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Frost A, Collins A, Chung EO, Escobar Carias MS, Hagaman A, Gupta S, Bibi A, Sikander S, Maselko J. Trauma exposure among young children in rural Pakistan: Associations with gender, mental health, and cognitive skills. BMC Psychol 2024; 12:454. [PMID: 39183356 PMCID: PMC11346172 DOI: 10.1186/s40359-024-01944-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 08/12/2024] [Indexed: 08/27/2024] Open
Abstract
BACKGROUND The burden of childhood trauma (violence, injury/illness, loss) in low-resource settings is high, although the effect of trauma on children's mental and cognitive health is under-researched. Child gender may moderate the association between trauma and outcomes; boys are more likely to experience trauma, but girls are more likely to show distress following trauma. METHODS We draw on data from the Bachpan cohort (n = 888), a sample of mother-child dyads in rural Pakistan, to investigate these associations among 6-year-old children in a South Asian, low-resource setting. Mothers reported on children's lifetime exposure to 15 possible traumas and their current mental health. In addition, children were assessed for their verbal skills, working memory, and inhibitory control. We estimated trauma prevalence and used generalized estimating equations to test the association between number of traumatic events and child mental health and cognitive skills in the overall sample and by gender. RESULTS 90.5% of children experienced at least one trauma. The most common traumas were death of a loved one (47%) and hearing about war/terrorism on the TV/radio (48%). On average, boys experienced more traumas (M = 3.00) than girls (M = 2.67). Specifically, boys were more likely than girls to experience an injury or hospitalization (30% vs. 21%, p < .05) and to hear about war/terrorism on the TV/radio (52% vs. 43%, p < .05). Trauma was associated with increased mental health difficulties and increased anxiety scores. There was little evidence that trauma exposure was associated with child cognitive skills. The strength of association between trauma and outcomes was similar for boys and girls. CONCLUSIONS Findings show that childhood trauma exposure is common in this setting and associated with worse mental health problems among young boys and girls. Results suggest that trauma-informed interventions are important for supporting child mental health in South Asia.
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Affiliation(s)
- Allison Frost
- Carolina Population Center, University of North Carolina, Chapel Hill, USA.
| | - Amanda Collins
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
| | | | | | - Ashley Hagaman
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut, USA
| | - Sugandh Gupta
- Department of Anthropology, University of North Carolina, Chapel Hill, USA
| | - Amina Bibi
- Human Development Research Foundation, Islamabad, Pakistan
- Global Institute of Human Development, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Siham Sikander
- Department of Primary Care & Mental Health, University of Liverpool, Liverpool, UK
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Joanna Maselko
- Carolina Population Center, University of North Carolina, Chapel Hill, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA
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Kerbage H, Elbejjani M, Bazzi O, El-Hage W, BouKhalil R, Corruble E, Purper-Ouakil D. 'We are all children of war': a qualitative inquiry into parenting following adolescents' recent traumatic exposure in a multiple crisis setting in Beirut, Lebanon. Eur J Psychotraumatol 2024; 15:2382650. [PMID: 39113651 PMCID: PMC11312994 DOI: 10.1080/20008066.2024.2382650] [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: 03/06/2024] [Revised: 07/08/2024] [Accepted: 07/09/2024] [Indexed: 08/11/2024] Open
Abstract
Background: Strong familial bonds are crucial to building resilience among youth exposed to traumatic events in socially adverse environments. Exploring parental experiences in the aftermath of adolescents' traumatic exposure in these settings would help tailor early interventions.Objective: We qualitatively explored experiences and perceived needs among parents of teenagers aged 11-16 years who were exposed in the last three months to a potentially traumatic event in Beirut, Lebanon.Method: We purposively sampled 28 parents of 24 adolescents meeting the inclusion criteria. Semi-structured interviews were conducted, and thematic analysis was applied combined with a grounded theory approach.Results: The most frequent traumatic event was direct exposure to the violent clashes that happened in Beirut on 14 October 2021. Parents identified that the recent event exacerbated pre-existing mental health difficulties caused by cumulative stress. They were reminded of their own war experiences and tended to reject the 'sick role' associated with trauma. A majority of participants viewed resilience as a fixed trait characteristic of the Lebanese and avoided communication with their children about traumatic memories, while a significant minority criticised resilience as a myth that added pressure on them and had more open communication about trauma. Parenting styles oscillated between controlling behaviours, warmth, and avoidance, which impacted the family dynamic. Despite adversity, most parents tried to cope through social connectedness, humour, and living day by day.Conclusions: Our findings hold implications for contextual adaptations of early posttraumatic interventions aimed at strengthening family support, such as addressing parental mental health; increasing awareness among first-line responders on parents' potential representations of trauma and resilience; addressing the issue of controlling parenting; and including a component in psychoeducation on traumatic stress that validates the impact of daily stressors on mental health while avoiding direct labelling. Further research is needed to validate the impact of these domains.
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Affiliation(s)
- Hala Kerbage
- Department of Child and Adolescent Psychiatry, Saint Eloi University Hospital, Montpellier, France
- Center for Epidemiology and Population Health (CESP), Paris-Saclay University, Paris, France
| | - Martine Elbejjani
- Clinical Research Institute, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Ola Bazzi
- Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Wissam El-Hage
- CHRU de Tours, Regional Trauma Center CRP-CVL, Tours, France
- UMR 1253, iBraiN, University of Tours, INSERM, Tours, France
| | - Rami BouKhalil
- Saint-Joseph University; Hotel-Dieu de France Hospital, Beirut, Lebanon
| | - Emmanuelle Corruble
- CESP, MOODS Team, INSERM U1018, School of Medicine, Paris-Saclay University, Le Kremlin Bicêtre, France
- Service Hospitalo-Universitaire de Psychiatrie de Bicêtre, Hôpitaux Universitaires Paris-Saclay, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Le Kremlin Bicêtre, France
| | - Diane Purper-Ouakil
- Department of Child and Adolescent Psychiatry, Saint Eloi University Hospital, Montpellier, France
- Center for Epidemiology and Population Health (CESP), Paris-Saclay University, Paris, France
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3
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Yang XJ, Meng XX, Zhang LB, Wang LL, Deng H, Yang YC, Zhou SJ. Mediating effects of insomnia and resilience on COVID-19-related post-traumatic stress disorder and quality of life in adolescents. Sci Rep 2024; 14:17969. [PMID: 39095413 PMCID: PMC11297128 DOI: 10.1038/s41598-024-69093-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Accepted: 07/31/2024] [Indexed: 08/04/2024] Open
Abstract
The coronavirus disease-2019 (COVID-19) pandemic has impaired the quality of life (QoL) for many due to its extensive impacts. However, few studies have addressed the specific impact of COVID-19 on the mental health of adolescents, particularly post-traumatic stress disorder (PTSD). This study considered the impact of COVID-19-related PTSD on the QoL of adolescents in China, the mediating effects of insomnia, and the moderating effects of resilience. Participants included 50,666 adolescents aged 12-18 years selected using a comprehensive sampling method. We performed data collection from January 8th to January 18th, 2023, using the Children's Revised Impact of Event Scale, Pittsburgh Sleep Quality Index, Ten-item Connor-Davidson Resilience Scale, and Screening for and Promotion of Health-related QoL in Children and Adolescents Questionnaire for data collection. Male adolescents exhibited significantly lower levels of PTSD and insomnia compared to females and scored significantly higher in psychological resilience and overall QoL. Insomnia played a mediating role between PTSD and QoL. Psychological resilience moderated the impact of COVID-19-related stress on adolescents' QoL through its influence on insomnia. PTSD resulting from the COVID-19 pandemic affects the QoL of adolescents through the presence of insomnia. Psychological resilience plays a moderating role in this process. Cultivating psychological resilience in adolescents can effectively enhance their ability to cope with the impacts of sudden public events.
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Affiliation(s)
- Xing-Jie Yang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, China
| | - Xue-Xue Meng
- School of Psychology and Mental Health, North China University of Science and Technology, Hebei, China
| | - Li-Bin Zhang
- Collaborative Innovation Center of Assessment for Basic Education Quality, Beijing Normal University, Beijing, China
| | - Lei-Lei Wang
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, China
| | - Hu Deng
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, China
| | - Yu-Chun Yang
- Faculty of Education, Beijing Normal University, Beijing, 100875, China.
| | - Shuang-Jiang Zhou
- Beijing HuiLongGuan Hospital, Peking University HuiLongGuan Clinical Medical School, Beijing, 100096, China.
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4
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McGuire A, Jackson Y, Grasso DJ, Slavich GM, Kingston N. Caregiver Report of Children's Exposure to Adverse Life Events: Concordance Between Questionnaire and Interview Approaches. JOURNAL OF INTERPERSONAL VIOLENCE 2024; 39:3712-3737. [PMID: 38702867 PMCID: PMC11281863 DOI: 10.1177/08862605241233271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2024]
Abstract
Assessment practices for measuring adverse life events (ALEs) are often characterized by considerable variability, which is associated with inconsistency and reproducibility issues when conducting research on children with ALE exposure. One aspect of assessment variability for caregiver report of children's ALE history that has received minimal attention is assessment format. To address this issue, the current study evaluated concordance between two main ALE assessment formats: interviews and questionnaires. This involved examining overall endorsement of ALEs and concordance among multiple characteristics of ALE exposure, including type, polyvictimization, frequency, severity, and age of onset. Fifty-eight caregivers (Mage = 33.72; 60% Black; 55% below the federal poverty line) of preschool and school-age children were administered an ALE assessment in both a questionnaire and interview format across two sessions. The sum scores and concordance rates between format responses were compared based on ALE type, polyvictimization, frequency, severity, and age of onset of exposure. Results indicated that most total or sum scores were similar between formats, with the exception of ALE severity scores. However, there was most often low-to-moderate concordance across the 50 types of ALEs examined in the current study, suggesting that a different constellation of events comprised each sum or total score. This was also the case across all characteristics of the ALEs and most notably for the severity of ALE. Based on these findings, the format of assessment may be associated with inconsistent reporting of children's ALE exposure across multiple characteristics of ALE. Researchers may need to utilize multiple types of ALE assessments when relying on caregiver report of a child's ALEs.
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Affiliation(s)
- Austen McGuire
- Medical University of South Carolina, Charleston, South Carolina, USA
| | - Yo Jackson
- The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Damion J. Grasso
- University of Connecticut School of Medicine, Farmington, Connecticut, USA
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Padhi BK, Khatib MN, Serhan HA, Gaidhane AM, Rustagi S, Zahiruddin QS, Sharma RK, Satapathy P. Cardiovascular impact of post-traumatic stress disorder: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102632. [PMID: 38797508 DOI: 10.1016/j.cpcardiol.2024.102632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Post-traumatic stress disorder (PTSD) is increasingly recognized for its effects beyond mental health, with emerging evidence suggesting a significant association with cardiovascular diseases (CVD). This systematic review and meta-analysis aimed to synthesize available evidence on the association between PTSD and various cardiovascular outcomes. METHODS We conducted a comprehensive literature search in databases until March 15, 2024. Studies were included if they were observational in design and assessed the association between PTSD and cardiovascular outcomes. Data were extracted on study characteristics, participant demographics, PTSD assessment, cardiovascular outcomes, and effect estimates. Meta-analyses were performed using random-effects models, and heterogeneity was assessed using the I² statistic. All statistical analyses were conducted using R software version 4.3. RESULTS Twenty studies met the inclusion criteria, encompassing a total of over 335,000 participants. The pooled analyses demonstrated a statistically significant increased risk of any CVD (HR = 1.417, 95 % CI: 1.313-1.522), MI (HR = 1.415, 95 % CI: 1.331-1.500), and stroke (HR = 2.074, 95 % CI: 1.165-2.982) associated with PTSD. Substantial heterogeneity was observed across the studies for stroke and MACE, and evidence of publication bias was noted. CONCLUSION This meta-analysis confirms a significant association between PTSD and an increased risk of several cardiovascular outcomes, indicating the importance of integrating cardiovascular risk management with psychiatric care for PTSD patients to mitigate the heightened risk of CVDs. Future research should focus on exploring the underlying mechanisms and potential interventions to manage both PTSD and its associated cardiovascular risks effectively.
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Affiliation(s)
- Bijaya K Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Mahalaqua Nazli Khatib
- Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India.
| | - Hashem Abu Serhan
- Department of Ophthalmology, Hamad Medical Corporation, Doha, Qatar.
| | - Abhay M Gaidhane
- Jawaharlal Nehru Medical College, and Global Health Academy, School of Epidemiology and Public Health. Datta Meghe Institute of Higher Education, Wardha, India.
| | - Sarvesh Rustagi
- School of Applied and Life Sciences, Uttaranchal University, Dehradun, Uttarakhand, India.
| | - Quazi Syed Zahiruddin
- South Asia Infant Feeding Research Network (SAIFRN), Division of Evidence Synthesis, Global Consortium of Public Health and Research, Datta Meghe Institute of Higher Education, Wardha, India.
| | - Rakesh Kumar Sharma
- Graphic Era (Deemed to be University) Clement Town Dehradun 248002, India; Graphic Era Hill University Clement Town Dehradun 248002, India.
| | - Prakasini Satapathy
- Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, Chennai, India; Medical Laboratories Techniques Department, AL-Mustaqbal University, 51001 Hillah, Babil, Iraq.
