Trauma experience in children and adolescents: an assessment of the effects of trauma type and role of interpersonal proximity

Gun violence exposure and population health inequality: a conceptual framework

This essay establishes a conceptual framework to understand how direct, secondar and community exposures to gun violence converge to influence population health. Our framework asserts that persistent gun violence in structurally disadvantaged communities enacts broad consequences for mental, physical and behavioural health, operating as a key driver of racial and socioeconomic health disparities. We discuss the applications of this framework for research and improved data collection with a focus on establishing timely and accurate measures of gun violence alongside individual and community health measures. We then address the policy implications of the framework, emphasising the need for long-term, institutional investment in gun violence prevention and intervention, survivor service provision and evidence-based policies at all levels of government.

From adverse childhood experiences to harsh parenting: Psychological symptoms as a mediator

BACKGROUND

Research evidence has demonstrated a direct link between ACEs and harsh parenting. However, the mechanisms linking paternal ACEs to harsh parenting have remained largely unexplored among Asian populations.

OBJECTIVE

In the current study, we examined the relationships between parental ACEs and harsh parenting and explored the potential mediating effect of psychological symptoms on the relationship between parental ACEs and harsh parenting.

PARTICIPANTS AND SETTING

A total of 6195 Taiwanese parents of children aged 6 to 12 were recruited from 58 primary schools in the Taiwanese cities of Taipei and New Taipei.

METHOD

Using probability-proportional-to-size sampling and a self-report survey, we collected data relating to parental ACEs, psychological symptoms, and child-rearing behaviors. A hierarchical regression analysis was completed to examine the effects of parental ACEs and psychological symptoms on harsh parenting. In addition, we tested the potential mediating effects of psychological symptoms on the relationship between parental ACEs and harsh parenting by employing a simple mediation model (PROCESS) with a bootstrapping procedure.

RESULTS

We found that both parental ACEs and psychological symptoms were significant predictors for mothers' and fathers' adoption of harsh parenting behaviors. Moreover, after adjusting for covariates, we discovered the unique finding that psychological symptoms mediated the relationship between parental ACEs and harsh parenting among Taiwanese parents.

CONCLUSIONS

The study revealed a direct link between parental ACEs and harsh parenting, with psychological symptoms serving as a mediator. Our findings suggest that trauma-recovery programs should promote regular screening and interventions for parents with ACEs.

Interpersonal early adversity demonstrates dissimilarity from early socioeconomic disadvantage in the course of human brain development: A meta-analysis

It has been established that early-life adversity impacts brain development, but the role of development itself has largely been ignored. We take a developmentally-sensitive approach to examine the neurodevelopmental sequelae of early adversity in a preregistered meta-analysis of 27,234 youth (birth to 18-years-old), providing the largest group of adversity-exposed youth to date. Findings demonstrate that early-life adversity does not have an ontogenetically uniform impact on brain volumes, but instead exhibits age-, experience-, and region-specific associations. Relative to non-exposed comparisons, interpersonal early adversity (e.g., family-based maltreatment) was associated with initially larger volumes in frontolimbic regions until ∼10-years-old, after which these exposures were linked to increasingly smaller volumes. By contrast, socioeconomic disadvantage (e.g., poverty) was associated with smaller volumes in temporal-limbic regions in childhood, which were attenuated at older ages. These findings advance ongoing debates regarding why, when, and how early-life adversity shapes later neural outcomes.

Interpersonal early adversity demonstrates dissimilarity from early socioeconomic disadvantage in the course of human brain development: A meta-analysis

It has been established that early-life adversity impacts brain development, but the role of development itself has largely been ignored. We take a developmentally-sensitive approach to examine the neurodevelopmental sequelae of early adversity in a preregistered meta-analysis of 27,234 youth (birth to 18-years-old), providing the largest group of adversity-exposed youth to date. Findings demonstrate that early-life adversity does not have an ontogenetically uniform impact on brain volumes, but instead exhibits age-, experience-, and region-specific associations. Relative to non-exposed comparisons, interpersonal early adversity (e.g., family-based maltreatment) was associated with initially larger volumes in frontolimbic regions until ~10-years-old, after which these exposures were linked to increasingly smaller volumes. By contrast, socioeconomic disadvantage (e.g., poverty) was associated with smaller volumes in temporal-limbic regions in childhood, which were attenuated at older ages. These findings advance ongoing debates regarding why, when, and how early-life adversity shapes later neural outcomes.

