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Lieberman AF, Ghosh Ippen C. Engaging the child-parent relationship to treat early trauma: The challenge and promise of scaling with fidelity. J Trauma Stress 2024. [PMID: 39018350 DOI: 10.1002/jts.23077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 07/19/2024]
Abstract
There is an urgent imperative to scale up access to effective, family-focused mental health services for trauma-exposed infants, toddlers, and preschoolers, who represent the most vulnerable and most underserved sector of the clinical child population. This article describes the process of scaling child-parent psychotherapy, an evidence-based treatment currently used in 39 U.S. states and six countries, as an example of the promise and challenge of large-scale implementation of relationship-based treatments.
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Affiliation(s)
- Alicia F Lieberman
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
| | - Chandra Ghosh Ippen
- Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
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2
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Sloover M, Stoltz SEM, van Ee E. Parent-Child Communication About Potentially Traumatic Events: A Systematic Review. TRAUMA, VIOLENCE & ABUSE 2024; 25:2115-2127. [PMID: 37946404 PMCID: PMC11155229 DOI: 10.1177/15248380231207906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
Social support plays an important role in children's well-being after experiencing a potentially traumatic event (PTE). One such source of support is the parent-child relationship, specifically by discussing the event. However, current literature provides no consensus on whether parents and children communicate about PTEs, in what way they might communicate and how this affects the child. Hence the goal of the current study is threefold, to explore: (a) whether parents and children communicate about PTEs, (b) what this communication looks like, and (c) how this affects children's well-being. These questions are answered by means of a systematic literature review. Articles were eligible for inclusion if it was an empirical study on communication between parents and children about a PTE that the child (under 18 years) had experienced. Initial searches in electronic databases provided 31,233 articles, of which 26 were deemed eligible for inclusion. Results show that most parents and children have discussed PTEs, but that this may depend on cultural background. What the parent-child communication looks like depends on various factors such as, age of the child, tone, and child's initiation of discussion. Parental post-traumatic stress symptoms seem to negatively impact communication. The results of the impact of communication are less clear-cut, but it seems to have a predominantly positive effect on the child's well-being, depending on parental sensitivity. Clinicians should be watchful for parental symptoms of post-traumatic stress disorder and can focus on promoting parental sensitivity and responsiveness when discussing PTEs with their child or on creating a joint narrative within families.
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Affiliation(s)
| | | | - Elisa van Ee
- Radboud University Nijmegen, The Netherlands
- Psychotraumacentrum Zuid Nederland, Reinier van Arkel, s-Hertogenbosch, The Netherlands
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Chung US. Disasters and Trauma, That Are Harmful to Children and Adolescents, Are All Too Common in the Real World and the Digital World. Soa Chongsonyon Chongsin Uihak 2024; 35:151-152. [PMID: 38966204 PMCID: PMC11220476 DOI: 10.5765/jkacap.240024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/06/2024] Open
Affiliation(s)
- Un Sun Chung
- Department of Psychiatry, Kyungpook National University Children's Hospital, School of Medicine, Kyungpook National University, Daegu, Korea
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Allbaugh LJ, George G, Klengel T, Profetto A, Marinack L, O'Malley F, Ressler KJ. Children of trauma survivors: Influences of parental posttraumatic stress and child-perceived parenting. J Affect Disord 2024; 354:224-231. [PMID: 38490588 DOI: 10.1016/j.jad.2024.03.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 02/20/2024] [Accepted: 03/09/2024] [Indexed: 03/17/2024]
Abstract
BACKGROUND Research has established a negative association between parental posttraumatic stress symptoms (PTSS), including subthreshold symptoms, and child physical and behavioral health outcomes. Such intergenerational transmission of risk has multiple possible mechanisms, including lack of positive parenting, increased negative parenting, shared environmental and contextual risks, and potential biological components such as shared genetics or even transmission of epigenetic risk. METHOD This study examined 93 parent-child dyads (n = 171 participants total) from a mixed Urban-Suburban US metropolitan area to investigate the relations between parental PTSS and child-perceived parenting and child PTSS. We sought to examine interactions between parental PTSS and parenting on child PTSS. RESULTS We found an association between parent and child PTSS, consistent with prior literature showing increased risk for children of trauma survivors. Interestingly, we found effects of positive parenting on diminished child PTSS symptoms only in parents without PTSS, whereas the effect of positive parenting on buffering child symptoms was absent in parents with PTSS. LIMITATIONS The present findings are tempered by the use of self-report data to assess parent and child PTSS, which is not as reliable as clinician assessment of symptoms. Further, the use of survey data limits what is known about the extent of trauma exposure in parents and children, and different measures were used to assess PTSS in parents and kids, which limits comparability of these reported symptoms. DISCUSSION Limitations notwithstanding, findings suggest joint attention paid to parenting practices and to a parent's recovery, even from subthreshold symptoms of PTSS, as two different but important ways to support trauma survivor parents in their efforts to most optimally parent and protect their children from intergenerational risk.
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Affiliation(s)
- Lucy J Allbaugh
- Department of Psychology, University of Dayton, Dayton, OH, United States of America.
| | - Grace George
- McLean Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Torsten Klengel
- McLean Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
| | - Alex Profetto
- McLean Hospital, Boston, MA, United States of America
| | - Lucas Marinack
- Department of Psychology, University of Wyoming, Laramie, WY, United States of America
| | - Fiona O'Malley
- Nationwide Children's Hospital, Columbus, OH, United States of America
| | - Kerry J Ressler
- McLean Hospital, Boston, MA, United States of America; Department of Psychiatry, Harvard Medical School, Boston, MA, United States of America
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Huffhines L, Parade SH, Martin SE, Gottipaty A, Kavanaugh B, Spirito A, Boekamp JR. Early childhood trauma exposure and neurocognitive and emotional processes: Associations in young children in a partial hospital program. Dev Psychopathol 2024:1-17. [PMID: 38711378 DOI: 10.1017/s0954579424000956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
Early childhood trauma has been linked to neurocognitive and emotional processing deficits in older children, yet much less is known about these associations in young children. Early childhood is an important developmental period in which to examine relations between trauma and executive functioning/emotion reactivity, given that these capacities are rapidly developing and are potential transdiagnostic factors implicated in the development of psychopathology. This cross-sectional study examined associations between cumulative trauma, interpersonal trauma, and components of executive functioning, episodic memory, and emotion reactivity, conceptualized using the RDoC framework and assessed with observational and performance-based measures, in a sample of 90 children (ages 4-7) admitted to a partial hospital program. Children who had experienced two or more categories of trauma had lower scores in episodic memory, global cognition, and inhibitory control as measured in a relational (but not computerized) task, when compared to children with less or no trauma. Interpersonal trauma was similarly associated with global cognition and relational inhibitory control. Family contextual factors did not moderate associations. Findings support examining inhibitory control in both relationally significant and decontextualized paradigms in early childhood, and underscore the importance of investigating multiple neurocognitive and emotional processes simultaneously to identify potential targets for early intervention.
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Affiliation(s)
- Lindsay Huffhines
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Bradley/Hasbro Children's Research Center, E. P Bradley Hospital, Riverside, RI, USA
| | - Stephanie H Parade
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Bradley/Hasbro Children's Research Center, E. P Bradley Hospital, Riverside, RI, USA
| | - Sarah E Martin
- Department of Psychology, Simmons University, Boston, MA, USA
- Emma Pendleton Bradley Hospital, Riverside, RI, USA
| | - Anjali Gottipaty
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, Riverside, RI, USA
| | - Brian Kavanaugh
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, Riverside, RI, USA
| | - Anthony Spirito
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - John R Boekamp
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, Riverside, RI, USA
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Rinne-Wolf S, Finkeldei S, Kern T. Breaking the news of the violent death of a close person to children under 18 years of age: A qualitative interview study. DEATH STUDIES 2024:1-15. [PMID: 38588451 DOI: 10.1080/07481187.2024.2337210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Children who lose a close person to suicide or homicide will most likely receive this news from a carer. The caregiver's personal beliefs and approaches to addressing the topic will influence the child. A total of 10 interviews were conducted with carers of children aged 0-17 years, and the data were analyzed using reflexive thematic analysis. Four themes were developed, exploring: (1) how carers attempted to manage the task of delivering the news of death to the child and discussing it using careful wording; (2) how some carers' desire to protect the child from the truth hindered honesty and open conversations; (3) how and why some carers deliberately challenged societal taboos; and (4) how external influences prompted conversations about the topic. The discussion projects potential consequences for the children and their families. It also derives necessary societal changes, support measures, and further research suggestions.
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Affiliation(s)
- Susanna Rinne-Wolf
- AETAS Children's Foundation, Munich, Germany
- Chair for Public Health and Health Services Research, Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Ludwig-Maximilians-Universität (LMU) Munich, Germany
| | - Simon Finkeldei
- AETAS Children's Foundation, Munich, Germany
- Institute for Psychology, University Innsbruck, Austria
| | - Tita Kern
- AETAS Children's Foundation, Munich, Germany
- Institute for Psychology, University Innsbruck, Austria
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Strøm IF, Wentzel-Larsen T, Stensland S, Dyb G, Stene LE. Health care needs, experiences, and satisfaction after terrorism: a longitudinal study of parents of survivors of the Utøya attack. BMC Health Serv Res 2024; 24:277. [PMID: 38454472 PMCID: PMC10921612 DOI: 10.1186/s12913-024-10592-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 01/11/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND There is scarce knowledge on the health care follow-up of parents of terror attack survivors. This study focused on the mothers and fathers of survivors and examined (1) their perceived health care needs relative to their psychological reactions, physical health problems (unmet health care needs), and adaptation to work; (2) whether sociodemographic characteristics, health problems and social support were associated with unmet health care needs; and (3) how unmet health care needs, sociodemographic characteristics, and experiences with health services associated with overall dissatisfaction during the health care follow-up. METHODS Interview and questionnaire data from three waves of the Utøya parent study were analyzed (n = 364). Chi-square tests and t- tests were used to compare unmet physical and psychological health care needs, sociodemographic factors and post-terror attack health reported by mothers and fathers. Logistic regression analyses were used to examine whether sociodemographic characteristics, unmet health care needs, and health care experiences were associated with overall dissatisfaction among mothers and fathers of the survivors during the health care follow-up. RESULTS Among the mothers, 43% reported unmet health care needs for psychological reactions, while 25% reported unmet health care needs for physical problems. Among the fathers, 36% reported unmet health care needs for psychological reactions, and 15% reported unmet health care needs for physical problems. Approximately 1 in 5 mothers and 1 in 10 fathers reported "very high/high" needs for adaptation to work. Poorer self-perceived health, higher levels of posttraumatic stress and anxiety/depression symptoms, and lower levels of social support were significantly associated with reported unmet psychological and physical health care needs in both mothers and fathers. Parents with unmet health care needs reported significantly lower satisfaction with the help services received compared to parents whose health care needs were met. Low accessibility of help services and not having enough time to talk and interact with health care practitioners were associated with overall dissatisfaction with the help received. CONCLUSIONS Our findings highlight that parents of terror-exposed adolescents are at risk of having unmet psychological and physical health care needs and thus need to be included in proactive outreach and health care follow-up programs in the aftermath of a terror attack.
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Affiliation(s)
- Ida Frugård Strøm
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway.
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway
- Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
| | - Synne Stensland
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Grete Dyb
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Lise Eilin Stene
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, 0409, Oslo, Norway
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Sloss IM, Smith J, Sebben S, Wade M, Prime H, Browne DT. Family functioning in the context of current and historical stressors: Exploring the buffering role of social support. CHILD ABUSE & NEGLECT 2024:106711. [PMID: 38388324 DOI: 10.1016/j.chiabu.2024.106711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 01/10/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Adverse Childhood Experiences (ACEs) can be passed onto future generations through complex biopsychosocial mechanisms. However, social support in caregivers who have experienced adversity may lead to adaptation. Most research on the intergenerational consequences of ACEs has focused on mental health in subsequent generations, while overlooking family functioning as an outcome. OBJECTIVE This pre-registered study addresses this gap by examining a hypothesized association between caregiver ACEs and caregiver-perceived family functioning, and the moderating role of social support. It was expected that high levels of social support would attenuate the association between caregiver ACEs and family functioning, controlling for contemporaneous stressors in the context of the COVID-19 pandemic. PARTICIPANTS AND SETTING Data come from a multinational non-clinical sample (n = 310). METHODS Caregivers completed self-report measures to assess caregiver ACEs, social support, COVID stressors, and family dysfunction. RESULTS Multiple regression analyses revealed that the ACEs-by-social support interaction was not significant. Exploratory analyses revealed a significant three-way interaction between COVID stressors, ACEs, and social support (b = 0.001, SE < 0.001, p = .008). For lower adversity, social support protected against the association between COVID stressors and family dysfunction; however, for higher adversity, social support was only protective when COVID stressors were low. CONCLUSIONS Social support is protective against concurrent stressors during the pandemic in relation to family functioning, though this buffering depends on historical levels of adversity. Findings are interpreted through a trauma-informed lens and provide support for family-focused interventions and policies to mitigate the impact of stress on caregivers with high ACEs.
