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Kazlauskas E, Kairyte A, Zelviene P. Complex posttraumatic stress disorder in adolescence: A two-year follow-up study. Clin Child Psychol Psychiatry 2024; 29:466-478. [PMID: 37402474 PMCID: PMC10945978 DOI: 10.1177/13591045231187975] [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: 07/06/2023]
Abstract
BACKGROUND Complex posttraumatic stress disorder is a new diagnosis in the 11th edition of the International Classification of Diseases (ICD-11). There is a need for a better understanding of complex PTSD in children and adolescents. OBJECTIVE The study aimed to estimate the factors associated with chronic complex PTSD versus recovery of complex PTSD in adolescents in a 2-year follow-up study. METHOD In total, 66 adolescents, mean age 14.5, 73% female, identified as having complex PTSD using self-report at baseline recruited from a general population sample, were included in the study. The International Trauma Questionnaire - Child and Adolescent Version (ITQ-CA) was used for the assessment of complex PTSD. RESULTS Overall, 36% of the study sample has been identified as having chronic complex PTSD over 2 years, 10% met the criteria for PTSD at a 2-year follow-up, and 54% recovered. A higher risk for chronic complex PTSD was associated with exposure to more traumatic events and more life-stressors over the 2 years, low social network, low positive social support, bullying at school, and loneliness. CONCLUSION The study found that around one-third of the traumatized youth had a prolonged trajectory of complex PTSD symptoms, which were associated with negative life experiences and social difficulties.
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Affiliation(s)
- Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Agniete Kairyte
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Paulina Zelviene
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
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Skandsen A, Hysing M, Askeland KG, Teicher MH, Sand L, Bøe T. Using Norwegian National Patient Registry data to understand associations between potentially traumatic life experiences and mental health care use in adolescence. J Trauma Stress 2024; 37:92-102. [PMID: 37985958 DOI: 10.1002/jts.22996] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 10/12/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023]
Abstract
Exposure to potentially traumatic experiences (PTEs) is common among children and adolescents and associated with an increased risk of psychiatric diagnoses. This study aimed to ascertain how the number of PTEs differed across adolescent psychiatric diagnoses. Data on PTE exposure were derived from the youth@hordaland survey, and Axis 1 data were from the linked Norwegian National Patient Registry (NPR). Among 10,257 total adolescents, 9,555 (age range: 16-19 years, 53.9% female) consented to register linkage, 8,845 of whom were included in the analyses. Having contact with Child and Adolescent Mental Health Services (CAMHS) predicted more PTEs (estimated marginal mean [EMM] = 1.04, SE = 0.05) and exposure to two or more PTEs compared to having no CAMHS contact (EMM = 0.60) after adjusting for age, ethnicity, sex, and parental education. Adolescents diagnosed with attention-deficit/hyperactivity disorder, depression, trauma-related disorders, conduct disorder, and anxiety experienced significantly more PTEs (EMMs = 0.90-1.63) than those with no CAMHS contact (EMM = 0.57, SE = 0.01). All diagnostic categories except psychosis, autism spectrum disorders, and eating disorders had a significantly higher rate of PTEs compared with adolescents with no CAMHS contact. The study highlights the potential role of exposure to multiple PTEs as a transdiagnostic risk factor, although the level of risk varies between diagnoses.
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Affiliation(s)
- Annika Skandsen
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
- Stavanger University Hospital, Stavanger, Norway
| | - Mari Hysing
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Kristin Gärtner Askeland
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
| | - Martin H Teicher
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
- Developmental Biopsychiatry Research Program, McLean Hospital, Belmont, Massachusetts, USA
| | - Liv Sand
- Stavanger University Hospital, Stavanger, Norway
| | - Tormod Bøe
- Department of Psychosocial Science, Faculty of Psychology, University of Bergen, Bergen, Norway
- Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre, Bergen, Norway
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Kleva CS, Keeley JW, Evans SC, Maercker A, Cloitre M, Brewin CR, Roberts M, Reed GM. Examining accurate diagnosis of complex PTSD in ICD-11. J Affect Disord 2024; 346:110-114. [PMID: 37918575 DOI: 10.1016/j.jad.2023.10.137] [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: 05/10/2023] [Revised: 10/13/2023] [Accepted: 10/21/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Complex posttraumatic stress disorder (complex PTSD), the most frequently suggested new category for inclusion by mental health professionals, has been included in the Eleventh Revision of the World Health Organization's International Classification of Diseases (ICD-11). Research has yet to explore whether clinicians' recognition of the distinct complex PTSD symptoms predicts giving the correct diagnosis. The present study sought to determine if international mental health professionals were able to accurately diagnose complex PTSD and identify the shared PTSD features and three essential diagnostic features, specific to complex PTSD. METHODS Participants were randomly assigned to view two vignettes and tasked with providing a diagnosis (or indicating that no diagnosis was warranted). Participants then answered a series of questions regarding the presence or absence of each of the essential diagnostic features specific to the diagnosis they provided. RESULTS Clinicians who recognized the presence or absence of complex PTSD specific features were more likely to arrive at the correct diagnostic conclusion. Complex PTSD specific features were significant predictors while the shared PTSD features were not, indicating that attending to each of the specific symptoms was necessary for diagnostic accuracy of complex PTSD. LIMITATIONS The use of written case vignettes including only adult patients and a non-representative sample of mental health professionals may limit the generalizability of the results. CONCLUSIONS Findings support mental health professionals' ability to accurately identify specific features of complex PTSD. Future work should assess whether mental health providers can effectively identify symptoms of complex PTSD in a clinical setting.
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Affiliation(s)
- Christopher S Kleva
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Spencer C Evans
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Marylene Cloitre
- National Center for PTSD, Division of Dissemination and Training, VA Palo Alto Health Care System, CA, USA; Department of Psychiatry and Behavioral Sciences, Standford University, Stanford, CA, USA
| | - Chris R Brewin
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Michael Roberts
- Office of Graduate Studies and Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA; Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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Examination of ICD-11 PTSD and CPTSD using the International Trauma Questionnaire – Child and Adolescent version (ITQ-CA) in a sample of Danish children and adolescents exposed to abuse. Eur J Psychotraumatol 2023; 14:2178761. [PMID: 37052084 PMCID: PMC9980161 DOI: 10.1080/20008066.2023.2178761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Abstract
Background: International research has established that children and adolescents are at risk for posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as defined by the WHO ICD-11. There is a need for a Danish language version of the International Trauma Questionnaire – Child and Adolescent (ITQ-CA) to assess symptoms of PTSD and CPTSD. Objective: To test the ICD-11 formulations of PTSD and DSO (Disturbances of Self-Organization) using the ITQ-CA version in a sample of children exposed to abuse. Additionally, to study the distribution of symptoms and probable prevalence of ICD-11 PTSD and CPTSD among the population of children exposed to violence or sexual abuse. Method: Confirmatory factor analysis of competing models of the dimensionality of the ITQ-CA was tested among a sample of 119 children and adolescents that were referred to the Danish Children Centres on suspicion of physical or sexual abuse or both. Latent class analysis (LCA) was used to study the distribution of symptoms and consequences of different operationalisations of functional impairment were explored. Results: Findings supported a two-factor second-order model corresponding to the operationalisation of CPTSD in ICD-11 as the best representation of the data. Findings from the LCA suggested that symptoms were distributed in a pattern consistent with the ICD-11 proposal for CPTSD. CPTSD was more prevalent than PTSD regardless of the operationalisation of functional impairment. Conclusion: ITQ-CA is a valid tool for identifying symptoms of ICD-11 PTSD and CPTSD among Danish children exposed to physical or sexual abuse. Further research is needed to study the relationship between ICD-11 C/PTSD symptomatology and anxiety and depression in this population. The International Trauma Questionnaire – Child and Adolescent version (ITQ-CA) is a valid measure of symptoms of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD among Danish children exposed to physical or sexual violence. The structure of the ITQ-CA in the Danish sample reflects the ICD-11 diagnostic algorithm. CPTSD is a more prevalent disorder among children recently exposed to violence than PTSD.
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Chiu HTS, Alberici A, Claxton J, Meiser-Stedman R. The prevalence, latent structure and psychosocial and cognitive correlates of complex post-traumatic stress disorder in an adolescent community sample. J Affect Disord 2023; 340:482-489. [PMID: 37573893 DOI: 10.1016/j.jad.2023.08.033] [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: 03/09/2023] [Revised: 07/21/2023] [Accepted: 08/04/2023] [Indexed: 08/15/2023]
Abstract
Complex PTSD has received growing attention in recent years. However, the validity, prevalence and risk factors of this diagnosis remain unclear. This study examined PTSD presentations in adolescents using diagnostic criteria and latent class analysis (LCA). It then explored the role of demographics factors, trauma history factors, psychopathology factors and cognitive factors in predicting different PTSD presentations. A cross-sectional data comprising self-report measures of 342 community adolescents (12-15 years) were collected and analysed. 2.3 %, 5.6 % and 10 % of adolescents met the criteria for PTSD, CPTSD and disturbances in self-organisation (DSO) respectively. A three-class model (healthy class, CPTSD class and DSO class) were generated from LCA. Adolescents with CPTSD were most likely to be female and endorsed the most overall trauma types, interpersonal trauma types, depression, anxiety and maladaptive cognitive processes, followed by adolescents with DSO and subsequently healthy adolescents. CPTSD appeared to be a more common presentation than PTSD among community adolescents. The relatively high prevalence of DSO is noteworthy and suggests that DSO is not necessarily accompanied by PTSD. Given the strong associations between CPTSD and cognitive processes implicated in PTSD, CPTSD as a construct might be conceptually similar to PTSD.
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Affiliation(s)
- Henry Tak Shing Chiu
- Department of Clinical Psychology and Psychological Therapies, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK.
| | - Alice Alberici
- Department of Clinical Psychology and Psychological Therapies, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Jade Claxton
- Department of Clinical Psychology and Psychological Therapies, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Vindbjerg E, Sandahl H, Mortensen EL, Roberts NP, Carlsson J. The structure of ICD-11 post traumatic stress disorder in a clinical sample of refugees based on the International Trauma Interview. Acta Psychiatr Scand 2023; 148:302-309. [PMID: 37469111 DOI: 10.1111/acps.13592] [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: 02/03/2023] [Revised: 04/20/2023] [Accepted: 07/02/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND The ICD-11 proposes fundamental changes to the PTSD diagnostic criteria, prompting thorough validation. While this is ideally carried out based on diagnostic interviews, most-and in the case of transcultural psychiatry all-studies have relied on self-reported measures. In this study, we used the International Trauma Interview (ITI) to assess the factor structure of ICD-11 PTSD symptoms in a sample of trauma-affected refugees. METHOD The ITI was administered with a sample of refugees (n = 198), originating mainly from the Greater Middle East. The symptom ratings were subjected to a confirmatory factor analysis (CFA), comparing the ICD-11 concordant three-factor model with alternative two- and one-factor models. RESULTS The overall fit was adequate for both the two- and three-factor models, but favored the two-factor model. Results for both models indicated local misspecifications and that item 5, hypervigilance, displayed a suboptimal loading. CONCLUSION The results generally support the use of the ITI in a severely trauma-affected refugee population, albeit with particular attention needed in the administration of item 5. The superior fit of a two-factor model warrants further testing across populations.