The Association Between Patterns of Trauma Exposure, Family Dysfunction, and Psychopathology Among Adolescent Females With Depressive Symptoms From Low-Income Contexts

Distinguishing profiles of trauma exposure among low-income adolescent females with depressive symptoms is important for understanding comorbidity, family relationships, and treatment. Specifically, child maltreatment is essential to examine in comparison to other traumas. Participants included 170 adolescent females (65.3% Black; 21.2% White; 13.5% other race; 14.1% Latina/x) with depressive symptoms and their primary caregiver from low-income families. Latent class analysis (LCA) identified three trauma classes. Probabilities of endorsing different subtypes of maltreatment (physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse), number of subtypes of maltreatment, and non-maltreatment traumas (accident, experiencing or witnessing physical assault, death or injury of loved one, medical trauma) varied among groups. Higher levels of family dysfunction and traumatic stress symptoms were reported in both classes with maltreatment exposure as compared to the class with only non-maltreatment trauma exposure. Findings have implications for family-focused interventions for maltreated adolescent females with depressive symptoms from low-income contexts.

Withdrawn and Acting out?: Early Adolescents' Social Avoidance and Externalizing Problems

Relative to other motivations of social withdrawal (i.e., shyness, unsociability), social avoidance is understudied. Furthermore, the relation between social avoidance and externalizing problems seldom has been investigated despite reasons to expect an association. We examined the association between social avoidance and externalizing problems using a sample of early adolescents in the United States using parents' reports (N = 294; 54.1% boys; M age = 12.43 years). Supporting our hypotheses, structural equation models indicated that social avoidance positively predicted concurrent externalizing problems, controlling for shyness, unsociability, and internalizing problems (including depression and anxiety). Findings highlight that socially avoidant adolescents' behaviors may include avoiding others as well as acting out. Longitudinal work is needed to examine the potential bidirectional relations between social avoidance and externalizing problems.

Trauma in Context: an Integrative Treatment Model

Evidenced based trauma treatments benefit children, but they rarely suffice for youth with multiple and complex comorbidities. After the completion of standard treatments, many children continue to show residual social, behavioral, and emotional difficulties. Part of the difficulty is that while the literature on trauma describes numerous facets that contribute to the severity, expression, and outcomes of trauma exposure, clinical assessments and interventions do not sufficiently reflect that literature. Clinicians thus have little guidance on how to integrate the intricacies of client's circumstances into a trauma-informed framework. To expand the scope and efficacy of treatments and guide clinicians in selecting appropriate interventions, this paper explores factors associated with pretreatment traumatic responses and proposes an integrative treatment model that includes the trauma experience, itself, combined with pre- and post-trauma factors that are both internal and external to the child and family. Pre-trauma experiences influence the severity of traumatic responses, while post-trauma factors impact a person's ability to cope and recover. Both are important targets for direct intervention.

Links between Oppositional Defiant Disorder Dimensions, Psychophysiology, and Interpersonal versus Non-interpersonal Trauma

The etiology of oppositional defiant disorder (ODD) is not well understood but appears to have both biologically-based roots and can develop following adverse experiences. The current study is the first to examine the interaction between biologically-based factors and type of trauma experience (i.e., interpersonal and non-interpersonal) and associations with ODD. The psychophysiological factors included baseline resting heart rate, respiratory sinus arrhythmia (RSA), and cortisol. ODD was measured as two dimensions of irritable and defiant/vindictive. The sample included 330 children, 3-7 years-old, oversampled for a history of trauma. Results showed the interactions between baseline physiological arousal variables and trauma type in predicting ODD dimensions were not supported. However, the baseline RSA by trauma interaction was a significant predictor of defiance/vindictiveness among boys, but not girls, when interpersonal trauma was compared to controls. Several other gender differences emerged. Among boys, both interpersonal and non-interpersonal trauma were predictive of ODD dimensions; however, among girls, non-interpersonal trauma was not. Among girls, there was a significant negative bivariate relationship between baseline cortisol and irritability. Also, when the sample was restricted to those with interpersonal trauma only and controls, baseline RSA was negatively associated with irritability in girls only (controlling for trauma). Finally, retrospective reports revealed that children who met criteria for ODD diagnosis and experienced interpersonal trauma were more likely to exhibit ODD symptoms prior to their trauma compared to those who experienced non-interpersonal trauma. Results are discussed in the context of previous mixed findings, and avenues for future research are highlighted.