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6
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Davis RS, Devaney J, Halligan SL, Meiser-Stedman R, Oliveira P, Smith P, Stallard P, Kandiyali R, Phillips A, John A, Hiller RM. The feasibility and acceptability of delivering a group trauma-focused intervention to children in care. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024. [PMID: 39054608 DOI: 10.1111/bjc.12494] [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: 11/06/2023] [Accepted: 06/28/2024] [Indexed: 07/27/2024]
Abstract
OBJECTIVE Young people in care (i.e., in the child welfare system) are a group who have often experienced very high rates of potentially traumatic events, including maltreatment. It is well-documented that they have high rates of trauma-related mental health difficulties, such as posttraumatic stress. To address the needs of the large number of young people who may benefit from support, scalable interventions are crucial. But also important is that they are effective and deliverable - particularly given the complexity of this group and services. We assessed a five-session group CBT-based intervention for PTSD. The primary goal was to understand core procedural and protocol uncertainties to address prior to a definitive trial. METHODS Participants were 34 10-17 year olds in care, with moderate to severe posttraumatic stress symptoms, and their caregiver. We ran seven groups (four online), delivered in social care and NHS-based mental health teams. Data were collected via pre-, post-, 3-month follow-up questionnaires and qualitative interviews. RESULTS Of the 34 participants allocated to the intervention, 27 (80%) attended at least three of the five sessions (most attended all). Caregiver attendance was lower (50%). There was generally good completion of assessment measures. Qualitatively, most participants were positive about the intervention, and many reported improvements in areas such as coping, sleep, and willingness to talk about experiences. However, there were important concerns about the lack of ongoing support, given this was a low-intensity intervention for a group who often had complex needs. CONCLUSION The intervention and research protocols were acceptable to most young people and carers. With modifications, a future definitive trial would likely be possible. However, key considerations include: how (and whether) to screen for PTSD; the trial design; and the option to embed high-intensity support (e.g., via assessing a stepped-care model).
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Affiliation(s)
| | - John Devaney
- School of Social and Political Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Paula Oliveira
- Anna Freud National Centre for Children and Families, London, UK
| | - Patrick Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | | | | | - Aalia John
- Department of Psychology, University of Bath, Bath, UK
| | - Rachel M Hiller
- Department of Psychology, University of Bath, Bath, UK
- Anna Freud National Centre for Children and Families, London, UK
- Division of Psychology and Language Sciences, University College London, London, UK
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Jann P, Netzer J, Hecker T. Traumatic loss: a systematic review of potential risk factors differentiating between posttraumatic stress disorder and prolonged grief disorder. Eur J Psychotraumatol 2024; 15:2371762. [PMID: 39021231 PMCID: PMC11259072 DOI: 10.1080/20008066.2024.2371762] [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: 12/07/2023] [Accepted: 06/11/2024] [Indexed: 07/20/2024] Open
Abstract
Background: When traumatic events and losses intersect in the form of traumatic loss, these events can trigger both posttraumatic stress disorder and pathological grief.Objective: This systematic review investigates which characteristics differentiate between the development of the respective disorders or are associated with comorbidity.Method: A systematic literature search using Medline, PubMed, APA PsycInfo and Web of Science yielded 46 studies which met the inclusion criteria. In these studies, PTSD was assessed using 17 and pathological grief using 16 different validated instruments. In the quality assessment, 12 studies were classified as average, 30 as above average, and 4 as excellent. The investigated risk factors were categorized into 19 superordinate clusters and processed using narrative synthesis.Results: The relationship to the deceased, mental health issues, and religious beliefs seem to be associated specifically with pathological grief symptoms compared to PTSD symptoms. Social support and social emotions emerged as significant correlates and potential risk factors for both PTSD and pathological grief. Included studies had mainly cross-sectional designs.Conclusions: Differentiating factors between pathological grief and PTSD appear to exist. The results should be considered within the limitations of the heterogeneity of the included studies and the research field. There is a lack of studies (1) using a longitudinal study design, (2) starting data collection early following the traumatic loss, (3) using standardized, up-to-date measurement instruments and (4) including comorbidity in their analyses. Further research is urgently needed for more accurate (acute) screenings, prognoses, and interventions following traumatic loss.
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Affiliation(s)
- Philipp Jann
- Department of Clinical Psychology & Violence Research, Bielefeld University, Bielefeld, Germany
- Institute for Emergency Psychology, Bielefeld, Germany
| | - Jessica Netzer
- Department of Clinical Psychology & Violence Research, Bielefeld University, Bielefeld, Germany
| | - Tobias Hecker
- Department of Clinical Psychology & Violence Research, Bielefeld University, Bielefeld, Germany
- Institute for Interdisciplinary Research on Conflict and Violence, Bielefeld University, Bielefeld, Germany
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Phillips AR, Halligan SL, Lavi I, Macleod JAA, Robinson S, Wilkins D, Hiller RM. A Scoping Review of Factors Associated With the Mental Health of Young People Who Have "Aged Out" of the Child Welfare System. TRAUMA, VIOLENCE & ABUSE 2024; 25:1780-1798. [PMID: 37776530 PMCID: PMC11155215 DOI: 10.1177/15248380231196107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/02/2023]
Abstract
Young people who grow up in care and then exit care around the age of 18 (care-leavers) are a particularly vulnerable group, at increased risk for mental health problems even relative to other care-experienced groups. Yet, little is understood about the factors underpinning this association. We used scoping review methods to synthesize the quantitative and qualitative literature on factors that are associated with mental health problems for care-leavers. Following rigorous methods, we systematically searched three scientific databases spanning psychology and social care and identified 23 peer-reviewed studies for inclusion. This review highlights the heterogeneity of this research, in terms of methodology and topics investigated. Topics included are as follows: pre-care maltreatment, care-related experiences, psychological factors (emotion regulation), social support, education, and adult functioning (e.g., housing, finances, employment). We found mixed and inconsistent findings across research studies. The strongest evidence-base is around the influence of social support upon the mental health of recent care-leavers, though methodological problems are discussed. The field benefits from several large-scale observational and longitudinal research studies. However, there is an over-reliance upon retrospective reporting, and the use of unvalidated measures is common. It is apparent that there are significant gaps in our current understanding of the mental health of care-leavers, in particular around modifiable factors. We discuss potential directions for future empirical research, both in terms of methodology and factors investigated.
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Affiliation(s)
| | | | | | - John A. A. Macleod
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, UK
- The University of Bristol, UK
| | | | | | - Rachel M. Hiller
- University College London, UK
- Anna Freud Centre for Children and Families, London, UK
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Haag K, Halligan SL, Hiller R, Skeen S, Tomlinson M. Long-term associations between early attachment and parenting and adolescent susceptibility to post-traumatic distress in a South African high-risk sample. J Child Psychol Psychiatry 2024; 65:921-931. [PMID: 38111273 DOI: 10.1111/jcpp.13930] [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] [Accepted: 11/16/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND It has been proposed that children and young people living in low- and middle-income countries (LMICs) are not only exposed more frequently to trauma but also have a higher likelihood of encountering traumas of greater severity than those living in high-income countries (HICs). This may lead to higher rates of post-traumatic stress symptoms (PTSS). However, developmental pathways to risk or resilience after trauma exposure in LMICs are underresearched. METHODS We examined early parenting and attachment as potentially important formative factors for later stress reactivity in a longitudinal cohort of South African children (N = 449). Parenting and attachment were assessed at child age 18 months, and interpersonal trauma exposure, PTSS and parenting stress were measured at 13 years (N = 333; core sample with data on all measures: N = 213). Following a vulnerability-stress approach, separate regression models were run to investigate whether parent-child attachment at 18 months, parental sensitivity and intrusiveness during play at 12 months, and current parenting stress at 13 years, interacted with adolescents' extent of interpersonal trauma exposure to predict their PTSS levels at 13 years. RESULTS We found no predictive effects of either early attachment or current parenting stress in relation to child PTSS. There was some evidence for predictive influences of parental early intrusiveness and sensitivity on adolescent outcomes, though associations were unexpectedly positive for the latter. No interaction effects supporting a vulnerability-stress model were found. CONCLUSIONS Overall, we found limited evidence that elements of the early parent-child environment predict child risk/resilience to trauma in LMIC children. Future studies should include more frequent assessments of relevant constructs to capture changes over time and consider further what comprises adaptive parenting in high-risk contexts.
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Affiliation(s)
| | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Rondebosch, South Africa
- Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Rachel Hiller
- Department of Psychology, University of Bath, Bath, UK
| | - Sarah Skeen
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, The Netherlands
| | - Mark Tomlinson
- Department of Global Health, Stellenbosch University, Stellenbosch, South Africa
- School of Nursing and Midwifery, Queens University, Belfast, UK
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10
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Ramelet AS, Barnes S. The healing power of family partnership in pediatric and neonatal intensive care. JBI Evid Synth 2024; 22:1206-1207. [PMID: 38984561 DOI: 10.11124/jbies-24-00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Affiliation(s)
- Anne-Sylvie Ramelet
- University Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Bureau d'Echange des Savoirs pour des praTiques exemplaires de soins (BEST): A JBI Centre of Excellence, Lausanne, Switzerland
| | - Shannon Barnes
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
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11
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Lortye SA, Will JP, Rameckers SA, Marquenie LA, Goudriaan AE, Arntz A, de Waal MM. Types of childhood maltreatment as predictors of posttraumatic stress disorder severity and complex posttraumatic stress disorder in patients with substance use disorders. Eur J Psychotraumatol 2024; 15:2367179. [PMID: 38934350 PMCID: PMC11212561 DOI: 10.1080/20008066.2024.2367179] [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: 08/28/2023] [Accepted: 05/26/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Childhood maltreatment (CM) can be divided into: emotional abuse (EA), physical abuse (PA), sexual abuse (SA), emotional neglect (EN), and physical neglect (PN). CM is associated with (Complex)Posttraumatic stress disorder (PTSD/CPTSD) and substance use disorder (SUD).Objective: This cross-sectional study examined the relationships between CM-subtypes with PTSD-severity and CPTSD in patients with SUD-PTSD.Method: Participants (N = 209) were treatment-seeking SUD-PTSD patients who completed the Childhood Trauma Questionnaire-short form, the Clinician-Administered PTSD Scale for DSM-5 and the International Trauma Questionnaire. Regression analyses and a model selection procedure to select an optimal model were used to examine CM-subtypes as predictors of (C)PTSD, adjusted for sex and age.Results: Total CM and all CM-types significantly predicted PTSD-severity in the univariate regression analysis, with EA begin the strongest predictor. In the multiple regression only SA predicted PTSD-severity. Subsequently, model selection indicated that the optimal model to predict PTSD-severity included EA and SA. In the univariate analyses total CM, EA, and PN significantly predicted CPTSD-classification, and total CM and all CM-types significantly predicted CPTSD-severity. In the multiple regression for CPTSD-classification only EA and PA were significant predictors and for CPTSD-severity EA, PA and SA were significant predictors. In post-hoc multiple regression analyses, only EA was a significant predictor of CPTSD-classification and CPTSD-severity. Finally, in the model selection the most parsimonious model only included EA for both CPTSD-classification and CPTSD-severity. Sex was not a moderator in the relationship between CM and PTSD, nor in CM and CPTSD.Conclusions: These findings indicate that for SUD-PTSD patients, several CM-types have predictive value for (C)PTSD-severity, however SA and especially EA appear to contribute to these complaints. Since EA does not constitute an A-criterion, it is generally more overlooked in PTSD treatment. Its impact should therefore be underlined, and clinicians should be attentive to EA in their treatment.
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Affiliation(s)
- Sera A. Lortye
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Joanne P. Will
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Sophie A. Rameckers
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Loes A. Marquenie
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
| | - Anna E. Goudriaan
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Arnoud Arntz
- Department of Clinical Psychology, University of Amsterdam, Amsterdam, The Netherlands
| | - Marleen M. de Waal
- Arkin Mental Health Care, Jellinek, Amsterdam Institute for Addiction Research, Amsterdam, The Netherlands
- Department of Psychiatry, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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12
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Sirotich AC, Camisasca E. PTSD risk factors in earthquake survivors and their families: a systematic review. Eur J Psychotraumatol 2024; 15:2365477. [PMID: 38919135 PMCID: PMC11210410 DOI: 10.1080/20008066.2024.2365477] [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: 03/12/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
Background: Exposure to earthquakes can cause adverse effects on the mental health of survivors, including an increased risk of PTSD.Objective: This systematic review aims to analyse the previous secondary studies to identify the risk factors for PTSD from children to elderly earthquake survivors. In addition, it aims to consider the complexity of the joint effects of the individual, relational, and contextual risk factors, to also detect the most at-risk families.Method: After reviewing and screening studies from the literature search through PubMed, Web of Science, Scopus, and EBSCO under the guidance of PRISMA guidelines, ten eligible secondary studies were identified that examine the risk factors for PTSD in individuals (from children to elderly) affected by worldwide earthquakes.Results: The analysis of the included studies allowed the identification of a series of socio-demographic, pre-traumatic, peri-traumatic, and post-traumatic PTSD risk factors in children, adolescents, youth, adults, and elderly survivors. The results represent the complexity of the joint effects of these risk factors at individual, relational, and contextual levels.Conclusions: The consideration of the PTSD risk factors highlights the importance of individual characteristics and the type of experiences and exposure in the period before, during, and after the earthquake. This knowledge could allow the early identification of at-risk individuals of different ages and families and the implementation of intervention programmes.