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Affiliation(s)
- Erik Vindbjerg
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Hinuga Sandahl
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
| | - Erik Lykke Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Neil P Roberts
- Cardiff and Vale University Health Board, Cardiff, UK
- Division of Psychological Medicine and Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Jessica Carlsson
- Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup, Copenhagen University Hospital - Mental Health Services CPH, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Ford JD. Why We Need a Developmentally Appropriate Trauma Diagnosis for Children: a 10-Year Update on Developmental Trauma Disorder. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:403-418. [PMID: 37234835 PMCID: PMC10205922 DOI: 10.1007/s40653-021-00415-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2021] [Indexed: 05/28/2023]
Abstract
Developmental Trauma Disorder (DTD) was proposed almost two decades ago as a psychiatric diagnosis for children who have been traumatically victimized and whose attachment bonding with primary caregivers has been compromised. DTD was designed to complement and extend post-traumatic stress disorder (PTSD) by addressing forms of trauma-related biopsychosocial dysregulation not included in PTSD, many of which are attributed to other psychiatric disorders. In the past decade, evidence from clinician surveys and research field trial studies has provided evidence of DTD's validity and potential clinical utility. The growing evidence base for DTD is summarized and clinical rationales for the proposed DTD symptoms are described. DTD shows promise as a developmentally-attuned traumatic stress diagnosis for traumatized children.
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Affiliation(s)
- Julian D. Ford
- University of Connecticut School of Medicine, Farmington, USA
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Kerig PK. Introduction to the Special Section: Developmental Perspectives on Trauma Exposure and Posttraumatic Stress. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:381-390. [PMID: 37234830 PMCID: PMC10205950 DOI: 10.1007/s40653-023-00557-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 05/28/2023]
Abstract
This article provides an introduction and overview of the current special section devoted to developmental perspectives on trauma exposure and posttraumatic stress reactions. Although there have been many revisions to the posttraumatic stress disorder (PTSD) diagnosis in the four decades that have ensued since its inclusion in our diagnostic systems, and many decades of empirical and clinical work investigating the differential effects of traumatic stress on children and adolescents, a truly developmental perspective is still lacking in the diagnosis. In a call to address this gap, this article outlines principles of developmental psychopathology as applied to the phenomenology of trauma and points to potential developmental transformations in the expression of posttraumatic stress across developmental epochs. The introduction then goes on to describe the valuable contributions to the literature represented by the six teams of contributing authors to this present special section, in which they discuss stability and change in posttraumatic symptom expression across development, the current state of validation research on the proposed diagnosis of Developmental Trauma Disorder, complex symptom arrays in children who have been complexly traumatized, distinctions between Complex PTSD and emerging personality pathology, developmental perspectives on prolonged grief, and developmental considerations for understanding the intersection between trauma and moral injury. It is hoped that this collection of articles will serve to stimulate new research and inform effective interventions for young persons affected by traumatic stress.
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Affiliation(s)
- Patricia K. Kerig
- Department of Psychology, University of Utah, Salt Lake City, UT 84112 USA
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Kairyte A, Truskauskaite I, Daniunaite I, Gelezelyte O, Zelviene P. Resilience trajectories and links with childhood maltreatment in adolescence: a latent growth modeling approach. Child Adolesc Psychiatry Ment Health 2023; 17:10. [PMID: 36658591 PMCID: PMC9851572 DOI: 10.1186/s13034-023-00558-2] [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: 10/07/2022] [Accepted: 01/09/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The current definitions of resilience can be addressed as a process, an outcome, or a trait. Empirical studies should be carried out to determine the most appropriate definition for it. Therefore, the main aim of the current study was to investigate changes in adolescents' resilience over two years and explore the links between resilience and different forms of child maltreatment. METHODS The three-wave longitudinal study "Stress and resilience in adolescence" (STAR-A) sample was comprised of a general school-based sample of Lithuanian adolescents [baseline N = 1295, 56.7% females; M(SD)age = 14.24 (1.26)]. Resilience was measured using the 14-item Resilience Scale (RS-14), lifetime exposure to maltreatment was measured at wave 1 using a questionnaire developed by the Norwegian Center for Violence and Traumatic Stress Studies (NKVTS), risk of psychopathology-using the Strengths and Difficulties Questionnaire (SDQ). The changes in resilience scores over the period of two years were investigated using the latent growth modeling approach. RESULTS The analyses revealed two classes of resilience-stable higher and stable lower. We found that experience of at least one form of abuse was significantly more prevalent in the lower resilience group in comparison to the higher resilience group. Also, adolescents with lower resilience had a higher probability of psychopathology. CONCLUSIONS This study provided meaningful insights into the stability of resilience over time in adolescence and its relation to various types of child maltreatment. Experiences of maltreatment, as well as risk for psychopathology, were linked to lower resilience in adolescence.
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Affiliation(s)
- Agniete Kairyte
- Center for Psychotraumatology, Institute of Psychology, Faculty of Philosophy, Vilnius University, M. K. Ciurlionio str. 29, Vilnius, 01300, Lithuania.
| | - Inga Truskauskaite
- grid.6441.70000 0001 2243 2806Center for Psychotraumatology, Institute of Psychology, Faculty of Philosophy, Vilnius University, M. K. Ciurlionio str. 29, Vilnius, 01300 Lithuania
| | - Ieva Daniunaite
- grid.6441.70000 0001 2243 2806Center for Psychotraumatology, Institute of Psychology, Faculty of Philosophy, Vilnius University, M. K. Ciurlionio str. 29, Vilnius, 01300 Lithuania
| | - Odeta Gelezelyte
- grid.6441.70000 0001 2243 2806Center for Psychotraumatology, Institute of Psychology, Faculty of Philosophy, Vilnius University, M. K. Ciurlionio str. 29, Vilnius, 01300 Lithuania
| | - Paulina Zelviene
- grid.6441.70000 0001 2243 2806Center for Psychotraumatology, Institute of Psychology, Faculty of Philosophy, Vilnius University, M. K. Ciurlionio str. 29, Vilnius, 01300 Lithuania
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Olstad K, Sørensen T, Lien L, Danbolt LJ. Adolescents with developmental traumas in therapy in a child and adolescent mental health service, outpatient unit: experiences of daily living and expectations for therapy - a qualitative study. Front Psychol 2023; 14:946394. [PMID: 37213362 PMCID: PMC10196012 DOI: 10.3389/fpsyg.2023.946394] [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: 05/26/2022] [Accepted: 04/18/2023] [Indexed: 05/23/2023] Open
Abstract
Background Developmental trauma has a profound effect on people's lives. There are few studies of the perceived difficulties and treatment needs of adolescents with developmental trauma. More studies are called for to explore the perspectives and experiences of these patients, especially adolescents. Method Semi-structured interviews were conducted with eight adolescents with developmental trauma aged 14-18 years in a Child and Adolescent Mental Health Service, Outpatient Unit. The interviews were analyzed using systematic text condensation. Results A main finding in this study regards the participants' understanding of why they needed therapy: symptom alleviation and coping tools. They expressed a need for talking with a safe and reliable adult who understood their situation. Their stories of daily functioning and bodily sensations align mainly with symptoms described for adolescents with developmental trauma. The study also shows that the participants' experiences of trauma affected their lives to a greater or lesser extent, in the form of ambivalence, avoidance, regulation, and coping strategies. They also described various physical problems, especially insomnia and inner restlessness. Their subjective stories revealed insights into their experiences. Conclusion Based on the results, we recommend that adolescents with developmental trauma be allowed to express their understandings of their difficulties and their treatment expectations at an early stage of their therapy. An emphasis on patient involvement and the therapeutic relationship can increase their autonomy and control over their own lives and treatment.
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Affiliation(s)
- Kjerst Olstad
- Innlandet Hospital Trust, Brumunddal, Norway
- Faculty of Health Science, VID Specialized University, Oslo, Norway
- *Correspondence: Kjersti Olstad,
| | - Torgeir Sørensen
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Hamar, Norway
| | - Lars Lien
- MF Norwegian School of Theology, Religion and Society, Majorstuen, Oslo, Norway
| | - Lars Johan Danbolt
- Innlandet Hospital Trust, Brumunddal, Norway
- Faculty of Health Science, VID Specialized University, Oslo, Norway
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Redican E, Murphy J, McBride O, Bunting L, Shevlin M. The Prevalence, Patterns and Correlates of Childhood Trauma Exposure in a Nationally Representative Sample of Young People in Northern Ireland. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:963-976. [PMID: 35571535 PMCID: PMC9077031 DOI: 10.1007/s40653-022-00449-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Childhood trauma (CT) exposure is common, with many young people affected by multiple co-occurring traumas. METHODS Participants were a representative sample of 11-19-year-olds (n = 1293), who participated in the largest ever representative survey of youth mental health in Northern Ireland (NI) - the NI Youth Wellbeing Prevalence Survey 2020. This study used latent class analysis (LCA) to identify typologies that were most representative of trauma experience and co-occurrence among young people living in NI. Demographic, parental and deprivation variables were then used within a multinomial logistic regression analysis to describe trauma class membership. RESULTS Over 35% (n = 478) of participants reported exposure to at least one CT, with over 50% (n = 259) of trauma-exposed young people reporting multiple trauma exposure. LCA results provided support for a three-class model; 'low-exposure', 'moderate-exposure: community-victimization' and 'high-exposure: sexual-trauma'. While none of the child, parental or familial covariates differentiated members of the 'moderate-exposure: community-victimization' from 'low-exposure', those in 'high-exposure: sexual-trauma' were over four and a half times more likely to belong to a family in receipt of income benefits and over ten times more likely to have experienced some form of out-of-home care. CONCLUSIONS This study highlights the presence of three distinct trauma classes in the NI adolescent population. In particular, this study identifies a small minority of young people who have experienced multiple CT's, including sexually based traumas, with these traumas most likely to have occurred in the context of out-of-home care and familial poverty.
