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Kuru N, Ungar M. A structural equation model of parenting and child's resilience after the earthquake in Türkiye. FAMILY PROCESS 2024. [PMID: 39314161 DOI: 10.1111/famp.13061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 08/12/2024] [Accepted: 08/17/2024] [Indexed: 09/25/2024]
Abstract
This study investigated the relationship between parental psychological wellbeing, parenting, children's psychological difficulties, and prosocial behavior in Kahramanmaraş earthquake-affected families living in Türkiye in 2023. To this end, a mediation model was proposed for parental psychological distress that was hypothesized to exert an indirect effect on a child's psychological difficulties and prosocial behavior through parenting. Participants were 358 preschoolers between 4 and 6 years old and their one parent (father or mother) who completed a set of validated self-report surveys in a cross-sectional design study. Results showed positive associations between parental psychological distress and child's psychological difficulties but negative association with child's prosocial behavior. Furthermore, quality of parenting mediated the association between parental psychological distress and child's psychological difficulties and prosocial behavior. Our findings suggest that positive parenting may serve as a protective mechanism that mediates the association between parental psychological distress and a child's psychological difficulties and prosocial behaviors among families displaced by a natural disaster like an earthquake. These findings point to the need for supporting positive parent-child relationships in addition to decreasing the psychological distress of parents when exposed to potentially traumatizing events like this.
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Affiliation(s)
- Nilüfer Kuru
- Siirt University, Siirt, Turkey
- Resilience Research Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Michael Ungar
- Resilience Research Centre, Dalhousie University, Halifax, Nova Scotia, Canada
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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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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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Parental Internalizing Psychopathology and PTSD in Offspring after the 2012 Earthquake in Italy. CHILDREN-BASEL 2021; 8:children8100930. [PMID: 34682196 PMCID: PMC8535087 DOI: 10.3390/children8100930] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/13/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
Post-traumatic stress disorder (PTSD) is common in youths after earthquakes, with parental psychopathology among the most significant predictors. This study investigated the contribution and the interactional effects of parental internalizing psychopathology, the severity of exposure to the earthquake, and past traumatic events to predict PTSD in offspring, also testing the reverse pattern. Two years after the 2012 earthquake in Italy, 843 children and adolescents (9-15 years) living in two differently affected areas were administered a questionnaire on traumatic exposure and the UCLA PTSD Reaction Index. Anxiety, depression, and somatization were assessed in 1162 parents through the SCL-90-R. General linear model showed that, for offspring in the high-impact area, predictors of PTSD were earthquake exposure, past trauma, and parental internalizing symptoms, taken individually. An interaction between earthquake exposure and parental depression or anxiety (not somatization) was also found. In the low-impact area, youth PTSD was only predicted by earthquake exposure. The reverse pattern was significant, with parental psychopathology explained by offspring PTSD. Overall, findings support the association between parental and offspring psychopathology after natural disasters, emphasizing the importance of environmental factors in this relationship. Although further research is needed, these results should be carefully considered when developing mental health interventions.
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Mactavish A, Mastronardi C, Menna R, Babb KA, Battaglia M, Amstadter AB, Rappaport LM. Children's Mental Health in Southwestern Ontario during Summer 2020 of the COVID-19 Pandemic. JOURNAL OF THE CANADIAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY = JOURNAL DE L'ACADEMIE CANADIENNE DE PSYCHIATRIE DE L'ENFANT ET DE L'ADOLESCENT 2021; 30:177-190. [PMID: 34381510 DOI: 10.31234/osf.io/5cwb4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 04/12/2021] [Indexed: 05/23/2023]
Abstract
OBJECTIVE COVID-19 presents an unprecedented global crisis. Research is critically needed to identify the impact of the pandemic on children's mental health including psychosocial factors that predict resilience, recovery, and persistent distress. The present study collected data in June-July 2020 to describe children's mental health during the initial phase of the pandemic, including the magnitude and nature of psychiatric and psychological distress in children, and to evaluate social support as a putative psychosocial moderator of children's increased distress. METHOD Children and parents from 190 families of children aged 8 to 13 from the Windsor-Essex region of Southwestern Ontario reported (i) retrospectively on children's well-being (e.g., worry, happiness) immediately prior to the pandemic and (ii) on children's current well-being; irritability; social support; and anxiety, depressive, and posttraumatic stress symptoms at the baseline assessment of an ongoing longitudinal study of the COVID-19 pandemic. RESULTS Children and parents reported worsened well-being and psychological distress during the pandemic compared to retrospective report of pre-pandemic well-being. Child-perceived social support from family and friends was associated with lower symptom severity and attenuated increase in psychological distress. CONCLUSIONS Study findings suggest possible broad psychological impacts of the COVID-19 pandemic and are consistent with prior research that indicates a protective role of social support to mitigate the negative psychological impact of the pandemic. These findings may inform clinical assessments and highlight the need for public resources to safeguard children's mental health.