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Affiliation(s)
| | - Elena Camisasca
- Faculty of Psychology, Università Telematica eCampus, Novedrate, Italy
- C.R.I.d.e.e., Psychology Department, Catholic University of the Sacred Heart, Milano, Italy
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Eberle DJ, Maercker A, Levin Y, Mutuyimana C, Wen J, Makhashvili N, Javakhishvili D, Papava A, Yu X, Qian W, Wang J, Asatsa S, Bachem R. Cultural psychological factors in posttraumatic symptom development and expression: a study protocol. Eur J Psychotraumatol 2024; 15:2364998. [PMID: 38916108 PMCID: PMC11207911 DOI: 10.1080/20008066.2024.2364998] [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: 08/17/2023] [Accepted: 05/28/2024] [Indexed: 06/26/2024] Open
Abstract
Introduction: Cultural factors were shown to be particularly relevant for the development and expression of posttraumatic stress. Recently, the concept of cultural scripts of trauma has been introduced, which proposes that trauma sequelae elements may be sequentially linked and specifically associated with cultural factors. Furthermore, a cascade model is proposed, including trauma exposure, demographic characteristics, cultural affiliation, and trauma-related value orientations as influencing factors of posttraumatic development. The purpose of this Network Project is to investigate cultural psychological factors that contribute to the expression of posttraumatic stress.Methods: The present Network Project implements a mixed methods approach and will be conducted in 5 different study sites, including Switzerland, Israel, Georgia, China, and East Africa. In sub-study I, the cultural scripts of traumatic stress inventories (CSTIs) will be developed. These scales provide a pool of trauma sequelae elements for each cultural group. For this purpose, focus groups with trauma survivors and trauma experts will be conducted and analysed using qualitative research methods. Sub-study II implements a validation analysis of the CSTIs and the empirical investigation of a cultural cascade model. This quantitative approach will include a larger sample of individuals who experienced traumatic life events.Discussion: This contribution is timely and enriches the knowledge of trauma and culture. Future publications of this Network Project will address trauma sequelae from a cultural perspective and provide diagnostic and psychotherapeutic implications.
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Affiliation(s)
- David J. Eberle
- Division of Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zürich, Switzerland
| | - Andreas Maercker
- Division of Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zürich, Switzerland
| | - Yafit Levin
- Department of Social Work, Ariel University, Ariel, Israel
| | | | - Jun Wen
- Division of Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zürich, Switzerland
| | - Nino Makhashvili
- Faculty of Arts and Science, Ilia State University, Tbilisi, Georgia
| | | | - Ana Papava
- Faculty of Arts and Science, Ilia State University, Tbilisi, Georgia
| | - Xinyi Yu
- Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Haidian District, People’s Republic of China
| | - Wenli Qian
- Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Haidian District, People’s Republic of China
| | - Jianping Wang
- Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Faculty of Psychology, Beijing Normal University, Haidian District, People’s Republic of China
| | | | - Rahel Bachem
- Division of Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zürich, Switzerland
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14
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Allbaugh LJ, George G, Klengel T, Profetto A, Marinack L, O'Malley F, Ressler KJ. Children of trauma survivors: Influences of parental posttraumatic stress and child-perceived parenting. J Affect Disord 2024; 354:224-231. [PMID: 38490588 DOI: 10.1016/j.jad.2024.03.067] [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: 10/02/2023] [Revised: 02/20/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Research has established a negative association between parental posttraumatic stress symptoms (PTSS), including subthreshold symptoms, and child physical and behavioral health outcomes. Such intergenerational transmission of risk has multiple possible mechanisms, including lack of positive parenting, increased negative parenting, shared environmental and contextual risks, and potential biological components such as shared genetics or even transmission of epigenetic risk. METHOD This study examined 93 parent-child dyads (n = 171 participants total) from a mixed Urban-Suburban US metropolitan area to investigate the relations between parental PTSS and child-perceived parenting and child PTSS. We sought to examine interactions between parental PTSS and parenting on child PTSS. RESULTS We found an association between parent and child PTSS, consistent with prior literature showing increased risk for children of trauma survivors. Interestingly, we found effects of positive parenting on diminished child PTSS symptoms only in parents without PTSS, whereas the effect of positive parenting on buffering child symptoms was absent in parents with PTSS. LIMITATIONS The present findings are tempered by the use of self-report data to assess parent and child PTSS, which is not as reliable as clinician assessment of symptoms. Further, the use of survey data limits what is known about the extent of trauma exposure in parents and children, and different measures were used to assess PTSS in parents and kids, which limits comparability of these reported symptoms. DISCUSSION Limitations notwithstanding, findings suggest joint attention paid to parenting practices and to a parent's recovery, even from subthreshold symptoms of PTSS, as two different but important ways to support trauma survivor parents in their efforts to most optimally parent and protect their children from intergenerational risk.
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Affiliation(s)
- Lucy J Allbaugh
- Department of Psychology, University of Dayton, Dayton, OH, United States of America.
| | - Grace George
- McLean Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Torsten Klengel
- McLean Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Alex Profetto
- McLean Hospital, Boston, MA, United States of America
| | - Lucas Marinack
- Department of Psychology, University of Wyoming, Laramie, WY, United States of America
| | - Fiona O'Malley
- Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Kerry J Ressler
- McLean Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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15
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Ascienzo S, Sprang G, Royse D. Are Differences Evident in the Ways Boys and Girls Appraise and Interpret Their Traumatic Experiences? A Qualitative Analysis of Youth Trauma Narratives. VIOLENCE AND VICTIMS 2024; 39:143-167. [PMID: 38955470 DOI: 10.1891/vv-2024-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2024]
Abstract
The purpose of this study was to explore potential similarities and differences in the ways boys and girls appraise and interpret their traumatic experiences, and better understand how gender roles, performance, and socialization processes may impact trauma experiences, appraisals, and narratives within the context of trauma-focused treatment. We used thematic analysis to analyze the trauma narratives of youth (N = 16) ages 8-16 who had experienced multiple types (M = 5.38) of child maltreatment and who were receiving Trauma-focused Cognitive Behavioral Therapy to address clinically elevated posttraumatic stress symptoms. Four themes emerged: variations in the content of negative cognitions, differences in relational emotion, adoption of socially prescribed gender roles, and symptom differences. Although many similarities existed in youth's trauma narratives, differences emerged that point to the importance of social context and the ways gender role expectations and socialization processes influence youth's appraisal of and responses to traumatic events. Findings indicate the importance of considering distress tolerance, relational emotion, gender identity development, and role socialization within the treatment milieu.
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Affiliation(s)
- Sarah Ascienzo
- School of Social Work, North Carolina State University, Raleigh, NC, USA
| | - Ginny Sprang
- Center on Trauma and Children, Department of Psychiatry, University of Kentucky, Lexington, KY, USA
| | - David Royse
- College of Social Work, University of Kentucky, Lexington, KY, USA
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Zhen-Duan J, Alvarez K, Zhang L, Cruz-Gonzalez M, Kuo J, Falgas-Bagué I, Bird H, Canino G, Duarte CS, Alegría M. Parental psychopathology and posttraumatic stress in Puerto Ricans: the role of childhood adversity and parenting practices. J Child Psychol Psychiatry 2024; 65:742-752. [PMID: 37850715 PMCID: PMC11024057 DOI: 10.1111/jcpp.13902] [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] [Accepted: 08/04/2023] [Indexed: 10/19/2023]
Abstract
BACKGROUND Parental psychopathology is associated with their children's posttraumatic stress symptoms (PTSS). However, the mechanisms through which this occurs remain unclear. We hypothesized that exposure to childhood adversities is the mechanism linking parental psychopathology to child PTSS and that parenting practices moderated these associations. METHODS Participants (N = 1,402) with an average age of 24.03 years old (SD = 2.20), were all Puerto Ricans (50% Male and 50% Female) from the Boricua Youth Study, which is a four-wave longitudinal study spanning almost 20 years, following individuals from childhood (ages 5-13 at Wave 1) to young adulthood. Measured variables include parental psychopathology at Wave 1, childhood adversities and parenting practices at Waves 2-3, and PTSS at Wave 4. A traditional mediation model estimated the association between parental psychopathology and child PTSS via childhood adversities. A moderated mediation model was used to examine whether parenting practices moderated this mediation model. RESULTS Results showed that the total effect of parental psychopathology at Wave 1 on PTSS at Wave 4 was fully mediated by childhood adversities at Waves 2-3 (direct effect b = 1.72, 95% CI = [-0.09, 3.83]; indirect effect b = 0.40, 95% CI = [0.15, 0.81]). In addition, the magnitude of this pathway varied by levels of parenting practices (i.e. parental monitoring and parent-child relationship quality). Specifically, the indirect effect of additional adversities in the psychopathology-PTSS link was stronger with higher levels of parental monitoring but weaker with higher parent-child relationship quality scores. CONCLUSIONS Intergenerational continuity of psychopathology may be mitigated through the prevention of additional childhood adversities via upstream interventions, emphasizing providing parents with mental health needs with parenting tools. Family-based interventions focused on providing families with the tools to improve parent-child relationships may reduce the negative impact of childhood adversities on mental health across the life course.
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Affiliation(s)
- Jenny Zhen-Duan
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Kiara Alvarez
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Lulu Zhang
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Josephine Kuo
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Community Health, Tufts University, Medford, MA, USA
| | - Irene Falgas-Bagué
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Hector Bird
- Department of Psychiatry, Columbia University – New York State Psychiatric Institute, New York, NY, USA
| | - Glorisa Canino
- Department of Pediatrics, University of Puerto Rico School of Medicine, San Juan, PR, USA
| | - Cristiane S. Duarte
- Department of Psychiatry, Columbia University – New York State Psychiatric Institute, New York, NY, USA
| | - Margarita Alegría
- Disparities Research Unit, Massachusetts General Hospital, Boston, MA, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
- Department of Medicine, Harvard Medical School, Boston, MA, USA
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17
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Chen JJ, Yu B, Yan L, Sun XX, Dai Q. A study on post-traumatic stress disorder and post-traumatic growth among patients infected with COVID-19 in Wuhan. Front Psychol 2024; 15:1343264. [PMID: 38817834 PMCID: PMC11139024 DOI: 10.3389/fpsyg.2024.1343264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/16/2024] [Indexed: 06/01/2024] Open
Abstract
Objective The purpose of this study is to assess the physical and psychological conditions of hospitalized patients who were infected with COVID-19 in Wuhan, China, including post-traumatic stress disorder (PTSD) and post-traumatic growth (PTG) scores and predictors. Methods The test group consisted of 102 hospitalized patients diagnosed with COVID-19 in Wuhan between March 4, 2020 and April 5, 2020, whereas the control group comprised 168 healthy study participants. Relevant information of the study participants was obtained using online questionnaires, covering five aspects-general information, physical state, emotional state, PTSD, and PTG. Results In Wuhan, 37.3% of COVID-19-diagnosed hospitalized patients exhibited hyper-arousal symptoms of PTSD. This percentage is significantly higher than the 13.1% observed in the healthy population. Furthermore, the prevalence of PTG among the same group of hospitalized patients stood at 77.5%, surpassing the 66.1% rate found within the healthy population. It was determined that inconsistent sleep patterns during the hospitalization phase could be indicative of heightened vulnerability to hyperarousal symptoms of PTSD in COVID-19-diagnosed hospitalized patients. The study determined that inconsistent sleep patterns during hospitalization may be a predisposition factor that makes hospitalized patients diagnosed with covid-19 more susceptible to high arousal symptoms of post-traumatic stress disorder. Conversely, COVID-19-diagnosed hospitalized patients who maintained a tranquil demeanor and exhibited positive emotional perceptions during their hospitalization displayed reduced susceptibility to these PTSD symptoms. Factors such as possession of a bachelor's degree, history of severe acute respiratory syndrome (SARS) infection, and poor sleep patterns were identified as predictors elevating the risk of PTG. Whereas, a sentiment of happiness and consistent positive emotional perception during hospitalization were predictors of PTG. Intriguingly, a direct correlation was established between hyper-arousal symptoms of PTSD and PTG. Conclusion Although the outbreak of COVID-19 has badly affected the physical and psychological well-being of patients, it has greatly enhanced their PTG.
