Assessing the latent structure of DSM-5 PTSD among Chinese adolescents after the Ya'an earthquake

Turning pain into strength: prosocial behaviours in coping with trauma

Background: Various coping strategies have been shown to alleviate the negative effects of trauma, yet the significance of prosocial behaviour in this realm has been notably underexplored. The present study explored the hypothesis that engaging in prosocial behaviour mitigates the impacts of trauma by promoting a sense of competence and relatedness, post-traumatic growth (PTG), and reconstruction of meaning.Methods: Three consecutive studies were conducted with college students to compare differences in consequence of prosocial behaviours between a trauma group and a control group. Study 1 (N = 96) used self-reported experiences of traumatic vs non-traumatic events; Study 2 (N = 43) used exposure vs. no exposure to video of an earthquake; Study 3 (N = 20) used a randomized controlled trial (RCT) of a prosocial-themed intervention vs. no intervention. Outcomes in all studies were assessed by self-report questionnaires.Results: Trauma damaged participants' sense of competence and meaningfulness. Prosocial behaviour relieved the impact of trauma on meaning, specifically manifested in the individuals' sense of meaningfulness and their search for meaning. Group interventions with a prosocial theme (based on effect size results) reduced post-traumatic stress disorder (PTSD) and enhanced PTG in victims. The promoting effect on PTG persisted a month later, and its enhancing effect on meaning manifested with a delay.Conclusion: Prosocial behaviour can potentially serve as a beneficial strategy for individuals coping with trauma because it helps enhance meaning and promotes PTG in victims. This conclusion is supported by laboratory experiments and a tentative small-scale intervention study, which provide an innovative perspective for future trauma interventions.

Trajectories of parental posttraumatic stress disorder and children's mental health following Super Typhoon Lekima: The mediating role of feeling of safety

INTRODUCTION

Several studies have examined the impact of parents' posttraumatic stress disorder (PTSD) on their children's mental health, but few have evaluated the role of parents' specific PTSD trajectories. The aim of this study was to assess the mechanisms underlying distinct trajectories of parental PTSD that affect children's PTSD and depression through the feeling of safety.

METHODS

The final sample comprised 242 dyads of parents and their children who experienced Super Typhoon Lekima in 2019. All participants were surveyed at three time points after the typhoon: 3 months (T1), 15 months (T2), and 27 months (T3). Parental PTSD symptoms at three time points and children's PTSD, depression, and feeling of safety at T3 were analyzed.

RESULTS

Four parental PTSD trajectories were identified: recovery, resilience, delayed, and coping. Compared with the resilient group, children of parents with delayed PTSD trajectories reported higher levels of depression at T3, while children of parents in the coping group were more likely to experience severe PTSD at T3. Children of parents in the recovery group, with a reduced feeling of safety, exhibited more severe depression and PTSD at T3, whereas children of parents in the delayed group were at an increased risk of PTSD at T3.

CONCLUSIONS

These findings highlight the heterogeneity of parental PTSD trajectories following natural disasters and their distinct effects on children's PTSD and depression. Furthermore, feeling of safety emerges as a crucial mechanism in this process.

Perceived parental depression, intrusive rumination, and internalizing problems: A three-wave longitudinal study in adolescents

Research suggests that perceiving parental depression elicits internalizing problems in adolescents, but certain studies have indicated that adolescents' internalizing problems also increase their perception of parental emotion. To further investigate the inconsistent findings about the nature of this relationship, the current study used longitudinal data to examine the causal association between adolescents' internalizing problems and the parental depression they perceived, as well as the role of intrusive rumination in the relationship. Method: In this longitudinal study, 392 adolescents who experienced the catastrophic Jiuzhaigou earthquake in 2017 were surveyed at three time points after the earthquake: 12 months (T1), 21 months (T2) and 27 months (T3). A cross-lagged panel model was used to carry out the data analysis. Results: Mutual cause-and-effect relationships were found between intrusive rumination and both perceived parental depression and internalizing problems, respectively; a unilateral causal relationship in which internalizing problems positively predicted perceived parental depression was also found. In addition, internalizing problems predicted perceived parental depression via the mediating role of intrusive rumination; similarly, intrusive rumination predicted perceived parental depression via internalizing problems. Conclusions: Internalizing problems were a risk factor for perceived parental depression, and intrusive rumination played an important role in the relationship between internalizing problems and perceived parental depression.