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Affiliation(s)
| | | | - Rosanne Menna
- Department of Psychology, University of Windsor, Windsor, Ontario
| | - Kimberley A Babb
- Department of Psychology, University of Windsor, Windsor, Ontario
| | - Marco Battaglia
- Department of Psychiatry, University of Toronto, Toronto, Ontario; Division of Child and Youth, Centre for Addiction and Mental Health, Toronto, Ontario
| | - Ananda B Amstadter
- Virginia Institute for Psychiatric and Behavioral Genetics, Departments of Psychiatry and Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
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The Association between Child and Parent Psychiatric Disorders in Families Exposed to Flood and/or Dioxin. Behav Sci (Basel) 2021; 11:bs11040046. [PMID: 33915718 PMCID: PMC8066693 DOI: 10.3390/bs11040046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 03/05/2021] [Accepted: 03/26/2021] [Indexed: 01/27/2023] Open
Abstract
Associations of disaster mental health sequelae between children and their parents have been demonstrated, but not using full diagnostic assessment. This study examined children and their parents after a series of disasters in 1982 to investigate associations of their psychiatric outcomes. Members of 169 families exposed to floods and/or dioxin or no disaster were assessed in 1986–1987 with structured diagnostic interviews. This vintage dataset collected several decades ago provides new information to this field because of the methodological rigor that is unparalleled in this literature. Disaster-related PTSD and incident postdisaster disorders in children were associated, respectively with disaster-related PTSD and incident postdisaster disorders in the chief caregiver and mother. More flood-only than dioxin-only exposed parents reported great harm by the disaster, but neither children nor parents in these two groups differed in incident psychiatric disorders. Although this study did not determine the direction of causal influences, its findings suggest that clinicians working with disaster-exposed families should work with children and adult members together, as their mental health outcomes may be intertwined.
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Tutus D, Pfeiffer E, Plener PL, Rosner R, Bernheim D, Sachser C. The Change in Parental Symptoms and Dysfunctional Cognitions in the Course of Trauma-Focused Cognitive-Behavioral Therapy: Sustainability Until One-Year Post-Treatment. J Child Adolesc Psychopharmacol 2021; 31:129-136. [PMID: 33370208 DOI: 10.1089/cap.2020.0097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objectives: Symptoms of distress and dysfunctional posttraumatic cognitions (PTCs) have been frequently described in parents of children and adolescents with posttraumatic stress symptoms (PTSS), especially if the parents had experienced traumatic events themselves. The inclusion of non-offending parents in trauma-focused cognitive-behavioral therapy (TF-CBT) for children and adolescents may, thus, help parents to cope with the traumatic experience of their child. The aim of this study is to investigate the effects of TF-CBT on the parents, while taking their own history of traumatic experiences into account. Methods: Parents (N = 57, 84.2% mothers) of children and adolescents who received TF-CBT completed the Posttraumatic Diagnostic Scale, the Beck Depression Inventory, the State-Trait Anxiety Inventory, and the Posttraumatic Cognitions Inventory. Treatment effects and the sustainability at 6- and 12 months post-treatment were tested via repeated-measures analysis of variance, following the intention-to-treat approach. Results:N = 19 (35.2%) of the parents evaluated their child's trauma as the worst event, 18 (33.3%) rated their own experience as their worst event, and 17 (31.5%) indicated that their own worst traumatic experience was the same type as their child's trauma. Significant improvements (p < 0.001) emerged for parental PTSS [F(2, 837) = 8.27; d = 0.30], depression [F(3, 284) = 14.73; d = 0.41], anxiety symptoms [F(3, 185) = 17.44; d = 0.64], and dysfunctional PTCs [F(2, 465) = 13.58; d = 0.46]. Sustainability of these treatment gains remained at both follow-up time points (p < 0.05). There was no interaction between the time and the reference person of the traumatic index event, reported by parents. Conclusion: These results indicate parental benefits from participation in TF-CBT delivered to their child, until 1-year post-treatment and independently from the parental trauma history. The ongoing tendency of improvement might indicate that TF-CBT furnishes children and their parents with skills to further reduce the impact of their traumatic memories. ClinicalTrials.gov NCT01516827.