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Affiliation(s)
- Jing-jing Chen
- School of Nursing, Fujian Medical University, Research Center for Nursing Humanity, Fuzhou, Fujian, China
- Department of Psychology, Army Medical University, Chongqing, China
| | - Bing Yu
- Anesthesiology Department, The 965 Hospital of the Joint Logistic, Jilin, China
| | - Ling Yan
- The First Affiliated Hospital of Army Medical University, Chongqing, China
| | - Xiao-xiao Sun
- Department of Psychology, Army Medical University, Chongqing, China
| | - Qin Dai
- Department of Psychology, Army Medical University, Chongqing, China
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Théorêt V, Hébert É, Hébert M. Investigating the role of alexithymia in the association between cumulative childhood maltreatment and teen dating violence victimization. J Psychiatr Res 2024; 173:192-199. [PMID: 38547741 DOI: 10.1016/j.jpsychires.2024.03.030] [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: 02/14/2023] [Revised: 03/15/2024] [Accepted: 03/21/2024] [Indexed: 04/17/2024]
Abstract
BACKGROUND Childhood maltreatment is increasingly recognized as an important risk factor for teen dating violence (TDV) victimization. However, far too little research has studied the mechanisms that could explain this higher risk of revictimization. The present study investigated the role of alexithymia in the association between cumulative childhood maltreatment, TDV victimization occurrence and chronicity, and TDV-related post-traumatic stress disorder (PTSD) symptoms. METHODS A total of 2780 adolescents, aged 13 to 19, completed measures of childhood maltreatment and alexithymia at Time 1 and TDV victimization and TDV-related PTSD symptoms at Time 2 (6 months later). Two mediational models were tested to examine the role of alexithymia as a risk factor for revictimization. One model assessed TDV occurrence as an outcome, while the other explored TDV chronicity and TDV-related PTSD symptoms as outcomes. RESULTS Findings suggest that cumulative childhood maltreatment is associated with an increased probability of TDV occurrence through alexithymia. Cumulative childhood maltreatment and alexithymia are also associated with TDV chronicity and TDV-related PTSD symptoms. Notably, cumulative childhood maltreatment is associated with higher levels of alexithymia among adolescent victims of TDV, which, in turn, predicts higher TDV chronicity and TDV-related PTSD symptoms. LIMITATIONS This study relied on abbreviated measures and did not include all forms of child maltreatment (e.g., emotional and physical neglect). CONCLUSIONS Promoting emotional awareness and identification among youth victims of child maltreatment could reduce the risk of TDV occurrence, TDV chronicity, and TDV-related PTSD symptoms.
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Affiliation(s)
- Valérie Théorêt
- School of Criminology, Université de Montréal, Québec, Canada
| | - Élizabeth Hébert
- Department of Psychology, Université du Québec à Montréal, Québec, Canada
| | - Martine Hébert
- Canada Research Chair in Interpersonal Traumas and Resilience, Canada; Department of Sexology, Université du Québec à Montréal, Québec, Canada.
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19
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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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20
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Rinne-Wolf S, Finkeldei S, Kern T. Breaking the news of the violent death of a close person to children under 18 years of age: A qualitative interview study. DEATH STUDIES 2024:1-15. [PMID: 38588451 DOI: 10.1080/07481187.2024.2337210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Children who lose a close person to suicide or homicide will most likely receive this news from a carer. The caregiver's personal beliefs and approaches to addressing the topic will influence the child. A total of 10 interviews were conducted with carers of children aged 0-17 years, and the data were analyzed using reflexive thematic analysis. Four themes were developed, exploring: (1) how carers attempted to manage the task of delivering the news of death to the child and discussing it using careful wording; (2) how some carers' desire to protect the child from the truth hindered honesty and open conversations; (3) how and why some carers deliberately challenged societal taboos; and (4) how external influences prompted conversations about the topic. The discussion projects potential consequences for the children and their families. It also derives necessary societal changes, support measures, and further research suggestions.
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Affiliation(s)
- Susanna Rinne-Wolf
- AETAS Children's Foundation, Munich, Germany
- Chair for Public Health and Health Services Research, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU) Munich, Germany
| | - Simon Finkeldei
- AETAS Children's Foundation, Munich, Germany
- Institute for Psychology, University Innsbruck, Austria
| | - Tita Kern
- AETAS Children's Foundation, Munich, Germany
- Institute for Psychology, University Innsbruck, Austria
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21
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Levin RY, Liu RT. Post-traumatic stress disorder in a national sample of preadolescent children 9 to 10 years old: Prevalence, correlates, clinical sequelae, and treatment utilization. Transl Psychiatry 2024; 14:152. [PMID: 38503761 PMCID: PMC10951365 DOI: 10.1038/s41398-024-02868-1] [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: 08/28/2023] [Revised: 03/06/2024] [Accepted: 03/11/2024] [Indexed: 03/21/2024] Open
Abstract
Although posttraumatic stress disorder (PTSD) has been well characterized in adults, its epidemiology in children is unclear. The current study provides the first population-based examination of the prevalence of PTSD, sociodemographic and psychiatric correlates, clinical sequelae, and associations with psychiatric treatment in preadolescents 9-10 years old in the United States. Data from the Adolescent Brain and Cognitive Development (ABCD) Study (release 5.0) was analyzed. Participants (unweighted n = 11,875) were recruited from 21 sites across the United States. Current and lifetime PTSD prevalence were estimated, as was treatment use among children with PTSD. Sociodemographic, psychiatric correlates and sequelae of PTSD were analyzed using logistic regression, as was the association between PTSD and psychiatric treatment. After the application of propensity weights, lifetime prevalence of PTSD was 2.17%. Sexual minority status, being multiracial, having unmarried parents, and family economic insecurity were associated with greater odds of PTSD. Among psychiatric disorders, separation anxiety was most strongly associated with PTSD, although general comorbid psychopathology was associated with greater odds of PTSD. Prior history of PTSD predicted a new onset of other psychiatric disorders after PTSD remission. Nearly one in three children with lifetime PTSD did not receive psychiatric treatment, despite negative long-term outcomes of PTSD and significant psychiatric comorbidity. Even among preadolescents who experience full remission of PTSD, a significant risk for future psychiatric illness remains. Further, the current findings underscore the need for improved efforts to reduce unmet treatment needs among those with PTSD at this age.
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Affiliation(s)
- Rachel Y Levin
- University of Rochester, Department of Psychology, Rochester, NY, 14611, USA.
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, 02114, USA.
| | - Richard T Liu
- Massachusetts General Hospital, Department of Psychiatry, Boston, MA, 02114, USA
- Harvard Medical School, Boston, MA, 02114, USA
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22
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Danzi BA, Kelly JT, Knowles EA, Burdette ET, La Greca AM. Perceived life threat in children during the COVID-19 pandemic: associations with posttraumatic stress, anxiety, and depressive symptoms. Child Adolesc Psychiatry Ment Health 2024; 18:35. [PMID: 38500140 PMCID: PMC10949745 DOI: 10.1186/s13034-024-00725-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 02/27/2024] [Indexed: 03/20/2024] Open
Abstract
Defining children's "trauma exposure" in the context of the COVID-19 pandemic has been a source of debate. Children were exposed to threatening messaging about COVID-19 but might interpret this information differently than adults. Perceived life threat (PLT), the belief that one's life is in danger, has been identified as a robust predictor of posttraumatic stress symptoms (PTSS), and may be a better predictor of PTSS than actual life threat (ALT). This study investigated parent reports of children's self-PLT (belief that they might die from COVID-19) and family-PLT (belief that a family member might die from COVID-19). The aims were to compare PLT to ALT, evaluate their associations with children's psychological functioning, and identify risk factors associated with PLT. We hypothesized an association between PLT and children's psychological functioning in the context of the COVID-19 pandemic. Parents (N = 140) reported on their child's (M age = 9.81 years, 47% female) pandemic experiences, psychological functioning, and both self-PLT and family-PLT. Results revealed self-PLT for 10% of the children and family-PLT for 43% of the children, yet only 6% experienced ALT (i.e., they or their parent tested positive for COVID-19). Children with reported self- or family-PLT had higher PTSS, depressive symptoms, anxiety symptoms, and functional impairment compared to children without these reported beliefs. PLT, but not ALT, was associated with psychological outcomes. Children with only PLT had greater PTSS and impairment than children with ALT. There were differences in parental functioning and pandemic-related information/media exposure between children with and without PLT. Children's perceptions, rather than objective experiences, may be more central to their psychological functioning. This has implications for screening for pandemic-related symptomatology in children as traditional trauma exposure measures may not adequately identify distressed children.
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Affiliation(s)
- BreAnne A Danzi
- Department of Psychology, University of South Dakota, 414 East Clark Street, Vermillion, SD, 57069, USA.
| | - Jessica T Kelly
- Department of Psychology, University of South Dakota, 414 East Clark Street, Vermillion, SD, 57069, USA
| | - Ellen A Knowles
- Department of Psychology, University of South Dakota, 414 East Clark Street, Vermillion, SD, 57069, USA
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Canty AR, Windsor TD, Nixon RDV. Using experience sampling methodology (ESM) to improve our understanding of day-to-day intrusion frequency and related distress in survivors of trauma. J Behav Ther Exp Psychiatry 2024; 82:101921. [PMID: 37944379 DOI: 10.1016/j.jbtep.2023.101921] [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: 02/07/2023] [Revised: 10/02/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Cognitive models of posttraumatic stress disorder (PTSD) suggest that appraisals of traumatic sequelae and subsequent distress drive the development and maintenance of PTSD. Posttraumatic research has relied heavily on macro-longitudinal designs, with weeks or months between assessments of trauma-related cognitions and symptoms. The present study uses experience sampling methodology (ESM) better understand the day-to-day experiences of trauma exposed individuals. METHODS One-hundred trauma exposed adults reported their posttraumatic symptoms, interpretations, and behaviours four times a day over a 10-day ESM period. RESULTS As anticipated, within-person fluctuations in negative appraisals of intrusions and maladaptive coping strategies (e.g., thought suppression) were significantly positively associated with intrusion frequency and related distress. In all cases, the associations for negative appraisals and maladaptive coping were stronger with intrusion related distress than intrusion frequency. LIMITATIONS The observed contemporaneous associations only demonstrate that variables reliably fluctuated together and cannot indicate causality. CONCLUSIONS The findings demonstrate that day-to-day fluctuations in trauma related perceptions and sequelae are significant and should be explored alongside broader individual differences to advance our understanding of the development, maintenance, and treatment of PTSD.
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Affiliation(s)
- Alexandra R Canty
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia.
| | - Tim D Windsor
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia; Flinders University Institute for Mental Health and Wellbeing, Adelaide, Australia
| | - Reginald D V Nixon
- College of Education, Psychology, and Social Work, Flinders University, Adelaide, Australia; Flinders University Institute for Mental Health and Wellbeing, Adelaide, Australia.
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24
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Fogarty A, Seymour M, Savopoulos P, Talevski T, Ruthven C, Giallo R. The COVID-19 pandemic and Australian parents with young children at risk of interparental conflict. J Reprod Infant Psychol 2024; 42:338-352. [PMID: 35650517 DOI: 10.1080/02646838.2022.2084055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 05/24/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND The COVID-19 pandemic has created many challenges for families across the world, with those who have recently had a baby particularly vulnerable to increased stress Study Aim: The current study aimed to explore the experiences of the COVID-19 pandemic of families who have recently had a baby in Melbourne, Australia. METHODS Interviews were conducted with sixteen parents participating in a family-based intervention during early parenthood and seven clinicians who delivered the program. RESULTS Parents and clinicians described impacts of the pandemic on parent and family functioning included mental health concerns, stress and irritability, feelings of isolation, and increased relationship tension. Parents discussed coping strategies used during the crisis, including activities with their family, connecting with others, trying to stay positive, and self-care activities such as spending time outdoors. Both parents and clinicians acknowledged the importance of mental health and parenting support during and following the pandemic, and for these services to be promoted and easily accessible. DISCUSSION The study highlights the mental health and parenting support needs of families during times of crisis and emphasises the importance of early intervention for families exhibiting poor communication and relationship tension.
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Affiliation(s)
- Alison Fogarty
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Monique Seymour
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Priscilla Savopoulos
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Australia
| | - Tom Talevski
- Family Foundations, Merri Health, Melbourne, Australia
| | | | - Rebecca Giallo
- Intergenerational Health Group, Murdoch Children's Research Institute, Melbourne, Australia
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25
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Witt A, Sachser C, Fegert JM. Scoping review on trauma and recovery in youth after natural disasters: what Europe can learn from natural disasters around the world. Eur Child Adolesc Psychiatry 2024; 33:651-665. [PMID: 35426528 PMCID: PMC10894166 DOI: 10.1007/s00787-022-01983-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/29/2022] [Indexed: 11/27/2022]
Abstract
In the last decade, Europe has seen a rise in natural disasters. Due to climate change, an increase of such events is predicted for the future. While natural disasters have been a rare phenomenon in Europe so far, other regions of the world, such as Central and North America or Southeast Asia, have regularly been affected by Hurricanes and Tsunamis. The aim of the current study is to synthesize the literature on child development in immediate stress, prolonged reactions, trauma, and recovery after natural disasters with a special focus on trajectories of (mal-)adaptation. In a literature search using PubMed, Psychinfo and EBSCOhost, 15 studies reporting about 11 independent samples, including 11,519 participants aged 3-18 years, were identified. All studies identified resilience, recovery, and chronic trajectories. There was also evidence for delayed or relapsing trajectories. The proportions of participants within each trajectory varied across studies, but the more favorable trajectories such as resilient or recovering trajectory were the most prevalent. The results suggested a more dynamic development within the first 12 months post-disaster. Female gender, a higher trauma exposure, more life events, less social support, and negative coping emerged as risk factors. Based on the results, a stepped care approach seems useful for the treatment of victims of natural disasters. This may support victims in their recovery and strengthen their resilience. As mental health responses to disasters vary, a coordinated screening process is necessary, to plan interventions and to detect delayed or chronic trauma responses and initiate effective interventions.