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Affiliation(s)
- Enya Redican
- School of Psychology, Ulster University, Coleraine, UK
| | - Jamie Murphy
- School of Psychology, Ulster University, Coleraine, UK
| | - Orla McBride
- School of Psychology, Ulster University, Coleraine, UK
| | | | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, UK
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Tian Y, Li W, Wu X, Cheng X. Complex PTSD in Chinese Adolescents Exposed to Childhood Trauma: A Latent Profile Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2022; 37:NP20190-NP20211. [PMID: 34775874 DOI: 10.1177/08862605211050111] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Although numerous studies have supported the idea that complex posttraumatic stress disorder (CPTSD) is a distinct disorder from posttraumatic stress disorder (PTSD) and demonstrated that childhood interpersonal trauma is an important risk factor for CPTSD, few studies have examined the validity of CPTSD in adolescents, especially in non-Western contexts. Moreover, the question of which form of child maltreatment plays the most important role in predicting CPTSD, and how CPTSD is associated with psychological health, physical health, and social function among adolescents, is not clear. The present study used a Chinese high school student sample with childhood trauma experiences (N = 395) to address these questions. Latent profile analysis indicated that there were four subgroups in our sample: Low symptoms (54.43%), Disturbance of self-organization (DSO, 18.99%), PTSD (15.95%), and CPTSD (10.63%). Further analysis revealed that emotional abuse was an important risk factor for CPTSD. In addition, the CPTSD class showed the highest levels of depression, anxiety, and stress, as well as the lowest levels of life satisfaction and physical health. This study revealed that CPTSD is a distinct disorder from PTSD in Chinese adolescents exposed to childhood trauma. It provides evidence that emotional abuse might be an important risk factor for CPTSD, and demonstrates that CPTSD is accompanied by serious psychological and physical consequences in adolescents. We suggest that parents and educators should focus more on adolescents' emotional needs, avoid using negative ways such as verbal violence to express love, and pay more attention to adolescents' DSO symptoms in parenting, teaching practices and clinical interventions.
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Affiliation(s)
- Yuxin Tian
- School of Psychology, 12534Nanjing Normal University, Nanjing, China
| | - Wenqi Li
- Department of Psychology, 12581Nanjing University, Nanjing, China
- Yuxiu Postdoctoral Institute, 47836Nanjing University, Nanjing, China
| | - Xinchun Wu
- Yuxiu Postdoctoral Institute, 47836Nanjing University, Nanjing, China
| | - Xiaochun Cheng
- Beijing Key Laboratory of Applied Experimental Psychology, Faculty of Psychology, Beijing Normal University, Beijing, China
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Can Developmental Trauma disorder be distinguished from posttraumatic stress disorder? A confirmatory factor Analytic Test of Four Structural Models. Res Child Adolesc Psychopathol 2022; 50:1207-1218. [DOI: 10.1007/s10802-022-00916-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 10/18/2022]
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Ho GWK, Liu H, Karatzias T, Hyland P, Cloitre M, Lueger-Schuster B, Brewin CR, Guo C, Wang X, Shevlin M. Validation of the International Trauma Questionnaire-Child and Adolescent Version (ITQ-CA) in a Chinese mental health service seeking adolescent sample. Child Adolesc Psychiatry Ment Health 2022; 16:66. [PMID: 35962396 PMCID: PMC9375312 DOI: 10.1186/s13034-022-00497-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 07/13/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The International Trauma Questionnaire-Child and Adolescent version (ITQ-CA) is a self-report measure that assesses posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) based on the diagnostic formulation of the 11th version of the International Classification of Diseases (ICD-11). This study aimed to provide a Chinese translation and psychometric evaluation of the ITQ-CA using a sample of mental-health service seeking adolescents in Mainland China. METHODS The ITQ-CA was translated and back-translated from English to simplified Chinese and finalized with consensus from an expert panel. Adolescents ages 12-17 were recruited via convenience sampling from an outpatient psychiatric clinic in Mainland China. Participants completed the ITQ-CA; measures of four criterion variables (depression, anxiety, stress, adverse childhood experiences); and the PTSD Checklist for DSM-5 (PCL-5). Construct validity, concurrent validity, and comparison of PTSD caseness between ICD-11 and DSM-5 measures were assessed. RESULTS The final sample consisted of 111 Chinese adolescents (78% female; mean age of 15.23), all diagnosed with a major depressive disorder. Confirmatory factor analysis indicated the two-factor second-order model provided optimal fit. All criterion variables were positively and significant correlated with the six ITQ-CA symptom cluster summed scores. In the present sample, 69 participants (62.16%) met symptom criteria for ICD-PTSD or CPTSD using the ITQ-CA, and 73 participants (65.77%) met caseness for DSM-5 PTSD using the PCL-5. Rates of PTSD symptom cluster endorsement and caseness deriving from both diagnostic systems were comparable. CONCLUSIONS The Chinese ITQ-CA has acceptable psychometric properties and confers additional benefits in identifying complex presentations of trauma-related responses in younger people seeking mental health services.
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Affiliation(s)
- G. W. K. Ho
- grid.16890.360000 0004 1764 6123School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
| | - H. Liu
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China ,grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - T. Karatzias
- grid.20409.3f000000012348339XSchool of Health & Social Care, Edinburgh Napier University, Edinburgh, UK ,grid.39489.3f0000 0001 0388 0742Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK
| | - P. Hyland
- grid.95004.380000 0000 9331 9029Maynooth University, Maynooth, Ireland
| | - M. Cloitre
- grid.168010.e0000000419368956Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, USA ,grid.280747.e0000 0004 0419 2556National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA USA
| | - B. Lueger-Schuster
- grid.10420.370000 0001 2286 1424Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
| | - C. R. Brewin
- grid.83440.3b0000000121901201Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - C. Guo
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China ,grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - X. Wang
- grid.459419.4Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China ,grid.186775.a0000 0000 9490 772XSchool of Mental Health and Psychological Sciences, Anhui Medical University, Hefei, China ,grid.186775.a0000 0000 9490 772XAnhui Psychiatric Center, Anhui Medical University, Hefei, China
| | - M. Shevlin
- grid.12641.300000000105519715School of Psychology, Ulster University, Derry, Northern Ireland
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15
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Redican E, Hyland P, Cloitre M, McBride O, Karatzias T, Murphy J, Bunting L, Shevlin M. Prevalence and predictors of ICD-11 posttraumatic stress disorder and complex PTSD in young people. Acta Psychiatr Scand 2022; 146:110-125. [PMID: 35503737 PMCID: PMC9540630 DOI: 10.1111/acps.13442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 04/26/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The prevalence, construct validity, risk factors and psychopathological correlates associated with ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as measured by the International Trauma Questionnaire for Children and Adolescents (ITQ-CA) were assessed in a sample of young people from Northern Ireland. METHOD Participants were trauma-exposed 11-19-year-olds (N = 507) who participated in the Northern Ireland Youth Wellbeing Prevalence Survey (YWS-NI, 2020). Factor mixture modelling (FMM) was used to test the latent structure of the ITQ-CA. Risk-factors and psychopathological correlates associated with latent class membership, and ICD-11diagnostic status, were also investigated. RESULTS More participants met the ITQ-CA criteria for CPTSD (3.4%, n = 44) than PTSD (1.5%, n = 19). A second-order FMM comprising a 'partial-PTSD class', a 'CPTSD class', a 'DSO class' and a 'low symptom endorsement class' was the best-fitting model. Younger age and cumulative trauma were risk factors for all trauma classes. Female gender and two or more violent traumas were significant predictors of the 'PTSD' and 'CPTSD' classes, while single sexual trauma was a significant predictor of the 'DSO' and 'CPTSD' classes. Two or more sexual traumas was a unique predictor of 'CPTSD class', while two or more vicarious traumas was a unique predictor of 'DSO class'. The 'CPTSD' class displayed the most notable comorbidity. CONCLUSIONS Findings indicate that CPTSD may be more prevalent than PTSD in children and young people. Support for the ICD-11 conceptualisation of CPTSD as representing a unique diagnostic construct was supported using FMM, with findings indicating trauma symptom class-specific risk profiles.
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Affiliation(s)
- Enya Redican
- School of PsychologyUlster UniversityColeraineUK
| | - Philip Hyland
- Department of PsychologyMaynooth UniversityMaynoothIreland
| | - Marylene Cloitre
- National Center for PTSDVerterans Affairs Palo Alto Health Care SystemPalo AltoCaliforniaUSA
| | - Orla McBride
- School of PsychologyUlster UniversityColeraineUK
| | - Thanos Karatzias
- School of Health and Social CareEdinburgh Napier UniversityEdinburghUK
| | - Jamie Murphy
- School of PsychologyUlster UniversityColeraineUK
| | - Lisa Bunting
- School of Social Sciences, Education and Social WorkQueen's UniversityBelfastUK
| | - Mark Shevlin
- School of PsychologyUlster UniversityColeraineUK
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Bunting L, McCartan C, Davidson G, Grant A, Mulholland C, Schubotz D, McBride O, Murphy J, Shevlin M. Rationale and methods of the 'Northern Ireland Youth Wellbeing Survey' and initial findings from the Strengths and Difficulties Questionnaire. Clin Child Psychol Psychiatry 2022; 27:670-685. [PMID: 35232265 PMCID: PMC9234773 DOI: 10.1177/13591045221075525] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Backgrounds and Aims: The Northern Ireland Youth Wellbeing Survey (NIYWS) was commissioned by the Health and Social Care Board (NI) with the aim of providing reliable prevalence estimates of the mental health problems of children and young people aged 2-19 years. Method: The NIYWS used a random probability design, stratified by deprivation decile and county, to ensure even geographical distribution and representation. The survey used a broad range of validated measures to identify children and young people who met established clinical criteria for common mood, anxiety and behaviour disorders, trauma related disorders, as well as those at risk of autism spectrum disorder, eating disorders, future psychotic illness, self-injury or suicide. Results: Data were collected on 3074 children and young people aged 2-19 years, as well as over 2800 parents. The survey achieved a high response rate (67%) and initial findings indicated that 11% of the sample were at risk of emotional or behavioural problems. Conclusions: The NIYWS was the first large scale nationally representative survey of the mental health of children and young people in NI. Despite the legacy of political violence the initial findings show comparable levels of emotional and behavioural problems to England.
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Affiliation(s)
| | | | | | - Anne Grant
- Queen’s University
Belfast, Northern Ireland
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17
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Amari N, Mahoney A. Compassion and complex interpersonal trauma in adolescence: An early systematic review. Clin Psychol Psychother 2022; 29:799-814. [PMID: 34779081 DOI: 10.1002/cpp.2689] [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: 08/02/2021] [Revised: 09/24/2021] [Accepted: 11/08/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Whilst childhood trauma has been identified as a transdiagnostic risk factor for poly-psychopathology, compassion-focused interventions have emerged as transdiagnostic treatment modality. However, no previous systematic review has specifically explored the relationship between complex interpersonal trauma and compassion in adolescence. The aim of this early systematic review was to evaluate the existing evidence on the role of compassion in adolescents with complex interpersonal trauma. METHODS A systematic search of electronic databases was undertaken to identify cross-sectional and intervention studies that examined the role of compassion in the amelioration of psychopathology in adolescence. RESULTS Nine studies, including three intervention studies and six cross-sectional studies, met the inclusion criteria. The findings suggested a mediating role of compassion in trauma-specific and overall psychopathology. CONCLUSION Despite the dearth of research, this review suggests that integrating compassion might mediate the relationship between complex trauma and psychopathology in adolescents.