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Affiliation(s)
- Imogen M Sloss
- Department of Psychology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Jackson Smith
- Department of Psychology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada
| | - Sofia Sebben
- Department of Psychology, Federal University of Rio Grande do Sul, Farroupilha, Porto Alegre, RS 90010-150, Brazil
| | - Mark Wade
- Applied Psychology and Human Development, University of Toronto, 252 Bloor St W, Toronto, ON M5S 1V6, Canada
| | - Heather Prime
- Department of Psychology, York University, 4700 Keele St, North York, ON M3J 1P3, Canada
| | - Dillon T Browne
- Department of Psychology, University of Waterloo, 200 University Ave W, Waterloo, ON N2L 3G1, Canada.
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Sadeh Y, Graham L, Curtis M, Janson M, Kim J, Schwartz A, Undset A, Denejkina A. Posttraumatic stress and depression symptom classes in parents of trauma-exposed children: a transdiagnostic perspective using pooled individual participant data. Eur J Psychotraumatol 2024; 15:2299194. [PMID: 38197328 PMCID: PMC10783838 DOI: 10.1080/20008066.2023.2299194] [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: 05/25/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024] Open
Abstract
Background: In the aftermath of child trauma, post-traumatic stress (PTS) and depression symptoms often co-occur among trauma exposed children and their parents. Studies have used latent class analysis (LCA) to examine PTS and depression symptoms and identify homogeneous subgroups among trauma exposed children. However, little is known about subgroups or classes of PTS and depression reactions of parents of traumatised children.Objectives: (1) Determine PTS and depression symptom classes at 2-9 months post-trauma, and (2) to examine sociodemographic covariates among parents of trauma exposed children.Methods: Using harmonised individual participant data (n = 702) from eight studies (Australia, UK, US) included in the Prospective studies of Acute Child Trauma and Recovery Data Archive (PACT/R), we modelled these phenomena at the symptom level using LCA.Results: Our LCA yielded three solutions: 'high internalizing symptom' class (11%); 'low PTS-high depression' class (17%); and 'low internalizing symptom' class (72%). Parents of children in the 'low PTS-high depression' class were more likely to have children of older age and be part of an ethnic minority, compared to the 'low internalizing symptoms' class. Mothers were more likely to be in the 'high internalizing symptom' class compared to the 'low internalizing symptoms' class.Conclusions: These findings reveal a qualitative structure and relationship between depression and PTS symptoms that highlights the importance of assessing and targeting a broad range of internalising symptoms in post-trauma psychological treatment.
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Affiliation(s)
- Yaara Sadeh
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Leila Graham
- The Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael Curtis
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Melissa Janson
- Gevirtz Graduate School of Education, Department of Counseling, Clinical, and School Psychology, University of California, Santa Barbara, CA, USA
| | - Jeeeun Kim
- Soro Orot Institute, Inc. (Soro Orot Institute – Counselor Group for Counseling and Education of Multicultural and Social Justice Issues), Seoul, Korea
| | - Ashlyn Schwartz
- Bordeaux Population Health Research Center, University of Bordeaux, Bordeaux, France
- Department of Public Health, University of Tennessee-Knoxville, Knoxville, TN, USA
| | - Andrea Undset
- Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
| | - Anna Denejkina
- Translational Health Research Institute; YouthInsight, Sydney, Australia
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Long DA, Gilholm P, Le Brocque R, Kenardy J, Gibbons K, Dow BL. Post-traumatic stress and health-related quality of life after admission to paediatric intensive care: Longitudinal associations in mother-child dyads. Aust Crit Care 2024; 37:98-105. [PMID: 38030534 DOI: 10.1016/j.aucc.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 10/04/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
OBJECTIVE Elevated post-traumatic stress symptoms (PTSS) and reduced health-related quality of life (HRQoL) are commonly experienced in both children and their parent's following admission to the paediatric intensive care unit (PICU). Previous research has demonstrated a conflict in the directionality between PTSS and HRQoL in children and their parents. Our study sought to explore the interconnection and transmission between PTSS and HRQoL in children and their mothers following an admission to the PICU. DESIGN Prospective longitudinal design. SETTING Two tertiary care PICUs in Brisbane, Australia. PATIENTS Two hundred eighty-two mother-child dyads of children aged 2-16 years admitted to the PICU for >8 h. INTERVENTIONS None. MEASUREMENT AND MAIN RESULTS Four waves of dyadic data (n = 282 mother-child dyads) over a 12-month period from the PICU post-traumatic stress study were used. Cross-lagged panel modelling was used to examine the link between maternal-rated PTSS and HRQoL across children and their mothers. Actor-partner interdependence modelling was then used to examine the interconnections between mothers and children over time. In the dyadic model, partner effects were only present from mother to their child (i.e., higher maternal PTSS was predictive of higher child PTSS at subsequent time points). Higher maternal PTSS predicted lower maternal mental HRQoL but not lower child psychosocial HRQoL. Actor effects were also present with lower child psychosocial HRQoL, predicting higher child PTSS at subsequent time points. Findings indicated that a unidirectional transmission process from mother to child may be present after a child's life-threatening illness. CONCLUSIONS This study provides evidence for a long-term negative influence of maternal PTSS on child PTSS in families who have experienced a paediatric critical illness or injury. This highlights the important role of maternal wellbeing in children's mental health outcomes following PICU admission. Further research needs to explore the temporal and dyadic relationships of PTSS and HRQoL.
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Affiliation(s)
- Debbie A Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia; Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, Australia; Child Health Research Centre, The University of Queensland, Brisbane, Australia.
| | - Patricia Gilholm
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Robyne Le Brocque
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Justin Kenardy
- School of Psychology, The University of Queensland, Brisbane, Australia; Jamieson Trauma Institute, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Kristen Gibbons
- Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Belinda L Dow
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Australia; School of Psychology, The University of Queensland, Brisbane, Australia
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Ames RL, Loebach JE. Applying Trauma-Informed Design Principles to Therapeutic Residential Care Facilities to Reduce Retraumatization and Promote Resiliency Among Youth in Care. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:805-817. [PMID: 38045853 PMCID: PMC10689333 DOI: 10.1007/s40653-023-00528-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/21/2023] [Indexed: 12/05/2023]
Abstract
Purpose: This conceptual paper connects the literature on the experiences and needs of youth in therapeutic residential care, trauma-informed frameworks utilized in these settings, and early research on trauma-informed design to facilitate an understanding of these connections and move towards developing a blueprint for trauma-informed design in residential settings for traumatized youth. Methods: A critical literature review drawing on trauma theory, trauma-informed care, evidence-based design, and trauma-informed design was conducted to inform the argument presented in this conceptual paper. Results: While many therapeutic residential care models engage trauma-informed care approaches to support staff in promoting healing environments for youth who have histories of complex trauma, the focus has remained on the psychosocial environment of care, and has yet to be systematically applied to the design of the built environment in which these programs are implemented. By applying the principles of trauma-informed care to the built environment, trauma-informed design has the potential to reduce retraumatization and promote resiliency among youth in care. Conclusions: Ultimately, this conceptual paper illustrates the value of further developing trauma-informed design principles to apply to settings that serve traumatized youth, such as therapeutic residential care facilities.
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Affiliation(s)
- Rebecca L. Ames
- Department of Human Centered Design, Cornell University, Ithaca, NY 14853 United States
| | - Janet E. Loebach
- Department of Human Centered Design, Cornell University, Ithaca, NY 14853 United States
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12
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Lamoreau R, Obus E, Koren-Karie N, Gray SAO. The Protective Effects of Parent-Child Emotion Dialogues for Preschoolers Exposed to Intimate Partner Violence. Attach Hum Dev 2023; 25:613-639. [PMID: 37962391 PMCID: PMC10841411 DOI: 10.1080/14616734.2023.2272268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 10/14/2023] [Indexed: 11/15/2023]
Abstract
Exposure to intimate partner violence (IPV) during early childhood is associated with self-regulation difficulties. Caregivers can facilitate children's self-regulation through emotion-focused conversations about past experiences, buffering downstream effects. However, caregivers experiencing violence may avoid distressing emotions activated by such conversations. This paper explores two different models of relational stress responses, one involving indirect effects (i.e. spillover effects) and the other moderation (i.e. buffering effects). Mothers (n = 117), oversampled for violence exposure, self-reported on IPV and participated in an emotional reminiscing task with children (aged 3-5 years); narratives were coded for maternal sensitive guidance. Maternal sensitive guidance was related to children's self-regulation. Sensitive guidance did not have indirect effects in the association between IPV exposure and children's self-regulation, but did buffer the association between physical IPV and self-regulation; this pattern did not hold for psychological IPV. Results suggest sensitive guidance during reminiscing may promote self-regulation in contexts of high IPV.
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Affiliation(s)
- Renee Lamoreau
- Department of Psychology, Tulane University School of Science and Engineering, New Orleans, Louisiana, USA
| | - Elsa Obus
- Department of Psychology, Tulane University School of Science and Engineering, New Orleans, Louisiana, USA
| | - Nina Koren-Karie
- Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Sarah A O Gray
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
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Śliwerski A, Kossakowska K. The mental functioning of school-age children in Poland since the outbreak of war in Ukraine and during the subsequent refugee crisis. CHILD ABUSE & NEGLECT 2023:106500. [PMID: 37833119 DOI: 10.1016/j.chiabu.2023.106500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 09/21/2023] [Accepted: 10/05/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND There is growing body of research focusing on the functioning of children who have fled from war-torn areas. However, there is currently lack of data regarding the functioning of children residing in host countries. OBJECTIVE The aim of this study is to examine the presence of emotional problems, negative attitudes, interpersonal problems, and functional difficulties among Polish children during the first month after the outbreak of war and initial phase of the current refugee crisis. PARTICIPANTS AND METHOD The study group comprised children aged 9-15 (N = 360), living in Poland. The Children's Depression Inventory 2 (CDI-2) and The Cognitive Triad Inventory for Children (CTIC) was used to measure emotional functioning. The study took place 7 to 39 days after the outbreak of the war in Ukraine. RESULTS The children reported more emotional problems (t(359) = 9.340; p < .001; d = 0.49) with a negative mood (t(359) = 6.692; p < .001; d = 0.35) and negative self-esteem (t(359) = 9.632; p < .001; d = 0.51). The severity of depression symptoms was the highest in the first week after the outbreak of the war (F(5,354) = 2.472; p < .05; η2 = 0.03). The view of the self (F(1,358) = 3.858; p = .05; R2 = 0.01) and of the world (F(1,358) = 5.359; p < .05; R2 = 0.02) improved over time; however, their vision of the future remained unchanged. CONCLUSION The results shows that children who are not directly affected by the war can also display difficulties in mental functioning. In the initial months following the outbreak of the war and during the early stage of the current refugee crisis, Polish children demonstrated significantly higher levels of emotional problems and negative self-esteem. Moreover, the perception of oneself and the world appeared to be influenced by the duration since the onset of the war.