Post-traumatic stress disorders, anxiety, and depression in college students during the COVID-19 pandemic: a cross-sectional study

OBJECTIVES

The COVID-19 pandemic has caused an increase in psychiatric disorders in college students, particularly posttraumatic stress disorders (PTSD), depression, and anxiety. While existing studies assess the prevalence of these disorders and their predictors, they overlook potential complications caused by comorbidity between these disorders. To fill this gap, this study examined the prevalence of PTSD, depression, anxiety, and their comorbidity to inform targeted intervention for college students during the COVID-19 pandemic.

DESIGN

Self-report questionnaires were used to assess 6,898 college students about six months after the COVID-19 outbreak.

RESULTS

The results found that the prevalence of PTSD, depression, and anxiety were 15.5%, 32.2%, and 32.1% respectively, and the prevalence of comorbid PTSD and depression, comorbid PTSD and anxiety, comorbid depression and anxiety, and comorbid PTSD, depression, and anxiety symptoms were 11.5%, 11.6%, 20.4%, and 9.4% respectively. Moreover, left-behind status, lower economic status, previous trauma experiences, exposure to the pandemic, and rumination were risk factors of psychological distress, but self-disclosure was a protective factor for these disorders.

CONCLUSION

These results indicate that distinct psychiatric disorders may be comorbid in individuals, and are further influenced by pre-, within-, and post-disaster factors. Furthermore, psychological service targeted at college students should pay attention to comorbid symptoms rather than only symptoms of single disorders.

School bullying victimization and post-traumatic stress symptoms in adolescents: the mediating roles of feelings of insecurity and self-disclosure

BACKGROUND

Posttraumatic stress symptoms (PTSSs) is known to be a typical problem for school bullying victims. However, the underlying mechanism between school bullying victimization and PTSSs remains unknown. This study examined the mediating roles of feelings of insecurity and self-disclosure in the relationship between school bullying victimization and PTSSs in adolescents.

METHODS

Self-report questionnaires were used to assess 5013 adolescents; 443 of them with school bullying experiences were selected to carry out this study.

RESULTS

The results found that school bullying victimization was directly related to more PTSSs, indirectly associated with more PTSSs through feelings of insecurity, and through the path from feelings of insecurity to self-disclosure. However, school bullying victimization did not exert an indirect effect on PTSSs through one step effect of self-disclosure.

CONCLUSIONS

These findings indicated that feelings of insecurity and self-disclosure mediated the relationship between school bullying victimization and PTSSs. The psychological service should reduce adolescents' feelings of insecurity and give them more chances to disclose their bullying experiences.

Perceived parental depression and PTSD in adolescents: mediating roles of attachment insecurity and coping style

Background: Earthquakes can cause negative psychological states in adolescents and their parents, such as post-traumatic stress disorder (PTSD) and depression. Previous cross-sectional studies have shown that adolescents who perceive parental depression after an earthquake are more likely to experience PTSD. However, the mechanism underlying this process remains unclear and previous studies have not examined the association between these factors.Objective: The current study explored the mediating roles of attachment insecurity and coping style in the association between perceived parental depression and PTSD in adolescents after the Jiuzhaigou earthquake.Method: In total, 391 participants completed follow-up questionnaires at 12, 21, and 27 months (T1-T3, respectively) after the Jiuzhaigou earthquake.Results: T1 perceived parental depression was not a direct predictor of T3 PTSD in adolescents. In the full mediation model, T1 perceived parental depression predicted T3 PTSD in adolescents indirectly via T2 attachment insecurities through T2 emotion-focused coping.Conclusion: The findings highlight that attachment insecurity and emotion-focused coping mediated the relationship between perceived parental depression and PTSD in adolescents following an earthquake. To alleviate PTSD in adolescents, efforts should be directed toward reducing perceived parental depressive symptoms and emotion-focused coping, and promoting the formation of secure attachment styles.