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Affiliation(s)
- Dunja Tutus
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Elisa Pfeiffer
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany.,Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Rita Rosner
- Department of Psychology, Catholic University of Eichstaett-Ingolstadt, Eichstätt, Germany
| | - Dorothee Bernheim
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, Ulm University, Ulm, Germany
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Pfefferbaum B. Children's Exposure to Single Incidents of Terrorism: Perspectives Over 25 Years Since the Oklahoma City Bombing. Curr Psychiatry Rep 2020; 22:39. [PMID: 32514785 DOI: 10.1007/s11920-020-01163-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE OF REVIEW This paper traces advances in our knowledge about children's exposure and reactions to terrorist events over the last 25 years, beginning with the 1995 Oklahoma City bombing, and offers observations about cross-cutting issues including implications for services. RECENT FINDINGS Direct and indirect interpersonal exposures have been examined in community samples and in samples of children selected because of their event experiences. Despite its present exclusion from the stressor criterion for a diagnosis of posttraumatic stress disorder, considerable research has documented an association between children's initial subjective reaction and outcomes. Few studies have examined the influence of community or distant effects on outcomes, but contact with media coverage has been well studied. This review confirms the central role of exposure in influencing children's reactions to terrorist incidents and supports recent efforts to distinguish specific experiences that constitute children's event exposures.
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Affiliation(s)
- Betty Pfefferbaum
- Department of Psychiatry and Behavioral Sciences, College of Medicine, University of Oklahoma Health Sciences Center, 920 Stanton L. Young Boulevard, WP3217, P.O. Box 26901, Oklahoma City, OK, 73126-0901, USA.
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Li Y, Shi X, McReynolds LS, Tang H, Chen H, Wang T, Zhang Y, Geng F, Fan F, Hoven CW. Depressive symptoms between parent and adolescent survivors: A longitudinal actor-partner interdependence model. J Affect Disord 2020; 265:139-145. [PMID: 32090735 DOI: 10.1016/j.jad.2020.01.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 12/04/2019] [Accepted: 01/11/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND The association between parent-child depression following disasters has been well documented. However, longitudinal studies of posttraumatic depression using parent-child dyadic are scarce. This study aimed to investigate inter-related effects between parent and child depression, as well as predictors of depressive symptoms, in a large sample of Wenchuan earthquake survivors. METHODS Data are from the Wenchuan Earthquake Adolescent Health Cohort (WEAHC) Study that included 685 parent-child dyads exposed to the earthquake. Depression was assessed with the Self-Rating Depression Scale (for parents) and Depression Self-Rating Scale for Children, at 12 (T12m) and 18 months (T18m) post-earthquake. Longitudinal actor-partner interdependence models (APIMs) were employed to examine depression within dyads. Predictors of depressive symptoms were assessed by the cart algorithm throughout the 6-month follow-up. RESULTS Adjusting for earthquake exposure and previous depressive symptoms, parents' depression at 12 months predicted children's depressive symptoms at 18 months, and vice versa (β = 0.14 for parents and β = 0.12 for children). Psychomotor retardation in parents, and dysphoria/social isolation and positive affect in children were identified as crucial screening indicators identifying parents and children at increased risk for depression. CONCLUSION A bidirectional association was found between parent and child depression following a mass disaster. Both parent and child depression status should be examined when implementing interventions to identify and treat depression in earthquake survivors.