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Affiliation(s)
- Andrzej Śliwerski
- Institute of Psychology, University of Łódź, al. Rodziny Scheiblerów 2, 90-128 Łódź, Poland.
| | - Karolina Kossakowska
- Institute of Psychology, University of Łódź, al. Rodziny Scheiblerów 2, 90-128 Łódź, Poland
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14
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Yirmiya K, Motsan S, Zagoory-Sharon O, Schonblum A, Koren L, Feldman R. Continuity of psychopathology v. resilience across the transition to adolescence: role of hair cortisol and sensitive caregiving. Psychol Med 2023; 53:4487-4498. [PMID: 35634966 PMCID: PMC10388331 DOI: 10.1017/s0033291722001350] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND The transition to adolescence implicates heightened vulnerability alongside increased opportunities for resilience. Contexts of early life stress (ELS) exacerbate risk; still, little research addressed biobehavioral mediators of risk and resilience across the adolescent transition following ELS. Utilizing a unique cohort, we tested biosocial moderators of chronicity in adolescents' internalizing disorders v. resilience. METHOD Families exposed to chronic war-related trauma, v. controls, were followed. We utilized data from three time-points framing the adolescent transition: late childhood (N = 177, Mage = 9.3 years ± 1.41), early adolescence (N = 111, Mage = 11 0.66 years ± 1.23), and late adolescence (N = 138, Mage = 15.65 years ± 1.31). In late childhood and late adolescence children's internalizing disorders were diagnosed. At early adolescence maternal and child's hair cortisol concentrations (HCC), maternal sensitivity, and mothers' post-traumatic symptoms evaluated. RESULTS War-exposed children exhibited more internalizing disorders of chronic trajectory and mothers were less sensitive and more symptomatic. Three pathways elucidated the continuity of psychopathology: (a) maternal sensitivity moderated the risk of chronic psychopathology, (b) maternal post-traumatic symptoms mediated continuity of risk, (c) trauma exposure moderated the association between child internalizing disorders at late childhood and maternal HCC, which linked with child HCC. Child HCC linked with maternal post-traumatic symptoms, which were associated with child disorders in late adolescence. CONCLUSION Results demonstrate the complex interplay of maternal and child's biosocial factors as mediators and moderators of risk chronicity across the adolescent transition following trauma. Findings are first to utilize maternal and child's HCC as biomarkers of chronic stress v. resilience during adolescence, a period of neural reorganization and personal growth that shapes the individual's lifetime adaptation.
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Affiliation(s)
- Karen Yirmiya
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
| | - Shai Motsan
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
| | | | - Anat Schonblum
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Lee Koren
- Faculty of Life Sciences, Bar-Ilan University, Ramat Gan, Israel
| | - Ruth Feldman
- Baruch Ivcher School of Psychology, Reichman University, Herzliya, Israel
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15
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Wang X, Yang X, Zhou X. Perceived parental depression, intrusive rumination, and internalizing problems: A three-wave longitudinal study in adolescents. Int J Clin Health Psychol 2023; 23:100366. [PMID: 36714277 PMCID: PMC9845799 DOI: 10.1016/j.ijchp.2023.100366] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 01/03/2023] [Indexed: 01/15/2023] Open
Abstract
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.
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Affiliation(s)
- Xuan Wang
- Department of Psychology and Behavioral Sciences, Zhejiang University, No. 148 Tianmushan Road, Xihu District, Hangzhou, Zhejiang 310028, China
| | - Xima Yang
- Department of Psychology and Behavioral Sciences, Zhejiang University, No. 148 Tianmushan Road, Xihu District, Hangzhou, Zhejiang 310028, China
| | - Xiao Zhou
- Department of Psychology and Behavioral Sciences, Zhejiang University, No. 148 Tianmushan Road, Xihu District, Hangzhou, Zhejiang 310028, China
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16
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Howard Sharp KM, Tillery Webster R, Cook J, Okado Y, Long A, Phipps S. Profiles of Resilience, Distress, and Posttraumatic Growth in Parents of Children with Cancer and the Relation to Subsequent Parenting and Family Functioning. J Pediatr Psychol 2023; 48:375-385. [PMID: 36668686 PMCID: PMC10118855 DOI: 10.1093/jpepsy/jsac097] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE The aim of this study was to identify patterns of distress and growth in parents of children with cancer and examine associations with subsequent parenting, parent-child relationship, and family environment. METHODS Participants included children with cancer history (8-17 years) stratified by time since diagnosis and their parent. At enrollment, parents (n = 254) reported depression and anxiety, and post-traumatic stress symptoms, posttraumatic growth (PTG), and benefit finding in relation to their child's cancer. Three years later, children (n = 214) reported parenting behavior, parent reactions to their distress, and family environment. Parents reported their reaction to children's distress and qualities of the parent-child relationship. RESULTS Latent profile analysis empirically identified 3 cross-sectional profiles using baseline data: "Resilience, High Growth" (50%), characterized by the lowest distress and the highest PTG/benefit finding; "Moderate Distress with Growth" (33%), characterized by relatively high levels of all indicators; and "Resilience, Low Growth" (17%), characterized by relatively low distress with low PTG/benefit finding. Membership in profiles was associated with parent gender; parents' stressful life events; socioeconomic status; and child diagnosis, on versus off treatment status, and treatment intensity. Parent membership in the Moderate Distress with Growth profile was generally linked with poorer parenting behavior, parent-child relationship quality, and family functioning. CONCLUSION The majority of parents exhibited resilience and growth. However, a subset of parents displaying moderate distress may be at risk for subsequent parenting and family functioning challenges. Findings further highlight the importance of screening for even moderate parent distress and the possible impact of parent psychosocial interventions indirectly on parenting and family functioning.
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Affiliation(s)
| | | | - Jessica Cook
- Department of Psychology, St. Jude Children’s Research Hospital, USA
- Department of Psychology, The University of Memphis, USA
| | - Yuko Okado
- Department of Psychology, California State University, USA
| | - Alanna Long
- Department of Psychology, St. Jude Children’s Research Hospital, USA
| | - Sean Phipps
- Department of Psychology, St. Jude Children’s Research Hospital, USA
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17
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Moss SJ, Mizen SJ, Stelfox M, Mather RB, FitzGerald EA, Tutelman P, Racine N, Birnie KA, Fiest KM, Stelfox HT, Parsons Leigh J. Interventions to improve well-being among children and youth aged 6-17 years during the COVID-19 pandemic: a systematic review. BMC Med 2023; 21:131. [PMID: 37013542 PMCID: PMC10069351 DOI: 10.1186/s12916-023-02828-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 03/10/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic is an example of a global infectious disease outbreak that poses a threat to the well-being of children and youth (e.g., physical infection, psychological impacts). The consequences of challenges faced during COVID-19 may be longstanding and newly developed interventions are being deployed. We present a narrative synthesis of available evidence from the first 2 years of the COVID-19 pandemic on the feasibility, accessibility, and effects of interventions to improve well-being among children and youth to inform the development and refinement of interventions relevant to post-pandemic recovery. METHODS Six databases were searched from inception to August 2022. A total of 5484 records were screened, 39 were reviewed in full text, and 19 studies were included. The definition of well-being and the five domains of well-being as defined by the Partnership for Maternal, Newborn & Child Health and the World Health Organization in collaboration with the United Nations H6 + Technical Working Group on Adolescent Health and Well-Being were used. RESULTS Nineteen studies (74% randomized controlled trials) from 10 countries were identified, involving a total of 7492 children and youth (age range: 8.2-17.2 years; 27.8-75.2% males) and 954 parents that occurred during the COVID-19 pandemic (March 2020 to March 2021). Nearly all interventions (n = 18, 95%) targeted health and nutrition, followed by connectedness (n = 6, 32%), while fewer studies targeted agency and resilience (n = 5, 23%), learning and competence (n = 2, 11%), or safety and support (n = 1, 3%). Five interventions (26%) were self-guided while 13 interventions (68%) were guided synchronous by a trained professional, all of which targeted physical and mental health subdomains within health and nutrition; one intervention (5%) was unclear. CONCLUSIONS Studies deploying synchronous interventions most often reported improved well-being among children and youth largely in the domain of health and nutrition, specifically physical and mental health. Targeted approaches will be crucial to reach sub-groups of children and youth who are most at risk of negative well-being outcomes. Further research is needed to determine how interventions that best supported children and youth early in the pandemic are different from interventions that are required now as we enter into the post-pandemic phase.
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Affiliation(s)
- Stephana J Moss
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Sara J Mizen
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Maia Stelfox
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Rebecca Brundin Mather
- Cumming School of Medicine, Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
| | - Emily A FitzGerald
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Perri Tutelman
- Faculty of Science, Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
| | - Nicole Racine
- Faculty of Social Sciences, School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Kathryn A Birnie
- Cumming School of Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Alberta, Canada
- Cumming School of Medicine, Department of Community Health Sciences, Calgary, AB, Canada
| | - Kirsten M Fiest
- Cumming School of Medicine, Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- Cumming School of Medicine, Department of Community Health Sciences, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Henry T Stelfox
- Cumming School of Medicine, Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Jeanna Parsons Leigh
- Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.
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18
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Fagermoen EM, Jensen TK, Martinsen M, Ormhaug SM. Parent-Led Stepped Care Trauma Treatment: Parents' Experiences With Helping Their Child Recover. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:1-13. [PMID: 37359465 PMCID: PMC10064603 DOI: 10.1007/s40653-023-00537-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2023] [Indexed: 06/28/2023]
Abstract
Purpose There is a need for interventions for traumatized children that are easily accessible and effective, and that involve parents directly in the recovery process. To meet this challenge, stepped care trauma-focused cognitive behavioral treatment (SC TF-CBT), which consists of a parent-led therapist-assisted intervention as the first step, was developed. Parent-led trauma-treatment is a promising, but novel approach. The aim of this study was therefore to gain knowledge on how parents experience the model. Methods Parents who participated in a SC TF-CBT feasibility study were consecutively recruited and interviewed with semi-structured interviews, which were then analysed using interpretative phenomenological analysis. Results The parents described that the intervention gave them insights that led to a sense of parental agency. Through the analysis we identified and labelled four themes: (i) understanding my child: how the trauma has affected my child and our relationship; (ii) understanding myself: how my reactions have stood in the way of helping my child; (iii) gaining competence: how to learn specific tasks that were not part of my normal parenting skills; and (iv) receiving support: how guidance, warmth and encouragement was necessary. Conclusions The results from this study show how the shifting of therapeutic tasks to parents may facilitate parental empowerment and improve the parent-child relationship. This knowledge may guide clinicians on how to provide support to parents so they can take a leading role in their child's recovery process after trauma. Trial registration ClinicalTrials.gov, NCT04073862. Retrospectively registered 03 June 2019 (first patient recruited May 2019), https://clinicaltrials.gov/ct2/show/NCT04073862.
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Affiliation(s)
- Else Merete Fagermoen
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, Oslo, 0409 Norway
| | - Tine K. Jensen
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, Oslo, 0409 Norway
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Marianne Martinsen
- Faculty of Education, Inland Norway University of Applied Sciences, Hamar, Norway
| | - Silje M. Ormhaug
- Norwegian Centre for Violence and Traumatic Stress Studies, Pb 181 Nydalen, Oslo, 0409 Norway
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19
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Townsend AN, Batra N, Lilenfeld L, Maurin E, Inverso H, Burd RS, Tully CB. Parent Traumatic Stress After Minor Pediatric Burn Injury. J Burn Care Res 2023; 44:329-334. [PMID: 35452502 DOI: 10.1093/jbcr/irac055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Indexed: 11/15/2022]
Abstract
Parents are at increased risk for psychological sequelae following their child's burn injury which has demonstrated negative impacts on the child. The current study sought to address gaps in the literature on risk factors for parental distress by examining the relationships among demographic variables, burn characteristics, and child functioning after burn injury, with parent post-traumatic stress symptoms (PTSS). Participants included parents of 660 pediatric burn patients from a regional burn clinic. Parents completed measures during their initial visit to the burn clinic. Additional demographic and burn data were retrospectively collected by medical chart review. Fifteen percent of parents reported at-risk levels of parent PTSS. Parent PTSS was independently associated with child burn characteristics of total body surface area (TBSA) affected by the burn, required hospitalization, number of nights hospitalized, and number of ambulatory burn appointments attended. Minority race was associated with higher parent PTSS than non-minority race status, with Asian parents endorsing the highest scores. Furthermore, when considered simultaneously, impaired child quality of life (QOL), a higher number of ambulatory burn appointments attended, and racial minority status were associated with higher parent PTSS. These findings highlight the need for routine parent trauma screening in pediatric burn clinics, while additionally identifying a feasible screening measure.