Evaluation of an Early Intervention Model for Child and Adolescent Victims of Interpersonal Violence

Only the minority of youth exposed to traumatic events receive mental health care, as trauma-informed clinical services are lacking or are poorly accessible. In order to bridge this gap, the Outpatient Trauma Clinic (OTC) was founded, an easily accessible early, short-time intervention, with onward referral to follow-up treatment. This report presents the OTC's interventional approach and first outcome data. Using a retrospective naturalistic design, we analyzed trauma- and intervention-related data of the sample (n = 377, 55.4% female, mean age 10.95, SD = 4.69). Following drop-out analyses, predictors for treatment outcome were identified by logistic regression. The majority (81.9%) was suffering from posttraumatic stress disorder (PTSD) or adjustment disorders. Around one forth dropped out of treatment; these cases showed higher avoidance symptoms at presentation. In 91%, psychological symptoms improved. Experience of multiple traumatic events was the strongest predictor for poor treatment outcome (B = -0.823, SE = 0.313, OR = 0.439, 95% CI 0.238-0.811). Around two thirds were connected to follow-up treatment. The OTC realized a high retention rate, initial improvement of symptoms and referral to subsequent longer-term psychotherapeutic treatment in the majority. Further dissemination of comparable early intervention models is needed, in order to improve mental health care for this vulnerable group.

Interpersonal Trauma Exposure and Interpersonal Problems in Adolescent Posttraumatic Stress Disorder

Traumatic experiences have been differentiated as interpersonal (i.e., the direct result of actions by other people) or noninterpersonal (i.e., other life-threatening events, such as severe accidents). Interpersonal trauma exposure generally has been shown to be associated with more severe posttraumatic stress disorder (PTSD) symptoms than noninterpersonal trauma exposure. Interpersonal problems also tend to be associated with trauma exposure and PTSD symptoms, but it is unclear whether a mediating association exists between trauma type, interpersonal problems, and PTSD symptoms. A clinical sample of 4,275 adolescents (age range: 12-18 years) from the National Child Traumatic Stress Network Core Data Set were classified as having experienced interpersonal trauma, noninterpersonal trauma, or both. Interpersonal problems were operationalized by social problem behaviors (e.g., immature and dependent behaviors) and aggressive behaviors on the Child Behavior Checklist. The results of path analyses showed that cumulative interpersonal trauma exposure was both directly and indirectly associated with PTSD symptoms via social problem behaviors but not aggressive behaviors, total effect β = .20, 95% CI [.17, .23]. In a second model, path analyses showed that cumulative interpersonal trauma exposure was associated directly and indirectly via PTSD symptoms with social problem behaviors, total effect β = .15, 95% CI [.11, .18], and aggressive behaviors, total effect β = .13, 95% CI [.09, .17]. These findings suggest that during adolescence, interpersonal problems play an important role in the association between interpersonal trauma exposure and PTSD symptoms.

Psychological Distress and Well-Being in Trauma-Exposed Adolescents: A Residualized, Person-Centered Approach to Resilience

Positive adaptation manifests differently in the aftermath of traumatic events. Methodological limitations, however, impede the ability to test conceptualizations of resilience that emphasize the multifaceted nature of these responses. In response, an approach that synthesized a residualized and person-centered conceptualization of resilience examined associations between aspects of resilience in an adolescent sample. In total, 584 racially/ethnically diverse adolescents (age range: 12-17 years; M = 14.98 years; SD = 1.05; 50.9% female; 30.1% White, 29.6% African American, 19.5% Hispanic) self-reported lifetime emotional maltreatment and community violence exposure as well as current levels of depression, posttraumatic stress symptoms (PTSS), violent behavior, and psychological well-being (PWB). Each mental health outcome was regressed on lifetime trauma exposure to create residuals used as indices of resilience. Correlations between the residuals suggested that PWB was more closely related to resilience to depression and PTS, rs = .17-.30, than violent behavior, r = .00. Residuals were subsequently entered into person-centered analyses to identify representative well-being profiles. Cluster analysis identified four groups, including two adaptive profiles defined by (a) lower distress and higher PWB and (b) lower psychopathology and lower PWB, based on adolescents' levels of trauma exposure. These two profiles did not vary regarding impairment, p > .999, suggesting both profiles represent positive adaption to lifetime trauma exposure. Theoretical and clinical implications of distinguishing between these two profiles by assessing PWB in adolescents are discussed, as well as how PWB may manifest within the context of different patterns of psychological distress.

Psychiatric comorbidity of developmental trauma disorder and posttraumatic Stress disorder: findings from the DTD field trial replication (DTDFT-R)

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.