Attention to negative information and PTSSs during the COVID-19: A moderated mediational model

Post-traumatic stress symptoms (PTSSs) have been a common negative psychological response during the COVID-19 pandemic. Previous theories emphasized the unique effects of cognitive and family factors on PTSSs and overlooked their combined role, which suggested that the mechanisms underlying PTSSs were not fully understood. To fill this gap, this study aimed to examine the associations between attention to negative information, blaming others, parent-child relationship and PTSSs, as well as the combined role of these factors on PTSSs. During the COVID-19 pandemic, 1153 college students completed self-report questionnaires. Results indicated that attention to negative information increased PTSSs, both directly and via blaming others. Moreover, parent-child relationship buffered both the exacerbating effect of attention to negative information on blaming others and the effect of blaming others on worsening PTSSs. The current study integrates existing theories, expands the field of trauma research through considering the effect of cognitive and family factors on PTSSs, and provides theoretical support for interventions to relieve PTSSs.

Latent Patterns of Posttraumatic Stress Symptoms, Depression, and Posttraumatic Growth Among Adolescents During the COVID-19 Pandemic

Researchhas shown that posttraumatic reactions can co-occur in trauma-exposed individuals. Many studies have assessed the co-occurring patterns of two types of reactions, but few have assessed the patterns of multiple reactions. To build on existing knowledge, the present study examined co-occurring patterns of posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and posttraumatic growth (PTG) among adolescents during the COVID-19 pandemic. Participants (N = 683) were adolescents selected from an area in China severely affected by COVID-19 who completed the PTSD Checklist, a measure of depression, a PTG inventory, and a cognitive emotional regulation questionnaire. Latent profile analysis and multinomial logistic regression were used for the data analyses. The results showed three heterogeneous patterns characterized by growth (n = 248, 36.3%), distress (n = 101, 14.8%), and struggle (n = 334, 48.9%). Positive refocusing and reappraisal were associated with membership in the growth group compared with distress group, OR = 0.83, 95% CI [0.75, 0.93] and OR = 0.78, 95% CI [0.68, 0.90], whereas rumination, catastrophizing, and "putting into perspective" were associated with membership in the distress group compared with growth group, ORs = 1.15-1.44. These findings suggest that posttraumatic reactions show heterogeneous characteristics: struggle, rather than growth or distress, is common among adolescents during COVID-19; and distinct cognitive emotional regulation strategies have distinguishing roles in the three patterns of posttraumatic reactions.

Gaming to cope: Applying network analysis to understand the relationship between posttraumatic stress symptoms and internet gaming disorder symptoms among disaster-exposed Chinese young adults

Research has demonstrated that posttraumatic stress disorder (PTSD) is associated with internet-related problematic behaviors. However, studies have not explored the linkage between PTSD symptoms and internet gaming disorder (IGD) symptoms. The current study aimed to investigate the relationship between posttraumatic stress symptoms (PTSS) and IGD symptoms via network analysis. We conducted a cross-sectional study with 341 Chinese young adults directly exposed to a typhoon and examined the network structure of PTSS and IGD symptoms, along with bridge symptoms, to elucidate how they co-occur. Results indicated that 'avoiding external reminders' and 'anhedonia' were identified as the most central symptoms in the PTSD network, whereas 'preoccupation,' 'gaming despite harms', and 'loss of control' ranked highest on centrality in the IGD network. Two bridge symptoms emerged within the combined PTSD and IGD network model: 'concentration difficulties' and 'conflict due to gaming' from among the PTSS and IGD symptoms, respectively. These findings reveal novel associations between PTSS and IGD symptoms and provide an empirically-based hypothesis for how these two disorders may co-occur among individuals exposed to natural disasters.

Network analysis of comorbid posttraumatic stress disorder and depression in adolescents across COVID-19 epidemic and Typhoon Lekima

BACKGROUND

Network analytic studies indicate that posttraumatic stress disorder (PTSD) may be comorbid with depression at the symptom level, but it remains unclear whether these findings are replicable and generalizable across trauma types.

OBJECTIVE

This study aim was to examine and compare PTSD-depression comorbidity networks of two types of trauma related to Typhoon Lekima and COVID-19 epidemic.

METHODS

Participants were 1605 and 601 adolescents recruited following Typhoon Lekima and the COVID-19 outbreak, respectively.