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Affiliation(s)
- Allie N Townsend
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA.,The Chicago School of Professional Psychology, Washington, DC 20005, USA
| | - Nikita Batra
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA
| | - Lisa Lilenfeld
- The Chicago School of Professional Psychology, Washington, DC 20005, USA
| | - Elana Maurin
- The Chicago School of Professional Psychology, Washington, DC 20005, USA
| | - Hailey Inverso
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA
| | - Randall S Burd
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA.,Division of Trauma and Burn Surgery, Children's National Hospital, Washington, DC 20020, USA
| | - Carrie B Tully
- Center for Translational Research, Children's National Hospital, Washington, DC 20010, USA
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20
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Tabone JK, Rishel CW, Hartnett HP, Szafran KF, Royse R. Examining the Effects of Adverse Childhood Experiences and Gender on Trauma-Informed Intervention Outcomes. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2023; 16:9-19. [PMID: 36776631 PMCID: PMC9908787 DOI: 10.1007/s40653-022-00456-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/16/2022] [Indexed: 06/18/2023]
Abstract
Purpose The prevalence of Adverse Childhood Experiences (ACEs) and their link to negative behavioral and health outcomes is well documented, but very few studies have empirically examined the effect of ACEs on intervention outcomes. There is also emerging evidence of gender differences in vulnerability to developing traumatic symptoms, which relates to intervention outcomes. The current study examined the effects of ACEs and gender on trauma-informed intervention outcomes in a community-based clinical setting. Methods The study includes data from children who were treated with trauma-informed intervention services grounded in the Attachment, Self-Regulation, and Competency (ARC) framework from 2017 to 2019. ACE scores are measured as a total across 10 items and different types, maltreatment versus family dysfunction, at intake. Children's trauma-related symptoms are assessed at intake and every 90 days under the ARC framework. In order to examine the changes of traumatic symptoms over time, a total of 362 children with three time points are included for the current analyses using Multilevel modeling with SAS PROC MIXED. Results The study found that a trauma-informed intervention based on the ARC framework was effective in reducing children's trauma related symptoms until they experienced 6 or more ACEs. The intervention effect, however, did not hold when children's ACEs were cumulated to 7 or more. The study also revealed gender differences in intervention outcomes. Conclusions The finding has significant implications for early detection and preventative intervention efforts with children's ACEs before their ACEs further cumulate to a higher number. Gender difference should be considered in intervention planning and monitored during the intervention process.
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Affiliation(s)
- Jiyoung K. Tabone
- School of Social Work, West Virginia University, PO Box 6830, 26506 Morgantown, WV United States
| | - Carrie W. Rishel
- School of Social Work, West Virginia University, PO Box 6830, 26506 Morgantown, WV United States
| | - Helen P. Hartnett
- School of Social Work, West Virginia University, PO Box 6830, 26506 Morgantown, WV United States
| | - Kathy F. Szafran
- Crittenton Services of West Virginia, Inc, 2606 National Road, 26003 Wheeling, WV United States
| | - Richard Royse
- Crittenton Services of West Virginia, Inc, 2606 National Road, 26003 Wheeling, WV United States
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21
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Chien WT, Lau CT. Traumatised Children's Perspectives on Their Lived Experience: A Review. Behav Sci (Basel) 2023; 13:bs13020170. [PMID: 36829399 PMCID: PMC9952495 DOI: 10.3390/bs13020170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/10/2023] [Accepted: 02/12/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction: Most children have exposure of traumatic events during their life, such as natural disasters, accidents, and abuses. A review of traumatised children's perspective on traumatic events plays an important role in enhancing our understanding and promoting appropriate tailor-made intervention and support to these children. Methods: Four main health-related electronic databases were searched for all English full-text qualitative research articles over the past 11 years to uncover the recent best available perspective/evidence from traumatised children. The PRISMA checklist was adopted to guide the review process. Results: Five themes about children's experiences and perspectives towards the traumatic events encountered were summarised and integrated from 19 qualitative studies identified. They included daily life problems related to trauma, negative responses to trauma, perceived health needs, coping strategies related to trauma and stress, and growth from traumatic experience. Conclusions: This systematic review provides evidence about responses/impacts and perceived health needs of traumatised children and informs the direction caregivers' training can take, helping these children by early identification and timely intervention. More research is needed to examine/compare traumatised children's responses and coping between diverse traumatic experiences, time from exposure, and the sociodemographic characteristics of these children.
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22
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Moser DA, Graf S, Glaus J, Urben S, Jouabli S, Pointet Perrizolo V, Suardi F, Robinson J, Rusconi Serpa S, Plessen KJ, Schechter DS. On the complex and dimensional relationship of maternal posttraumatic stress disorder during early childhood and child outcomes at school-age. Eur Psychiatry 2023; 66:e20. [PMID: 36734250 PMCID: PMC9970153 DOI: 10.1192/j.eurpsy.2023.8] [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: 02/04/2023] Open
Abstract
BACKGROUND Several studies have shown associations between maternal interpersonal violence-related posttraumatic stress disorder (PTSD), child mental health problems, and impaired socioemotional development. However, the existing literature lacks evidence linking constellations of risk factors such as maternal interpersonal-violence-related PTSD, psychopathology, and interactive behavior with toddlers and outcome measures at school-age. METHODS This study involved a prospective, longitudinal investigation of 62 mothers and examined the relationship between maternal variables measured when children were in early childhood (mean age 27 months), and child outcomes when children were school-age (age mean = 83.2 months) while retaining a focus on the context of maternal PTSD. To identify and weigh associated dimensions comparatively, we employed sparse canonical correlation analysis (sCCA) aimed at associating dimensions of a dataset of 20 maternal variables in early childhood with that of more than 20 child outcome variables (i.e., child psychopathology, life-events, and socioemotional skills) at school-age. RESULTS Phase 1 variables with the highest weights were those of maternal psychopathology: PTSD, depressive and dissociative symptoms, and self-report of parental stress. The highest weighted Phase 2 child outcome measures were those of child psychopathology: PTSD, anxiety, and depressive symptoms as well as peer bullying and victimization. CONCLUSIONS sCCA revealed that trauma-related concepts in mothers were significantly and reliably associated with child psychopathology and other indicators of risk for intergenerational transmission of violence and victimization. The results highlight the dimensional and multifaceted nature-both for mothers as well as children-of the intergenerational transmission of violence and associated psychopathology.
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Affiliation(s)
- Dominik Andreas Moser
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Institute of Psychology, University of Bern, Bern, Switzerland
| | - Shannen Graf
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Jennifer Glaus
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Sébastien Urben
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland
| | - Sondes Jouabli
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | | | - Francesca Suardi
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - JoAnn Robinson
- Department of Human Development and Family Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Sandra Rusconi Serpa
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - Kerstin Jessica Plessen
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Daniel Scott Schechter
- Child and Adolescent Psychiatry Service, Lausanne University Hospital, Lausanne, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland.,Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, New York, USA
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23
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Beebe B, Crown CL, Jasnow M, Sossin KM, Kaitz M, Margolis A, Lee SH. The vocal dialogue in 9/11 pregnant widows and their infants: Specificities of co-regulation. Infant Behav Dev 2023; 70:101803. [PMID: 36565493 DOI: 10.1016/j.infbeh.2022.101803] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 11/08/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
Mothers who were pregnant and widowed on September 11, 2001, and their 4-6-month infants (in utero on 9/11) were filmed during face-to-face interaction and their vocal dialogues were examined via microanalysis. Mothers were White, well-educated, mean age 34.3 years, and far from the World Trade Center site on 9/11; infants were 4-6 months, half female. We examined the bi-directional, moment-by-moment co-regulation of the timing of vocal dialogue, and particularly turn taking, in mother-infant and stranger-infant interactions, with time-series models. We analyzed the contingent coordination of durations of (1) vocalizations of the turn-holder, and (2) switching-pauses at the moment of the turn exchange. The switching pause is an aspect of the rhythm of the turn-holder who, after taking a turn, yields the floor to the partner through the switching pause. Turn taking is the lynchpin of dialogue, and the bi-directional contingent coordination of the switching-pause regulates the turn exchange. Both partners showed signs of risk and resilience. The 9/11 mothers did not coordinate the timing of turn taking with their infants, a highly unusual finding. In contrast, the 9/11 infants did coordinate the timing of turn taking with their mothers, and with the "stranger," forms of resilience. We propose that the 9/11 mother's difficulty coordinating with the infant's turn taking rhythm is a mode of transmission of her trauma to the infant. This work expands our knowledge of the specificities of co-regulation in the context of the 9/11 trauma.
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Affiliation(s)
- Beatrice Beebe
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA.
| | | | | | - K Mark Sossin
- Department of Psychology, Pace University, New York, NY, USA.
| | - Marsha Kaitz
- Department of Psychology, Hebrew University, Jerusalem, Israel.
| | - Amy Margolis
- Department of Psychiatry, New York State Psychiatric Institute, New York, NY, USA.
| | - Sang Han Lee
- The Nathan Kline Institute, Orangeburg, NY, USA.
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Mullins JL, Zhou E, Michalska KJ. How Parental Support Affects Latina Girls During the COVID-19 Pandemic. SOCIAL PSYCHOLOGY 2023. [DOI: 10.1027/1864-9335/a000476] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract. The current study focuses on a sample of low- to middle-income school-age Latina girls and their parents and examines how children’s distress proneness interacts with parental empathic accuracy and posttraumatic growth in the wake of the COVID-19 pandemic to predict children’s empathy and prosocial behavior toward unknown others. Approximately 2–3 months into state-mandated stay-at-home orders, 55 parent–daughter dyads were recruited to participate in this four-session longitudinal study. To assess distress proneness, daughters (ages 8–13 years, 100% Latina) identified their degree of distress in response to pandemic-related stressors. Concurrently, their parents reported how they thought their children would respond to these same pandemic-related stressors, which assessed parental empathic accuracy. Parents also completed an adapted version of the Posttraumatic Growth Inventory, which assessed perceived positive outcomes of the COVID-19 pandemic. Upon study completion, a behavioral measure of children’s empathic and prosocial behaviors was collected. Parental empathic accuracy interacted with children’s distress proneness to positively predict children’s affective empathy, such that children’s distress proneness predicted affective empathy at high and mean, but not low, levels of parental empathic accuracy. In a separate analysis, parental posttraumatic growth interacted with children’s distress proneness to positively predict children’s altruistic sharing behavior, such that children’s distress proneness predicted altruistic sharing behavior only at high, but not mean or low, levels of parental posttraumatic growth. The results of this study highlight how positive parental socialization and understanding of children’s tendencies toward distress are associated with children’s empathic and prosocial behaviors, particularly during major global crises.
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Affiliation(s)
- Jordan L. Mullins
- Department of Psychology, University of California, Riverside, CA, USA
| | - Elayne Zhou
- Department of Psychology, University of California, Riverside, CA, USA
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van der Asdonk S, Kesarlal AR, Schuengel C, Draaisma N, de Roos C, Zuidgeest K, Rippe RCA, Alink LRA. Testing an attachment- and trauma-informed intervention approach for parents and young children after interparental violence: protocol for a randomized controlled trial. Trials 2022; 23:973. [PMID: 36471412 PMCID: PMC9720940 DOI: 10.1186/s13063-022-06902-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/09/2022] [Indexed: 12/07/2022] Open
Abstract
BACKGROUND Interparental violence has persistent adverse effects on victimized parents and children. Young children, including infants and toddlers, are at particular risk to develop long-lasting negative outcomes, and yet specific evidence on effective intervention approaches for this vulnerable group is still lacking. This study will test the effectiveness of an attachment- and trauma-informed intervention approach in a sample of parent-child dyads who have experienced severe interparental violence. We test the individual and combined effects of two interventions: (1) "Nederlandse Interventie Kortdurend op Atypisch oudergedrag" (NIKA; Dutch, short-term intervention focused on atypical parenting behavior) aimed at improving the attachment relationship and (2) eye movement desensitization and reprocessing (EMDR) therapy aimed at reducing parental post-traumatic stress disorder (PTSD) symptoms. METHODS This study uses a multicenter randomized controlled design across multiple domestic violence shelters in the Netherlands. We aim to recruit 150 parent-child dyads with children aged between 0.5 and 6 years old. The study design consists of two phases. During the first phase for testing the effect of NIKA only, eligible dyads are randomly allocated to either NIKA or a waitlist usual care group. A pre-test is conducted prior to the treatment period and a post-test takes place directly afterwards (6 weeks after the pre-test). Phase 2 follows directly for testing the effects of EMDR and the combination of NIKA and EMDR. Parents who report clinical PTSD symptoms are randomly allocated to either EMDR therapy or a waitlist usual care group. Parents who do not report clinical PTSD symptoms only receive care as usual. Six weeks later, a post-test of phase 2 is conducted for all participating dyads. Primary study outcomes are disrupted parenting behavior, sensitive parenting behavior, and parental PTSD symptoms. Secondary study outcomes include PTSD symptoms and behavioral and emotional problems of the child. DISCUSSION This study will inform and enhance the clinical field by providing new insights regarding effective treatment combinations for traumatized parents and their young children after interparental violence. TRIAL REGISTRATION Netherlands Trial Register (NTR) NL9179 . Registered 7 January 2021.