Who worries about specific phobias? - A population-based study of risk factors

Although specific phobia is one of the most prevalent lifetime anxiety disorders, little is known about the particular risk factors related to its development. The underlying goal of this study was to analyse the risk factors associated with worrying about specific phobias (SP) in a representative sample of community dwelling adults. The sample was composed of 8461 participants (mean age 47.68 years, range 18-85, 54.60% female), from the Australian National Mental Health Survey. A total of 188 participants (2.22%) reported worrying about SPs. Multivariate logistic regression analysis indicated that female sex (odds ratio (OR) = 1.98, p < 0.0001) and a comorbid diagnosis of lifetime major depression disorder (OR = 2.80, p < 0.0001) were the factors most strongly associated with worrying about SPs. Having experienced traumatic experiences involving significant others (OR = 1.18, p = 0.02), the number of chronic diseases (OR = 1.21, p < 0.01), and a comorbid diagnosis of substance use (OR = 2.80, p = 0.02) were also associated. Our results are in line with previous studies focusing on other anxiety disorders. We provide further evidence that substance dependence appears to serve as a unique risk factor for the subsequent onset of SP. Further empirical and clinical implications are discussed.

Exposure to violence and neglect images differentially influences fear learning and extinction

The mechanisms by which exposure to adversity contributes to psychopathology development are poorly understood. Recent models link experiences of threat of harm and deprivation to psychopathology via disruptions in learning mechanisms underlying fear acquisition and extinction. We empirically tested dimensional elements of this model, by examining whether exposure to images of community violence or neglect differentially influenced fear learning and extinction relative to exposure to neutral images. Participants were randomly allocated to one of three exposure conditions: viewing images depicting neglect (n = 25), violence (n = 25) or control images (n = 24). All participants then completed a fear conditioning and extinction task in which the CS+ was paired with an aversive tone, and the CS- was presented alone during conditioning. Both CSs were presented alone during extinction and extinction retest. Skin conductance responses (SCR) and subjective ratings were assessed. Relative to control images, viewing scenes of neglect attenuated SCRs to the CSs during conditioning, extinction and extinction retest. Exposure to images of community violence accentuated SCRs during US anticipation on CS+ trials and impaired the retention of safety learning (larger SCRs to the CS+ compared to the CS- at retest and the CS+ at the end of extinction). No significant group differences emerged in subjective ratings. Findings lend preliminary support for suggestions that adverse experiences may be linked to impairments in fear and safety learning and provide key evidence suggesting that the expression of these impairments may differ as a function of the type of adversity.

Examination of Child Placement, Emotional, Behavioral and Attachment Problems Among Children with Caregiver-Perpetrated Trauma Histories

Caregiver-perpetrated trauma (CPT) is associated with adverse consequences for youth, including out-of-home placement. Although promotion of kinship care placement has recently increased, effects on youth remain unclear. Psychosocial functioning of 1107 CPT-exposed youth ages 2 to 18 was compared across placement types using generalized mixed models. Youth remaining at home had increased Somatization symptoms compared to kinship (OR = .25, CI = 0.07-.88) and foster care (OR = .32, CI = 0.11-.98) youth. Both out-of-home placement types had higher odds of Attachment Problems (OR = 3.61, CI = 2.22-5.87 and 4.41, CI = 2.71-7.18 respectively). PTSD symptoms varied, youth in kinship care had increased self-reported re-experiencing symptoms (OR = 2.66, CI = 1.04-6.8), while youth in foster care had elevated clinician-rated PTSD (OR = 2.07, CI = 1.1.3-3.80). Given the limited differences between kinship and foster care, studies should continue to delineate the impact of child placement type to inform child welfare policy.

Associations of Adolescent Exposure to Severe Violence with Substance Use From Adolescence into Adulthood: Direct Versus Indirect Exposures

BACKGROUND

While previous research has documented the impact of violence on substance use, none has looked longitudinally across the lifespan to measure independent effects of direct and indirect violence exposure.

OBJECTIVE

To examine independent associations between adolescent experiences of violence and subsequent substance use in adolescence and adulthood in the United States.

METHOD

Using the National Longitudinal Study of Adolescent to Adult Health (N = 12,288), we examined being shot or stabbed ("experienced"), being threatened with a knife or gun ("threatened"), and seeing someone either shot or stabbed ("witnessed") during adolescence (Wave I) as correlates of substance use in adolescence and adulthood (Wave IV) via logistic regression.