RESULTS

COVID-19 and Lekima PTSD-depression networks had considerable similarities, including adequate stability and accuracy, connected symptoms of PTSD and depression, symptoms with high centralities, and bridge symptoms. PTSD-depression comorbid symptoms were more complicated in the COVID-19 network but may show more persistence in the Lekima network. Distinct bridge symptoms contributed to the heterogeneity of PTSD-depression comorbidity characteristics between the two networks. Specifically, restricted affect and felt down and unhappy were two important bridge symptoms with high centrality unique to the COVID-19 network.

CONCLUSIONS

PTSD-depression comorbidity network has considerable replicability across trauma types, but specific symptom-level associations and some bridge symptoms may vary across trauma types. These findings also highlight the importance of negative emotions to comorbid PTSD and depression in adolescents following the COVID-19 outbreak compared with Typhoon Lekima.

Factor Structure and Psychometric Properties for the PTSD Checklist of Chinese Adolescents in the Closed Period after the COVID-19 Outbreak

After COVID-19 appeared in China in December 2019, the mental health of adolescents, as a vulnerable group in public health emergencies, was negatively affected by the epidemic and the unprecedented prevention and control measures. The purpose of this study was to investigate the factor structure and psychometric properties of the Posttraumatic Stress Disorder (PTSD) Checklist (PCL) among Chinese adolescents. A total of 915 participants completed the PTSD. Confirmatory factor analyses (CFAs) and multi-group CFAs were used to test the factor structure and psychometric properties of PTSD. The CFA results showed that five-factor PCL was the optimal fitting model with satisfactory reliability and validity; moreover, it was suggested that the properties of PCL were invariant across gender, PTSD and asymptomatic groups, early and late adolescents, as well as over time. In summary, PCL is applicable among Chinese adolescents and can be used for effective measurement of PTSD caused by epidemics and to conduct cross-group studies.

Post-Traumatic Stress Disorder, Mobile Phone Dependence, and Academic Boredom in Adolescents During the COVID-19 Pandemic

Background: The coronavirus disease (COVID-19) pandemic has threatened adolescents’ mental health and even elicited their academic problems. Post-traumatic stress disorder (PTSD) is one of the most common negative psychological reactions, and academic boredom is a typical academic problem to the pandemic. PTSD might be related to academic boredom, but the underlying mechanism of this potential relation in the context of the COVID-19 pandemic remains unclear.

Aims: Under the framework of the job demands–resources model and the model of compensatory internet use, this study aims to examine the mediating role of mobile phone dependency in the relation between PTSD and academic boredom.

Methods: Six hundred and thirty-one middle school students in Hubei Province were investigated using self-report questionnaires. SPSS19.0 and Mplus7.0 were used for data analysis.

Results: PTSD symptoms were associated positively with academic boredom, and mobile phone dependence played a mediating role in the relation between PTSD and academic boredom. Specifically, adolescents with severe PTSD symptoms tended to report greater dependency on mobile phones, and hence show higher levels of boredom in learning.

Conclusion: PTSD symptoms of adolescents directly aggravated their academic boredom, and indirectly affected academic boredom by increasing their dependence on mobile phones.

Full and partial posttraumatic stress disorders in adults exposed to super typhoon Lekima: a cross-sectional investigation

BACKGROUND

Super typhoon Lekima had a maximum wind force of 16 (52 m/s) and hit Wenling city, Zhejiang province in China on August 10, 2019. The typhoon left many victims showing symptoms of posttraumatic stress disorder (PTSD).

OBJECTIVE

This study aimed to assess the prevalence of full and partial PTSD to inform targeted interventions for adult victims.

METHOD

In total, four thousand seven hundred and forty-six adults who are parents of students in local primary and middle schools were recruited to participate in this study. Participants completed a trauma exposure scale and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition PTSD Checklist. Logistic regression analysis was used to examine the factors of full and partial PTSD.

RESULTS

Nine hundred and ten (19.2%) adults had full PTSD and 1775 (37.4%) had partial PTSD. Adults with a monthly income > 10,000 RMB (about 1530 dollars) and a high education level (bachelor's degree or above) were less likely to have full or partial PTSD than those with lower income and lower education levels. In addition, married adults were less likely to have full PTSD than divorced or widowed ones. Higher rates of PTSD were observed among those aged ≥40 years, who were injured/trapped, whose family members/friends were injured/trapped, and who lost property.