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Affiliation(s)
- Yuanyuan Li
- School of Psychology, Center for Studies of Psychological Application, and Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, South China Normal University, Shipai Road, Guangdong 510631, China
| | - Xuliang Shi
- College of education, Hebei University, Baoding, China
| | - Larkin S McReynolds
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
| | - Huilan Tang
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
| | - Huilin Chen
- Department of Psychology, University of Bath, Bath, Somerset, UK
| | - Tong Wang
- School of Psychology, Center for Studies of Psychological Application, and Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, South China Normal University, Shipai Road, Guangdong 510631, China
| | - Yuechu Zhang
- School of Psychology, Center for Studies of Psychological Application, and Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, South China Normal University, Shipai Road, Guangdong 510631, China
| | - Fulei Geng
- School of Psychology, Center for Studies of Psychological Application, and Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, South China Normal University, Shipai Road, Guangdong 510631, China
| | - Fang Fan
- School of Psychology, Center for Studies of Psychological Application, and Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, South China Normal University, Shipai Road, Guangdong 510631, China.
| | - C W Hoven
- Department of Child and Adolescent Psychiatry, New York State Psychiatric Institute, Columbia University, New York, USA
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Post-traumatic stress disorder, emotional and behavioral difficulties in children and adolescents 2 years after the 2012 earthquake in Italy: an epidemiological cross-sectional study. Eur Child Adolesc Psychiatry 2020; 29:227-238. [PMID: 31302773 DOI: 10.1007/s00787-019-01370-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/05/2019] [Indexed: 12/22/2022]
Abstract
Despite the occurrence of several earthquakes, only a few studies were conducted in Italy on the psychological impact in children and adolescents, with data mostly collected within one year after the disaster. This cross-sectional study aimed at exploring the prevalence of both post-traumatic stress disorder (PTSD) and emotional/behavioral difficulties, as well as at identifying their main predictors, among youths 2 years after the earthquake that hit Northern Italy in 2012. 682 children and adolescents (9-14 years) living in two districts (earthquake zone vs control zone) were administered an exposure questionnaire, the UCLA PTSD-Index for DSM-IV, and the Strengths and Difficulties Questionnaire (SDQ) and 1162 parents were assessed through the Symptom Checklist-90 (SCL-90). The prevalence of a likely PTSD in the earthquake zone was 1.9% (4.4% near the epicenter) and the total PTSD score in the affected area was significantly higher than in the control zone. 14.9% of youths living in the earthquake zone had a borderline/abnormal SDQ total difficulties score and 87.5% of youth with a likely PTSD also had a SDQ total score in the borderline/abnormal range. Regression analysis showed that the number of lifetime traumatic events (e.g., death of a relative) was the best predictor of children/adolescents psychological difficulties 2 years after the earthquake, followed by severity of exposure (personal injuries and losses) and parental psychopathology. Despite some limitations, this study highlights that youths may exhibit PTSD symptoms years after disasters, often in comorbidity with behavioral/emotional difficulties, stressing the need for long-term surveillance and interventions in exposed populations.