RESULTS

Violence exposure was a significant correlate of drug use in adolescence and several associations remained significant in adulthood. Witnessing violence had the highest point estimates in the adjusted models in adolescence for each substance use outcome (e.g., Cocaine-Adjusted Odds Ratios [AOR] = 2.59, 95% confidence interval [CI] = 1.21, 5.54). However, the point estimates for threatened with violence or experienced violence were highest in three out of the four drug outcomes in adulthood (e.g., Threatened with violence: Binge drinking-AOR = 1.41, 95% CI = 1.08, 1.83). Conclusion/Importance: Adolescent exposure to witnessing violence had stronger effects on substance use in adolescence, while experiencing and being threatened with violence in adolescence had stronger effects on substance use in adulthood. Violence prevention efforts targeted toward adolescents may lead to a reduction in substance use throughout the life-course, and clinicians and policy makers should be aware of the downstream effects of violence experienced in adolescence.

Effects of Trauma in Adulthood and Adolescence on Fear Extinction and Extinction Retention: Advancing Animal Models of Posttraumatic Stress Disorder

Evidence for and against adolescent vulnerability to posttraumatic stress disorder (PTSD) is mounting, but this evidence is largely qualitative, retrospective, or complicated by variation in prior stress exposure and trauma context. Here, we examine the effects of development on trauma vulnerability using adult post-natal (PN) day 61, early adolescent (PN23) and mid adolescence (PN34) rats and two types of trauma: an established animal model of PTSD, single prolonged stress (SPS), and a novel composite model—SPS predation (SPSp) version. We demonstrate that early and mid adolescent rats are capable of fear conditioning and fear extinction, as well as extinction retention. Our results also demonstrate that both types of trauma induced a deficit in the retention of fear extinction in adulthood, a hallmark of PTSD, but not after early or mid adolescence trauma, suggesting that adolescence might convey resilience to SPS and SPSp traumas. Across all three life stages, the effects of SPS exposure and a novel predation trauma model, SPSp, had similar effects on behavior suggesting that trauma type did not affect the likelihood of developing PTSD-like symptoms, and that SPSp is a predation-based trauma model worth exploring.

The Boy Who Was Hit in the Face: Somatic Regulation and Processing of Preverbal Complex Trauma

Examination of novel treatment for complexly traumatized youth, in particular, those exposed to preverbal trauma, is necessary given challenges associated with effective intervention for this population. Therapies that facilitate somatic regulation have demonstrated benefit for some trauma survivors. The current article briefly reviews the emerging literature on symptoms of and treatments for complex and preverbal child trauma and describes Sensory Motor Arousal Regulation Therapy (SMART), an intervention for child and adolescent trauma with preliminary empirical support. SMART aims to enhance sensory motor engagement and promote affective, behavioral and physiological regulation using somatic regulation and sensory integration techniques. Utilizing case study methodology, the article illustrates application of SMART in treatment of a latency-aged child with history of exposure to complex and preverbal traumatic experiences. Case analysis suggests the potential contribution of enhanced somatic regulation in traumatized children toward increased relational engagement, behavioral and emotional regulation, and trauma processing.

Community Violence and Associated Psychological Problems Among Adolescents in the General Population

Based on a populational survey conducted among 1400 adolescents aged between 12 and 17 years old, the aim of this study is to assess the relationships between their community violence experiences and their psychological health (anger, depressive symptoms, and post-traumatic stress disorder symptoms). One MANOVA confirms that both boys and girls who report at least one incident of physical community violence present more psychological difficulties, especially anger. Subsequent MANOVAs show that anger intensity varies depending on whether the youth was a direct victim or a witness only, as well as on the diversity of the types of violent manifestations and on acquaintance with the perpetrator, whereas the presence of injuries has no significant effect. This study highlights the importance of considering the context of the community violence incident, to clearly understand its relationships with the youth's psychological difficulties.

PTSD with and without dissociation in young children exposed to interpersonal trauma

BACKGROUND

A Dissociative Subtype of Posttraumatic Stress Disorder (PTSD) was added to the DSM-5, but little is known about this symptom pattern in young children exposed to trauma. Tailoring treatment to traumatized young children requires understanding the different patterns of trauma-related symptomatology and important correlates. The current study tested the hypothesis that type and number of child traumatic events, caregiver trauma exposure, and caregiver symptomatology would predict whether traumatized young children presented with PTSD, PTSD with clinical dissociation, or non-clinical trauma symptoms.

METHODS

A multinomial regression was conducted using data collected from an ethnically and economically diverse sample of 297 trauma-exposed children between the ages of 3 and 6 and their caregivers. Based on parent-report on a well-validated measure of trauma symptoms, children were categorized into three groups: non-clinical (n = 128), PTSD only (n = 104), or PTSD with dissociation (PTSD-DISS; n = 65). Predictors included trauma exposure, parent trauma symptoms, and child sex.