CONCLUSIONS

Partial and full PTSD were common among adults following super typhoon Lekima, and high income, high education level, and married status were protective factors, whereas trauma exposure was a risk factor of PTSD. Target psychological intervention should be provided to these victims who are in low income and education level, divorced and widowed, and experienced more serious trauma.

A Network Analysis of the Associations Between Posttraumatic Stress Symptoms and Posttraumatic Growth Among Disaster-Exposed Chinese Young Adults

Posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) have been shown to coexist following exposure to a traumatic event, but consensus about what accounts for this association is lacking. Network analysis is a novel analytic method that can explain this linkage. In a sample of 1,809 Chinese college students (66.1% female, age range: 16-35 years) who were directly exposed to a typhoon, we investigated the network structure of PTSS and PTG, along with bridge symptoms and elements, to elucidate how distress and growth coexist. The seven strongest edges found in the model included two between elements in the PTSS cluster, one between elements of PTG, and four between elements of PTSS and PTG. Eight bridge symptoms and elements emerged: intrusive thoughts, emotional cue reactivity, hypervigilance, self-destructive or reckless behavior, nightmares, and physiological cue reactivity among PTSS, and changed priorities and stronger religious faith among PTG elements. These findings reveal connections between PTSS and PTG that explain how these constructs may coexist in individuals exposed to natural disasters. The network perspective provides a novel way to conceptualize the association between PTSS and PTG and contributes to the field's understanding of recovery after traumatic events.

Associations between posttraumatic stress symptoms, perceived social support and psychological distress among disaster-exposed Chinese young adults: A three-wave longitudinal mediation model

Research has documented a strong association between perceived social support, posttraumatic stress symptoms (PTSS), and psychological distress (PD) among people exposed to natural disasters. However, the direction of associations between these factors remains unclear. This study examined possible mediational relationships among perceived social support, PTSS, and PD. A three-wave longitudinal design (6 months intervals) was employed in a sample of 341 Chinese university students (M_age = 21.24, SD = 2.72; 75.7% female) aged 18 to 34 who were directly exposed to a typhoon that occurred in Macao, China, during August 2017. Results indicated that perceived social support at T2 mediated the linkage between PTSS at T1 and PD at T3, and that PTSS at T2 significantly mediated the relationship between PD at T1 and perceived social support at T3. This three-wave longitudinal study highlights the key role of perceived social support on the aggravating effect of acute PTSS on long-term psychological problems, and demonstrates that adverse psychological health outcomes negatively affect the perception of supportive social resources in the context of a natural disaster.

Evaluating the Prevalence of PTSD among Children and Adolescents after Earthquakes and Floods: a Systematic Review and Meta-Analysis

Our study systematically reviews articles about the prevalence of Post-traumatic Stress Disorder (PTSD) among children and adolescents, aiming to evaluate its prevalence after earthquakes and floods.Three databases (PubMed, Scopus, and Web of Science) were searched for articles published from 1981 to 2019 containing information on PTSD prevalence among survivors of earthquakes and floods. Articles with insufficient data on the prevalence of PTSD or without any available full-text were excluded. Major study variables consist of the prevalence of PTSD of the included studies, gender, and the elapsed time after the disaster. The overall PTSD prevalence was determined using a fixed-effect model for eligible studies. Of 4107 studies listed using our search strategy, 439 underwent full-text review, 59 records included in the systematic review, and 39 records met the criteria for meta-analysis. The pooled prevalence of PTSD among children and adolescent survivors after earthquakes and floods was 19.2% (95%CI = 18.6-19.7%), 30.0% (95%CI = 29.5-30.6%), 24.4% (95%CI = 23.4-25.4%) and 20.4% (95%CI = 19.1-21.7%), in the first, second, third and fourth six-month intervals after the disaster, respectively. Our analysis also revealed that PTSD was more prevalent among girls (p < 0.001). The absence of psychological support for affected areas considerably increases the risk of PTSD among survivors. Our results indicated that children and adolescents, especially girls, are more vulnerable and should be in top priority. The governments should refine their policies on post-disaster services and run early screening, immediate intervention, and ongoing monitoring for PTSD, as well as mental and emotional supports.