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Affiliation(s)
- Nicola Amari
- Department of Psychology, Glasgow Caledonian University, Glasgow, UK
| | - Adam Mahoney
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, UK
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18
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Li S, Guo C, Chan SSS. ICD-11 Posttraumatic Stress Disorder and Complex PTSD Among Hospital Medical Workers in China: Impacts of Wenchuan Earthquake Exposure, Workplaces, and Sociodemographic Factors. Front Psychiatry 2022; 12:735861. [PMID: 35111084 PMCID: PMC8801437 DOI: 10.3389/fpsyt.2021.735861] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies address posttraumatic stress disorder (PTSD) following disasters as a public health issue. However, few studies investigate the long-term effect of disaster exposure on PTSD among hospital medical workers (HMWs). OBJECTIVES This study aimed to study the prevalence of ICD-11 PTSD and complex PTSD (CPTSD) among exposed and non-exposed HMWs 11 years after the Wenchuan earthquake in China, to identify the factors associated with PTSD and CPTSD scores, and to examine the factor structures of PTSD and CPTSD models. METHODS A cross-sectional study was conducted using a self-administered online questionnaire. Two thousand fifty-nine valid samples were collected from four hospitals in 2019. Descriptive statistical analysis, multivariate regression models, and confirmatory factor analysis (CFA) were performed. RESULTS The prevalence of PTSD and CPTSD was 0.58 and 0.34%, respectively. The unexposed group reported higher PTSD and CPTSD scores than the exposed group. The type of workplace and marital status were significantly associated with the PTSD and CPTSD scores of HMWs. The CFA results indicate that both the correlated first-order model and the correlated two-layer model were a good fit to explain the structure of PTSD and CPTSD. CONCLUSION These findings suggest that few HMWs who were exposed to the Wenchuan earthquake suffered from PTSD or CPTSD 11 years following the disaster. However, psychological support was still necessary for all HMWs, especially for unmarried HMWs who were Working in smaller hospitals. Further research is required to analyze mental health status using ICD-11 PTSD and CPTSD to provide ongoing evidence to help HWMs cope effectively with the challenges of future disasters.
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Affiliation(s)
- Sijian Li
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Chunlan Guo
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
- World Health Organization Collaborating Center for Community Health Services, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Sunshine S. S. Chan
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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19
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Hébert M, Tremblay-Perreault A, Jean-Thorn A, Demers H. Disentangling the diversity of profiles of adaptation in youth during COVID-19. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022; 7:100308. [PMID: 35018356 PMCID: PMC8730716 DOI: 10.1016/j.jadr.2022.100308] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/22/2021] [Accepted: 01/01/2022] [Indexed: 12/12/2022] Open
Abstract
Background: The COVID-19 outbreak has major psychosocial consequences on the global population and specialists report that youth may be significantly impacted. Adolescents and young adults, for whom social life is an important protective factor, had to face a new isolation caused by social distancing and home schooling. This study aims to explore youth's profiles of adaptation to COVID-19 pandemic in the province of Quebec, Canada, and the risk factors and strengths associated with each profile. Methods: A sample of 4936 youth living in Quebec were recruited on social media and filled out an online survey during the lockdown of the first wave of COVID-19. They completed measures of psychological distress, positive adaptation (well-being, resilience), risk factors (alexithymia and emotional dysregulation), COVID-related worries and fear of contamination and COVID-related post-traumatic stress disorder (PTSD). Results: The results of the latent class analysis showed four patterns of adjustment. The Resilient group (36.6% of the sample) showed the highest probability of a positive adaptation. The High distress class (29.5%) reported clinical distress, low to moderate symptoms of PTSD and fear of contamination and no significant well-being. The Moderate symptoms class (17.55%) showed moderate levels of distress and COVID-related symptoms, with half of the group still showing significant well-being. The Traumatized class (16.35%) reported the worst adaptation. Correlates significantly differentiated profiles. Limitations: The study relied on a convenience sample and a cross-sectional design. Conclusion: Disentangling the diversity of adaptation profiles may orient more adapted resources for youth in need during this unprecedented crisis.
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Affiliation(s)
- Martine Hébert
- Canada Research Chair in Interpersonal Traumas and Resilience, Département de sexologie, Université du Québec à Montréal, Montréal, Québec, Canada
| | | | - Arianne Jean-Thorn
- Département de psychologie, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Hélène Demers
- Département de psychologie, Université du Québec à Montréal, Montréal, Québec, Canada
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20
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Rossi R, Socci V, Pacitti F, Carmassi C, Rossi A, Di Lorenzo G, Hyland P. The Italian Version of the International Trauma Questionnaire: Symptom and Network Structure of Post-Traumatic Stress Disorder and Complex Post-Traumatic Stress Disorder in a Sample of Late Adolescents Exposed to a Natural Disaster. Front Psychiatry 2022; 13:859877. [PMID: 35693953 PMCID: PMC9174511 DOI: 10.3389/fpsyt.2022.859877] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 05/06/2022] [Indexed: 11/27/2022] Open
Abstract
The 11th revision of the International Classification of Diseases has endorsed substantial changes in Post-Traumatic Stress Disorder (PTSD) and has introduced Complex PTSD (cPTSD). The objective of this study was to assess the symptom and network structure of PTSD and cPTSD using the International Trauma Questionnaire- Italian version (ITQ) and the prevalence of PTSD and cPTSD in a community sample of late adolescents enriched with exposure to a destructive earthquake. A 1,010 high school students participated to the study. Confirmatory Factor Analysis supports that a six first-order correlated factors was the best fitting model of ICD-11 PTSD/cPTSD. The network analysis supports a clear separation between core PTSD symptoms and disturbances in self-organization (DSO) symptoms, avoidance, and negative self-concept were the most central items. The prevalence of PTSD and cPTSD was 9.11 and 4.06%, respectively. Female participants reported higher rates of both PTSD and cPTSD. This is the first study to report on ICD-11 PTSD and cPTSD rates on an Italian adolescence community sample. Consistent with other community samples, we found higher rates of PTSD compared to cPTSD. The results confirmed the factorial validity of the ITQ. The network structure highlights the importance of negative self-concept in cPTSD and avoidance in PTSD.
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Affiliation(s)
- Rodolfo Rossi
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy
| | - Valentina Socci
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Pacitti
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, Tor Vergata University of Rome, Rome, Italy.,IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Philip Hyland
- Department of Psychology, Maynooth University, Maynooth, Ireland
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21
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Ford JD, Charak R, Karatzias T, Shevlin M, Spinazzola J. Can developmental trauma disorder be distinguished from posttraumatic stress disorder? A symptom-level person-centred empirical approach. Eur J Psychotraumatol 2022; 13:2133488. [PMID: 36340008 PMCID: PMC9635476 DOI: 10.1080/20008066.2022.2133488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Developmental Trauma Disorder (DTD) is a proposed childhood psychiatric diagnosis for psychopathological and developmental sequela of victimization and attachment trauma extending beyond posttraumatic stress disorder (PTSD). OBJECTIVE To determine whether a sub-group of trauma-impacted children is characterized by symptoms of DTD that extend beyond, or co-occur with, the symptoms of PTSD. METHOD Person-centred Latent Class Analyses (LCA) were done with data from 507 children (ages 7-18 years, (M = 12.11, SD = 2/92); 49% female) referred to the study by mental health or paediatric clinicians. RESULTS A four class solution was optimal (LMR = 398.264, p < .001; Entropy = .93): (1) combined DTD + PTSD (n = 150); (2) predominant DTD (n = 156); (3) predominant PTSD (n = 54); (4) minimal symptoms (n = 147). Consistent with prior research, the DTD + PTSD class was most likely to have experienced traumatic emotional abuse and neglect (X2 (3) = 16.916 and 28.016, respectively, p < .001), and had the most psychiatric comorbidity (F(3, 502) = 3.204, p < .05). Predominant DTD class members were most likely to meet criteria for Oppositional Defiant Disorder (ODD) (X2(3) = 84.66, p < .001). CONCLUSION Symptoms of DTD may occur with, or separately from, PTSD symptoms. Children with high DTD|+PTSD symptoms had extensive psychiatric comorbidity, while those with high DTD symptoms and minimal PTSD symptoms were highly likely to meet criteria for ODD. In clinical and research assessment and treatment of children with complex psychiatric comorbidity or disruptive behaviour problems, symptoms of DTD should be considered, both along with, and in the absence of, PTSD symptoms.
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Affiliation(s)
- Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center MC1410, Farmington, CT, USA
| | - Ruby Charak
- University of Texas Rio Grande Valley, Edinburg, TX, USA
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22
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Sachser C, Berliner L, Risch E, Rosner R, Birkeland MS, Eilers R, Hafstad GS, Pfeiffer E, Plener PL, Jensen TK. The child and Adolescent Trauma Screen 2 (CATS-2) - validation of an instrument to measure DSM-5 and ICD-11 PTSD and complex PTSD in children and adolescents. Eur J Psychotraumatol 2022; 13:2105580. [PMID: 35928521 PMCID: PMC9344962 DOI: 10.1080/20008066.2022.2105580] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND The study examined the psychometric properties of the Child and Adolescent Trauma Screen 2 (CATS-2) as a measure of posttraumatic stress disorder (PTSD) according to DSM-5 and (Complex) PTSD following the ICD-11 criteria in children and adolescents (7-17 years). METHODS Psychometric properties were investigated in an international sample of traumatized children and adolescents (N = 283) and their caregivers (N = 255). We examined the internal consistency (α), convergent and discriminant validity, the factor structure of the CATS-2 total scores, latent classes of PTSD/Complex PTSD (CPTSD) discrimination, as well as the diagnostic utility using ROC-curves. RESULTS The DSM-5 total score (self: α = .89; caregiver: α = .91), the ICD-11 PTSD total score (self: α = .67; caregiver: α = .79) and the ICD-11 CPTSD total score (self: α = .83; caregiver: α = .87) have proven acceptable to excellent reliability. The latent structure of the 12-item ICD-11 PTSD/CPTSD construct was consistent with prior findings. Latent profile analyses revealed that ICD-11 CPTSD was empirically distinguishable from ICD-11 PTSD using the CATS-2. ROC-analysis using the CAPS-CA-5 as outcome revealed that CATS-2 DSM-5 PTSD scores of ≥21 (screening) to ≥25 (diagnostic) were optimally efficient for detecting probable DSM-5 PTSD diagnosis. For the ICD-11 PTSD scale scores of ≥7 (screening) to ≥9 (diagnostic) were optimally efficient for detecting probable DSM-5 PTSD diagnosis. CONCLUSIONS The CATS-2 is a brief, reliable and valid measure of DSM-5 PTSD, ICD-11 PTSD and CPTSD symptomatology in traumatized children and adolescents, allowing crosswalk between diagnostic systems using one measure. HIGHLIGHTS The CATS-2 screens for potentially traumatic events (PTEs) and PTSD symptoms.The CATS-2 captures DSM-5 and ICD-11 criteria for PTSD and CPTSD and enables clinicians and researchers to crosswalk between both diagnostic systems.International validation has proven good psychometric properties and presents cut-off scoresThe CATS-2 is a license-free instrument and is freely accessible.