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Affiliation(s)
- Sabine van der Asdonk
- grid.5132.50000 0001 2312 1970Institute of Education and Child Studies, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
| | - Ashwina R. Kesarlal
- grid.5132.50000 0001 2312 1970Institute of Education and Child Studies, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
| | - Carlo Schuengel
- grid.12380.380000 0004 1754 9227Clinical Child & Family Studies, Faculty of Behavioral and Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands
| | - Nina Draaisma
- grid.5132.50000 0001 2312 1970Institute of Education and Child Studies, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands ,NIKA Nederland, Haarlem, the Netherlands
| | - Carlijn de Roos
- grid.509540.d0000 0004 6880 3010Department of Child and Adolescent Psychiatry, Amsterdam University Medical Centre, Amsterdam, the Netherlands
| | | | - Ralph C. A. Rippe
- grid.5132.50000 0001 2312 1970Institute of Education and Child Studies, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
| | - Lenneke R. A. Alink
- grid.5132.50000 0001 2312 1970Institute of Education and Child Studies, Faculty of Social and Behavioural Sciences, Leiden University, Leiden, the Netherlands
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Greene CA, Goldstein BL, McCarthy KJ, Grasso DJ, Wakschlag LS, Briggs-Gowan MJ. Maternal posttraumatic stress predicts Mother-Child Symptom Flare-Ups over Time. Res Child Adolesc Psychopathol 2022; 50:1619-1628. [PMID: 35763123 PMCID: PMC9940819 DOI: 10.1007/s10802-022-00939-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/25/2022]
Abstract
Although concurrent associations between parent and child posttraumatic stress symptoms (PTSS) have been well-documented, few longitudinal studies have examined bidirectional influences by modeling the effects of both parent and child PTSS simultaneously over time. The current study examines patterns of PTSS in children and their mothers beginning in preschool and continuing through elementary school age (ages 4-9 years) in a large, heterogeneous sample (N = 331 mother-child dyads). Mothers reported on their own and their child's posttraumatic stress symptoms. A random intercept cross-lagged panel model (RI-CLPM) was used to examine associations between symptoms across six time points. Results indicated that maternal and child symptoms were associated with each other at concurrent time points and tended to fluctuate in a synchronized manner relative to their overall mean symptom levels. Longitudinal cross-lagged paths were significant from mother to child, but non-significant from child to mother, suggesting that mothers' symptom fluctuation at one time point predicted significant fluctuation in children's symptoms at the subsequent time point. The concurrent co-variation of maternal and child symptoms and the predictive nature of maternal symptom flare-ups have important implications for both maternal and child mental health interventions and underscore the importance of attending to mothers' symptomatology early in treatment.
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Affiliation(s)
- Carolyn A Greene
- School of Medicine, University of Connecticut, 263 Farmington Avenue, 06030, Farmington, CT, USA.
- Department of Psychiatry, School of Medicine, University of Connecticut, 65 Kane Street, 06119-7120, West Hartford, Connecticut, USA.
| | - Brandon L Goldstein
- School of Medicine, University of Connecticut, 263 Farmington Avenue, 06030, Farmington, CT, USA
| | - Kimberly J McCarthy
- School of Medicine, University of Connecticut, 263 Farmington Avenue, 06030, Farmington, CT, USA
| | - Damion J Grasso
- School of Medicine, University of Connecticut, 263 Farmington Avenue, 06030, Farmington, CT, USA
| | - Lauren S Wakschlag
- Department of Medical Social Sciences, Feinberg School of Medicine, and Institute for Innovations in Developmental Sciences, Northwestern University, 633 N. St. Clair, Suite 1900, 60611, Chicago, IL, USA
| | - Margaret J Briggs-Gowan
- School of Medicine, University of Connecticut, 263 Farmington Avenue, 06030, Farmington, CT, USA
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Zanbar L, Dekel R, Ben-Tzur N, Kaniasty K, Possick C. How Does Parenthood Moderate Paths Between Personal and Community Resources and Distress following Collective Trauma? JOURNAL OF CHILD AND FAMILY STUDIES 2022; 32:1148-1164. [PMID: 36465801 PMCID: PMC9702947 DOI: 10.1007/s10826-022-02492-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 06/17/2023]
Abstract
This study examines the moderating role of parenthood in associations between personal and community resources and psychological distress and somatization following collective exposure to security threats. The research questions were guided by Terror Management Theory that posits that parenthood involves heightened anxiety when children are in danger yet may also provide an existential resource that can reduce the individuals' distress. The study was conducted following the 2014 Israel-Gaza conflict and included 1014 Israelis. The participants completed a questionnaire assessing levels of trauma exposure (the predictors), sense of mastery (personal resource), engagement in community activities and trust in leaders (community resources), and psychological distress and somatization (the outcomes). Results indicated that parenthood moderated several associations between trauma exposure and personal and community resources as well as paths between these resources and psychological distress. In almost all these cases, these paths were statistically significant only among parents in two different directions. Parenthood was associated with more psychological distress through lower sense of mastery and greater engagement in community activities. On the other hand, parenthood was related to lower psychological distress through greater trust in local leaders. In addition, only among parents, lower levels of mastery mediated the association between trauma exposure and somatization. These results offer significant implications for practitioners. Although parents and non-parents can be similarly affected by trauma exposure with respect to trauma-related outcomes, the way to assist them to reduce these negative outcomes should be conducted through different paths involving their personal and community resources.
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Affiliation(s)
- Lea Zanbar
- School of Social Work, Ariel University, Ariel, Israel
| | - Rachel Dekel
- School of Social Work, Bar Ilan University, Ramat–Gan, Israel
| | | | - Krzysztof Kaniasty
- Indiana University of Pennsylvania & Polish Academy of Sciences, Indiana, 15705-1068 PA USA
| | - Chaya Possick
- School of Social Work, Ariel University, Ariel, Israel
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28
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Guardino CM, Rahal D, Rinne GR, Mahrer NE, Davis EP, Adam EK, Shalowitz MU, Ramey SL, Schetter CD. Maternal stress and mental health before pregnancy and offspring diurnal cortisol in early childhood. Dev Psychobiol 2022; 64:e22314. [PMID: 36282760 PMCID: PMC10111814 DOI: 10.1002/dev.22314] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 07/01/2022] [Accepted: 07/08/2022] [Indexed: 01/27/2023]
Abstract
The current study investigates whether prepregnancy maternal posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and stress predict children's cortisol diurnal slopes and cortisol awakening responses (CARs) adjusting for relevant variables. Mothers were enrolled after delivering a baby and followed through their subsequent pregnancy with 5 years of longitudinal data on their subsequent child. This prospective design allowed assessment of PTSD symptoms, depressive symptoms, and perceived stress prior to pregnancy. Children provided three saliva samples per day on three consecutive days at two timepoints in early childhood (M age = 3.7 years, SD = 0.38; M age = 5.04 years, SD = 0.43). Mothers' PTSD symptoms prior to pregnancy were significantly associated with flatter child diurnal cortisol slopes at 4 and 5 years, but not with child CAR. Findings at the age of 4 years, but not 5 years, remained statistically significant after adjustment for maternal socioeconomic status, race/ethnicity, child age, and other covariates. In contrast, maternal prepregnancy depressive symptoms and perceived stress did not significantly predict cortisol slopes or CAR. Results suggest that maternal prepregnancy PTSD symptoms may contribute to variation in early childhood physiology. This study extends earlier work demonstrating risk of adverse outcomes among children whose mothers experienced trauma but associations cannot be disentangled from effects of prenatal mental health of mothers on children's early childhood.
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Affiliation(s)
| | - Danny Rahal
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Gabrielle R Rinne
- Department of Psychology, University of California, Los Angeles, Los Angeles, California, USA
| | - Nicole E Mahrer
- Psychology Department, University of La Verne, La Verne, California, USA
| | - Elysia Poggi Davis
- Department of Psychology, University of Denver, Denver, Colorado, USA
- Department of Pediatrics, University of California, Irvine, Irvine, California, USA
| | - Emma K Adam
- School of Education and Social Policy and Institute for Policy Research, Northwestern University, Evanston, Illinois, USA
| | - Madeleine U Shalowitz
- Department of Pediatrics, NorthShore University HealthSystem Research Institute, Evanston, Illinois, USA
| | - Sharon L Ramey
- Department of Psychology, Virginia Tech, Blacksburg, Virginia, USA
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An Overview of Pediatric Approaches to Child with Developmental Delay Especially if There is Suspicion of ASD in First Few Years of Life. PRILOZI (MAKEDONSKA AKADEMIJA NA NAUKITE I UMETNOSTITE. ODDELENIE ZA MEDICINSKI NAUKI) 2022; 43:43-53. [PMID: 36473037 DOI: 10.2478/prilozi-2022-0035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
To be a pediatrician means that one encounters many serious childhood health problems and one finds many ways to help families cope with these problems. Symptoms in children can be discrete, and the responsibility of the pediatrician to distinguish normal development from pathological. We are facing a new era in the developmental assessment of children. A cluster of neurodevelopmental disorders includes ASD (autism spectrum disorder) and ADHD (attention deficit hyperactivity disorder). Parents often do not recognize the problem on time. Generally, their first concern is speech delay, leading to the suspicion of hearing problems. Therefore, it is very important to obtain objective anamnestic information and for the child to undergo a careful physical examination, a neurophysiological assessment, and metabolic and genetic testing. The etiology usually is multifactorial: genetic, epigenetic, and non-genetic factors act in combination through various paths. Most children seem to have typical neurodevelopment during first their year. It was found that approximately one-third of children with ASD lose some skills during the preschool period, usually speech related, but sometimes also non-verbal communication, social or play skills. In conclusion we must say that it is very important to recognize the early signs of ASD and any kind of other developmental delay and to start with early intervention. Clinical pediatricians tend to correlate clinical manifestations and biological underpinnings related to neurodevelopmental disorder, especially ASD. Therefore, better treatment possibilities are needed.
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Finkeldei S, Kern T, Rinne-Wolf S. Querschnittstudie zum Versorgungsstand von Familien nach Suizid und Suizidversuch eines Elternteils in Bayern. PRÄVENTION UND GESUNDHEITSFÖRDERUNG 2022. [PMCID: PMC9483877 DOI: 10.1007/s11553-022-00981-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Zusammenfassung
Hintergrund
In Bayern wurde 2019 mit 1520 Fällen die höchste absolute Anzahl von Suiziden in Deutschland registriert. Suizid als Todesursache ist besonders belastend für Angehörige und das Risiko von betroffenen Kindern, selbst im weiteren Lebensverlauf Suizid zu begehen, ist signifikant erhöht. Frühe und spezifische Ansätze der sog. psychosozialen Notfallversorgung sind nach hoch belastenden Lebenserfahrungen, wie Suizid im Nahfeld, fachlich indiziert.
Ziel der Arbeit
Ziel der Querschnittstudie ist es, die Versorgungssituation von Familien nach Suizid und Suizidversuch eines Elternteils in Bayern zu erheben und dadurch Bedarfe zu erkennen.
Methoden
Daten zu Versorgungsangeboten, der (Selbst)einschätzung der Kompetenzen zu traumaspezifischen Aspekten und der grundsätzlichen Beurteilung der Versorgungssituation und -qualität in Bayern wurden bei 108 Jugendämtern und Beratungsstellen per telefonischer Befragung erhoben und deskriptiv ausgewertet.
Ergebnisse
Fälle von Suizid/-versuch kommen in der Beratungs- und Betreuungsrealität von Mitarbeitenden in Jugendämtern und Beratungsstellen vor. Die am häufigsten genannte Hilfe ist die Weitervermittlung in andere zumeist heilkundliche Angebote. 80 % der befragten Mitarbeitenden in Beratungsstellen und Jugendämtern halten die Einführung einer zentralen Notfallrufnummer für Familien und Fachkräfte für sinnvoll.
Schlussfolgerung
Fachkräfte sehen den Bedarf für Beratung bei den Betroffenen und wollen diesem auch in der eigenen Einrichtung entsprechen, fühlen sich jedoch in Folge begrenzter interner und externer Angebote sowie eigener Qualifikation dafür nicht ausreichend ermächtigt. Die Angebote, in die weitervermittelt wird, sind in den meisten Fällen weder spezifisch, passgenau noch kurzfristig verfügbar, was angesichts des hohen Erkrankungsrisikos der betroffenen Kinder und Jugendlichen einen kritischen Faktor darstellt. Es besteht ein Bedarf für unmittelbar erreichbare spezifische Unterstützung sowohl für Fachkräfte als auch für betroffene Familien, z. B. durch eine Notfallrufnummer.