Rumination in posttraumatic stress disorder: A systematic review

Initial models and empirical investigations of rumination in the clinical literature were predominantly in the domain of depression. However, rumination is now well-established as a transdiagnostic cognitive process, including in the context of posttraumatic stress. To clarify the current understanding of rumination in posttraumatic stress, we conducted a systematic review of the empirical literature on rumination in posttraumatic stress disorder (PTSD). Six sub-groups of studies on this topic were identified; these addressed: (i) the frequency and nature of rumination, (ii) cross-sectional relationships between rumination and PTSD symptoms, (iii) the capacity of rumination to predict PTSD longitudinally, (iv) other processes associated with rumination, (v) neurobiological correlates of rumination, and (vi) whether treating PTSD reduces rumination. This review synthesizes these domains of research and identifies key methodological limitations which limit causal inferences, and points to important areas of future research to advance knowledge on rumination in PTSD.

Understanding the Relation Between Self-Compassion and Suicide Risk Among Adolescents in a Post-disaster Context: Mediating Roles of Gratitude and Posttraumatic Stress Disorder

Background

The suicide risk among adolescents post-earthquake remains an important issue in trauma psychology. While existing studies and theories suggest that factors such as self-compassion, gratitude, and posttraumatic stress disorder (PTSD) play roles in the risk of suicide, few studies have combined these factors to explore the relationship between them.

Objective

This study examined the mediating roles of gratitude and PTSD in the relationship between self-compassion and suicide risk among Chinese adolescents after the Ya’an earthquake.

Methods

Four and a half years after the Ya’an earthquake, 499 middle school students in Lushan County were assessed using the following systems: Measures of Self-Compassion Scale, Gratitude Questionnaire, PTSD Checklist for DSM-5, and Child Behavior Problems Questionnaire.

Results

When we controlled for gender, age, and traumatic exposure, in the direct effect model, positive self-compassion had a negative effect on suicide risk, and negative self-compassion had a positive effect on suicide risk. In the indirect effects model, both positive self-compassion and negative self-compassion had no significant direct effect on suicide risk. Moreover, we found an indirect and negative effect of positive self-compassion on suicide risk via gratitude and PTSD, as well as via an indirect path from gratitude to PTSD. On the other hand, we also found an indirect and positive effect of negative self-compassion on suicide risk via gratitude and PTSD, as well as via an indirect path from gratitude to PTSD.

Conclusion

Positive self-compassion reduces the risk of suicide, while negative self-compassion increases the risk of suicide. Gratitude and PTSD play significant mediating role between self-compassion and suicide risk.

Portuguese version of the Posttraumatic Stress Disorder Checklist for DSM-5 (PCL-5): Comparison of latent models and other psychometric analyses

OBJECTIVE

This psychometric study explores the Portuguese version of the Posttraumatic Stress Disorder (PTSD) Checklist (PCL-5). It aims to clarify the best-fitting latent structure among competing PTSD models (Diagnostic and Statistical Manual of Mental Disorders-fifth edition [DSM-5], Dysphoria, Dysphoric Arousal, Anhedonia, Externalizing Behavior, And Hybrid models) and its implications for PTSD measurement.

METHOD

Psychometric analyses were conducted in a sample from the general population of firefighters (N = 446), except the temporal stability, which was tested in a subsample of 100 participants.

RESULTS

The models presented significant differences in a global fit. The Hybrid model presented the best-fitting structure, but the DSM-5 model showed more favorable reliability and convergent validity in Confirmatory Factor Analyses. The DSM-5 model also proved to be internally consistency, temporally stable, and presented convergent validity.

CONCLUSION

The Portuguese version of PCL-5 is reliable and valid. The findings suggest the appropriateness of the DSM-5 model to assess PTSD symptomatology, encouraging its use in clinical, and research settings.

Prevalence and predictors of posttraumatic stress disorder and depression among adolescents over 1 year after the Jiuzhaigou earthquake

BACKGROUND

On August 8, 2017, a 7-magtitude earthquake struck Jiuzhaigou County in Sichuan, China. This was the third devastating earthquake in that province. The prevalence and predictors of posttraumatic stress disorder (PTSD), depression, and comorbid PTSD/depression among adolescents were unclear after the Jiuzhaigou earthquake.

METHODS

Participants were 1241 adolescent survivors in Jiuzhaigou. Data were collected using the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and the Chinese version of the Center for Epidemiologic Studies Depression Scale for Children.