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Affiliation(s)
- Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Lucy Berliner
- Harborview Center for Sexual Assault and Traumatic Stress, University of Washington, Seattle, WA, USA
| | - Elizabeth Risch
- Center on Child Abuse and Neglect, University of Oklahoma Health Sciences Center, Oklahoma City, OH, USA
| | - Rita Rosner
- Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | | | - Rebekka Eilers
- Department of Psychology, Catholic University of Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Gertrud S Hafstad
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Elisa Pfeiffer
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany.,Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria
| | - Tine K Jensen
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway.,Department of Psychology, University of Oslo, Oslo Norway
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23
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Trauma exposure and factors associated with ICD-11 PTSD and complex PTSD in adolescence: a cross-cultural study in Japan and Lithuania. Epidemiol Psychiatr Sci 2022. [PMCID: PMC9281490 DOI: 10.1017/s2045796022000336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aims Cross-cultural studies of posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) based on ICD-11 diagnostic criteria are scarce, especially in adolescence. The study aimed to evaluate the trauma exposure, prevalence and factors associated with PTSD and CPTSD in general populations of adolescents in Lithuania and Japan. Methods The study sample comprised 1746 adolescents from Lithuania (n = 832) and Japan (n = 914), 49.8% female. The mean age of study participants was 15.52 (s.d. = 1.64), ranging from 12 to 18 years. ICD-11 posttraumatic disorders were assessed using the International Trauma Questionnaire – Child and Adolescent version (ITQ-CA). Results More than half of the adolescents in a total sample (61.5%) reported exposure to at least one traumatic event in their lifetime, 80.0% in Lithuania and 44.6% in Japan, with a higher prevalence of interpersonal trauma in Lithuania and more natural disaster exposure in Japan. The prevalence of PTSD was 5.2% (95% CI 3.8–6.9%) and 2.3% (95% CI 1.4–3.5%), CPTSD 12.3% (95% CI 10.1–14.7%) and 4.1% (95% CI 2.9–5.5%) in Lithuanian and Japanese samples, respectively. Cumulative trauma exposure, female gender, loneliness and financial difficulties in family predicted both PTSD and CPTSD in the total sample. Loneliness discriminated CPTSD v. PTSD in both Lithuanian and Japanese samples. Conclusions This cross-cultural study is among the first which reported different patterns of trauma exposure in Asian Japanese and Lithuanian adolescents in Europe. Despite differences in trauma exposure and PTSD/CPTSD prevalence, we found similar predictors in both studies, particularly the importance of cumulative trauma exposure for PTSD/CPTSD, and social interpersonal factors for the risk of CPTSD. The study supports the universality of traumatic stress reactions to adverse life experiences in adolescence across cultures and regions and highlights different levels of traumatisation of adolescents in various countries.
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24
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The latent structure of ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD in a general population sample from USA: A factor mixture modelling approach. J Anxiety Disord 2022; 85:102497. [PMID: 34785481 DOI: 10.1016/j.janxdis.2021.102497] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/13/2021] [Accepted: 11/01/2021] [Indexed: 11/24/2022]
Abstract
The validity of ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD), as measured by the International Trauma Questionnaire (ITQ; Cloitre et al., 2018) has been supported in many factor analytic and mixture modelling studies. There is, however, a paucity of research investigating the latent structure of the ITQ using factor mixture modelling (FMM). FMM was applied to data collected from a nationally representative sample of U.S. adults (N = 1834). FMM results demonstrated strong support for a two-factor second-order model with four qualitatively distinct latent classes: a 'PTSD class', a 'CPTSD class', a 'DSO' (Disturbances in Self-Organisation) class and a 'low symptoms class'. Sexual abuse increased likelihood of membership to the 'CPTSD' (OR = 3.22) and physical abuse decreased likelihood of membership to the 'PTSD' (OR=0.51). Trauma exposure in adulthood predicted 'PTSD' and 'CPTSD' class membership. The 'CPTSD class' was characterised by higher levels of psychopathological co-morbidities and poorer psychological wellbeing compared to all other classes. Results provide additional support for the validity of PTSD and CPTSD as measured by the ITQ.
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Mediating role of avoidance of trauma disclosure and social disapproval in ICD-11 post-traumatic stress disorder and complex post-traumatic stress disorder: cross-sectional study in a Lithuanian clinical sample. BJPsych Open 2021. [PMCID: PMC8612022 DOI: 10.1192/bjo.2021.1055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background
ICD-11 includes a new diagnosis of complex post-traumatic stress disorder (CPTSD), resulting predominantly from reoccurring or prolonged trauma. Previous studies showed that lack of social support is among the strongest predictors of PTSD, but social factors have been sparsely studied in the context of the ICD-11 definition of PTSD and CPTSD.
Aims
To analyse the factor structure of the International Trauma Questionnaire (ITQ) in a Lithuanian clinical sample and to evaluate the mediating role of social and interpersonal factors in the relationship between trauma exposure and ICD-11 PTSD and CPTSD.
Method
The sample comprised 280 adults from out-patient mental health centres (age, years: mean 39.48 (s.d. = 13.35); 77.5% female). Trauma-related stress symptoms were measured with the ITQ. Social disapproval was measured with the Social Acknowledgment Questionnaire (SAQ) and trauma disclosure using the Disclosure of Trauma Questionnaire (DTQ).
Results
ICD-11 PTSD and CPTSD prevalence among the participants in this study was 13.9% and 10.0% respectively. Results indicated that avoidance of trauma disclosure mediated the relationship between trauma exposure and PTSD as well as CPTSD, whereas social disapproval mediated only the relationship between trauma exposure and CPTSD.
Conclusions
The findings suggest that disclosure of traumatic experiences and support from closest friends and family members might mitigate the effects of traumatic experiences, potentially reducing the risk of developing CPTSD.
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Post-traumatic stress disorder (PTSD) symptoms in children with severe epilepsy. Epilepsy Behav 2021; 122:108217. [PMID: 34352664 DOI: 10.1016/j.yebeh.2021.108217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 06/30/2021] [Accepted: 07/09/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To assess symptoms of post-traumatic stress disorder (PTSD) in children with severe epilepsy and the associations of trauma symptoms across age, comorbid symptoms, epilepsy-specific factors, parental resources, and psychopathology. METHODS Fifty children with severe epilepsy across three different age groups (0-5 yrs., 6-12 yrs., 13-18 yrs.) were assessed with developmental-sensitive and standardized PTSD assessment tools when hospitalized at the tertiary epilepsy center Filadelfia, Denmark. The Diagnostic Infant and Preschool Assessment (DIPA), the Darryl test, and the ITQ questionnaire were used to assess the three age groups, respectively. RESULTS Twenty-two percent of the overall sample met the criteria for PTSD, with a prevalence of symptoms increasing with age (6%, 28%, and 40%). Comorbid psychiatric symptoms in preschoolers were present in 81% of the children witnessing a high level of distress in this group. Behavioral difficulties were elevated across all three age groups, and 40% of the children with trauma symptoms had a parent with concurrent psychopathology. CONCLUSION To the authors' knowledge, this study is the first to assess trauma symptoms with standardized tests in children with more complicated epilepsies. Trauma symptoms in the group are high; however, there is a need for larger scale studies and research into trauma symptoms in children with more severe epilepsy than those assessable with the included assessment tools. The trauma perspective in severe childhood epilepsy might further clarify the complex associations of biological and contextual variables that affect the children's life quality and enable better preventative treatment options for this group.
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Examining the factor structure of ICD-11 posttraumatic stress disorder (PTSD) and complex-PTSD among prison staff exposed to potentially traumatic experiences. Psychiatry Res 2021; 303:114085. [PMID: 34247058 PMCID: PMC8519163 DOI: 10.1016/j.psychres.2021.114085] [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: 01/22/2021] [Revised: 06/17/2021] [Accepted: 06/26/2021] [Indexed: 11/20/2022]
Abstract
The recently released 11th edition of the International Classification of Diseases (ICD-11) classifies posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) as distinct, yet related, disorders within the spectrum of trauma and stress-related disorders. This study aimed to explore the construct validity of the International Trauma Questionnaire (ITQ), a measure of ICD-11 PTSD and CPTSD symptoms among prison governors (i.e., wardens in the U.S. and Canada). Trauma-exposed prison governors (N = 409) aged 26 to 82 years (M = 50.04, SD = 7.97) provided their data online anonymously. Confirmatory factor analyses were performed to evaluate the construct validity of ITQ scores. When using the five-point item response scale, our five first-order factor model produced the best fit to the data; however, when using a dichotomous item scale, the first-order two-factor PTSD and disturbances of self-organization (DSO) model produced the best fit to the data. These results indicate that item-coding and estimation methods can significantly impact conclusions about the best-fitting model for this measure among trauma-exposed prison governors.
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Daniunaite I, Truskauskaite-Kuneviciene I, Thoresen S, Zelviene P, Kazlauskas E. Adolescents amid the COVID-19 pandemic: a prospective study of psychological functioning. Child Adolesc Psychiatry Ment Health 2021; 15:45. [PMID: 34465354 PMCID: PMC8407140 DOI: 10.1186/s13034-021-00397-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The spread of coronavirus disease (COVID-19) and the accompanying countermeasures can significantly impact the wellbeing of adolescents. There is a lack of longitudinal studies that can shed light on potential social, emotional, and behavioral development in adolescents. We aimed to identify potential changes in adolescent psychosocial functioning from pre-pandemic to peri-pandemic assessment, and secondly, to identify specific patterns of change. METHODS This longitudinal study was based on a Lithuanian community sample of 331 adolescents aged 12-16 at T1 (M = 13.87, SD = 1.59). T1 data collected before the pandemic (March-June, 2019) was compared with T2 data collected during the COVID-19 outbreak (October 2020). Psychosocial functioning was assessed by The Strengths and Difficulties Questionnaire (SDQ). Multivariate latent change modeling and latent class change approaches were used to identify patterns of change. RESULTS We found a small but significant increase in hyperactivity/inattention, emotional symptoms, but also prosocial behavior from before to during the pandemic, even adjusting for resilience, lifetime abuse experience, and socio-demographic situation. Three change profiles were identified in the latent change analysis: (1) a majority (70.7%) experienced a significant increase in psychosocial problems; (2) a smaller sub-group (19.6%) with increased peer problems only; (3) a small group (9.7%) showing no negative change and an increase in prosocial behavior. CONCLUSIONS The study found a significant negative impact of the COVID-19 pandemic on mental health in the majority of adolescents, as well as indications of positive social development in a small group. These findings highlight the importance of identifying and supporting adolescents in the time of the pandemic more effectively. Accumulating knowledge about human responses to the coronavirus, particularly in young people, is pivotal to societal preparedness for future pandemics.