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Affiliation(s)
| | - Tita Kern
- AETAS Kinderstiftung, München, Deutschland
| | - Susanna Rinne-Wolf
- AETAS Kinderstiftung, München, Deutschland
- Fakultät für Sport- und Gesundheitswissenschaften, Technische Universität München, Uptown München-Campus D, Georg-Brauchle-Ring 60/62, 80992 München, Deutschland
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Eltanamly H, Leijten P, van Rooij F, Overbeek G. Parenting in times of refuge: A qualitative investigation. FAMILY PROCESS 2022; 61:1248-1263. [PMID: 34523125 PMCID: PMC9543259 DOI: 10.1111/famp.12717] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 06/24/2021] [Accepted: 07/10/2021] [Indexed: 06/13/2023]
Abstract
This qualitative study sheds light on how the different phases of refuge and resettlement shape parents' perceptions of their parenting. We used in-depth interviews to examine parents' accounts of how war and refuge gave rise to different stressors, and how these in turn shaped parenting. We interviewed 27 Syrian refugee parents recently settled in the Netherlands (16 families) twice, using a grounded theory approach. We distinguished five phases of refuge, namely prewar, war, flight, displacement, and resettlement. During flight and displacement, stressors associated with financial and material losses appeared to induce parental empathy for children's suffering, which seemed to increase parental leniency. Stressors emerging from family separation during displacement, however, were reported to burden parents and to lead to uncertainty, which seemed to compromise parental warmth and sensitive discipline. While narratives suggest that families reacted in similar ways during the phases of war, flight, and displacement, differences seemed to emerge during the resettlement phase. Some parents stated that in resettlement, they experienced post-traumatic growth (e.g., increased compassion for their children) and were more autonomy supporting than before the war. Other parents seemed to struggle with accepting and supporting their children's emotions and appeared to resort more readily to parental control. Our findings suggest that emotional exhaustion plays a key role in how parents viewed their parenting changed during refuge, and that individual differences in parents' abilities to recover from emotional exhaustion played a key role in shaping parenting in resettlement.
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Byers T, Newton K, Whitman T, Jones CW. Prevalence of and Relationship Between Caregiver Adversity Scores and Child Client Eco-systemic Structural Family Therapy (ESFT) Outcome: Implications for Family Based Mental Health Services (FBMHS). Community Ment Health J 2022; 58:895-906. [PMID: 34609634 PMCID: PMC8490852 DOI: 10.1007/s10597-021-00897-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
Adverse childhood experiences, especially with primary caregivers, impacts the mental, physical, and relational health of individuals (Felitti et al. in Am J Prev Med, 14(4):245-258. https://doi.org/10.1016/s0749-3797(98)00017-8 , 1998). Therefore, caregiver adversity is important to consider when delivering therapeutic interventions to children (Gardner et al. in Clin Soc Work J 42(1):81-89. https://doi.org/10.1007/s10615-012-0428-8 , 2014; Eslinger et al. in J Child Fam Stud 24(9):2757. https://doi.org/10.1007/s10826-014-0079-1 , 2015; Hagan et al. in J Trauma Stress 30(6):690-697, 2017). This study analyzed archival data to understand the role of caregiver adversity in Eco-Systemic Structural Family Therapy (ESFT) outcomes, within Family Based Mental Health Services. Results indicate caregiver lifetime adversity score did not predict treatment outcome. However, caregiver current adversity and family length of stay were negatively correlated as were length of stay and client discharge level of care. These findings suggest that ESFT benefits families regardless of caregiver childhood adversity level and that clinician attention to caregiver current adversity is important to ensure families receive the full benefits of ESFT. Implications for optimizing ESFT and future directions for ESFT clinical research are discussed.
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Affiliation(s)
- Tara Byers
- Shippensburg University of Pennsylvania, 1871 Old Main Drive, Shippensburg, PA, 17257, USA.
| | - Kathryn Newton
- Shippensburg University of Pennsylvania, 1871 Old Main Drive, Shippensburg, PA, 17257, USA
| | - Todd Whitman
- Shippensburg University of Pennsylvania, 1871 Old Main Drive, Shippensburg, PA, 17257, USA
| | - C Wayne Jones
- Center for Family Based Training, 1 Bala Ave, Suite 125, Bala Cynwyd, PA, 19004, USA
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Overbeek MM, Koren-Karie N, de Schipper JC, van Delft I, Schuengel C. Quality of Mother-child Dialogue About Emotional Events, Coping and Posttraumatic Stress Symptoms Among Children Exposed to Interpersonal Trauma. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:201-208. [PMID: 35600532 PMCID: PMC9120269 DOI: 10.1007/s40653-021-00381-x] [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: 06/24/2021] [Indexed: 06/15/2023]
Abstract
Children exposed to traumatic events are at increased risk for developing symptoms of a Post-Traumatic Stress Disorder. Children often discuss emotional, and therefore also traumatic, events in their lives with their parents, and the quality of these discussions can facilitate coping and further development. The study aim was 1) to explore whether the association between the quality of dialogue between mothers and children about emotional events and children's posttraumatic stress symptoms (PTSS) might be indirectly linked through children's adaptive coping skills, and 2) whether this association differed when discussing different negative emotions. 169 mother-child dyads with interpersonal trauma-exposure (86% domestic violence, 14% mother and/or child sexually abused) participated in the Autobiographical Emotional Events Dialogue (AEED). Quality of mother-child emotion dialogue, captured in maternal sensitive guidance and child cooperation, and approach-oriented coping were coded from transcripts. PTSS was measured with the Child Behavior Checklist. Lower quality of mother-child emotion dialogue was associated with less approach-oriented coping and more symptoms of posttraumatic stress. There was an indirect effect of approach-oriented coping with angry feelings linking quality of mother-child emotion dialogue and child PTSS. Children's symptoms of posttraumatic stress were reflected in the quality of mother-child dialogues about traumatic and other emotional events. Findings support that dialogues about emotional events may be a promising target for intervention with children exposed to trauma.
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Affiliation(s)
- Mathilde M. Overbeek
- Section of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | | | - J. Clasien de Schipper
- Section of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Ivanka van Delft
- Section of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Carlo Schuengel
- Section of Clinical Child and Family Studies, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Mertin P, Wijendra S, Loetscher T. Posttraumatic Stress Symptoms and Correlates in Women and Children From Backgrounds of Domestic Violence. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:391-400. [PMID: 35600536 PMCID: PMC9120313 DOI: 10.1007/s40653-021-00396-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 06/03/2023]
Abstract
Ongoing research has continued to inform our understanding of the effects of living with domestic violence on both women and children. The majority of this research, however, has tended to focus on each population separately, with only a relatively few studies to date assessing the relationship between maternal and child emotional functioning, particularly for symptoms of posttraumatic stress (PTSS). This study was designed to investigate trauma symptomatology in mother-child dyads from backgrounds of domestic violence, where the children are able to self-report on their own symptoms. In addition, the study examined anxiety and depression as important correlates of PTSD in children. Participants were recruited by staff at two metropolitan Domestic Violence Services and interviewed by the first author using standardised PTSD scales and trauma inventories. Results found no significant relationship between trauma symptoms in the mother and those in her child. With respect to children who met the criteria for a diagnosis of posttraumatic stress disorder (PTSD), they were more likely to have higher levels of anxiety and depression when compared to children who did not meet PTSD criteria. Results suggest that the emotional responses of older children may tend to reflect their own experiences rather than being a reflection of maternal distress as seems more likely with younger children. Implications of these findings include the importance of independent assessments of older children, and that older children may profit from early therapeutic interventions in their own right.
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Affiliation(s)
- Peter Mertin
- Private Practice, Adelaide, South Australia Australia
| | - Shankari Wijendra
- School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
| | - Tobias Loetscher
- School of Psychology, Social Work and Social Policy, University of South Australia, Adelaide, Australia
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Hoogsteder LM, Ten Thije L, Schippers EE, Stams GJJM. A Meta-Analysis of the Effectiveness of EMDR and TF-CBT in Reducing Trauma Symptoms and Externalizing Behavior Problems in Adolescents. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2022; 66:735-757. [PMID: 33899551 DOI: 10.1177/0306624x211010290] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This multi-level meta-analysis tested if evidence-based trauma treatment was effective in reducing trauma symptoms and externalizing behavior problems in adolescents. Based on eight independent samples and 75 effect sizes, results indicated that Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization Reprocessing (EMDR) had a large and significant overall effect (d = 0.909) on reducing trauma symptoms and externalizing behavior problems. Trauma treatment significantly decreased trauma symptoms (large effect) and externalizing behavior problems (medium effect). Age and type of control group moderated treatment effects. Treatment was more effective in older adolescents. Trauma treatment for adolescents with externalizing behavior problems had a larger effect compared to no treatment, but not compared to treatment as usual. It seems important to provide a broad treatment offer for adolescents with severe externalizing behavior problems, in which, besides trauma treatment, attention is paid to reducing relevant individual risk factors for behavior problems.
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Cordeiro K, Wyers C, Oliver M, Foroughe M, Muller RT. Caregiver maltreatment history and treatment response following an intensive Emotion Focused Family Therapy workshop. Clin Psychol Psychother 2022; 29:1728-1741. [PMID: 35373406 DOI: 10.1002/cpp.2739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 03/24/2022] [Accepted: 03/28/2022] [Indexed: 11/10/2022]
Abstract
This single-arm, repeated measures study investigated the impact caregiver trauma history may have on treatment response following an intensive, 2-day Emotion Focused Family Therapy (EFFT) caregiver workshop. Caregivers (n = 243) completed questionnaires regarding their child's emotion regulation and clinical symptoms, as well as their own childhood trauma history (i.e., exposure to various forms of child maltreatment), caregiver self-efficacy and caregiver blocks (e.g., fears) to support their child's treatment and recovery. Questionnaires were administered prior to and immediately following the workshop and again 4, 8 and 12 months later. At baseline, caregivers who reported experiences of childhood maltreatment demonstrated more blocks compared with caregivers who did not (B = 6.35, SE = 2.62, p < 0.05). Results indicated that caregivers with and without maltreatment histories reported similar, significant gains in their child's total difficulties (B = 0.64, SE = 0.41, p = 0.12) and emotional negativity and lability (B = 0.51, SE = 0.48, p = 0.29) at 12-month post-workshop. Caregivers with maltreatment histories reported greater improvements in caregiver blocks (B = 5.15, SE = 1.34, p < 0.001) and child emotion regulation (B = 0.90, SE = 0.18, p < 0.001) than caregivers without maltreatment histories. They also report less, but still significant, improvement in parental self-efficacy (B = -0.68, SE = 0.26, p < 0.01) when compared with caregivers without maltreatment histories. Findings suggest that EFFT workshops may be an acceptable and effective trans-diagnostic intervention for families presenting with complex histories, including caregiver exposure to childhood maltreatment.
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Affiliation(s)
- Kristina Cordeiro
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Cassandra Wyers
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | - Meghan Oliver
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
| | | | - Robert T Muller
- Department of Psychology, Faculty of Health, York University, Toronto, Ontario, Canada
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Eight-year trajectories of behavior problems and resilience in children exposed to early-life intimate partner violence: The overlapping and distinct effects of individual factors, maternal characteristics, and early intervention. Dev Psychopathol 2022; 35:850-862. [PMID: 35285428 DOI: 10.1017/s0954579422000104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Childhood exposure to intimate partner violence (IPV) can have lasting effects on well-being. Children also display resilience following IPV exposure. Yet, little research has prospectively followed changes in both maladaptive and adaptive outcomes in children who experience IPV in early life. The goal of the current study was to investigate how child factors (irritability), trauma history (severity of IPV exposure), maternal factors (mental health, parenting), and early intervention relate to trajectories of behavior problems (internalizing and externalizing problems) and resilience (prosocial behavior, emotion regulation), over 8 years. One hundred twenty mother-child dyads participated in a community-based randomized controlled trial of an intervention for IPV-exposed children and their mothers. Families completed follow-up assessments 6-8 months (N = 71) and 6-8 years (N = 68) later. Although intention-to-treat analyses did not reveal significant intervention effects, per-protocol analyses suggested that participants receiving an effective dose (eight sessions) of the treatment had fewer internalizing problems over time. Child irritability and maternal parenting were associated with both behavior problems and resilience. Maternal mental health was uniquely associated with child behavior problems, whereas maternal positive parenting was uniquely associated with child resilience. Results support the need for a dyadic perspective on child adjustment following IPV exposure.