RESULTS

In total, 46.3% of participants reported PTSD, 64.5% reported depression, and 39.2% reported comorbid PTSD/depression symptoms. Risk factors for symptoms of these disorders were being female, having been injured or trapped, and intrusive rumination. High school students were less likely to report PTSD and comorbid PTSD/depression than middle school students. Participants with family members/friends that were injured or trapped reported more PTSD and comorbid symptoms than those without this experience. Loss of property also predicted PTSD. However, deliberate rumination was a protective factor for depression.

LIMITATIONS

This study did not cover all adolescents in Jiuzhaigou and all potential predictors. As we used a cross-sectional design, this study could not assess the trajectory of PTSD, depression, and comorbid symptoms after the earthquake.

CONCLUSION

The findings are meaningful for mental health care among adolescents after natural disasters such as an earthquake.

Alternative Models of DSM-5 Posttraumatic Stress Disorder in Portuguese Adolescents Exposed to Trauma and Childhood Adversity

The factor structure of DSM-5 posttraumatic stress disorder (PTSD) has been extensively debated, with evidence supporting the recently proposed seven-factor hybrid model. However, few studies examining PTSD symptom structure have assessed the implications of these proposed models on diagnostic criteria and PTSD prevalence. In the present study, we examined seven alternative DSM-5 PTSD models within a confirmatory factor analysis (CFA), using the Child PTSD Symptom Scale-Self-Report for DSM-5 (CPSS-5). Additionally, we generated prevalence rates for each of the seven models by using a symptom-based diagnostic algorithm and assessed whether substance abuse, depression, anxiety symptoms, and daily functioning were differentially associated with PTSD depending on the model used to derive the diagnosis. Participants were 317 adolescents aged 13-17 years (M = 15.93, SD = 1.23) who had experienced a DSM-5 Criterion A trauma and/or childhood adversity. The CFA results showed good fit indices for all models, with the seven-factor hybrid model presenting the best fit. The rates of PTSD diagnosis varied according to each model. The four-factor DSM-5 model presented the highest rate (30.6%), and the seven-factor hybrid model presented the lowest rate (17.4%). Similar to the CFA analysis, the inclusion criteria for the diagnosis based on the hybrid model also presented the strongest associations with daily functional impairment, odds ratio (OR) = 1.48, 95% CI [1.25, 1.75]; and adverse childhood experiences, OR = 1.46, 95% CI [1.16, 1.82]. Research and clinical implications of these results are discussed, and suggestions for future investigation are presented.

Epidemiological Characteristics and Risk Factors of Posttraumatic Stress Disorder in Chinese Children After Exposure to an Injury

OBJECTIVE

The aim of this study is to describe the risk factors of injured children's posttraumatic stress disorder (PTSD) in China and provide the scientific data for PTSD prevention and control in children.

METHODS

Electronic databases, including Medline, Science Direct, Google Scholar, and CNKI (China National Knowledge Infrastructure), were searched for articles published on or before October 30, 2018, searching for the words, "PTSD," "child"/"children," "injury"/"injuries," and "China"/"Chinese." Forty-seven articles met the inclusion criteria and were meta-analyzed using random-effect models.

RESULTS

The total sample size in our meta-analysis was 65 298, and there were 13 402 children diagnosed with PTSD. The prevalence of PTSD after suffering from injury was 20.52% (95% CI = 17%-23%). PTSD occurrence was higher in girls than boys (24.61% vs 19.36%, P < 0.001). The PTSD rate for students was 51.82%, 37.12%, and 14.02% in senior, junior high school children, and primary school student, respectively. PTSD prevalence was 58.93% in rural children and higher than the urban children (57.36%). The prevalence of PTSD in ethnic minority children was significantly higher than that of Han Chinese children (35.38% vs 13.50%).

CONCLUSION

PTSD in injured children is significantly higher in girls, senior high school children, in rural areas, and in ethnic minority children. PTSD prevention and control should be focused on these 4 subgroups.

Applications of the Chinese version of the primary care PTSD screen for DSM-5 (PC-PTSD-5) for children

BACKGROUND

Effective screening is important for public mental health services. Although the primary care PTSD screen for DSM-5 (PC-PTSD-5) is useful in screening for post-traumatic stress disorder (PTSD) in adults, its reliability and validity for use in children remain unclear. This study aimed to examine the performance characteristics of the Chinese PC-PTSD-5 for children in children aged 8 to 16 years.

