence and substance use. Finally, we examined the moderating effect of gender on the relationships among exposure to family violence and depressive symptoms/substance use (N = 1,850). Results suggest that exposure to family violence positively associated with substance use. Mediation results revealed that depressive symptoms explained the relationship between exposure to family violence and substance use. Moderation results indicated that males who were exposed to family violence were more likely to endorse depressive symptoms and more likely to use substances while controlling for sibling aggression victimization. This study provides new insight into the internalizing and externalizing symptoms of exposure to family violence, specifically for male adolescents. Implications are discussed.

Trajectories of Posttraumatic Stress Symptoms Among Young Adults Exposed to a Typhoon: A Three-Wave Longitudinal Study

Objective: We used a latent class growth model to identify distinct PTSS trajectories and correlates of these trajectories among young adults who experienced Typhoon Hato, the strongest storm to strike China in the last 50 years. Methods: A longitudinal survey (three-waves) was conducted to explore the mental health status and its correlates among young adults exposed to the typhoon. Data from 362 participants were analyzed via a latent class growth model and multinomial logistic regression. Results: Three distinct classes of PTSS trajectories were identified, including: "resilience" (86.46%), "recovery" (9.12%), and "deterioration" (4.42%). The higher levels of direct typhoon exposure, media use, and posttraumatic growth significantly predicted the higher likelihood of participants being in the "recovery'' class. In addition, more social support significantly predicted the higher possibility of being in the "resilience" class. Finally, more severe depressive and anxiety symptoms significantly predicted the higher likelihood of being in the "deterioration" class. Conclusion: Further research should develop interventions to enhance protective factors (e.g., posttraumatic growth, media use), decrease risk factors (e.g., depressive and anxiety symptoms), and thereby prevent PTSS.

PTSD and depressive symptoms in Chinese adolescents exposed to multiple stressors from natural disasters, stressful life events, and maltreatment: A dose-response effect

Objectives

Little is known about the effects and the extent that childhood adversity has on post-traumatic stress disorder (PTSD) and depression.

Study design

A population-based, epidemiological study from the Wenchuan earthquake.

Methods

A total of 5,195 Wenchuan Earthquake adolescent survivors aged 11-18 years from nine high schools in southwest China completed questionnaires that assessed their PTSD and depression symptoms due to childhood maltreatment, stressful life events, and childhood earthquake exposure.

Results

The PTSD and depression prevalences were 7.1 and 32.4%. After controlling for age and gender, the multiple linear regressions revealed that stressful life events had the most significant direct effect on depression (β = 0.491), followed by childhood emotional abuse (β = 0.085), and earthquake exposure (β = 0.077). Similarly, stressful life events (β = 0.583) were found to have more significant direct effects on PSTD, followed by earthquake exposure (β = 0.140); however, childhood emotional abuse was not found to have an effect. The structural equation modeling (SEM) revealed that there were interactions between the three childhood adversities, with all three concurrently affecting both PTSD and depression.

Conclusion

These findings add weight to the supposition that psychological maltreatment, negative life events, and earthquake exposure contribute to PTSD and depression. In particular, the identification of subgroups that have a high prevalence of these childhood adversities could assist professionals to target populations that are at high risk of mental health problems.

The psychometric properties of the adolescent dissociative experiences scale (A-DES) in a sample of Portuguese at-risk adolescents

Dissociation is a process that often occurs as a sequela of psychological trauma, and it is interrelated with psychological and behavioral problems. In the at-risk adolescent population, dissociation is often underdiagnosed and undertreated. Having reliable measures to assess this phenomenon can help in identifying adolescents at-risk and improve treatment outcomes. This study assessed the psychometric properties of the Adolescent Dissociative Experiences Scale (A-DES) with a sample of 402 Portuguese adolescents recruited from three at-risk populations. Participants completed self-report measures of trauma exposure, posttraumatic symptoms, psychological and behavioral problems, and the A-DES. A subset of the sample also completed test-retest measures. Confirmatory factor analyses revealed a best-fitting 3-factor model. Analyses revealed good internal consistencies and good agreement test-retest reliability for the scale overall and the factor-based sub-scales. Construct and predictive validity was supported with results showing that A-DES discriminates between youth reporting high versus low levels of cumulative trauma exposure and youth who meet or do not meet criteria for a probable PTSD diagnosis. Study findings replicate prior research supporting a 3-factor model of dissociation and the usefulness of A-DES to identify adolescents with dissociative symptoms. Clinical and research implications are discussed.