RESULTS

Girls were twice more likely than boys to be in the PTSD-DISS group; sexually abused children were almost three times as likely to be in the PTSD-DISS group; and, for every unit increase in parent avoidance symptoms or number of traumatic events, the odds of being in the PTSD-DISS group increased significantly.

LIMITATIONS

Given the cross-sectional study design, conclusions cannot be drawn regarding causality. Measures were completed by a single reporter.

CONCLUSIONS

Findings suggest that subgroups of children may be especially vulnerable to comorbid PTSD and dissociation. Implications for treatment are discussed.

Adapting the Patient-Centered Medical Home to Address Psychosocial Adversity: Results of a Qualitative Study

OBJECTIVE

The patient-centered medical home (PCMH) seeks to improve population health. However, PCMH models often focus on improving treatment of chronic diseases rather than on addressing psychosocial adversity. We sought to gather key stakeholder input about how PCMHs might feasibly and sustainably address psychosocial adversity within their patient populations.

METHODS

We conducted 25 semistructured interviews with key stakeholders, such as physicians, nurses, medical assistants, and patients. The audiorecorded interviews focused on participants' perceptions of the best ways to modify the PCMH to address patients' psychosocial adversity. To facilitate information gathering, a fictional patient case was presented. Analyses were conducted using a 3-stage content-analysis process.

RESULTS

Participants identified provider-related and systems-level changes necessary for addressing these psychosocial adversities effectively. On the provider level, participants thought that practitioners should foster trusting relationships with patients and should be emotionally present as patients describe their life experiences. Participants also emphasized that providers need to have sensitive conversations about adversity and resilience. On a systems level, participants discussed that documentation must balance privacy and include relevant information in the medical record. In addition, care should be delivered not by a single provider but by a team that has a longitudinal relationship with the patient; this care team should include behavioral health support.

CONCLUSIONS

Participants provided practical strategies and highlighted provider and systems level changes to adequately address patients' prior psychosocial adversity. Future studies need to assess the degree to which such a trauma-informed approach improves patient access, outcomes, and care quality, and reduces cost.

Posttraumatic symptoms among maltreated youth using classification and regression tree analysis

Individual psychological factors have been shown to exacerbate risk for posttraumatic stress disorder (PTSD) symptoms in youth following maltreatment, but the novel contribution of the present study includes a focus on interactive relationships between these factors on specific PTSD symptom clusters. This study identified maltreated youth at highest risk for re-experiencing, avoidance, and hyperarousal symptom clusters via cognitive, affective, and demographic variables. Participants (n=400) included ethnically diverse maltreated youth. Classification and regression tree (CART) analysis, a form of binary recursive partitioning (BRP), identified subgroups of maltreated youth at highest risk for three core PTSD symptom clusters. Posttraumatic cognitions, anhedonia, negative mood, processing speed, and ethnicity best predicted re-experiencing symptoms. Depersonalization/derealization, verbal comprehension, sexual maltreatment, and age best predicted avoidance symptoms. Negative cognitions about self, IQ, dissociation, working memory, and posttraumatic cognitions best predicted hyperarousal symptoms. Core PTSD symptom clusters may thus be associated with unique collections of risk factors for maltreated youth. Clinical protocols for this population could be recalibrated to be more sensitive to specific profiles that more accurately identify highest risk maltreated youth and better inform evidence-based treatment practices.

Avaliação do impacto de acontecimentos traumáticos na adolescência: validação da Impact of Event Scale-Revised

Resumo O objetivo do presente estudo foi validar a Impact of Event Scale-Revised em uma amostra de adolescentes portugueses. Esta foi constituída por 383 adolescentes com idades compreendidas entre os 12 e os 18 anos. Foram usados outros questionários, que avaliavam a centralidade da memória de vergonha e sintomatologia psicopatológica. Foram testados vários modelos alternativos da estrutura fatorial da Escala do Impacto do Acontecimento através da Análise Fatorial Confirmatória. Os resultados mostraram que o modelo de três fatores com um fator de segunda ordem tem um melhor ajustamento aos dados. A escala e suas subescalas mostraram uma boa consistência interna, adequada estabilidade temporal e validade convergente com medidas de centralidade da memória de vergonha e sintomas de depressão, ansiedade e estresse. A versão portuguesa da Escala do Impacto do Acontecimento para adolescentes é uma medida válida para avaliar respostas gerais de estresse e/ou impacto traumático, em particular de vivências de vergonha.