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38
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Palmwood EN, Valadez EA, Zajac LA, Griffith AL, Simons RF, Dozier M. Early exposure to parent-perpetrated intimate partner violence predicts hypervigilant error monitoring. Int J Psychophysiol 2022; 173:58-68. [PMID: 35031350 PMCID: PMC8857045 DOI: 10.1016/j.ijpsycho.2022.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/19/2021] [Accepted: 01/07/2022] [Indexed: 11/30/2022]
Abstract
Early exposure to intimate partner violence (IPV) places children at risk for ongoing emotional difficulties, including problems with self-regulation and high levels of internalizing symptoms. However, the impact of IPV exposure on children's error monitoring remains unknown. The present study utilized electroencephalography (EEG) to examine the impact of exposure to IPV in infancy on error monitoring in middle childhood. Results indicated that parents' perpetration of IPV against their romantic partners when children were under 24 months of age predicted hypervigilant error monitoring in children at age 8 (N = 30, 16 female), as indexed by error-related neural activity (ERN and Pe difference amplitudes), above and beyond the effects of general adversity exposure and parental responsiveness. There was no association between partner perpetration of IPV and children's error monitoring. Results illustrate the harmful effects of early exposure to parent-perpetrated IPV on error monitoring and highlight the importance of targeting children's and parents' cognitive and emotional responses to error commission in psychotherapy.
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Affiliation(s)
- Erin N. Palmwood
- Department of Psychological Science, University of Mary Washington, Fredericksburg, VA
| | - Emilio A. Valadez
- Department of Human Development and Quantitative Methodology, University of Maryland, College Park, MD
| | | | | | - Robert F. Simons
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE
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Howard S. A Causal Model of Children's Vicarious Traumatization. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2021; 14:443-454. [PMID: 33425092 PMCID: PMC7779647 DOI: 10.1007/s40653-020-00331-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 06/12/2023]
Abstract
Children may be vicariously traumatized from learning about the trauma of family and friends. To date, a causal model of children's vicarious traumatization has not been empirically validated in the literature. This paper fills the gap in the literature by reporting on the direct effect of vicarious trauma on children independent of caregiving impairment. Data for the study came from the National Survey of Children's Exposure to Violence I (NATSCEV I). This unique dataset features two indicators of vicarious trauma exposure: (1) family victimization and (2) community violence. Hierarchical multiple regression was conducted in order to control for nuisance variables such as caregiver impairment, defined as the degree of warmth or hostility; time elapsed since the trauma occurred and the study taking place; and other trauma exposure (i.e. direct and witnessed trauma). As expected, the study found evidence of a direct and positive relationship between learning about the trauma of close friends and family and children's trauma symptomatology. Both adolescents and young children were found to be vulnerable to experience vicarious traumatization, with gender and ethnicity being contributing factors. Chronological age was not found to be significant in children's vicarious traumatization. These findings support the causal model of vicarious traumatization. They demonstrate that children may be traumatized by exposure to the trauma material of others above and beyond the influence of caregiver impairment. As such, attention should be given to interventions, practices, and policies that intervene in the lives of children exposed to violence.
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Affiliation(s)
- Stephenie Howard
- School of Social Work, Howard University, Washington, DC 20059 USA
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40
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Pitillas C, Berástegui A. Enhancing Caregiving in Traumatized Families: An Attachment-Centered Approach to Working with Parent Groups. FAMILY PROCESS 2021; 60:1568-1583. [PMID: 33460106 DOI: 10.1111/famp.12633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This paper outlines a model of attachment-centered group interventions to enhance caregiving among parents suffering from early trauma and/or social hardship. Groups are understood as an essential source of experiences that may restore traumatized adults' relational security, and enhance their parenting capacities, in face of biographical and contextual factors that compromise caregiving. The model is especially suited for intervention within social service/child protection contexts and with families that struggle to establish trusting alliances with professionals and institutions. Proposed intervention strategies are oriented toward making the group function as an attachment figure that meets parents' attachment and exploration needs and enhances parental sensitivity. Group therapists facilitate two sets of group processes: on the one hand, a sense of togetherness, emotional containment, protection and comfort (related to attachment needs); on the other hand, the development of parental mentalization, the revision of parental representations of the child, and the consolidation of parenting competence (related to exploration needs). A theoretical rationale for working with parent groups from an attachment-centered perspective, the basic intervention principles and specific strategies of the model are presented and illustrated.
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Affiliation(s)
- Carlos Pitillas
- University Institute of Family Studies, Pontifical Comillas University, Madrid, Spain
| | - Ana Berástegui
- University Institute of Family Studies, Pontifical Comillas University, Madrid, Spain
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41
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Yirmiya K, Motsan S, Kanat-Maymon Y, Feldman R. From mothers to children and back: Bidirectional processes in the cross-generational transmission of anxiety from early childhood to early adolescence. Depress Anxiety 2021; 38:1298-1312. [PMID: 34254404 DOI: 10.1002/da.23196] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 04/30/2021] [Accepted: 06/15/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Maternal psychopathology and caregiving behavior are linked with child anxiety and these associations may be particularly salient when families face mass trauma together and members influence each other's symptomatology and resilience. Despite the well-known mother-to-child effects, less research addressed the longitudinal bidirectional effects of maternal and child's anxiety symptoms on each other. METHODS Mothers and children exposed to chronic war-related trauma from Sderot, Israel, and comparison group were followed at three time-points; Early childhood (T1:N = 232, MAge = 2.76 years), late childhood (T3:N = 176, MAge = 9.3 years), and early adolescence (T4:N = 110, MAge = 11.66 years). At each time-point maternal and child's anxiety symptoms were evaluated via questionnaires and maternal sensitivity was coded from videotaped observations of parent-child interactions. Bidirectional associations were examined using traditional cross-lagged panel model (CLPM) and CLPM with random intercepts (RI-CLPM). RESULTS Trauma-exposed mothers and children exhibited more anxiety symptoms and lower maternal sensitivity. Cross-lagged panel models revealed cross-time bidirectional associations between maternal anxiety and child anxiety from early to late childhood. Child anxiety at each time-point predicted maternal anxiety and maternal sensitivity at the next stage; however, maternal sensitivity did not show longitudinal associations with child anxiety, highlighting children's role in shaping caregiving. CONCLUSIONS Findings demonstrate bidirectional cross-generational influences of mother and child on each other's anxiety in contexts of trauma and pinpoint early childhood as a sensitive period for such mutual influences. Children's increased anxiety following trauma appears to be further exacerbated via its impact on increasing maternal anxiety and compromising sensitive caregiving, underscoring the potential benefits of parental and mother-child interventions for trauma-exposed populations.
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Affiliation(s)
- Karen Yirmiya
- Interdisciplinary Center, Herzliya, Israel.,Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Shai Motsan
- Interdisciplinary Center, Herzliya, Israel.,Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
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Post-traumatic Stress Disorder in Parents Following Their Child's Single-Event Trauma: A Meta-Analysis of Prevalence Rates and Risk Factor Correlates. Clin Child Fam Psychol Rev 2021; 24:725-743. [PMID: 34554357 PMCID: PMC8541994 DOI: 10.1007/s10567-021-00367-z] [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] [Subscribe] [Scholar Register] [Accepted: 08/19/2021] [Indexed: 11/25/2022]
Abstract
Evidence suggests parents of children who experience a trauma may develop Post-Traumatic Stress Disorder (PTSD), which can have significant consequences for their own and their child’s functioning. As such, identifying the rates and possible correlates for the development of PTSD in parents is of clinical and theoretical importance, and would enhance our understanding of how best to support families in the aftermath of trauma. This meta-analysis of 41 studies (n = 4370) estimated the rate of PTSD in parents following their child’s single-incident trauma to be 17.0% (95% CI 14.1–20.0%); when removing samples which were mixed, or not exclusively single-incident traumas the prevalence estimate dropped to 14.4% (95% CI 10.8–18.5%). Pooled effect sizes of 32 potential correlates for parents developing PTSD were also identified. Medium-to-large effects were found for factors relating to the parent’s post-traumatic cognition, psychological functioning and coping strategies alongside child PTSD. Small effects were found for pre-trauma factors, objective trauma-related variables and demographic factors for both parent and child. Results are consistent with cognitive models of PTSD, suggesting peri- and post-trauma factors are likely to play a substantial role in its development. These findings indicate the clinical need for screening parents most vulnerable to adverse post-traumatic reactions within the context of child trauma and tailoring interventions to include the family where necessary.
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43
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Moner N, Soubelet A, Barbieri L, Askenazy F. Assessment of PTSD and posttraumatic symptomatology in very young children: A systematic review. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 35:7-23. [PMID: 34541737 DOI: 10.1111/jcap.12351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 11/30/2022]
Abstract
CONTEXT Very young children are said to be a vulnerable group for exposure to trauma, and for a psychopathological response (e.g., PTSD) after a risk-exposure. The specific assessment of young children is necessary to enable them to be enrolled in an appropriate care pathway. OBJECTIVE The objective was to identify the instruments available in the English language for the assessment of posttraumatic symptoms in very young children (from 0- to 5-year old). DESIGN This article reports on a systematic review, conducted using the search engines Google Scholar, Science Direct, PsycArticles, and PubMed. RESULTS Nine instruments are available to specifically assess traumatic symptomatology in very young children (0-7-year old), five instruments are available for the broader assessment of very young children (1-6-year old), six instruments are available for the assessment of traumatic symptoms in very young children and in older children (2-18-year old), one instrument did not correspond to any category. These 21 tools are adapted to different ages, built according to different objectives, and do not rely on the same diagnostic algorithm. CONCLUSION Future research should compare the instruments quantitatively to identify those most specific and sensitive to the assessment of trauma symptoms in young children.
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44
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Cohodes EM, Kribakaran S, Odriozola P, Bakirci S, McCauley S, Hodges HR, Sisk LM, Zacharek SJ, Gee DG. Migration-related trauma and mental health among migrant children emigrating from Mexico and Central America to the United States: Effects on developmental neurobiology and implications for policy. Dev Psychobiol 2021; 63:e22158. [PMID: 34292596 PMCID: PMC8410670 DOI: 10.1002/dev.22158] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/11/2021] [Accepted: 06/20/2021] [Indexed: 12/24/2022]
Abstract
Children make up over half of the world's migrants and refugees and face a multitude of traumatic experiences prior to, during, and following migration. Here, we focus on migrant children emigrating from Mexico and Central America to the United States and review trauma related to migration, as well as its implications for the mental health of migrant and refugee children. We then draw upon the early adversity literature to highlight potential behavioral and neurobiological sequalae of migration-related trauma exposure, focusing on attachment, emotion regulation, and fear learning and extinction as transdiagnostic mechanisms underlying the development of internalizing and externalizing symptomatology following early-life adversity. This review underscores the need for interdisciplinary efforts to both mitigate the effects of trauma faced by migrant and refugee youth emigrating from Mexico and Central America and, of primary importance, to prevent child exposure to trauma in the context of migration. Thus, we conclude by outlining policy recommendations aimed at improving the mental health of migrant and refugee youth.