Video calls did not reduce PTSD symptoms in relatives during restricted ICU visits in the COVID-19 pandemic

To help reduce the spread of the SARS-CoV-2 virus during the COVID-19 pandemic, ICU visits were banned or restricted. Therefore, family-centered care as usually practiced was not feasible Video calls were recommended to meet relatives’ needs. The aim of this study was to investigate the effect of video calls on symptoms of post-traumatic stress disorder (PTSD) in relatives of ICU patients. This single-center study was performed during the first wave (15.03.2020‒30.04.2020; visits banned) and the second wave (01.10.20‒08.02.21: visits restricted) of the COVID-19 pandemic. The Impact of Event Scale-Revised (IES-R) was used to assess PTSD symptoms and an adapted version of the Family Satisfaction in the Intensive Care Unit 24-Item-Revised questionnaire (aFS-ICU 24R) to assess family satisfaction 3 months after ICU stay. The primary outcome was the difference in IES-R score at 3 months between the video call group (VCG) and the standard care group (SCG, no video calls). In addition, inductive content analysis of relatives’ comments regarding their satisfaction with decision-making and ICU care was performed. Fifty-two relatives (VCG: n = 26, SCG: n = 26) were included in this study. No significant difference in IES-R scores was observed between the VCG and the SCG (49.52 ± 13.41 vs. 47.46 ± 10.43, p = 0.54). During the ICU stay (mean 12 days, range 5.25‒18.75 days), the members of the VCG made a median of 3 (IQR 1‒10.75) video calls. No difference between the groups was found for conventional telephone calls during the same period (VCG: 9 calls, IQR 3.75‒18.1; SCG: 5 calls, IQR 3‒9; p = 0.12). The aFS-ICU 24R scores were high for both groups: 38 (IQR 37‒40) in the VCG and 40 (IQR 37‒40: p = 0.24) in the SCG. Video calls appeared largely ineffective in reducing PTSD symptoms or improving satisfaction among relatives affected by banning/restriction of ICU visits during the COVID-19 pandemic. Further investigations are needed to acquire more data on the factors involved in PTSD symptoms experienced by relatives of ICU patients during the COVID-19 pandemic.

Interparental Violence and Early Adolescents' Adjustment Problems in China: Testing a Moderated Mediation Model of Parental Warmth and Emotional Insecurity

This study analyzed the relationships between exposure to interparental violence and adolescents' adjustment problems. It also explored the mediating role of emotional insecurity and the moderating role of parental warmth in these relationships. Five hundred and seventy-eight early adolescents from three migrant primary schools and one public school in Beijing participated in this survey, reporting on their perceived interparental violence, emotional insecurity, post-traumatic stress symptoms (PTSS), and internalizing and externalizing behavioral problems. The results revealed that emotional insecurity partially mediated the association between interparental violence and all three indicators of adjustment problems, with stronger mediating effects on PTSS and internalizing problems than on externalizing problems; parental warmth buffered the association between emotional insecurity and internalizing/externalizing problems. This study adds insights to present literature on how interparental violence contributes to different aspects of adolescents' adjustment problems in the Chinese context.