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Affiliation(s)
- Ieva Daniunaite
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Ciurlionio 29, 01300, Vilnius, Lithuania.
| | | | - Siri Thoresen
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Paulina Zelviene
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Ciurlionio 29, 01300, Vilnius, Lithuania
| | - Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Ciurlionio 29, 01300, Vilnius, Lithuania
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29
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Eilers R, Rosner R. Die einfache und komplexe Posttraumatische Belastungsstörung in der Praxis. KINDHEIT UND ENTWICKLUNG 2021. [DOI: 10.1026/0942-5403/a000342] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Zusammenfassung. Theoretischer Hintergrund: Die ICD-11 enthält reformulierte Kriterien für die Posttraumatische Belastungsstörung (PTBS) und die neue Diagnose komplexe PTBS (kPTBS). Fragestellung: Wie wirken sich die Neuerungen auf die Diagnostik und Behandlung von Kindern und Jugendlichen aus? Methode: In dieser Übersichtsarbeit werden die neuen Kriterien vorgestellt und mit früheren Diagnosemanualen verglichen. Bisherige Forschungsergebnisse zu PTBSICD-11 und kPTBS bei Kindern und Jugendlichen werden zusammengefasst und diskutiert. Ergebnisse: Die PTBSICD-11-Kriterien führen eher zu geringeren Prävalenzraten verglichen mit PTBSICD-10, PTBSDSM-IV und PTBSDSM-5. Erste Studien weisen darauf hin, dass evidenzbasierte traumafokussierte Therapiemanuale auch zur Behandlung der kPTBS geeignet sind. Diskussion und Schlussfolgerung: Die Anwendung neuer Kriterien stellt Praktiker_innen und Forscher_innen vor Herausforderungen. Bisherige Ergebnisse deuten an, dass die kPTBS gut behandelbar ist.
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Affiliation(s)
| | - Rita Rosner
- Katholische Universität Eichstätt-Ingolstadt
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30
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Campbell K, Lakeman R. Borderline Personality Disorder: A Case for the Right Treatment, at the Right Dose, at the Right Time. Issues Ment Health Nurs 2021; 42:608-613. [PMID: 33090931 DOI: 10.1080/01612840.2020.1833119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
There is now compelling evidence that a range of psychotherapeutic treatments are effective in the treatment of borderline personality disorder (BPD). Such treatments are often lengthy, expensive, subject to high rates of incompletion and are rarely available to people with sub-threshold symptoms. There is broad agreement that some combination of vulnerability, invalidating environment, childhood adversity, disrupted attachment in childhood or trauma play a role in the aetiology of the syndrome of BPD. These factors also contribute to problems with the capacity to mentalise, regulate emotions, tolerate distress and impact on psychosocial development with or without self-damaging and suicidal behaviour. This column takes as a given that people with BPD should receive evidence-based psychological treatments such as dialectical behaviour therapy (DBT), interpersonal therapy and cognitive behavioural therapy in a sufficient dose to be helpful. However, to avert an escalating trajectory which may lead to a diagnosis of BPD the right dose of the right therapy at the right time is necessary. Under-dosing or ineffective psychotherapy can be potentially harmful. This column reviews the evidence, such as it is, for therapeutic approaches which may contribute to more skilful negotiation of life's difficulties and which may avert deterioration in mental health and quality of life in vulnerable individuals and families.
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Affiliation(s)
- Katrina Campbell
- Faculty of Science, Health, Education and Engineering, School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sunshine Coast, Australia.,Faculty of Health Sciences, Lecturer School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Australia
| | - Richard Lakeman
- School of Health and Human Services, Southern Cross University, Lismore, Australia
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Zelviene P, Jovarauskaite L, Truskauskaite-Kuneviciene I. The Psychometric Properties of the Resilience Scale (RS-14) in Lithuanian Adolescents. Front Psychol 2021; 12:667285. [PMID: 34093364 PMCID: PMC8175371 DOI: 10.3389/fpsyg.2021.667285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/20/2021] [Indexed: 11/29/2022] Open
Abstract
In the current study, we provided the evidence of satisfactory validity of the RS-14 scale in the Lithuanian adolescents' sample (N = 1299; M age = 14.24; SD age = 1.26), based on its internal structure, and relations to other variables. The results of the study indicated an acceptable model fit for a single-factor structure of the scale with a high internal consistency (McDonald's omega = 0.89). We also confirmed the scalar measurement invariance across groups of adolescents in terms of their age (i.e., early and middle adolescence) and mental health profile as well as partial scalar gender invariance. Adolescents characterized by high levels of socio-emotional problems reported lower levels of resilience, in comparison to adolescents that reported low levels of socio-emotional problems. However, the data indicated that adolescents from emotional problems and behavioral problems groups cannot be differentiated with the RS-14 scale.
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Redican E, Nolan E, Hyland P, Cloitre M, McBride O, Karatzias T, Murphy J, Shevlin M. A systematic literature review of factor analytic and mixture models of ICD-11 PTSD and CPTSD using the International Trauma Questionnaire. J Anxiety Disord 2021; 79:102381. [PMID: 33714868 DOI: 10.1016/j.janxdis.2021.102381] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 02/24/2021] [Accepted: 02/24/2021] [Indexed: 12/16/2022]
Abstract
The 11th version of the International Classification of Diseases (ICD-11; WHO, 2018) describes two distinct trauma related disorders, Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD). This review aims to summarise and synthesize evidence from factor analytic and mixture modelling studies that have investigated the latent structure of the International Trauma Questionnaire. A systematic search of PsycInfo, Web of Science, Scopus and Pubmed databases was conducted to identify relevant articles. Thirty-three studies met the inclusion criteria for this systematic review. The latent structure of the ITQ was best represented by two models; a correlated six-factor model (Re-experiencing, Avoidance, Threat, Affect Dysregulation, Negative Self Concept, and Disturbed Relationships) and a two-factor second-order model (PTSD and Disturbances in Self-Organization). Mixture model studies consistently identified distinct classes representing those displaying PTSD and CPTSD symptoms. Numerous studies demonstrated support for the factorial and discriminant validity of PTSD and CPTSD when analysed in conjunction with other variables. Overall, support was found for the conceptual coherence of PTSD and CPTSD as empirically distinguishable disorders, as measured by the ITQ. The available evidence demonstrates that the ITQ is a valid measure of ICD-11 PTSD and CPTSD. Recommendations for future research are included.
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Affiliation(s)
- Enya Redican
- Ulster University, School of Psychology, Coleraine, UK
| | - Emma Nolan
- Ulster University, School of Psychology, Coleraine, UK
| | - Philip Hyland
- Department of Psychology, Maynooth University, Ireland
| | - Marylene Cloitre
- National Center for PTSD, Verterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Orla McBride
- Ulster University, School of Psychology, Coleraine, UK
| | - Thanos Karatzias
- Edinburgh Napier University, School of Health and Social Care, Edinburgh, UK
| | - Jamie Murphy
- Ulster University, School of Psychology, Coleraine, UK
| | - Mark Shevlin
- Ulster University, School of Psychology, Coleraine, UK.
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33
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Daniunaite I, Cloitre M, Karatzias T, Shevlin M, Thoresen S, Zelviene P, Kazlauskas E. PTSD and complex PTSD in adolescence: discriminating factors in a population-based cross-sectional study. Eur J Psychotraumatol 2021; 12:1890937. [PMID: 33968323 PMCID: PMC8075084 DOI: 10.1080/20008198.2021.1890937] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Chronic and repeated trauma are well-established risk factors for complex posttraumatic stress disorder (CPTSD) in adult samples. Less is known about how trauma history and other factors contribute to the development of CPTSD in adolescence. Objective: The aim of this study was to assess the potential contribution of trauma history and social factors to CPTSD in adolescents. Method: In a cross-sectional community study of 1299 adolescents aged 12-16 years, PTSD (n = 97) and CPTSD (n = 108) was assessed with the Child and Adolescent version of the International Trauma Questionnaire (ITQ-CA). Trauma exposure, family functioning, school problems, and social support as potential discriminating factors between the PTSD and CPTSD groups were investigated. Results: Cumulative trauma exposure did not discriminate between PTSD and CPTSD in this sample. CPTSD was associated with family problems (such as financial difficulties and conflicts in the home), school problems (bullying and learning difficulties), and lack of social support. Conclusions: Our study indicates that factors other than cumulative trauma are important for the development of CPTSD in adolescence. Interventions targeting adolescent's social environment both at home and at school may be beneficial.
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Affiliation(s)
- Ieva Daniunaite
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Marylene Cloitre
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA.,National Center for PTSD, Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, USA
| | - Thanos Karatzias
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK.,NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, UK
| | - Siri Thoresen
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Paulina Zelviene
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
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34
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Li J, Wang W, Hu W, Yuan Z, Zhou R, Zhang W, Qu Z. Validation of posttraumatic stress disorder (PTSD) and complex PTSD in Chinese children as per the ICD-11 proposals using the International trauma questionnaire. Eur J Psychotraumatol 2021; 12:1888525. [PMID: 33796232 PMCID: PMC7968872 DOI: 10.1080/20008198.2021.1888525] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Given that the validity of applying complex posttraumatic stress disorder (CPTSD) in nonclinical children remains unclear. Objectives: The current study aimed to explore the factor structure, discriminant validity, and risk factors of ICD-11 posttraumatic stress disorder (PTSD) and CPTSD using the International Trauma Questionnaire. Methods: A total of 3478 trauma-exposed Chinese children aged 9-12 years were included in this study. All participants were assessed for PTSD and CPTSD using the International Trauma Questionnaire (ITQ). Confirmatory factor analysis (CFA) was conducted to explore the factor structure of CPTSD in a sample of Chinese children. Latent class analysis (LCA) was employed to evaluate the discriminant validity of CPTSD symptoms. Multinomial logistic regression analyses determined associations between the different classes and traumatic events. Results: The CFA results showed that the first-order six-factor model was identified as the best-fitting model in Chinese children aged 9-12 years. Four different classes, CPTSD symptoms, PTSD symptoms, disturbances in self-organization (DSO) symptoms, and a low symptom class were found by LCA. Both prolonged interpersonal trauma and other types of trauma were risk factors for the CPTSD class and the PTSD class. Conclusions: The results of this study partially support the factorial validity and strongly support the discriminant validity of the ICD-11 proposals for PTSD and CPTSD in Chinese children, supporting the conceptualization of PTSD and CPTSD as sibling diagnoses based on the ICD-11. However, findings suggest the need for careful consideration of identified trauma types in the ICD-11 proposals.
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Affiliation(s)
- Jina Li
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, P.R.China
| | - Weiwei Wang
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, P.R.China
| | - Wei Hu
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, P.R.China
| | - Ziyue Yuan
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, P.R.China
| | - Ruifu Zhou
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, P.R.China
| | - Weijun Zhang
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, P.R.China
| | - Zhiyong Qu
- Center for Behavioral Health & School of Social Development and Public Policy, Beijing Normal University, Beijing, P.R.China
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Cloitre M, Brewin CR, Kazlauskas E, Lueger-Schuster B, Karatzias T, Hyland P, Shevlin M. Commentary: The need for research on PTSD in Children and adolescents - a commentary on Elliot et al. (2020). J Child Psychol Psychiatry 2021; 62:277-279. [PMID: 33289105 DOI: 10.1111/jcpp.13361] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/11/2020] [Indexed: 11/28/2022]
Abstract
The recent release of the 11th version of The International Classification of Diseases (ICD-11: WHO, 2018) marked a significant departure from the previous similarities between it and the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; APA, 2013) in terms of their conceptualization of posttraumatic stress disorder (PTSD). The ICD-11 proposed a reduced symptom set for PTSD and a sibling disorder called Complex PTSD. There have been numerous studies that have provided support for the integrity of, and distinction between, PTSD and CPTSD diagnoses in adult samples. Elliot and colleagues (2020) have added to the research literature by providing a valuable examination of the differences between ICD and DSM PTSD/CPTSD in a sample of youth aged 8 to 17 years. This commentary reviews this study and reflects on the need for greater understanding of developmental changes in the presentation of PTSD and Complex PTSD.