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Honda Y, Fujiwara T, Yagi J, Homma H, Mashiko H, Nagao K, Okuyama M, Ono-Kihara M, Kihara M. Long-Term Impact of Parental Post-Traumatic Stress Disorder Symptoms on Mental Health of Their Offspring After the Great East Japan Earthquake. Front Psychiatry 2019; 10:496. [PMID: 31404309 PMCID: PMC6675868 DOI: 10.3389/fpsyt.2019.00496] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 06/24/2019] [Indexed: 12/02/2022] Open
Abstract
Longitudinal studies of the long-term psychological impact of the Great East Japan Earthquake (GEJE) on parents and their children have been limited. The current study aimed to monitor parents' post-traumatic stress disorder (PTSD) symptoms and behavioral problems among their children over time and to analyze their long-term associations among the survivors of the GEJE. We used data from the GEJE Follow-up for Children study, which recruited 4- to 6-year-old children and those children's parents immediately after the GEJE in March 2011, with ongoing follow-up. Children's total, internalizing, and externalizing behavioral problems were assessed using the Child Behavior Checklist (CBCL), and parental probable PTSD was assessed using the Impact of Event Scale-R (IES-R), in 2012 (baseline) and 2014 (follow-up). Parental PTSD symptoms and children's behavioral problems declined slightly over time, and both showed a significant correlation between the surveys (r = 0.55-0.77, P < 0.001). The association between parental PTSD symptoms and children's behavioral problems was investigated using multivariate logistic regression analysis adjusting for baseline children's behavioral problems and other potential confounders. Cross-sectionally, while no significant association was detected in 2012, all types of children's behavioral problems exhibited significant positive associations with parental PTSD symptoms in multiple logistic regression analysis adjusted odds ratio (AOR) = 3.03, 3.30, and 5.34 for total, internalizing, and externalizing behavior problems, respectively. Maternal educational attainment level (higher than high school education) showed a significant negative association with children's total and externalizing behavioral problems (AOR = 0.30 and 0.13, respectively) in 2014. Longitudinally, parental PTSD symptoms in 2012 showed a significant association with children's internalizing behavioral problems in 2014 after adjusting for children's behavioral problems in 2012 and parental PTSD symptoms in 2014 (AOR = 4.62). These results suggest that the effect of the GEJE on parental PTSD symptoms and children's behavioral problems was long-term, lasting for at least 3 years. These possibilities should be carefully considered in mental health support for parents and their offspring in areas affected by the GEJE.
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Affiliation(s)
- Yukiko Honda
- Division of Advanced Preventive Medical Sciences, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
- Faculty of Advanced Science and Technology, Kumamoto University, Kumamoto, Japan
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Takeo Fujiwara
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
- Department of Global Health Promotion, Tokyo Medical and Dental University, Tokyo, Japan
| | - Junko Yagi
- Department of Psychiatry, Iwate Medical University, Iwate, Japan
| | | | | | | | - Makiko Okuyama
- Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Masako Ono-Kihara
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masahiro Kihara
- Department of Global Health and Socio-epidemiology, School of Public Health, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Gallo A, Wertz C, Kairis S, Blavier A. Exploration of relationship between parental distress, family functioning and post-traumatic symptoms in children. EUROPEAN JOURNAL OF TRAUMA & DISSOCIATION 2019. [DOI: 10.1016/j.ejtd.2018.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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The Effects of Family Functioning on the Development of Posttraumatic Stress in Children and Their Parents Following Admission to the PICU. Pediatr Crit Care Med 2019; 20:e208-e215. [PMID: 30951005 PMCID: PMC7518640 DOI: 10.1097/pcc.0000000000001894] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To report the rate of acute stress and posttraumatic stress among children and parents following PICU admission and the relation between family function and posttraumatic stress. DESIGN Prospective, longitudinal, multi-informant observational study. Pediatric patients (n = 69) and parents were recruited in the ICU. They completed measures evaluating acute stress and posttraumatic stress during their hospitalization and at 3-month follow-up. Parents completed measures of family functioning during the hospitalization. Pearson correlations and multiple regression models were used to examine the relations between family functioning and acute stress and posttraumatic stress. SETTING An academic, urban, pediatric hospital in California. PATIENTS Children, 8-17 years old, admitted to the PICU for greater than 24 hours and their English- or Spanish-speaking parents. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All children endorsed acute stress during their PICU admission, with 51% meeting criteria for acute stress disorder. At 3-month follow-up, 53% of the children continued to endorse posttraumatic stress with 13% meeting criteria for posttraumatic stress disorder. Among parents, 78% endorsed acute stress during admission with 30% meeting criteria for acute stress disorder, and at follow-up, 35% endorsed posttraumatic stress with 10% meeting criteria for posttraumatic stress disorder. In multiple linear regression modeling, child acute stress significantly predicted child posttraumatic stress (β = 0.36; p < 0.01). In the parent model, parent acute stress (β = 0.29; p < 0.01) and parent education (β = 0.59; p < 0.00) positively predicted parent's posttraumatic stress. Family function was not a predictor of either's posttraumatic stress. CONCLUSIONS Both children and parents have alarmingly high rates of acute stress and posttraumatic stress following the child's PICU admission. Although family function did not emerge as a predictor in this study, further understanding of the influence of the family and the interplay between child and parent posttraumatic stress is needed to improve our understanding of the model of development of posttraumatic stress in this population to inform the intervention strategies.