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Affiliation(s)
- Andreas Witt
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhövelstraße 1, 89073, Ulm, Germany.
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhövelstraße 1, 89073, Ulm, Germany
| | - Jörg M Fegert
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Steinhövelstraße 1, 89073, Ulm, Germany
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26
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Pfeiffer E, Garbade M, Sachser C. Traumatic events and posttraumatic stress symptoms in a treatment-seeking sample of Ukrainian children during the war. Child Adolesc Psychiatry Ment Health 2024; 18:25. [PMID: 38336707 PMCID: PMC10858633 DOI: 10.1186/s13034-024-00715-1] [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: 11/20/2023] [Accepted: 01/25/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND The Russian invasion of Ukraine resulted in a dramatic increase of children and adolescents being confronted with war and other traumatic experiences, which could result in an increase of trauma-related mental health disorders such as posttraumatic stress disorder (PTSD) in an entire generation. This study aims at reporting the prevalence of traumatic events, PTSD, and Complex PTSD (CPTSD) in children and adolescents seeking for mental health treatment since the Russian invasion. Additionally, the consistency of child and caregiver reported trauma, PTSD and CPTSD will be examined. METHODS This study is part of the "TF-CBT Ukraine" project in which Ukrainian therapists were trained in assessing their patients via the "Child and Adolescent Trauma Screen" (CATS-2) before initiating trauma-focused treatment, if indicated. Altogether N = 200 Ukrainian children and adolescents (Mage = 12.01, range 4-21; 62.0% female) were included in the study between October 2022 and August 2023. Data were analysed descriptively, via t-tests and bivariate correlations. RESULTS The children and adolescents reported on average four different traumatic events, most frequently war (n = 123; 68.7%), bullying threats (n = 71; 39.7%) and domestic violence (n = 68; 38.0%). Almost 70% (n = 123) of the participants fulfilled the DSM-5 PTSD criteria, 31% (n = 56) fulfilled the ICD-11 PTSD criteria and 21% (n = 38) the ICD-11 CPTSD criteria. Rates of PTSD were even higher in preschool children (95%). The comparisons of self-and caregiver reports on traumatic events and PTSD/CPTSD severity scores indicated moderate to high correlations between the patients and their caregivers (r = 0.710-0.767). CONCLUSIONS This study shows that Ukrainian children and adolescents starting treatment report a high number of traumatic events and trauma-related symptoms, which could have a long-lasting negative impact on their social-emotional development and quality of life. The implementation of evidence-based trauma-focused interventions for these children is therefore crucial.
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Affiliation(s)
- Elisa Pfeiffer
- Department of Child and Adolescent Psychiatry/ Psychotherapy, Ulm University, Steinhoevelstr. 2, 89075, Ulm, Germany.
| | - Maike Garbade
- Department of Child and Adolescent Psychiatry/ Psychotherapy, Ulm University, Steinhoevelstr. 2, 89075, Ulm, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/ Psychotherapy, Ulm University, Steinhoevelstr. 2, 89075, Ulm, Germany
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27
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Fagermoen EM, Skjærvø I, Birkeland MS, Jensen TK, Ormhaug SM. The bidirectional associations between caregiver and child symptoms in the parent-led treatment stepping together for children after trauma. Behav Res Ther 2024; 173:104459. [PMID: 38128401 DOI: 10.1016/j.brat.2023.104459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/06/2023] [Accepted: 12/10/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND An innovative approach to child trauma treatment in which caregivers are allocated treatment tasks has shown promising results, but less is known about the bidirectional associations between caregiver and child symptoms during treatment. METHODS Eighty-two child-caregiver dyads who participated in the parent-led therapist-assisted Stepping Together for Children after Trauma (ST-CT) were included (child age: 7-12 years, mean = 9.9 years). Caregivers' emotional reactions and anxiety/depression and children's posttraumatic stress (PTS) and depression were assessed pretreatment, mid-treatment, and posttreatment. We investigated the possible directional associations between caregivers' emotional reactions and anxiety/depression and children's PTS and depression using random intercept cross-lagged panel models. RESULTS Symptoms improved in both caregivers and children. Lower levels of caregiver emotional reactions at pretreatment predicted improved child PTS at mid-treatment; lower levels of caregiver emotional reactions at mid-treatment predicted improved child depression at posttreatment; and lower levels of child PTS at mid-treatment predicted improved caregiver emotional reactions at posttreatment. CONCLUSIONS These findings suggest that caregivers and children can impact each other's responses to a parent-led child trauma-focused treatment. Notably, children with caregivers who were less affected by their own emotional reactions exhibited greater improvement in both PTS and depression. Supporting the caregivers may benefit both children and caregivers. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT04073862; https://clinicaltrials.gov/ct2/show/NCT04073862.
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Affiliation(s)
| | - Ingeborg Skjærvø
- Norwegian Centre for Violence and Traumatic Stress Studies, 0409 Oslo, Norway
| | | | - Tine K Jensen
- Norwegian Centre for Violence and Traumatic Stress Studies, 0409 Oslo, Norway; Department of Psychology, University of Oslo, 0317 Oslo, Norway
| | - Silje Mørup Ormhaug
- Norwegian Centre for Violence and Traumatic Stress Studies, 0409 Oslo, Norway
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Rodman AM, Rosen ML, Kasparek SW, Mayes M, Lengua L, Meltzoff AN, McLaughlin KA. Social experiences and youth psychopathology during the COVID-19 pandemic: A longitudinal study. Dev Psychopathol 2024; 36:366-378. [PMID: 36503551 PMCID: PMC10258229 DOI: 10.1017/s0954579422001250] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The early stages of the COVID-19 pandemic and associated stay-at-home orders resulted in a stark reduction in daily social interactions for children and adolescents. Given that peer relationships are especially important during this developmental stage, it is crucial to understand the impact of the COVID-19 pandemic on social behavior and risk for psychopathology in children and adolescents. In a longitudinal sample (N=224) of children (7-10y) and adolescents (13-15y) assessed at three strategic time points (before the pandemic, during the initial stay-at-home order period, and six months later after the initial stay-at-home order period was lifted), we examine whether certain social factors protect against increases in stress-related psychopathology during the pandemic, controlling for pre-pandemic symptoms. Youth who reported less in-person and digital socialization, greater social isolation, and less social support had worsened psychopathology during the pandemic. Greater social isolation and decreased digital socialization during the pandemic were associated with greater risk for psychopathology after experiencing pandemic-related stressors. In addition, children, but not adolescents, who maintained some in-person socialization were less likely to develop internalizing symptoms following exposure to pandemic-related stressors. We identify social factors that promote well-being and resilience in youth during this societal event.
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Affiliation(s)
| | | | | | - Makeda Mayes
- Department of Psychology, University of Washington-Seattle
| | - Liliana Lengua
- Department of Psychology, University of Washington-Seattle
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29
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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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30
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Kerbage H, Elbejjani M, El-Hage W, Purper-Ouakil D. 'Life should go on': a qualitative inquiry of parental reactions, experiences, and perceived needs following adolescents' recent traumatic exposure. Eur J Psychotraumatol 2024; 15:2299660. [PMID: 38285906 PMCID: PMC10826792 DOI: 10.1080/20008066.2023.2299660] [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: 06/13/2023] [Accepted: 12/19/2023] [Indexed: 01/31/2024] Open
Abstract
Background: Parents have a significant role in supporting children who have been exposed to traumatic events. Little is known about parental experiences and needs in the wake of traumatic exposure, which could help in designing tailored early interventions.Objective: This qualitative study explored experiences, perceived needs, and factors impacting those needs being met, in parents of adolescents aged 11-16 years who had been exposed in the past 3 months to a potentially traumatic event, in the city of Montpellier, France.Method: We purposively sampled 34 parents of 25 adolescents aged 11-16 years meeting the inclusion criteria and used semi-structured in-depth interviews. Thematic analysis was applied using a multistage recursive coding process.Results: Parents lacked trauma-informed explanations to make sense of their child's reduced functioning. They experienced stigma attached to the victim label and were reluctant to seek help. School avoidance and lack of collaboration with schools were major obstacles experienced by parents. Parents trying to navigate conflicting needs fell into two distinct categories. Those who experienced distressing levels of shame and guilt tended to avoid discussing the traumatic event with their child, pressuring them to resume life as it was before, despite this perpetuating conflictual interactions. Others adapted by revisiting their beliefs that life should go on as it was before and by trying to come up with new functional routines, which improved their relationship with their child and helped them to restore a sense of agency and hope, but at the cost of questioning their parental role.Conclusions: Key domains of parental experiences could provide potential early intervention targets, such as psychoeducation on traumatic stress, representations about recovery and the victim status, parent-child communication, and involvement of schools and primary caregivers. Further research is needed to validate the impact of these domains in early post-traumatic interventions.
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Affiliation(s)
- Hala Kerbage
- Department of Child and Adolescent Psychiatry, Saint-Eloi University Hospital, Montpellier, France
- Center for Epidemiology and Population Health (CESP) INSERM U1018, Developmental Psychiatry Team, Paris-Saclay University, Paris, France
| | - Martine Elbejjani
- Clinical Research Institute, Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Wissam El-Hage
- UMR 1253, iBrain, University of Tours, INSERM, Tours, France
| | - Diane Purper-Ouakil
- Department of Child and Adolescent Psychiatry, Saint-Eloi University Hospital, Montpellier, France
- Center for Epidemiology and Population Health (CESP) INSERM U1018, Developmental Psychiatry Team, Paris-Saclay University, Paris, France
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Salas F, Nvo-Fernández M, Leiva-Bianchi M, Sáez DA, Páeza GS, García MV, Villacura-Herrera C. Components of event-related potentials and borderline personality disorder: a meta-analysis. Eur J Psychotraumatol 2024; 15:2297641. [PMID: 38214169 PMCID: PMC10791106 DOI: 10.1080/20008066.2023.2297641] [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: 08/31/2023] [Accepted: 11/17/2023] [Indexed: 01/13/2024] Open
Abstract
Background: Borderline personality disorder (BPD) is characterized by symptoms associated with difficulties in emotion regulation, altered self-image, impulsivity, and instability in personal relationships. A relationship has been found between BPD symptoms and altered neuropsychological processes. Studies of event-related potentials (ERP) measured with electroencephalogram (EEG) have found neural correlates related to BPD symptoms. Of note is the P300 component, considered a potential mental health biomarker for trauma-associated disorders. However, no meta-analysis has been found to demonstrate this relationship.Objectives: To evaluate the relationship between the P300 component and BPD symptoms. To evaluate the relationship of other ERP components with BPD symptoms.Methods: The method and procedure were adjusted to the PRISMA checklist. The search was performed in three databases: WOS, Scopus and PubMed. A Random Effects Model was used to perform the analysis of the studies. In addition, a meta-regression was performed with % women, Gini and GDP. Finally, a descriptive analysis of the main results found between P300, other ERP components (LPP, P100 and ERN/Ne) and BPD symptoms was performed.Results: From a review of 485 articles, a meta-analysis was performed with six articles that met the inclusion criteria. A moderate, positive relationship was found between the P300 component and BPD symptoms (REM = .489; p < .001). It was not possible to perform meta-analyses for other ERP components (LPP, P100 and ERN/Ne) due to the low number of articles found.Conclusion: The idea that P300 could be considered for use as a biomarker to identify altered neural correlates in BPD is reinforced. In addition, a moderating effect of inequality (Gini) was detected.