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Affiliation(s)
- Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA.,Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | - Chris R Brewin
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | | | - Thanos Karatzias
- Rivers Centre for Traumatic Stress, NHS Lothian, Edinburgh, UK.,School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Philip Hyland
- School of Business, National College of Ireland, Dublin, Ireland.,Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, UK
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36
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Eilers R, Rimane E, Vogel A, Renneberg B, Steil R, Rosner R. Response of young patients with probable ICD-11 complex PTSD to treatment with developmentally adapted cognitive processing therapy. Eur J Psychotraumatol 2021; 12:1929024. [PMID: 34262664 PMCID: PMC8253183 DOI: 10.1080/20008198.2021.1929024] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: ICD-11 features Complex Posttraumatic Stress Disorder (CPTSD) as a new diagnosis. To date, very few studies have investigated CPTSD in young patients, and there is a need for evidence on effective treatment. Objective: The present study evaluates the applicability of developmentally adapted cognitive processing therapy (D-CPT) for CPTSD in young patients in a secondary analysis of the treatment condition of a randomized controlled trial (RCT) investigating the efficacy of D-CPT. Methods: The D-CPT treatment group in the original study included 44 patients (14-21 years) with DSM-IV PTSD after childhood abuse. We used the ICD-11 algorithm to divide the sample into a probable CPTSD and a non-CPTSD group. We performed multilevel models for interviewer-rated and self-rated PTSD symptoms with fixed effects of group (CPTSD, non-CPTSD) and time (up to 12 months follow-up) and their interaction. Treatment response rates for both groups were calculated. Results: Nineteen (43.2%) patients fulfilled criteria for probable ICD-11 CPTSD while 25 (56.8%) did not. Both CPTSD and non-CPTSD groups showed symptom reduction over time. The CPTSD group reported higher symptom severity before and after treatment. Linear improvement and treatment response rates were similar for both groups. D-CPT reduced symptoms of disturbances in self-regulation in both groups. Discussion: Both, patients with and without probable ICD-11 CPTSD seemed to benefit from D-CPT and the treatment also reduced disturbances in self-regulation. Conclusion: This study presents initial evidence of the applicability of D-CPT in clinical practice for young patients with CPTSD. It remains debatable whether CPTSD implies different treatment needs as opposed to PTSD.
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Affiliation(s)
- Rebekka Eilers
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Eline Rimane
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Anna Vogel
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
| | - Babette Renneberg
- Department of Clinical Psychology, Freie Universität of Berlin, Berlin, Germany
| | - Regina Steil
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Goethe University Frankfurt, Frankfurt Am Main, Germany.,Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Marburg, Germany
| | - Rita Rosner
- Department of Psychology, Catholic University Eichstätt-Ingolstadt, Eichstätt, Germany
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Armour C, Robinson M, Ross J. Factor structure of the International Trauma Questionnaire in UK Armed Forces veterans residing in Northern Ireland. Eur J Psychotraumatol 2021; 12:1924954. [PMID: 34992753 PMCID: PMC8725758 DOI: 10.1080/20008198.2021.1924954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background: Complex Posttraumatic Stress Disorder (C-PTSD) was recently included in the revised International Classification of Diseases (ICD-11) by the World Health Organization (WHO, 2018). C-PTSD is a new trauma related disorder which may develop after prolonged and multiple exposures to trauma. It is a sister disorder of PTSD and is further characterized by symptomatology of disorganized self-organization (DSO). To qualify for the diagnosis, individuals must first meet the diagnostic criteria for PTSD, then report DSO symptoms and functional impairment. A body of work is emerging which has focused on the underlying dimensionality of C-PTSD across both adult and more recently adolescent populations from differing index trauma groups and from across several nations and cultures. However, few studies have been conducted in populations exposed to combat trauma despite the obvious prolonged and multiple nature of their trauma histories. Objective: To contribute to emerging evidence of the factor structure of ICD-11 C-PTSD in a novel population. Methods: This is the first factor analytic study to explore C-PTSD in a sample of UK Armed Forces veterans residing in Northern Ireland (N = 732). C-PTSD was measured via the ITQ and we utilized CFA to assess the fit of 7 competing models. Results: Based on established CFA fit indices, a correlated, first order, 6-factor model of C-PTSD, representing 3 PTSD and 3 DSO symptom groupings, was deemed to provide superior fit to the data compared to 6 alternative C-PTSD models. The superiority of the model was further supported by statistical comparisons of competing C-PTSD models. All factor loadings (0.866-0.998) and inter-factor correlations (.746-.975) of the optimally fitting model were statistically significant and high. Conclusion: These results provide support for the construct validity of ICD-11 C-PTSD in a unique sample of Armed Forces veterans residing in Northern Ireland.
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Affiliation(s)
- Cherie Armour
- Stress Trauma and Related Conditions (STARC) Research Lab, School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Martin Robinson
- Stress Trauma and Related Conditions (STARC) Research Lab, School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Jana Ross
- Stress Trauma and Related Conditions (STARC) Research Lab, School of Psychology, Queen's University Belfast, Belfast, Northern Ireland, UK
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Ford JD, Spinazzola J, van der Kolk B. Psychiatric comorbidity of developmental trauma disorder and posttraumatic Stress disorder: findings from the DTD field trial replication (DTDFT-R). Eur J Psychotraumatol 2021; 12:1929028. [PMID: 34249242 PMCID: PMC8245086 DOI: 10.1080/20008198.2021.1929028] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
Background: Developmental Trauma Disorder (DTD) has extensive comorbidity with internalizing and externalizing disorders distinct from posttraumatic stress disorder (PTSD). Objective: To replicate findings of DTD comorbidity and to determine whether this comorbidity is distinct from, and extends beyond, comorbidities of PTSD. Method: DTD was assessed by structured interview, and probable DSM-IV psychiatric disorders were identified with KSADS-PL screening modules, in a multi-site sample of 271 children (ages 8-18 years old; 47% female) in outpatient or residential mental health treatment for multiple (M = 3.5 [SD = 2.4]) psychiatric diagnoses other than PTSD or DTD. Results: DTD (N = 74, 27%) and PTSD (N = 107, 39%) were highly comorbid and shared several DSM-IV internalizing and externalizing disorder comorbidities. Children with DTD with or without PTSD had more comorbid diagnoses (M = 5.7 and 5.2 [SD = 2.4 and 1.7], respectively) than children with PTSD but not DTD (M = 3.8[SD = 2.1]) or neither PTSD nor DTD (M = 2.1[SD = 1.9]), F[3,267] = 55.49, p < .001. Further, on a multivariate basis controlling for demographics and including all potential comorbid disorders, DTD was associated with separation anxiety disorder, depression, and oppositional defiant disorder after controlling for PTSD, while PTSD was associated only with separation anxiety disorder after controlling for DTD. Both DTD and PTSD were associated with suicidality. Conclusions: DTD is associated with psychiatric comorbidity beyond that of PTSD, and DTD warrants assessment for treatment planning with children in intensive psychiatric services.
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Affiliation(s)
- Julian D Ford
- University of Connecticut School of Medicine, Farmington, CT, USA
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Sölva K, Haselgruber A, Lueger-Schuster B. Latent classes of childhood maltreatment in children and adolescents in foster care: associations with ICD-11 PTSD and complex PTSD. Eur J Psychotraumatol 2020; 11:1832757. [PMID: 33408807 PMCID: PMC7747931 DOI: 10.1080/20008198.2020.1832757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 07/30/2020] [Accepted: 09/18/2020] [Indexed: 12/27/2022] Open
Abstract
Background: Children and adolescents in foster care often experience many co-occurring subtypes of maltreatment. However, little is known about different combinations of maltreatment subtypes, referred to as maltreatment classes. Furthermore, the association between those maltreatment classes and ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) has not been investigated in children and adolescents. In previous studies, classes characterized by cumulative maltreatment were associated with severe psychopathological symptoms. So far, no study investigated ICD-11 PTSD and CPTSD. Objective: The first aim of this study was the detection of distinct maltreatment classes by examining frequently co-occurring maltreatment subtypes. The second aim was the examination of the association between those maltreatment classes and ICD-11 PTSD and CPTSD. Method: Participants were 147 children and adolescents currently living in foster care institutions in Lower Austria. Maltreatment history, ICD-11 PTSD and CPTSD were assessed using standardized self-report questionnaires. Latent class analysis was applied to examine maltreatment subtypes. χ2 difference testing was used to examine class associations with PTSD and CPTSD. Results: Three latent classes that comprised different subtypes of maltreatment were identified (limited maltreatment, n = 49; high neglect, n = 53; cumulative maltreatment, n = 45). Cumulative maltreatment was associated with higher symptom severity of PTSD and CPTSD than the limited maltreatment and the high neglect class, with effect sizes ranging from 0.62 to 0.93. Conclusions: The association of the cumulative maltreatment class with the highest symptom severity of PTSD and CPTSD highlights the detrimental effect of cumulative maltreatment. The detection of a high neglect class identifies children and adolescents, who are at high-risk of experiencing future maltreatment because of their previous experiences of neglect and the associated lack of protection. The examination of the association of distinct maltreatment classes with ICD-11 PTSD and CPTSD might provide implications for targeted prevention, assessment and treatment.