METHODS

4,022 rural children from Grades 4 to 9 in China were included in this study. All participants were assessed for PTSD using the Chinese PC-PTSD-5 for children and the PTSD Checklist for DSM-5 (PCL-5), and assessed for anxiety using the Chinese version of the State Anxiety Scale for Children (CSAS-C), and for depression using the Children's Depression Inventory - Short Form (CDI-S). The performance characteristics of the PC-PTSD-5 for children were evaluated using receiver operating characteristic analyses.

RESULTS

The mean scores on the PCL-5 and the PC-PTSD-5 were 17.45 (SD = 14.78) and 1.78 (SD = 1.33), respectively. There was a significant correlation between the PC-PTSD-5 and PCL-5 (r = 0.54, p < 0.001), and small but significant correlations of the PC-PTSD-5 with the CSAS-C (r = 0.31, p < 0.001) and CDI-S (r = 0.27, p < 0.001). In this study, 2 and 3 were both found to be acceptable cutoff values. A cutoff value of 2 yielded a sensitivity of 0.87 and a specificity of 0.52, while a cutoff of 3 had sensitivity = 0.57, and specificity = 0.77.

LIMITATIONS

A clinical interview was not used to validated diagnostic findings.

CONCLUSIONS

The reliability and validity of the Chinese PC-PTSD-5 were statistically acceptable for screening for probable PTSD in children. Additionally, the Chinese PC-PTSD-5 had a favorable sensitivity at a cut off 2 and a favorable specificity at a cut off 3, based on PCL-5 results.

Co-occurring patterns of post-traumatic stress disorder and depression among flood victims: A latent profile analysis

This study examined the co-occurring patterns of post-traumatic stress disorder and depression. A sample of 187 victims completed self-report questionnaires after a major flood disaster. Results indicated four classes: low symptoms group (49.7%), mild comorbid symptoms group (24.1%), serious comorbid symptoms group (3.2%), and medium comorbid symptoms group (23.0%). Male victims were less likely and older victims were more likely to belong to the medium comorbid symptoms group; victims with more serious trauma exposure and those using more maladaptive cognition emotional regulation strategies were more likely to belong to both the mild and medium comorbid symptoms groups.

The relationship between PTSD, depression and negative life events: Ya'an earthquake three years later

PTSD (Posttraumatic Stress Disorder) is a common post-disaster psychological condition which research has shown to have comorbidity with depression. To explore the relationship between PTSD and depression further, a cross-sectional study design was adopted. Three years after the Ya'an earthquake, 4137 adolescents (mean age 15.12) who had personally experienced the earthquake were assessed. The study results showed that PTSD significantly predicted future depression, with the effect being partially mediated by the negative life events after the earthquake. Gender was not found to be a significant moderator between PTSD and depression.

The 7-factor hybrid model of DSM-5 PTSD symptoms and alcohol consumption and consequences in a national sample of trauma-exposed veterans

The purpose of the present study was to investigate associations between the 7-factor hybrid model of DSM-5 posttraumatic stress disorder (PTSD) symptoms, which includes intrusions, avoidance, negative affect, anhedonia, externalizing behaviors, anxious arousal, and dysphoric arousal symptoms, and alcohol consumption and consequences. A nationally representative sample of 916 trauma-exposed U.S. military veterans were administered the Trauma History Screen, PTSD Checklist-5, and Alcohol Use Disorders Identification Test. Confirmatory factor analyses were conducted to determine associations between the 7-factor hybrid model of PTSD symptoms, and alcohol consumption and consequences. Results revealed that lifetime dysphoric arousal (r=0.31), negative affect (r=0.30), and anhedonia (r=0.29) symptom clusters were most strongly associated with past-year alcohol consequences. No significant associations were observed for alcohol consumption. While the cross-sectional study design does not allow one to ascertain causative associations between PTSD factors and alcohol consumption and consequences, results generally align with the self-medication hypothesis, as PTSD factors reflecting internalizing were most strongly related to alcohol-related consequences. These results underscore the importance of assessing for alcohol use problems in veterans who score highly on PTSD symptoms reflecting internalizing symptomatology.