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Affiliation(s)
- Fabiola Salas
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Marcelo Nvo-Fernández
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Marcelo Leiva-Bianchi
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Daniela Avello Sáez
- School of Occupational Therapy, Faculty of Health, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Geraldy Sepúlveda Páeza
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
| | - Marc Via García
- Department of Clinical Psychology and Psychobiology, Universitat de Barcelona, Barcelona, Spain
- Institut de Neurociències, Universitat de Barcelona, Barcelona, Spain
| | - Cesar Villacura-Herrera
- Laboratory of Methodology for Behavioral Sciences and Neurosciences, Faculty of Psychology, Universidad de Talca, Talca, Chile
- Centro de Investigación en Ciencias Cognitivas, Faculty of Psychology, Universidad de Talca, Talca, Chile
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Afzal N, Lyttle MD, Rajabi M, Rushton-Smith F, Varghese R, Trickey D, Halligan SL. Emergency department clinicians' views on implementing psychosocial care following acute paediatric injury: a qualitative study. Eur J Psychotraumatol 2024; 15:2300586. [PMID: 38197257 PMCID: PMC10783840 DOI: 10.1080/20008066.2023.2300586] [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: 08/22/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024] Open
Abstract
Introduction: The early post-trauma period is a key time to provide psychological support to acutely injured children. This is often when they present to emergency departments (EDs) with their families. However, there is limited understanding of the feasibility of implementing psychological support for children and their families in EDs. The aim of this study was to explore UK and Irish ED clinicians' perspectives on developing and implementing psychosocial care which educates families on their children's post-trauma psychological recovery.Methods: Semi-structured individual and group interviews were conducted with 24 UK and Irish ED clinicians recruited via a paediatric emergency research network.Results: Clinicians expressed that there is value in offering psychological support for injured children and their families; however, there are barriers which can prevent this from being effectively implemented. Namely, the prioritisation of physical health, time constraints, understaffing, and a lack of training. Therefore, a potential intervention would need to be brief and accessible, and all staff should be empowered to deliver it to all families.Conclusion: Overall, participants' views are consistent with trauma-informed approaches where a psychosocial intervention should be able to be implemented into the existing ED system and culture. These findings can inform implementation strategies and intervention development to facilitate the development and delivery of an accessible digital intervention for acutely injured children and their families.
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Affiliation(s)
- Nimrah Afzal
- Department of Psychology, University of Bath, Bath, UK
| | - Mark D. Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
| | - Mohsen Rajabi
- Department of Psychology, University of Bath, Bath, UK
| | | | - Rhea Varghese
- Department of Psychology, University of Bath, Bath, UK
| | | | | | - on behalf of the Paediatric Emergency Research in the UK and Ireland (PERUKI)
- Department of Psychology, University of Bath, Bath, UK
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
- Anna Freud Centre, UK Trauma Council, London, UK
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Ferrajão P, Batista CI, Rocha R, Elklit A. Coping Styles and Defense Mechanisms Mediate Associations Between Exposure to Adverse Childhood Experiences and CPTSD Symptoms in Faroese Adolescents. Scand J Child Adolesc Psychiatr Psychol 2024; 12:33-46. [PMID: 38933756 PMCID: PMC11202398 DOI: 10.2478/sjcapp-2024-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024] Open
Abstract
Background The experience of several adverse childhood experiences (ACEs) has been shown to be associated with Post-Traumatic Stress Disorder (PTSD) and Disturbances in Self-Organization (DSO) symptoms among adolescents. Defense mechanisms and coping styles are psychological processes involved in the association of ACEs with PTSD and DSO symptoms. However, there is a lack of research on the joint association of these variables among Faroese adolescents. Aim The aim of this study was to analyze the effect of exposure to ACEs on PTSD and DSO symptoms trough the indirect effect of defense mechanisms and coping styles in a sample of Faroese adolescents. Method Six hundred and eighty-seven Faroese adolescents were recruited from 19 schools. Participants responded to validated self-report questionnaires. A multiple step mediation and a serial mediation methodology were conducted through structural equation modeling. Results Exposure to ACEs was linked to PTSD and DSO symptoms through the indirect effect of immature defense mechanisms, emotional coping, and detachment coping. Exposure to ACEs was linked to PTSD symptoms through rational coping. Conclusions The results suggest a mutual relationship between defense mechanisms and coping styles in coping with multiple adversity among adolescents.
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Affiliation(s)
- Paulo Ferrajão
- Department of Psychology, Faculty of Health Sciences, European University of Lisbon, Lisbon, Portugal
- CIDESD - Research Center in Sports Sciences, Health Sciences and Human Development, University of Trás-os-Montes and Alto Douro, Vila Real, Portugal
| | - Carolina Isabel Batista
- Department of Psychology, Faculty of Health Sciences, European University of Lisbon, Lisbon, Portugal
| | - Rebeca Rocha
- Department of Psychology, Faculty of Health Sciences, European University of Lisbon, Lisbon, Portugal
| | - Ask Elklit
- Naional Center for Psychotraumatology, University of Southern Denmark, Odense, Denmark
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A systematic literature review of the relationship between parenting responses and child post-traumatic stress symptoms. Eur J Psychotraumatol 2023; 14:2156053. [PMID: 37052099 PMCID: PMC9788707 DOI: 10.1080/20008066.2022.2156053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Parents are a key source of support for children exposed to single-incident/acute traumas and can thereby play a potentially significant role in children's post-trauma psychological adjustment. However, the evidence base examining parental responses to child trauma and child posttraumatic stress symptoms (PTSS) has yielded mixed findings.Objective: We conducted a systematic review examining domains of parental responding in relation to child PTSS outcomes.Method: Studies were included if they (1) assessed children (6-19 years) exposed to a potentially traumatic event, (2) assessed parental responses to a child's trauma, and (3) quantitatively assessed the relationship between parental responses and child PTSS outcomes. A systematic search of three databases (APAPsycNet, PTSDpubs, and Web of Science) yielded 27 manuscripts.Results: Parental overprotection, trauma communication, avoidance of trauma discussion and of trauma reminders, and distraction were consistently related to child PTSS. There was more limited evidence of a role for trauma-related appraisals, harsh parenting, and positive parenting in influencing child outcomes. Significant limitations to the evidence base were identified, including limited longitudinal evidence, single informant bias and small effect sizes.Conclusion: We conclude that key domains of parental responses could be potential intervention targets, but further research must validate the relationship between these parental responses and child PTSS outcomes.
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Ye Y, Li Y, Jin S, Huang J, Ma R, Wang X, Zhou X. Family Function and Post-Traumatic Stress Disorder in Children and Adolescents: A Meta-Analysis. TRAUMA, VIOLENCE & ABUSE 2023; 24:3151-3169. [PMID: 36226805 DOI: 10.1177/15248380221126182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Family function reflects the operating status of the family system, which plays a vital role in children's mental health. The current meta-analysis examined the association between family function and post-traumatic stress disorder (PTSD) in children and adolescents for the first time. Studies published from 1980 to 2021 were identified via searching and screening. We identified 31 studies (91 unique effects) with 8,684 children. A three-level meta-analysis revealed that overall family function was negatively associated with PTSD (r = -0.205). Among elements of family function, family affect (r = -0.251), communication (r = -0.221), and cohesion (r = -0.184) were associated with less PTSD, whereas family conflict (r = 0.228) was associated with more PTSD in children. Family flexibility (r = -0.103) was not associated with PTSD. Moderator analyses revealed differences between various types of trauma events and family function scales. The findings highlight the differences in the roles of the elements of family function and suggest that interventions should be focused on targeting specific elements of family function.
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Affiliation(s)
- Yingying Ye
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Yifan Li
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Shuxian Jin
- Department of Experimental and Applied Psychology, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Jiali Huang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Rong Ma
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Xuan Wang
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, Hangzhou, China
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Clarke V, Goddard A, Wellings K, Hirve R, Casanovas M, Bewley S, Viner R, Kramer T, Khadr S. Medium-term health and social outcomes in adolescents following sexual assault: a prospective mixed-methods cohort study. Soc Psychiatry Psychiatr Epidemiol 2023; 58:1777-1793. [PMID: 34370051 PMCID: PMC10627884 DOI: 10.1007/s00127-021-02127-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 06/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe medium-term physical and mental health and social outcomes following adolescent sexual assault, and examine users' perceived needs and experiences. METHOD Longitudinal, mixed methods cohort study of adolescents aged 13-17 years recruited within 6 weeks of sexual assault (study entry) and followed to study end, 13-15 months post-assault. RESULTS 75/141 participants were followed to study end (53% retention; 71 females) and 19 completed an in-depth qualitative interview. Despite many participants accessing support services, 54%, 59% and 72% remained at risk for depressive, anxiety and post-traumatic stress disorders 13-15 months post-assault. Physical symptoms were reported more frequently. Persistent (> 30 days) absence from school doubled between study entry and end, from 22 to 47%. Enduring mental ill-health and disengagement from education/employment were associated with psychosocial risk factors rather than assault characteristics. Qualitative data suggested inter-relationships between mental ill-health, physical health problems and disengagement from school, and poor understanding from schools regarding how to support young people post-assault. Baseline levels of smoking, alcohol and ever drug use were high and increased during the study period (only significantly for alcohol use). CONCLUSION Adolescents presenting after sexual assault have high levels of vulnerability over a year post-assault. Many remain at risk for mental health disorders, highlighting the need for specialist intervention and ongoing support. A key concern for young people is disruption to their education. Multi-faceted support is needed to prevent social exclusion and further widening of health inequalities in this population, and to support young people in their immediate and long-term recovery.
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Affiliation(s)
- Venetia Clarke
- The Havens Sexual Assault Referral Centres, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Andrea Goddard
- The Havens Sexual Assault Referral Centres, King's College Hospital, Denmark Hill, London, SE5 9RS, UK
- Department of Paediatrics, Imperial College Healthcare NHS Trust, London, W2 1NY, UK
| | - Kaye Wellings
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - Raeena Hirve
- Department of Women and Children's Health, King's College London, c/o 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7NH, UK
| | - Marta Casanovas
- Division of Psychiatry, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK
| | - Susan Bewley
- Department of Women and Children's Health, King's College London, c/o 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7NH, UK
| | - Russell Viner
- Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 3EH, UK
| | - Tami Kramer
- Division of Psychiatry, Imperial College London, 7th Floor Commonwealth Building, Du Cane Road, London, W12 0NN, UK
| | - Sophie Khadr
- The Havens Sexual Assault Referral Centres, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.
- Department of Women and Children's Health, King's College London, c/o 10th Floor North Wing, St Thomas' Hospital, Westminster Bridge Road, London, SE1 7NH, UK.
- Great Ormond Street Institute of Child Health, University College London, 30 Guilford Street, London, WC1N 3EH, UK.
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Bartsch CJ, Jacobs JT, Mojahed N, Qasem E, Smith M, Caldwell O, Aaflaq S, Nordman JC. Visualizing traumatic stress-induced structural plasticity in a medial amygdala pathway using mGRASP. Front Mol Neurosci 2023; 16:1313635. [PMID: 38098941 PMCID: PMC10720331 DOI: 10.3389/fnmol.2023.1313635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 11/07/2023] [Indexed: 12/17/2023] Open
Abstract
Traumatic stress has been shown to contribute to persistent behavioral changes, yet the underlying neural pathways are not fully explored. Structural plasticity, a form of long-lasting neural adaptability, offers a plausible mechanism. To scrutinize this, we used the mGRASP imaging technique to visualize synaptic modifications in a pathway formed between neurons of the posterior ventral segment of the medial amygdala and ventrolateral segment of the ventromedial hypothalamus (MeApv-VmHvl), areas we previously showed to be involved in stress-induced excessive aggression. We subjected mice (7-8 weeks of age) to acute stress through foot shocks, a reliable and reproducible form of traumatic stress, and compared synaptic changes to control animals. Our data revealed an increase in synapse formation within the MeApv-VmHvl pathway post-stress as evidenced by an increase in mGRASP puncta and area. Chemogenetic inhibition of CaMKIIα-expressing neurons in the MeApv during the stressor led to reduced synapse formation, suggesting that the structural changes were driven by excitatory activity. To elucidate the molecular mechanisms, we administered the NMDAR antagonist MK-801, which effectively blocked the stress-induced synaptic changes. These findings suggest a strong link between traumatic stress and enduring structural changes in an MeApv-VmHvl neural pathway. Furthermore, our data point to NMDAR-dependent mechanisms as key contributors to these synaptic changes. This structural plasticity could offer insights into persistent behavioral consequences of traumatic stress, such as symptoms of PTSD and social deficits.
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Affiliation(s)
| | | | | | | | | | | | | | - Jacob C. Nordman
- Department of Physiology, Southern Illinois University School of Medicine, Carbondale, IL, United States
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Keenan HT, Wade SL, Miron D, Presson AP, Clark AE, Ewing-Cobbs L. Reducing Stress after Trauma (ReSeT): study protocol for a randomized, controlled trial of an online psychoeducational program and video therapy sessions for children hospitalized after trauma. Trials 2023; 24:766. [PMID: 38017574 PMCID: PMC10683223 DOI: 10.1186/s13063-023-07806-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Post-traumatic stress symptoms develop in a quarter to half of injured children affecting their longer-term psychologic and physical health. Evidence-based care exists for post-traumatic stress; however, it is not readily available in some communities. We have developed an eHealth program consisting of online, interactive educational modules and telehealth therapist support based in trauma-focused cognitive behavioral therapy, the Reducing Stress after Trauma (ReSeT) program. We hypothesize that children with post-traumatic stress who participate in ReSeT will have fewer symptoms compared to the usual care control group. METHODS This is a randomized controlled trial to test the effectiveness of the ReSeT intervention in reducing symptoms of post-traumatic stress compared to a usual care control group. One hundred and six children ages 8-17 years, who were admitted to hospital following an injury, with post-traumatic stress symptoms at 4 weeks post-injury, will be recruited and randomized from the four participating trauma centers. The outcomes compared across groups will be post-traumatic stress symptoms at 10 weeks (primary outcome) controlling for baseline symptoms and at 6 months post-randomization (secondary outcome). DISCUSSION ReSeT is an evidence-based program designed to reduce post-traumatic stress symptoms among injured children using an eHealth platform. Currently, the American College of Surgeons standards suggest that trauma programs identify and treat patients at high risk for mental health needs in the trauma system. If effectiveness is demonstrated, ReSeT could help increase access to evidence-based care for children with post-traumatic stress within the trauma system. TRIAL REGISTRATION ClinicalTrials.gov NCT04838977. 8 April 2021.