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Affiliation(s)
- Katharina Sölva
- Unit of Psychotraumatology, Department of Applied Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Alexander Haselgruber
- Unit of Psychotraumatology, Department of Applied Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - Brigitte Lueger-Schuster
- Unit of Psychotraumatology, Department of Applied Psychology, Faculty of Psychology, University of Vienna, Vienna, Austria
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Rink J, Lipinska G. Evidence of distinct profiles of ICD-11 post-traumatic stress disorder (PTSD) and complex PTSD in a South African sample. Eur J Psychotraumatol 2020; 11:1818965. [PMID: 33282146 PMCID: PMC7685205 DOI: 10.1080/20008198.2020.1818965] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background: Both post-traumatic stress disorder (PTSD) and complex post-traumatic stress disorder (CPTSD) have been included in the 11th edition of the International Classification of Diseases (ICD-11). Although the validity of CPTSD has been controversial, a growing number of studies support the distinction between PTSD and CPTSD. However, the majority of this research has originated in high-income countries (HICs), whereas the prevalence of trauma experience associated with PTSD/CPTSD diagnosis is significantly higher in low- and middle-income countries (LMICs). Objective: This study assessed whether a sample from an LMIC setting produced distinct classes that reflect ICD-11 criteria for PTSD and CPTSD. Furthermore, this study investigated whether childhood trauma distinguished between PTSD and CPTSD. Method: International Trauma Questionnaire responses from a sample of South African university undergraduates were used as indicator variables in a latent class analysis (LCA). Chi-squared tests of independence and Kruskal-Wallis H tests were used to assess between-class differences. Results: The LCA identified four distinct classes: a PTSD class with elevated symptoms of PTSD, but low endorsement of disturbances in self-organization (DSO; symptoms that are specific to CPTSD); a CPTSD class with elevated symptoms of PTSD and DSO; a DSO class with low symptoms of PTSD, but elevated symptoms of DSO; and a Low class with low endorsements on all symptoms. Regarding childhood trauma, participants in the CPTSD class had more severe childhood abuse and neglect, specifically emotional abuse and neglect, than participants in the PTSD class. Conclusions: Findings were consistent with the distinction between PTSD and CPTSD symptom profiles in the ICD-11. Our findings support a similar qualitative distinction between PTSD and CPTSD in our LMIC context, as previously reported in HICs. This distinction is especially relevant in LMICs because of the significant number of individuals vulnerable to these disorders.
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Affiliation(s)
- James Rink
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, Cape Town, South Africa
| | - Gosia Lipinska
- Applied Cognitive Science and Experimental Neuropsychology Team (ACSENT), Department of Psychology, University of Cape Town, Cape Town, South Africa
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Haselgruber A, Sölva K, Lueger-Schuster B. Symptom structure of ICD-11 Complex Posttraumatic Stress Disorder (CPTSD) in trauma-exposed foster children: examining the International Trauma Questionnaire - Child and Adolescent Version (ITQ-CA). Eur J Psychotraumatol 2020; 11:1818974. [PMID: 33244361 PMCID: PMC7678682 DOI: 10.1080/20008198.2020.1818974] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/24/2020] [Accepted: 08/24/2020] [Indexed: 01/02/2023] Open
Abstract
Background: The 11th edition of the International Classification of Diseases (ICD-11) introduces Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD) as two distinct trauma-related disorders. Numerous studies support the proposed symptom structure of ICD-11 CPTSD in adults, but only a few studies have examined CPTSD symptom structure in children, reporting diverging results. To assess ICD-11 CPTSD in children, the International Trauma Questionnaire (ITQ) was recently adapted for children and adolescents (ITQ-CA), with no validated German version available yet. Objective: This study aimed (1) to test the symptom structure of ICD-11 CPTSD in a sample of trauma-exposed foster children using the ITQ-CA, and (2) to examine the concurrent, convergent and discriminant validity of the German ITQ-CA. Method: Altogether, 161 Austrian foster children completed a set of standardized measures, resulting in a final sample of 135 trauma-exposed foster children meeting the inclusion criteria. Psychometric properties of the ITQ-CA were assessed using confirmatory factor analysis (CFA), bivariate correlations and multivariate regression. Results: CFA supported ICD-11 CPTSD symptom structure in children as a two-factor higher-order model with PTSD and Disturbances in Self-Organization (DSO) as correlated factors with very good model fit, while a one-factor higher-order model also fitted the data very well. High factor loadings and excellent levels of internal reliability evidenced the psychometric adequacy of the ITQ-CA. Concurrent and convergent validity were evidenced by high correlations between ITQ-CA scales and criterion variables (PTSD symptoms, depression, anxiety, dissociation, lifetime traumatization). Discriminant validity was partly supported by PTSD and DSO being differently predicted by exogenous criterion variables. Conclusions: CPTSD symptom structure in children is in support of the ICD-11 conceptualization. The reliability and validity of the German ITQ-CA are evidenced for the first time, identifying it as an easy-to-use screening instrument to assess ICD-11 PTSD and CPTSD in children. Further implications and areas for upcoming studies are discussed.
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Affiliation(s)
- A. Haselgruber
- Unit of Psychotraumatology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - K. Sölva
- Unit of Psychotraumatology, Faculty of Psychology, University of Vienna, Vienna, Austria
| | - B. Lueger-Schuster
- Unit of Psychotraumatology, Faculty of Psychology, University of Vienna, Vienna, Austria
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Zelviene P, Daniunaite I, Hafstad GS, Thoresen S, Truskauskaite-Kuneviciene I, Kazlauskas E. Patterns of abuse and effects on psychosocial functioning in Lithuanian adolescents: A latent class analysis approach. CHILD ABUSE & NEGLECT 2020; 108:104684. [PMID: 32854055 DOI: 10.1016/j.chiabu.2020.104684] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/10/2020] [Accepted: 08/10/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND There is considerable evidence that child abuse and neglect has a significant impact on social relationships and mental health across the lifespan. OBJECTIVE We aimed to estimate the prevalence of child abuse in Lithuanian adolescents, to identify patterns of abuse experiences using a latent class analysis approach, and to assess psychosocial functioning associated with these patterns of abuse. PARTICIPANTS AND SETTING The study was based on a sample of 1299 adolescents from the Lithuanian general population aged 12-16 (M = 14.24, SD = 1.26) years. METHODS Lifetime abuse exposure measures included neglect, emotional abuse, physical abuse, online sexual violence, sexual abuse from adult, and sexual abuse from peers. Psychosocial functioning was measured with the Strength and Difficulties Questionnaire (SDQ). Patterns of abuse were identified by a two-step latent class analysis (LCA). RESULTS Around two-thirds of adolescents (71 %) reported at least one type of abuse over their lifetime. The results of the LCA indicated that for each type of abuse two different groups of adolescents can be distinguished in terms of the severity of abuse, and four classes 'less-severe', 'peer sexual', 'adult sexual', and 'severe abuse' were identified. Psychosocial functioning varied significantly between the four classes with higher psychosocial functioning problems associated with high severity and sexual abuse. CONCLUSIONS The study revealed a high child abuse prevalence in Lithuania. The results show that the psychosocial functioning of adolescents is associated with severity and types of abuse experiences.
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Affiliation(s)
- Paulina Zelviene
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | - Ieva Daniunaite
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania
| | | | - Siri Thoresen
- Norwegian Center for Violence and Traumatic Stress Studies, Oslo, Norway
| | | | - Evaldas Kazlauskas
- Center for Psychotraumatology, Institute of Psychology, Vilnius University, Vilnius, Lithuania.
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Hébert M, Amédée LM. Latent class analysis of post-traumatic stress symptoms and complex PTSD in child victims of sexual abuse and their response to Trauma-Focused Cognitive Behavioural Therapy. Eur J Psychotraumatol 2020; 11:1807171. [PMID: 33062212 PMCID: PMC7534355 DOI: 10.1080/20008198.2020.1807171] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: PTSD symptoms are frequent in child victims of sexual abuse. Yet, authors have argued that early trauma could lead to alterations in development that go far beyond the primary symptoms of PTSD and have proposed Complex PTSD as an alternative diagnosis encompassing difficulties in affect regulation, relationships and self-concept. Objective: To delineate profiles in child victims of sexual abuse and explore whether profiles are associated with treatment response to Trauma-Focused Cognitive Behavioural Therapy. Method: Latent class analysis was used to identify symptom profiles at baseline assessment of 384 children ages 6 to 14, recruited in a Child Advocacy Centre following disclosure of sexual abuse. Dimensions of Complex PTSD diagnosis as proposed by the ICD-11 were derived from self-report questionnaires. Results: Latent class analysis identified a best fitting model of three classes: Classic PTSD regrouping 51% of children, Complex PTSD describing 23% of children, and Resilient describing 25% of children. Trauma-focused therapy was associated with a significant reduction of dissociation, internalizing, and externalizing problems for children of all three classes. Trauma-focused therapy was also linked to a significant reduction of PTSD symptoms with larger effect size (d = .90; 95%CI: 0.63-1.16) for children classified in the Complex PTSD class. Conclusion: These findings highlight the utility of a person-oriented approach to enhance our understanding of the diversity of profiles in child victims. The results offer empirical support for the ICD-11 PTSD and Complex PTSD distinction in a clinical sample of sexually abused children and the relevance of this distinction in foreseeing treatment outcomes.
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Affiliation(s)
- Martine Hébert
- Canada Research Chair in Interpersonal Traumas and Resilience, Département de sexologie, Université du Québec à Montréal, Montréal, Québec, Canada
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Cloitre M, Brewin CR, Bisson JI, Hyland P, Karatzias T, Lueger-Schuster B, Maercker A, Roberts NP, Shevlin M. Evidence for the coherence and integrity of the complex PTSD (CPTSD) diagnosis: response to Achterhof et al., (2019) and Ford (2020). Eur J Psychotraumatol 2020; 11:1739873. [PMID: 32341764 PMCID: PMC7170304 DOI: 10.1080/20008198.2020.1739873] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 12/14/2022] Open
Abstract
This letter to the editor responds to a recent EJPT editorial and following commentary which express concerns about the validity of the ICD-11 complex PTSD (CPTSD) diagnosis. Achterhof and colleagues caution that latent profile analyses and latent class analyses, which have been frequently used to demonstrate the discriminative validity of the ICD-11 PTSD and CPTSD constructs, have limitations and cannot be relied on to definitively determine the validity of the diagnosis. Ford takes a broader perspective and introduces the concept of 'cPTSD' which describes a wide ranging set of symptoms identified from studies related to DSM-IV, DSM-V and ICD-11 and proposes that the validity of the ICD-11 CPTSD is in question as it does not address the multiple symptoms identified from previous trauma-related disorders. We argue that ICD-11 CPTSD is a theory-driven, empirically supported construct that has internal consistency and conceptual coherence and that it need not explain nor resolve the inconsistencies of past formulations to demonstrate its validity. We do agree with Ford and with Achterhof and colleagues that no one single statistical process can definitively answer the question of whether CPTSD is a valid construct. We reference several studies utilizing many different statistical approaches implemented across several countries, the overwhelming majority of which have supported the validity of ICD-11 as a unique construct. We conclude with our own cautions about ICD-11 CPTSD research to date and identify important next steps.
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Affiliation(s)
- Marylène Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | - Chris R. Brewin
- Clinical Educational & Health Psychology, University College London, London, UK
| | | | - Philip Hyland
- Department of Psychology, Maynooth University, Kildare, Ireland
- Centre for Global Health, Trinity College Dublin, Dublin, Ireland
| | - Thanos Karatzias
- NHS Lothian, Rivers Centre for Traumatic Stress, Edinburgh, UK
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | | | - Andreas Maercker
- Division of Psychopathology and Clinical Intervention Zurich, University of Zurich, Switzerland
| | - Neil P. Roberts
- Psychology and Psychological Therapies Directorate, Cardiff & Vale University Health Board, Cardiff, UK
- Division of Psychological Medicine & Clinical Neurosciences, Cardiff University, Cardiff, UK
| | - Mark Shevlin
- School of Psychology, Ulster University, Derry, Northern Ireland
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