The Bidirectional Relationship between Posttraumatic Stress Symptoms and Social Support in a 9/11-Exposed Cohort: A Longitudinal Cross-Lagged Analysis

Research on the longitudinal relationship between posttraumatic stress disorder (PTSD) and social support among survivors of large-scale trauma is limited. This study assessed bidirectional relationships between PTSD and perceived social support in a large sample of the 9/11-exposed cohort over a 14-year follow-up. We used data from 23,165 World Trade Center Health Registry (WTCHR) enrollees who were exposed to the 9/11 attacks and participated in the first four WTCHR surveys (Wave 1 (2003−2004) to Wave 4 (2015−2016)). PTSD symptoms were measured using the 17-item PTSD Checklist. Perceived social support was measured using the five-item version of the Modified Social Support Survey. We used a cross-lagged panel analysis and found an inverse relationship between PTSD symptoms and social support. PTSD at Wave 2 (W2) predicted less social support at Wave 3 (W3) (β = −0.10, p < 0.01), and PTSD at W3 predicted less social support at W4 (β = −0.05, p < 0.01). Conversely, social support at W3 buffered PTSD symptoms at W4 (β = −0.03, p < 0.05). Sub-analyses by types of perceived social support suggest greater effects of PTSD on emotional support than tangible support and in community members than rescue/recovery workers. Our findings suggest a bidirectional effect between PTSD symptoms and social support in a longitudinal study of 9/11-exposed populations.

The correlation between social support and post-traumatic stress disorder in children and adolescents: A meta-analysis

BACKGROUND

Risk factors exploring the link between trauma and Post-traumatic stress disorder (PTSD) have been extensively explored in adults, however, less is known about child and adolescent populations.

METHODS

The current meta-analysis aimed to systematically evaluate and summarise the child focused literature to estimate the strength of the relationship between social support and PTSD symptoms following traumatic events.

RESULTS

Fifty primary studies reporting an effect size for the relationship between total social support scale or a source of social support with PTSD were included. A small effect size was found for the relationship between social support and PTSD (r = -0.12, 95% CI -0.16 to -0.07, k = 41), with large heterogeneity (I² = 90.3%). The effect sizes between peer support (r = -0.18, 95% CI -0.10 to -0.25, k = 12), family support (r = -0.16, 95% CI -0.09 to -0.24, k = 13) and teacher support (r = -0.20, 95% CI -0.15 to -0.24, k = 5) and PTSD were also small. Moderator analyses indicated that studies reporting on participants exposed to abuse (r = -0.25) and correlations based on univariate data (r = -0.14) had higher correlations and medium heterogeneity. The main effect size was robust to publication bias and study quality.

LIMITATIONS

The cross-sectional design of the studies limits the findings and future research using prospective and longitudinal design would help to explain the relationship between social support and PTSD further.

CONCLUSIONS

The current review suggests that social support may only play a small role in protecting against PTSD and future research may benefit from exploring the link between post-trauma cognitions and social support.

Symptoms of post-traumatic stress disorder (PTSD) in next of kin during suspension of ICU visits during the COVID-19 pandemic: a prospective observational study

BACKGROUND

During the COVID-19 pandemic, suspension of visits by next of kin to patients in intensive care units (ICU), to prevent spread of the SARS-CoV-2 virus, has been a common practice. This could impede established family-centered care and may affect the mental health of the next of kin. The aim of this study was to explore symptoms of post-traumatic stress syndrome (PTSD) in the next of kin of ICU patients.

METHODS

In this prospective observational single-center study, next of kin of ICU patients were interviewed by telephone, using the Impact of Event Scale-Revised (IES-R), to assess symptoms of acute stress disorder during the ICU stay and PTSD symptoms at 3 months after the ICU stay. The primary outcome was the prevalence of severe PTSD symptoms (IES-R score ≥ 33) at 3 months. The secondary outcomes comprised the IES-R scores during the ICU stay, at 3 months, and the prevalence of severe symptoms of acute stress disorder during ICU stay. An inductive content analysis was performed of the next of kin's comments regarding satisfaction with patient care and the information they were given.

RESULTS

Of the 411 ICU patients admitted during the study period, 62 patients were included together with their next of kin. An IES-R score > 33 was observed in 90.3% (56/62) of next of kin during the ICU stay and in 69.4% (43/62) 3 months later. The median IES-R score was 49 (IQR 40-61) during the ICU stay and 41 (IQR 30-55) at 3 months. The inductive content analysis showed that communication/information (55%), support (40%), distressing emotions (32%), and suspension of ICU visits (24%) were mentioned as relevant aspects by the next of kin.