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Affiliation(s)
- Heather T Keenan
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA.
| | - Shari L Wade
- Cincinnati Children's Hospital Medical Center Division of Pediatric Rehabilitation, Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Devi Miron
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave. #8055, New Orleans, LA, 70112, USA
| | - Angela P Presson
- Department of Internal Medicine, University of Utah School of Medicine, 30 N Mario Capecchi Dr. , Salt Lake City, UT, 84112, USA
| | - Amy E Clark
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Linda Ewing-Cobbs
- Children's Learning Institute, McGovern Medical School at UTHealth, 7000 Fannin, Suite 2401, Houston, TX, 77030, USA
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König M, Berhe O, Ioannidis K, Orellana S, Davidson E, Kaser M, Moreno-López L, van Harmelen AL. The stress-buffering role of friendships in young people with childhood threat experiences: a preliminary report. Eur J Psychotraumatol 2023; 14:2281971. [PMID: 38154076 PMCID: PMC10990450 DOI: 10.1080/20008066.2023.2281971] [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: 07/03/2023] [Accepted: 10/12/2023] [Indexed: 12/30/2023] Open
Abstract
Background: High-quality friendships have a positive impact on the mental health of young people with childhood adversity (CA). Social stress buffering, the phenomenon of a social partner attenuating acute stress responses, is a potential yet unexplored mechanism that may underlie this relationship.Objective: This study examined whether perceived friendship quality was related to better mental health and lower neural stress response in young people with CA.Method: A total of N = 102 young people (aged 16-26) with low to moderate CA were included in the study. We first investigated associations between friendship quality, mental health, and CA. In a representative subset (n = 62), we assessed neural stress responses using the Montreal Imaging Stress Task. In our sample, CA was best described along two dimensions resembling threat or deprivation like experiences. Hence, we investigated both cumulative and dimensional effects of CA.Results: We found no support for social thinning after CA, meaning that the severity of CA (cumulative or dimensional) did not differentially impact friendship quality. High-quality friendships, on the other hand, were strongly associated with better mental health. Furthermore, acute stress increased state anxiety and enhanced neural activity in five frontolimbic brain regions, including the left hippocampus. We found weak support that threat experiences interacted with friendship quality to predict left hippocampal reactivity to stress. However, this effect did not survive multiple comparison correction.Conclusion: The absence of social thinning in our sample may suggest that the risk of developing impoverished social networks is low for rather well-functioning young people with low to moderate CA. Regardless, our findings align with prior research, consistently showing a strong association between high-quality friendships and better mental health in young people with CA. Future research is needed to examine whether friendships aid neural stress responses in young people with childhood threat experiences.
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Affiliation(s)
- Maximilian König
- Institute of Education and Child Studies, Leiden University, Leiden, the Netherlands
| | - Oksana Berhe
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
| | - Konstantinos Ioannidis
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
| | - Sofia Orellana
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
| | - Eugenia Davidson
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
| | - Muzaffer Kaser
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
| | - RAISE Consortium
- Institute of Education and Child Studies, Leiden University, Leiden, the Netherlands
- Department of Psychiatry and Psychotherapy, Medical Faculty Mannheim, Central Institute of Mental Health, Heidelberg University, Mannheim, Germany
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
| | - Laura Moreno-López
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
| | - Anne-Laura van Harmelen
- Institute of Education and Child Studies, Leiden University, Leiden, the Netherlands
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Addenbrooke’s Hospital, Cambridge, UK
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Levin R, Liu R. Post-traumatic stress disorder in a national sample of preadolescent children: Prevalence, correlates, clinical sequelae, and treatment utilization. RESEARCH SQUARE 2023:rs.3.rs-3303568. [PMID: 38014240 PMCID: PMC10680942 DOI: 10.21203/rs.3.rs-3303568/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Although posttraumatic stress disorder (PTSD) has been well characterized in adults, its epidemiology in children is unclear. The current study provides the first population-based examination of the prevalence of PTSD, sociodemographic and psychiatric correlates, clinical sequelae, and associations with psychiatric treatment in preadolescents in the United States. Data from the Adolescent Brain and Cognitive Development (ABCD) Study (release 5.0) was analyzed. Participants (unweighted n = 11, 875) were recruited from 21 sites across the United States. Current and lifetime PTSD prevalence were estimated, as was treatment use among children with PTSD. Sociodemographic, psychiatric correlates and sequelae of PTSD were analyzed using logistic regression, as was the association between PTSD and psychiatric treatment. Lifetime prevalence of PTSD was 2.17%. Sexual minority status, being multiracial, having unmarried parents, and family economic insecurity were associated with greater odds of PTSD. Among psychiatric disorders, separation anxiety was most strongly associated with PTSD, although general comorbid psychopathology was associated with greater odds of PTSD. Prior history of PTSD predicted new onset of other psychiatric disorders after PTSD remission. Nearly one in three children with lifetime PTSD did not receive psychiatric treatment, despite negative long-term outcomes of PTSD and significant psychiatric comorbidity. Even among preadolescents who experience full remission of PTSD, significant risk for future psychiatric illness remains. Further, the current findings underscore the need for improved efforts to reduce unmet treatment needs among those with PTSD at this age.
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Sorjonen K, Melin B. Prospective associations between social support and posttraumatic stress disorder may be spurious: A re-meta-analysis of longitudinal studies and a simulation. J Affect Disord 2023; 340:174-180. [PMID: 37557992 DOI: 10.1016/j.jad.2023.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 07/18/2023] [Accepted: 08/03/2023] [Indexed: 08/11/2023]
Abstract
A recent meta-analysis concluded to have found proof for both a social causation model, according to which social support protects against posttraumatic stress disorder (PTSD), and a social selection model, which claims that PTSD erodes social support. However, the prospective cross-lagged effects were estimated while adjusting for a prior measurement of the outcome and this method is vulnerable for spurious findings due to correlations with residuals and regression toward the mean. The present re-analyses of the meta-analytic effects indicated that depending on used model one can choose to claim that social support has either a decreasing, an increasing, or no prospective effect on subsequent change in PTSD symptom severity, and vice versa. Therefore, claims over and above a negative cross-sectional correlation between social support and PTSD, including the social causation and social selection models, can be questioned. The findings were validated by analyses of simulated data, which indicated that prospective effects were not necessary for the observed meta-analytic associations.
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Affiliation(s)
- Kimmo Sorjonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
| | - Bo Melin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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de Lacy N, Ramshaw MJ, McCauley E, Kerr KF, Kaufman J, Nathan Kutz J. Predicting individual cases of major adolescent psychiatric conditions with artificial intelligence. Transl Psychiatry 2023; 13:314. [PMID: 37816706 PMCID: PMC10564881 DOI: 10.1038/s41398-023-02599-9] [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: 06/03/2022] [Revised: 09/10/2023] [Accepted: 09/20/2023] [Indexed: 10/12/2023] Open
Abstract
Three-quarters of lifetime mental illness occurs by the age of 24, but relatively little is known about how to robustly identify youth at risk to target intervention efforts known to improve outcomes. Barriers to knowledge have included obtaining robust predictions while simultaneously analyzing large numbers of different types of candidate predictors. In a new, large, transdiagnostic youth sample and multidomain high-dimension data, we used 160 candidate predictors encompassing neural, prenatal, developmental, physiologic, sociocultural, environmental, emotional and cognitive features and leveraged three different machine learning algorithms optimized with a novel artificial intelligence meta-learning technique to predict individual cases of anxiety, depression, attention deficit, disruptive behaviors and post-traumatic stress. Our models tested well in unseen, held-out data (AUC ≥ 0.94). By utilizing a large-scale design and advanced computational approaches, we were able to compare the relative predictive ability of neural versus psychosocial features in a principled manner and found that psychosocial features consistently outperformed neural metrics in their relative ability to deliver robust predictions of individual cases. We found that deep learning with artificial neural networks and tree-based learning with XGBoost outperformed logistic regression with ElasticNet, supporting the conceptualization of mental illnesses as multifactorial disease processes with non-linear relationships among predictors that can be robustly modeled with computational psychiatry techniques. To our knowledge, this is the first study to test the relative predictive ability of these gold-standard algorithms from different classes across multiple mental health conditions in youth within the same study design in multidomain data utilizing >100 candidate predictors. Further research is suggested to explore these findings in longitudinal data and validate results in an external dataset.
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Affiliation(s)
- Nina de Lacy
- Huntsman Mental Health Institute, Salt Lake City, UT, 84103, USA.
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84103, USA.
| | - Michael J Ramshaw
- Huntsman Mental Health Institute, Salt Lake City, UT, 84103, USA
- Department of Psychiatry, University of Utah, Salt Lake City, UT, 84103, USA
| | - Elizabeth McCauley
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Kathleen F Kerr
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - J Nathan Kutz
- Department of Applied Mathematics, University of Washington, Seattle, WA, USA
- AI Institute for Dynamical Systems, Seattle, WA, USA
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Kangaslampi S, Zijlmans J. MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02310-9. [PMID: 37814082 DOI: 10.1007/s00787-023-02310-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
3,4-Methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement. We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms. Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on (1) reinforcing motivation, (2) the development of a strong therapeutic alliance, (3) additional emotion and behavior management techniques, (4) more directive exposure-based methods during MDMA sessions, (5) more support for concomitant challenges and integrating treatment benefits, and (6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues. We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents.
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Affiliation(s)
- Samuli Kangaslampi
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland.
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | - Josjan Zijlmans
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam University Medical Center, Mental Health, Amsterdam, The Netherlands
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Yuan T, Li X, Liu H, Guo LL, Li JL, Xu G, Li X, Sun L, Wang C, Yang L, Zhang D, Hua Y, Lei Y, Zhang L. Community trauma exposure and post-traumatic stress disorder in Chinese children and adolescents. Front Psychiatry 2023; 14:1151631. [PMID: 37867778 PMCID: PMC10587585 DOI: 10.3389/fpsyt.2023.1151631] [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: 01/26/2023] [Accepted: 09/13/2023] [Indexed: 10/24/2023] Open
Abstract
Background An increasing number of studies have shown the association between traumatic events occurring in childhood and adolescence and post-traumatic stress disorder (PTSD). A gap remains in the literature on the epidemiology and influencing factors of traumatic events and post-traumatic stress disorder in communities in northern China. This study aimed to determine the prevalence of traumatic events and PTSD in communities in northern China, to explore the types of stressful traumatic events and the impact of these traumatic events on children and adolescents, and to investigate the effect of sociodemographic factors on PTSD. Methods A cross-sectional survey study was conducted among 6,027 students (7-17 years old) from 6 cities in Liaoning Province, China. The sample consisted of 2,853 males (47.34%) and 3,174 females (52.66%). The Essen Trauma-Inventory for Children and Adolescents (ETI-CA) Scale was used. The ETI-CA has 5 sections, which include type of traumatic events, worst traumatic event, post-traumatic symptoms, onset, duration, burden of PTSD, and present difficulties in different areas of life. PTSD symptoms were assessed with 23 items in Part 3 of the ETI-CA. Results We found that 2,068 (34.3%) of 6,027 participants experienced trauma events and 686 (33.2%) of 2,068 reported PTSD. Among trauma-exposed youth (2,068), the sudden death of close relatives (33.9%), serious accidents (20.9%), and parental divorce (15.5%) were reported as the worst traumatic events. Studies have shown that after exposure to stressful life events, more than 30% of people feel nervous or upset (39.8%), scared (33.4%), helpless (32.6%), and about 10% have headaches (15.5%), rapid heartbeat (13.3%), and dizziness (11.8%). Multivariable logistic regression analyses showed that students in middle school [OR = 1.29 (1.016, 1.637)], not a student leader [OR = 0.738 (0.618, 0.881)], and their parents in single marital status significantly predicted higher PTSD prevalence the remarried [OR = 0.474 (0.252, 0.893)], married [OR = 0.42 (0.227, 0.778)]. Conclusion The present study suggests the government to train psychological counselors in schools and communities to provide emotional and psychological support, as well as the school leaders and parents to elevate adolescents' psychological suzhi. Particularly, counseling and professional support should be given to those students whose parents are single.