Self-Injury and Suicide Attempt in Relation with Trauma and Dissociation among Adolescents with Dissociative and Non-Dissociative Disorders

OBJECTIVE

To explore the role of trauma and dissociation over self-injurious behaviors (SIB) and suicide attempts (SA) in adolescents.

METHODS

A total of 207 adolescents participated in the study. After conducting diagnostic interview, participants were divided into five groups as subjects with dissociative disorders (DD), attention deficit hyperactivity disorder (ADHD), major depressive disorder (MDD) and anxiety disorders (AD), and a control group (CG) without any psychiatric disorder. ADHD, MDD and AD groups were considered as non-dissociative disorders (non-DD group) in the present study.

RESULTS

There is no significant difference between groups in terms of number and age of the subjects (p>0.05). Among all participants SIB was reported in 32.2% of females (n=37) and 25% of males (n=23) while SA was reported in 29.6% of females (n=34) and 4.4% of males (n=4). Adolescents with DD were found to experience higher rates of SIB and SA than the other groups. Dissociation was the most important variable contributing to SIB and female gender was the most efficient variable for SA. Total trauma scores were also found to be significantly higher in DD group followed by non-DD and CG respectively.

CONCLUSION

SIB and SA are complex behavioral problems which may be associated with many psychiatric factors. However higher level dissociation seems as an important mediating factor, even regardless of psychiatric diagnosis, in the development of SIB and SA. More research is needed to further explore the factors effective over SIB and SA in adolescents.

The relationship between sensory processing patterns, alexithymia, traumatic childhood experiences, and quality of life among patients with unipolar and bipolar disorders

Several studies documented the involvement of sensory perception in emotional processes. The long-term consequences of traumatic experiences and alexithymia have been demonstrated as well. However, the role of extreme sensory processing patterns, traumatic childhood experiences, and alexithymia has not been thoroughly examined in major affective disorders. The present study aimed to: (1) compare unipolar/bipolar patients with regard to their sensory processing patterns, alexithymia, childhood traumatic experiences and quality of life; (2) examine the correlations between sensory processing patterns and childhood traumatic experiences; (3) investigate the relative contribution of diagnostic groups (unipolar/bipolar), sensory processing patterns, alexithymia, and childhood traumatic experiences in predicting quality of life. The sample included 336 participants, 197 with unipolar and 139 with bipolar disorder. All participants completed the Adolescent/Adult Sensory Profile (AASP), Toronto Alexithymia Scale, Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory (BDI)-II, and Short Form 12 Health Survey version 2 (SF-12). Bipolar patients showed significantly higher physical neglect, emotional abuse, and emotional neglect compared with unipolar patients. Both in unipolar and bipolar groups, lower registration of sensory input as well as hypersensitivity correlated with enhanced childhood trauma events. Reduced sensory sensitivity accounted for 11% of the variance in physical health composite score (PCS) of SF-12 whereas reduced depression accounted for 8% of the variance in mental health composite score (MCS). Furthermore, elevated MCS was predicted by depression, physical and emotional neglect. Sensory processing patterns and childhood traumatic experiences may specifically characterize individuals with major affective disorders and play a role in the prediction of their quality of life.

Substance use to regulate intense posttraumatic shame in individuals with childhood abuse and neglect

Childhood abuse and neglect (CAN) is considered as a risk factor for substance use disorder (SUD). Based on the drinking to cope model, this study investigated the association of two trauma-relevant emotions (shame and sadness) and substance use. Using ecological momentary assessment we compared real-time emotion regulation in situations with high and low intensity of shame and sadness in currently abstinent patients with CAN and lifetime SUD (traumaSUD group), healthy controls with CAN (traumaHC group), and without CAN (nontraumaHC group). Multilevel analysis showed a positive linear relationship between high intensity of both emotions and substance use for all groups. The traumaSUD group showed heightened substance use in low, as well as in high, intensity of shame and sadness. In addition, we found an interaction between type of emotion, intensity, and group: the traumaHC group exhibited a fourfold increased risk for substance use in high intense shame situations relative to the traumaSUD group. Our findings provide evidence for the drinking to cope model. The traumaSUD group showed a reduced distress tolerance for variable intensity of negative emotions. The differential effect of intense shame for the traumaHC group emphazises its potential role in the development of SUD following CAN. In addition, shame can be considered a relevant focus for therapeutic preinterventions and interventions for SUD after CAN.