CONCLUSIONS

During the suspension of ICU visits in the COVID-19 pandemic, high prevalence and severity of both symptoms of acute stress disorder during the ICU stay and PTSD symptoms 3 months later were observed in the next of kin of ICU patients.

PTSD and complex PTSD in adolescence: discriminating factors in a population-based cross-sectional study

Background: Chronic and repeated trauma are well-established risk factors for complex posttraumatic stress disorder (CPTSD) in adult samples. Less is known about how trauma history and other factors contribute to the development of CPTSD in adolescence. Objective: The aim of this study was to assess the potential contribution of trauma history and social factors to CPTSD in adolescents. Method: In a cross-sectional community study of 1299 adolescents aged 12-16 years, PTSD (n = 97) and CPTSD (n = 108) was assessed with the Child and Adolescent version of the International Trauma Questionnaire (ITQ-CA). Trauma exposure, family functioning, school problems, and social support as potential discriminating factors between the PTSD and CPTSD groups were investigated. Results: Cumulative trauma exposure did not discriminate between PTSD and CPTSD in this sample. CPTSD was associated with family problems (such as financial difficulties and conflicts in the home), school problems (bullying and learning difficulties), and lack of social support. Conclusions: Our study indicates that factors other than cumulative trauma are important for the development of CPTSD in adolescence. Interventions targeting adolescent's social environment both at home and at school may be beneficial.

Social support and posttraumatic stress disorder: A meta-analysis of longitudinal studies

Social support has long been associated with posttraumatic stress disorder (PTSD), but there is no consistent evidence on the strength and direction of this relationship. Whereas the social causation model claims that social support buffers against PTSD, the social selection model states that PTSD reduces social support resources. As the first meta-analysis of the prospective relationships between social support and PTSD, this study synthesized the available longitudinal data (75 samples including 32,402 participants) on these two constructs with a random-effects model. In total, three hundred and fifty-five effect sizes (including cross-sectional, prospective and cross-lagged coefficients) were included in the meta-analysis. With prior levels of the relevant outcomes controlled for, results showed that social support and PTSD reciprocally predicted each other over time with similar effect sizes: Social support predicted PTSD with β = -0.10; PTSD predicted social support with β = -0.09. Moderator analyses suggested that the effects held across most sample characteristics and research designs except for several moderators (gender, time lag, publication year, source of support). These findings provided strong evidence for both the social causation and social selection models, suggesting that the link between social support and PTSD is symmetrically reciprocal and robust.

The Impact of Psychopathology Associated With Childhood Trauma on Quality of Life in Portuguese Adolescents: A Two-Wave Longitudinal Study

Introduction: The aim of this study was to explore the mediating effect of psychopathology between childhood adversity and trauma and quality of life (QOL) in adolescents. The second aim of the study was testing the moderation by social support of this mediation effect. Methods: Self-reports of childhood adversity and trauma, QOL, social support, and psychopathology were collected from 150 Portuguese adolescents' who had been exposed to at least one traumatic event or one childhood adversity (M _age = 16.89, SD = 1.32). The surveys were administered at two time points with an approximate time interval of 1 year. Results: Indirect effects were observed for depression (B = -0.33, CI [-0.62, -0.11]), somatization (B = -0.52, CI [-0.82, -0.23]), and post-traumatic stress symptoms (PTSS) (B = -0.23, CI [-0.45, -0.01]), but not for anxiety (B = 0.20, CI [-0.08, 0.50]). A moderated mediation was found between social support and depression (B = -0.10, CI [-16, -0.04]), and PTSS (B = 0.03, CI [-0.1, -0.05]), but not for somatization (B = -0.02, CI [-0.8, 0.05]). Conclusions: We found that depression and somatization were strong mediators of the relationship between adversity/trauma and QOL, whereas PTSS was moderately mediated this relationship. Anxiety did not mediate this relationship. The moderated-mediation effect of social support was only found for depression and PTSS. The improvement of QOL in adolescents exposed to childhood adversity and trauma should include the assessment of psychopathology symptoms and social support, with the aim of identifying risk and protective factors.