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Affiliation(s)
- Ting Yuan
- Department of Gynecology and Obstetrics Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Xiangdong Li
- Department of Gerontology, Yijishan Hospital, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, China
| | - Haiyang Liu
- Student Health Center, Wannan Medical College, Wuhu, Anhui, China
| | - Lei-lei Guo
- Department of Surgical Nursing, School of Nursing, Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Jin-long Li
- Department of Occupational and Environmental Health, Key Laboratory of Occupational Health and Safety for Coal Industry in Hebei Province, School of Public Health, North China University of Science and Technology, Tangshan, Hebei, China
| | - Guang Xu
- Department of Radiotherapy, Third Affiliated Hospital of Jinzhou Medical University, Jinzhou, Liaoning, China
| | - Xiaoping Li
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Lu Sun
- Department of Emergency and Critical Care Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Congzhi Wang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Liu Yang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Dongmei Zhang
- Department of Pediatric Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Ying Hua
- Rehabilitation Nursing, School of Nursing, Wanna Medical College, Wuhu, Anhui, China
| | - Yunxiao Lei
- Department of Gynecology and Obstetrics Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
| | - Lin Zhang
- Department of Internal Medicine Nursing, School of Nursing, Wannan Medical College, Wuhu, Anhui, China
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Zhou H, Hu Y, Cheng X, Sun X. Resilience as Mediator in Relation to Parental Attachment and Posttraumatic Stress Disorder in Adolescents Following the Yancheng Tornado. Clin Child Psychol Psychiatry 2023; 28:1408-1419. [PMID: 36866772 DOI: 10.1177/13591045231160639] [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: 03/04/2023]
Abstract
Resilience and secure parental attachment have been proven as important factors to alleviate the posttraumatic stress disorder (PTSD). However, the effects of the two factors on PTSD and the mechanisms of its effect at different time points in the aftermath of trauma are still unclear. This study explores the relationship among parental attachment, resilience, and development of PTSD symptoms in adolescents from a longitudinal perspective following the Yancheng Tornado. Using cluster sampling method, a total of 351 Chinese adolescents, survivors of a severe tornado, were tested on their PTSD, parental attachment and resilience at 12-months and 18-months after experiencing the natural disaster. The results showed that our proposed model fit the data well: χ2/df = 3.197, CFI = 0.967, TLI = 0.950, RMSEA = 0.079. It revealed that the resilience at 18-months partially mediated the relationship between parental attachment at 12-months and PTSD at 18-months. Research results showed that parental attachment and resilience are key resources for coping with trauma.
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Affiliation(s)
- Hong Zhou
- School of Psychology, Nanjing Normal University, Nanjing, PR China
| | - Yutong Hu
- School of Psychology, Nanjing Normal University, Nanjing, PR China
| | - Xuan Cheng
- School of Psychology, Nanjing Normal University, Nanjing, PR China
| | - Xiaoran Sun
- School of Psychology, Nanjing Normal University, Nanjing, PR China
- No.1 Middle School of Suzhou New District, Suzhou, PR China
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Georgescu T, Nedelcea C. Pretrauma risk factors and posttraumatic stress disorder symptoms following subsequent exposure: Multilevel and univariate meta-analytical approaches. Clin Psychol Psychother 2023. [PMID: 37690794 DOI: 10.1002/cpp.2912] [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: 06/01/2023] [Revised: 08/26/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
The endeavour to comprehend why certain individuals develop posttraumatic stress disorder (PTSD) symptoms subsequent to experiencing traumatic events, while others do not, underscores the paramount importance of pretraumatic risk factors. This meta-analysis summarises the extant results of studies assessing risk factors prior exposure and PTSD symptoms following an index event on the same participants. It includes 43 studies (N = 19,239) yielding 174 effect sizes of pretraumatic risk factors categories such as demographic factors, cognitive factors, personality traits, coping styles, psychopathology, psychophysiological and environmental factors, which were examined using a three-level meta-analysis. Additionally, univariate random-effects meta-analyses were performed to separately investigate individual risk factors reported in more than one study. The findings revealed significant, small and medium associations for all categories, except for demographic factors and coping styles, also highlighting that certain individual risk factor domains (i.e. previous mental disorders, negative emotionality, sleep complaints and PTSD symptoms) represent the strongest predictors for PTSD symptoms after subsequent exposure. Several moderators were also investigated for individual risk factors. Future research could benefit from considering the interplay of pretraumatic risk factors to draw a more complex picture of the aetiology and underlying mechanisms of PTSD symptoms.
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Affiliation(s)
- Teodora Georgescu
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
| | - Cătălin Nedelcea
- Department of Psychology and Cognitive Sciences, University of Bucharest, Bucharest, Romania
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Pearce E, Birken M, Pais S, Tamworth M, Ng Y, Wang J, Chipp B, Crane E, Schlief M, Yang J, Stamos A, Cheng LK, Condon M, Lloyd-Evans B, Kirkbride JB, Osborn D, Pitman A, Johnson S. Associations between constructs related to social relationships and mental health conditions and symptoms: an umbrella review. BMC Psychiatry 2023; 23:652. [PMID: 37667255 PMCID: PMC10478264 DOI: 10.1186/s12888-023-05069-0] [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: 03/26/2023] [Accepted: 07/31/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Loneliness and social isolation are increasingly recognised as prevalent among people with mental health problems, and as potential targets for interventions to improve quality of life and outcomes, as well as for preventive strategies. Understanding the relationship between quality and quantity of social relationships and a range of mental health conditions is a helpful step towards development of such interventions. PURPOSE Our aim was to give an overview of associations between constructs related to social relationships (including loneliness and social isolation) and diagnosed mental conditions and mental health symptoms, as reported in systematic reviews of observational studies. METHODS For this umbrella review (systematic review of systematic reviews) we searched five databases (PsycINFO, MEDLINE, EMBASE, CINAHL, Web of Science) and relevant online resources (PROSPERO, Campbell Collaboration, Joanna Briggs Institute Evidence Synthesis Journal). We included systematic reviews of studies of associations between constructs related to social relationships and mental health diagnoses or psychiatric symptom severity, in clinical or general population samples. We also included reviews of general population studies investigating the relationship between loneliness and risk of onset of mental health problems. RESULTS We identified 53 relevant systematic reviews, including them in a narrative synthesis. We found evidence regarding associations between (i) loneliness, social isolation, social support, social network size and composition, and individual-level social capital and (ii) diagnoses of mental health conditions and severity of various mental health symptoms. Depression (including post-natal) and psychosis were most often reported on, with few systematic reviews on eating disorders or post-traumatic stress disorder (PTSD), and only four related to anxiety. Social support was the most commonly included social construct. Our findings were limited by low quality of reviews and their inclusion of mainly cross-sectional evidence. CONCLUSION Good quality evidence is needed on a wider range of social constructs, on conditions other than depression, and on longitudinal relationships between social constructs and mental health symptoms and conditions.
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Affiliation(s)
- Eiluned Pearce
- Division of Psychiatry, University College London, London, UK
| | - Mary Birken
- Division of Psychiatry, University College London, London, UK
| | - Sarah Pais
- Division of Psychiatry, University College London, London, UK
| | - Millie Tamworth
- Division of Psychiatry, University College London, London, UK
| | - Yutung Ng
- Division of Psychiatry, University College London, London, UK
| | - Jingyi Wang
- Key Laboratory of Public Health Safety, NHC Key Laboratory of Health Technology Assessment, School of Public Health, Fudan University, Shanghai, China
| | - Beverley Chipp
- Co-production Group, Loneliness and Social Isolation in Mental Health Research Network, Division of Psychiatry, University College London, London, UK
| | - Ellena Crane
- Division of Psychiatry, University College London, London, UK
| | - Merle Schlief
- Division of Psychiatry, University College London, London, UK
| | - Jinyan Yang
- Division of Psychiatry, University College London, London, UK
| | - Aggelos Stamos
- Division of Psychiatry, University College London, London, UK
| | - Lui Kwan Cheng
- Division of Psychiatry, University College London, London, UK
| | - Maria Condon
- Division of Psychiatry, University College London, London, UK
| | | | | | - David Osborn
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Alexandra Pitman
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK.
- Camden and Islington NHS Foundation Trust, London, UK.
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Walsh C, Cunningham T. THE PAINS OF PARAMILITARISM: The Latent Criminogenic Effects of Exposure to Paramilitary Violence Among Young Men in a Post-Conflict Society. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:547-558. [PMID: 37593052 PMCID: PMC10427590 DOI: 10.1007/s40653-023-00516-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/05/2023] [Indexed: 08/19/2023]
Abstract
Purpose: Whilst most people who experience adversity recover, there is a cumulative body of evidence that illustrates that the effects can be long lasting, and can even become debilitating over time. Links have been made between traumatic distress, mental health disorders and disturbances in behavioural and emotional regulatory systems that may in context elevate the risk of offending. Despite the burgeoning evidence around the criminogenic effects of adversity, few studies have examined the traumatic effects of paramilitary related adversity in the context of post-conflict Northern Ireland. Methods: With reference to DSM-V PTSD diagnostic clusters, the aim of this study was to explore the latent impact of adversity and latent trauma among justice involved young men and identify potential criminogenic effects of exposure to paramilitary related adversity. Results and conclusions: This study found that across the sample, young men had self-reported to have experienced significant adversity, including violent victimisation. Exposure to paramilitary adversity often began during early adolescence. The participants described symptoms that were consistent with clinically diagnosable disorders such as Post-Traumatic Stress Disorder. Despite this, there appears to be a paucity of trauma screening and assessment, and few supports that victim could benefit from. In the absence of appropriate and evidence-based supports, many young men appear to find other (and more maladaptive) ways to cope. This exacerbates the risk of interfacing with the justice system and may even contribute towards a deterioration in wider psycho-social outcomes. Implications for practice are discussed.
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Affiliation(s)
- Colm Walsh
- Queen’s University Belfast, Belfast, United Kingdom
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49
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May C, Miller PE, Naqvi M, Rademacher E, Klajn J, Hedequist D, Shore BJ. The Incidence of Posttraumatic Stress Symptoms in Children. J Am Acad Orthop Surg Glob Res Rev 2023; 7:01979360-202308000-00007. [PMID: 37579777 PMCID: PMC10424889 DOI: 10.5435/jaaosglobal-d-22-00245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 04/17/2023] [Accepted: 06/30/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVE To determine the incidence of posttraumatic stress disorder (PTSD) symptoms and risk factors for their development in children and adolescents undergoing orthopaedic surgery for trauma. DESIGN Prospective cohort study. SETTING Level-1 trauma center. PATIENTS Children (8 to 18), undergoing surgery for orthopaedic trauma. INTERVENTION Upper and lower extremity surgery for orthopaedic trauma. MAIN OUTCOME MEASUREMENTS PTSD symptoms at postoperative follow-up as determined by the Child PTSD Symptom Scale (CPSS). RESULTS A total of 176 children with an average age at surgery of 13 years (8 to 18.8 years) participated in the study. Twenty-six subjects had high levels of PTSD symptoms (15%; 95% CI = 10.0 to 21.1%). Univariable and multivariable analyses determined that female sex (OR 2.63, 95% CI = 1.06 to 6.67, P = 0.04), older age at surgery (OR 1.25, 95% CI = 1.04 to 1.51, P = 0.02), and undergoing a previous surgery (OR 2.86, 95% CI = 1.06 to 7.73, P = 0.04) were all associated with increased PTSD risk. CONCLUSIONS Children and adolescents experience a high level of PTSD symptoms (15%) after surgery for orthopaedic trauma. Clinicians should be aware of PTSD symptoms in children and adolescents after surgery for orthopaedic injuries and use comprehensive screening to facilitate timely intervention and treatment. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Collin May
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Patricia E. Miller
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Manahill Naqvi
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Emily Rademacher
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Justyna Klajn
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Daniel Hedequist
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
| | - Benjamin J. Shore
- From the Department of Orthopedic Surgery, Boston Children's Hospital, Boston, MA
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50
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White LK, Barzilay R, Moore TM, Calkins ME, Jones JD, Himes MM, Young JF, Gur RC, Gur RE. Risk and Resilience Measures Related to Psychopathology in Youth. Child Psychiatry Hum Dev 2023; 54:961-972. [PMID: 35037180 PMCID: PMC9289457 DOI: 10.1007/s10578-021-01296-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 11/30/2022]
Abstract
Childhood adversity places youth at risk for multiple negative outcomes. The current study aimed to understand how a constellation of risk and resilience factors influenced mental health outcomes as a function of adversities: socioeconomic status (SES) and traumatic stressful events (TSEs). Specifically, we examined outcomes related to psychosis and mood disorders, as well as global clinical functioning. The current study is a longitudinal follow up of 140 participants from the Philadelphia Neurodevelopmental Cohort (PNC) assessed for adversities at Time 1 (Mean age: 14.11 years) and risk, resilience, and clinical outcomes at Time 2 (mean age: 21.54 years). In the context of TSE, a limited set of predictors emerged as important; a more diverse set of moderators emerged in the context of SES. Across adversities, social support was a unique predictor of psychosis spectrum diagnoses and global functioning; emotion dysregulation was an important predictor for mood diagnoses. The current findings underscore the importance of understanding effects of childhood adversity on maladaptive outcomes within a resilience framework.
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Affiliation(s)
- Lauren K White
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Ran Barzilay
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Tyler M Moore
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Monica E Calkins
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Jason D Jones
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Megan M Himes
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
| | - Jami F Young
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Ruben C Gur
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Raquel E Gur
- Lifespan Brain Institute, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA
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