A Critical Look At Trauma-Informed Care Among Agencies and Systems Serving Maltreated Youth and Their Families

The past two decades have witnessed an increase in programs targeting children and youth impacted by traumatic events, with a heightened focus on ensuring that all such programs and relevant service systems are trauma informed. While such efforts are laudable, trauma-informed care (TIC) is defined in a number of ways, limiting evaluation of these initiatives, specifically as they relate to the potential for improved outcomes or reduced costs often used to advocate for TIC. Widespread interest in TIC, despite an apparent dearth of empirical research, served as the impetus for this special section. Our goal was to identify the most rigorous empirical studies available. These six papers were selected based on their inclusion of a definition of TIC, focus on at least one component of TIC in a child-serving system, and availability of empirical data demonstrating the effectiveness of their efforts. In addition to introducing these papers, we share preliminary data from a brief, anonymous survey of child-serving professionals across various systems and roles to obtain feedback about definitional and conceptual issues related to TIC. While this special section provides a representation of available empirical work, significant gaps between research and practice of TIC remain, with important implications for future work.

Trauma exposure in elementary school children: Description of screening procedures, level of exposure, and posttraumatic stress symptoms

Traumatic childhood events can have a significant impact on overall child functioning. Early identification and intervention could offer significant benefits for children's mental health and educational trajectories, but how to effectively identify young children is a challenge. In this paper, we describe screening for exposure to traumatic events and associated symptoms of posttraumatic stress, and examine differences by child gender and grade level. A total of 402 elementary school children in grades 1-5 participated across four elementary schools. We describe modified administration procedures of screening instruments for these young children. Children who endorsed exposure to one or more traumatic events were individually assessed for posttraumatic stress symptom severity. Thirty-four percent (n=138) of children screened experienced one or more traumatic events, and 75.4% of those exposed to at least one traumatic event endorsed moderate levels or higher of posttraumatic stress symptoms. Internal consistency of the symptom self-report instrument was adequate for children of all grade levels. Posttraumatic stress symptom severity increased for children exposed to more types of events. No gender/grade differences were found in symptom severity. Findings suggest that young children are impacted by traumatic events in relatively high numbers, that they can reliably report their posttraumatic stress symptoms, and that a large portion of those exposed to trauma experience significant distress. These results highlight the importance of early screening and identification of these children to curtail potential risk for future academic, social, and psychological maladjustment.

The expression of personality among adolescents exposed to community interpersonal violence

The high level of crime in South Africa affects many adolescents. Experience of community interpersonal violence affects the social, emotional, and cognitive functioning of adolescents and could have an impact on their personality development. The aim of the study was to explore possible differences in the expression of personality between adolescents exposed to community interpersonal violence and those not exposed to such violence. The sample comprised 183 Grade 12 learners from a secondary school in a middle-class community in Gauteng. Participants were divided into two groups: adolescents who reported exposure to community interpersonal violence ( n = 93) and those who did not report exposure to such violence ( n = 90). Both groups completed the 16 Personality Factor and Posttraumatic Diagnostic Scales. Differences between the groups were explored using a one-way between-groups multivariate analysis of variance and t-tests for independent groups. Results indicated statistically significant differences between the two groups on Factor G (rule consciousness), Factor I (emotional sensitivity), and Factor Q4 (anxiety). Adolescents exposed to interpersonal violence reported higher levels of posttraumatic stress disorder symptoms than the control group. The group that experienced posttraumatic stress disorder symptoms differed more in terms of personality functioning (Factors I and Q4). Violence-exposed adolescents experienced more emotional volatility, difficulty to regulate emotions, anxiety, and sensitivity to environmental stressors than those not exposed to such violence. Although causality cannot be assumed, it is possible that exposure to community interpersonal violence, which could result in posttraumatic stress disorder symptoms, has implications for the personality development of adolescents. Interventions for adolescents exposed to interpersonal violence are recommended to prevent the development of posttraumatic stress disorder symptoms.

Trauma exposure and posttraumatic stress disorder among incarcerated men

Trauma exposure and trauma-related symptoms are prevalent among incarcerated men, suggesting a need for behavioral health intervention. A random sample of adult males (N = 592) residing in a single high-security prison were screened for trauma exposure and posttraumatic stress disorder (PTSD) symptoms. Trauma was a universal experience among incarcerated men. Rates of current PTSD symptoms and lifetime PTSD were significantly higher (30 to 60 %) than rates found in the general male populations (3 to 6 %). Lifetime rates of trauma and PTSD were associated with psychiatric disorders. This study suggests the need for a gender-sensitive response to trauma among incarcerated men with modification for comorbid mental disorders and type of trauma exposure. Developing gender-sensitive trauma interventions for incarcerated men and testing them is necessary to improve the behavioral health outcomes of incarcerated men who disproportionately return to urban communities.