A Preliminary Study Examining the Validity of Brief Trauma Screening Tools for Young Adolescents in School-Based Health Centers

BACKGROUND AND PURPOSE

There are very limited brief, validated, open access screening tools for trauma symptoms in adolescent populations. This study aimed to test two brief tools used with adults in primary care settings for use with adolescents.

METHODS

Youth (n = 77) completed the Posttraumatic Stress Disorder (PTSD) Checklist (PCLC-2), the Primary Care PTSD Screen for Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition (DSM-IV; PC-PTSD), and the PTSD Reaction Index for DSM-5 (reference tool). Sensitivities and specificities were analyzed.

RESULTS

The PCLC-2 and PC-PTSD demonstrated high sensitivity and specificity with adolescents when using lower cutoff scores than those recommended for adults.

CONCLUSIONS

The PC-PTSD and PCLC-2 have the potential to be used as brief screens with adolescents. Additional research is needed to further examine their validity with larger, diverse youth samples in primary care and school-based settings.

Psychological Distress and Its Correlates Among COVID-19 Survivors During Early Convalescence Across Age Groups

OBJECTIVE

To examine the psychological distress and the associated predictor factors of the 2019 corona-virus disease (COVID-19) on survivors in the early convalescence in Shenzhen.

METHOD

A survey questionnaire consisting of post-traumatic stress disorder self-rating scale (PTSD-SS), self-rating depression scale (SDS), and self-rating anxiety scale (SAS) was presented to COVID-19 survivors still in quarantine. Scores of each scale and subscale were dependent variables in the Mann-Whitney test and stepwise regression analysis.

RESULTS

A total of 126 subjects were included in the study, the mean scores of PTSD-SS, SDS, and SAS were 45.5 ± 18.9, 47.3 ± 13.1, and 43.2 ± 10.2, respectively, meanwhile, 9 (31.0%), 28 (22.2%), and 48 (38.1%) of the survivors met the cut-score for clinical significant symptoms of stress response, anxiety, and depression, respectively. Infected family members, and postinfection physical discomforts were significantly associated with scores on all three scales. Social support, retirement, and being female had significant associations with the PTSD-SS score. The survivors aged 60 or above experienced less severe stress response symptoms, fewer emotional symptoms of depression, and fewer anxiety symptoms than younger survivors.

CONCLUSION

The occurrence rate of psychological distress among the COVID-19 survivors in early convalescence was high, highlighting the need for all COVID-19 survivors to be screened for psychological distress regularly for timely intervention. The predictors indicated by the current study may help to identify those at high-risk. Besides, the results indicated the older survivors suffered less emotional reactivity and fewer stress response symptoms from infectious diseases than the younger ones.

Long-Term PTSD Risks in Emergency Medical Technicians Who Responded to the 2016 Taiwan Earthquake: A Six-Month Observational Follow-Up Study

Although several factors associated with posttraumatic stress disorder (PTSD) in disaster rescue workers were identified in previous studies, the results were inconsistent. This study aimed to explore the prognostic factors of PTSD among disaster rescuers using different screening tools. A 6.4 magnitude earthquake struck southern Taiwan on February 6, 2016. Emergency medical technicians (EMTs) who responded to the earthquake were recruited. The initial survey was conducted one month after the earthquake using a standardized, self-reported, paper-based questionnaire. After six months, we re-evaluated the EMTs using the same questionnaire that was used in the baseline survey. A total of 38 EMT-paramedics were enrolled in the final analysis. Significant differences in PTSD scores at baseline existed between EMTs with and without certain risk factors. The interaction between survey time and risk factors was not significant, but several risk factors correlated with a nonsignificant improvement in the PTSD score after the 6-month follow-up. Perfectionism personality characteristics and several specific field experiences (managing injured patients, managing dead victims, managing dead victims who were pregnant, managing emotionally distraught families, or guilty feelings during the missions) might affect different subdomains of PTSD symptom improvement. Disaster rescuers should be followed up after their missions, regardless of their age, gender, or previous experience with disaster response. EMTs with certain personality characteristics or who are involved in specific field operations should be carefully monitored during and after disaster rescue missions.