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Affiliation(s)
- Emily M Cohodes
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Sahana Kribakaran
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Paola Odriozola
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Sarah Bakirci
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Sarah McCauley
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - H R Hodges
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Lucinda M Sisk
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Sadie J Zacharek
- Department of Psychology, Yale University, New Haven, Connecticut, USA
| | - Dylan G Gee
- Department of Psychology, Yale University, New Haven, Connecticut, USA
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45
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De Young AC, Vasileva M, Boruszak-Kiziukiewicz J, Demipence Seçinti D, Christie H, Egberts MR, Anastassiou-Hadjicharalambous X, Marsac ML, Ruiz G, COVID-19 Unmasked Global Collaboration. COVID-19 Unmasked Global Collaboration Protocol: longitudinal cohort study examining mental health of young children and caregivers during the pandemic. Eur J Psychotraumatol 2021; 12:1940760. [PMID: 34394856 PMCID: PMC8354018 DOI: 10.1080/20008198.2021.1940760] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 06/03/2021] [Accepted: 06/06/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Early empirical data shows that school-aged children, adolescents and adults are experiencing elevated levels of anxiety and depression during the COVID-19 pandemic. Currently, there is very little research on mental health outcomes for young children. OBJECTIVES To describe the formation of a global collaboration entitled, 'COVID-19 Unmasked'. The collaborating researchers aim to (1) describe and compare the COVID-19 related experiences within and across countries; (2) examine mental health outcomes for young children (1 to 5 years) and caregivers over a 12-month period during the COVID-19 pandemic; (3) explore the trajectories/time course of psychological outcomes of the children and parents over this period and (4) identify the risk and protective factors for different mental health trajectories. Data will be combined from all participating countries into one large open access cross-cultural dataset to facilitate further international collaborations and joint publications. METHODS COVID-19 Unmasked is an online prospective longitudinal cohort study. An international steering committee was formed with the aim of starting a global collaboration. Currently, partnerships have been formed with 9 countries (Australia, Cyprus, Greece, the Netherlands, Poland, Spain, Turkey, the UK, and the United States of America). Research partners have started to start data collection with caregivers of young children aged 1-5 years old at baseline, 3-months, 6-months, and 12-months. Caregivers are invited to complete an online survey about COVID-19 related exposure and experiences, child's wellbeing, their own mental health, and parenting. DATA ANALYSIS Primary study outcomes will be child mental health as assessed by scales from the Patient-Reported Outcomes Measurement Information System - Early Childhood (PROMIS-EC) and caregiver mental health as assessed by the Depression Anxiety Stress Scale (DASS-21). The trajectories/time course of mental health difficulties and the impact of risk and protective factors will be analysed using hierarchical linear models, accounting for nested effects (e.g. country) and repeated measures.
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Affiliation(s)
- Alexandra C. De Young
- Queensland Centre for Perinatal and Infant Mental Health (QCPIMH), Children’s Health Queensland Hospital and Health Service (CHQ, HHS), Brisbane, Australia
- School of Psychology, Health and Behavioural Sciences, University of Queensland (UQ), Brisbane, Australia
| | - Mira Vasileva
- Child and Community Wellbeing Unit, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | | | - Dilara Demipence Seçinti
- Child and Adolescent Mental Health Department, Şişli Etfal Hamidiye Research and Training Hospital, Istanbul, Turkey
- Department of Psychology, Istanbul Rumeli University, Istanbul, Turkey
| | - Hope Christie
- Department of Clinical Psychology, University of Edinburgh, Scotland, UK
| | - Marthe R. Egberts
- Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | | | - Meghan L. Marsac
- College of Medicine, UK Healthcare, University of Kentucky, Lexington, KYUSA
| | - Gemma Ruiz
- Faculty of Psychology and Education Sciences, Universitat Oberta de Catalunya, Barcelona, Spain
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Marti Castaner M, Fowler R, Landers C, Cohen L, Orjuela M. How trauma related to sex trafficking challenges parenting: Insights from Mexican and Central American survivors in the US. PLoS One 2021; 16:e0252606. [PMID: 34133449 PMCID: PMC8208566 DOI: 10.1371/journal.pone.0252606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 05/18/2021] [Indexed: 11/19/2022] Open
Abstract
Sex trafficking, a form of human trafficking for the purpose of commercial sexual exploitation, with a global prevalence of 4.5 million, has pervasive effects in the mental and physical health of survivors. However, little is known about the experiences and needs of Latinx migrants (the majority of sex trafficking victims in the US) after trafficking, particularly regarding parenting. This QUAL-quant study examines how 14 survivors of sex trafficking (mean age = 30) from Mexico and Central America encounter and respond to parenting experiences after escaping sexual exploitation. Combining a bio-ecological model of parenting with Zimmerman's framework on human trafficking we identified how trauma related to sex trafficking can challenge parenting and how relational and contextual pre and post trafficking factors (dis)enable women to respond to such challenges. Psychological consequences of daily victimization primarily manifested in three ways: overprotective parenting in a world perceived to be unsafe, emotional withdraw when struggling with stress and mental health symptoms, and challenges building confidence as mothers. These experiences were accentuated by pre-trafficking experiences of neglect and abuse, forced separation from their older children, poverty post-trafficking, and migration-related stressors. Yet, finding meaning in the birth of their child, having social support, and faith, also enable mothers to cope with such challenges. We conclude that motherhood after surviving sex trafficking presents new challenges and opportunities in the path to recovery from trauma. Interventions at the policy, community and individual level are needed to support survivors of sex trafficking as they enter motherhood.
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Affiliation(s)
- Marti Marti Castaner
- Department of Public Health, Section of Health Research Services, Copenhagen University, Copenhagen, Denmark
| | - Rachel Fowler
- The Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, New York, United States of America
| | - Cassie Landers
- The Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, New York City, New York, United States of America
| | - Lori Cohen
- ECPAT-USA (End Child Prostitution and Trafficking-USA), New York City, New York, United States of America
| | - Manuela Orjuela
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York, United States of America
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Sood E, Lisanti AJ, Woolf-King SE, Wray J, Kasparian N, Jackson E, Gregory MR, Lopez KN, Marino BS, Neely T, Randall A, Zyblewski SC, Brosig CL. Parent mental health and family functioning following diagnosis of CHD: a research agenda and recommendations from the Cardiac Neurodevelopmental Outcome Collaborative. Cardiol Young 2021; 31:900-914. [PMID: 34082841 PMCID: PMC8759239 DOI: 10.1017/s1047951121002134] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Diagnosis of CHD substantially affects parent mental health and family functioning, thereby influencing child neurodevelopmental and psychosocial outcomes. Recognition of the need to proactively support parent mental health and family functioning following cardiac diagnosis to promote psychosocial adaptation has increased substantially over recent years. However, significant gaps in knowledge remain and families continue to report critical unmet psychosocial needs. The Parent Mental Health and Family Functioning Working Group of the Cardiac Neurodevelopmental Outcome Collaborative was formed in 2018 through support from an R13 grant from the National Heart, Lung, and Blood Institute to identify significant knowledge gaps related to parent mental health and family functioning, as well as critical questions that must be answered to further knowledge, policy, care, and outcomes. Conceptually driven investigations are needed to identify parent mental health and family functioning factors with the strongest influence on child outcomes, to obtain a deeper understanding of the biomarkers associated with these factors, and to better understand how parent mental health and family functioning influence child outcomes over time. Investigations are also needed to develop, test, and implement sustainable models of mental health screening and assessment, as well as effective interventions to optimise parent mental health and family functioning to promote psychosocial adaptation. The critical questions and investigations outlined in this paper provide a roadmap for future research to close gaps in knowledge, improve care, and promote positive outcomes for families of children with CHD.
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Affiliation(s)
- Erica Sood
- Nemours Cardiac Center & Nemours Center for Healthcare Delivery Science, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA; Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amy Jo Lisanti
- Department of Nursing and Clinical Care Services, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA
| | | | - Jo Wray
- Centre for Outcomes and Experience Research in Children’s Health, Illness and Disability and NIHR GOSH Biomedical Research Centre, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Nadine Kasparian
- Cincinnati Children’s Center for Heart Disease and Mental Health, Heart Institute and the Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children’s Hospital; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Heart Centre for Children, The Sydney Children’s Hospitals Network, Sydney, Australia
| | - Emily Jackson
- Department of Patient and Family Services, Alfred I. duPont Hospital for Children, Wilmington, Delaware, USA
| | - Mary R. Gregory
- Department of Nursing, School of Nursing and Health Professions, Missouri Western State University, Saint Joseph, Missouri, USA
- Department of Developmental Medicine/Behavior Sciences, Children’s Mercy Hospital, Kansas City, Missouri, USA
| | - Keila N. Lopez
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Bradley S. Marino
- Department of Pediatric Cardiology, Cleveland Clinic Children’s Hospital, Cleveland, Ohio, USA
| | - Trent Neely
- Sisters by Heart/Brothers by Heart, El Segundo, California, USA
| | - Amy Randall
- Mended Little Hearts of Wisconsin, Mended Hearts/Mended Little Hearts, Albany, Georgia, USA
| | - Sinai C. Zyblewski
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Cheryl L. Brosig
- Herma Heart Institute, Children’s Wisconsin, Milwaukee, Wisconsin, USA; Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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De Padova S, Grassi L, Vagheggini A, Belvederi Murri M, Folesani F, Rossi L, Farolfi A, Bertelli T, Passardi A, Berardi A, De Giorgi U. Post-traumatic stress symptoms in long-term disease-free cancer survivors and their family caregivers. Cancer Med 2021; 10:3974-3985. [PMID: 34061453 PMCID: PMC8209622 DOI: 10.1002/cam4.3961] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/18/2021] [Accepted: 04/19/2021] [Indexed: 12/25/2022] Open
Abstract
Background The experience of cancer is highly stressful and potentially traumatic. We assessed the presence of Post‐Traumatic Stress Symptoms (PTSS) in long‐term cancer survivors and their caregivers, while examining the association between PTSS and clinical, demographic and psychological variables in the long term. Methods In this cross‐sectional study 212 survivor‐family caregiver dyads completed measures of post‐traumatic stress symptoms (PTSS) (Impact of Event Scale), depression and anxiety (Hospital Anxiety Depression Scale). Coping strategies, fatigue, cognitive decline, stressful life events and psychopathological history were also assessed among survivors. Data were analyzed using mixed models, accounting both for individual and dyadic effects. Results Cancer survivors and their caregivers were assessed after a mean of 6 years after treatment. Twenty per cent of survivors and 35.5% of caregivers had possible posttraumatic stress disorder (PTSD), while 23 patients (11.0%) and 33 caregivers (15.6%) had probable PTSD. Among cancer patients, the severity of post‐traumatic symptoms was associated with an anxious coping style, previous psychopathology and depression (p < 0.001), whereas among caregivers it was associated with depression and having a closer relationship with patients (p < 0.001). Patients’ depression was associated with caregivers’ intrusion symptoms. Conclusions High levels of cancer‐related PTSS were still present several years after treatment in both survivors and caregivers. Psychopathology may derive from complex interactions among coping, previous disorders and between‐person dynamics.
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Affiliation(s)
- Silvia De Padova
- Psycho-Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Luigi Grassi
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara and University Hospital Psychiatry Unit, Integrated Department of Mental Health S. Anna University Hospital and Health Authorities, Anna University Hospital, Ferrara, Italy
| | - Alessandro Vagheggini
- Unit of Biostatistics and Clinical Trials, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Martino Belvederi Murri
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara and University Hospital Psychiatry Unit, Integrated Department of Mental Health S. Anna University Hospital and Health Authorities, Anna University Hospital, Ferrara, Italy
| | - Federica Folesani
- Department of Biomedical and Specialty Surgical Sciences, University of Ferrara and University Hospital Psychiatry Unit, Integrated Department of Mental Health S. Anna University Hospital and Health Authorities, Anna University Hospital, Ferrara, Italy
| | - Lorena Rossi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alberto Farolfi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Tatiana Bertelli
- Psycho-Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessandro Passardi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alejandra Berardi
- Psycho-Oncology Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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Elkins SR, Darban B, Millmann M, Martinez M, Short MB. Predictors of Parental Accommodations in the Aftermath of Hurricane Harvey. CHILD & YOUTH CARE FORUM 2021. [DOI: 10.1007/s10566-021-09619-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Chronic early trauma impairs emotion recognition and executive functions in youth; specifying biobehavioral precursors of risk and resilience. Dev Psychopathol 2021; 34:1339-1352. [PMID: 33779536 DOI: 10.1017/s0954579421000067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Exposure to chronic early trauma carries lasting effects on children's well-being and adaptation. Guided by models on resilience, we assessed the interplay of biological, emotional, cognitive, and relational factors in shaping two regulatory outcomes in trauma-exposed youth: emotion recognition (ER) and executive functions (EF). A unique war-exposed cohort was followed from early childhood to early adolescence. At preadolescence (11-13 years), ER and EF were assessed and respiratory sinus arrhythmia (RSA), biomarker of parasympathetic regulation, was quantified. Mother-child dyadic reciprocity, child's avoidance symptoms, and cortisol (CT) were measured in early childhood. Trauma-exposed youth displayed impaired ER and EF abilities. Conditional process analysis described two differential indirect paths leading from early trauma to regulatory outcomes. ER was mediated by avoidance symptoms in early childhood and modulated by cortisol, such that this path was evident only for preadolescents with high, but not low, CT. In comparison, EF was mediated by the degree of dyadic reciprocity experienced in early childhood and modulated by RSA, observed only among youth with lower RSA. Findings pinpoint trauma-related disruptions to key regulatory support systems in preadolescence as mediated by early-childhood relational, clinical, and physiological factors and highlight the need to specify biobehavioral precursors of resilience toward targeted early interventions.
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