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Doric A, Stevanovic D, Stupar D, Vostanis P, Atilola O, Moreira P, Dodig-Curkovic K, Franic T, Davidovic V, Avicenna M, Noor M, Nussbaum L, Thabet A, Ubalde D, Petrov P, Deljkovic A, Antonio ML, Ribas A, Oliveira J, Knez R. UCLA PTSD reaction index for DSM-5 (PTSD-RI-5): a psychometric study of adolescents sampled from communities in eleven countries. Eur J Psychotraumatol 2019; 10:1605282. [PMID: 31105904 PMCID: PMC6507911 DOI: 10.1080/20008198.2019.1605282] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 12/12/2022] Open
Abstract
Background: Children and adolescents are often exposed to traumatic events, which may lead to the development of posttraumatic stress disorder (PTSD). It is therefore important for clinicians to screen for potential symptoms that can be signs of PTSD onset. PTSD in youth is a worldwide problem, thus congruent screening tools in various languages are needed. Objective: The aim of this study was to test the general psychometric properties of the Traumatic Stress Disorder Reaction Index for children and adolescents (UCLA PTSD) Reaction Index for DSM-5 (PTSD-RI-5) in adolescents, a self-report instrument intended to screen for trauma exposure and assess PTSD symptoms. Method: Data was collected from 4201 adolescents in communities within eleven countries worldwide (i.e. Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestine-Gaza, Philippines, Portugal, Romania, and Serbia). Internal consistency, discriminant validity, and a confirmatory factor analysis of a four-factor model representing the main DSM-5 symptoms of the PTSD-RI-5 were evaluated. Results: The PTSD-RI-5 total score for the entire sample shows very good reliability (α = .92) as well as across all countries included (α ranged from .90 to .94). The correlations between anxiety/depressive symptoms and the PTSD-RI-5 scores were below .70 indicating on good discriminant validity. The four-factor structure of the scale was confirmed for the total sample and data from six countries. The standardized regression weights for all items varied markedly across the countries. The lack of a common acceptable model across all countries prevented us from direct testing of cross-cultural measurement invariance. Conclusions: The four-factor structure of the PTSD-RI-5 likely represents the core PTSD symptoms as proposed by the DSM-5 criteria, but there could be items interpreted in a conceptually different manner by adolescents from different cultural/regional backgrounds and future cross-cultural evaluations need to consider this finding.
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Affiliation(s)
- Ana Doric
- Department of Psychology (Center for Applied Psychology), Faculty of Humanities and Social Sciences, University of Rijeka, Rijeka, Croatia
| | - Dejan Stevanovic
- Child Psychiatry, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Dusko Stupar
- Child Psychiatry, Clinic for Neurology and Psychiatry for Children and Youth, Belgrade, Serbia
| | - Panos Vostanis
- School of Psychology, Leicester University, Leicester, UK
| | - Olayinka Atilola
- Department of Behavioural Medicine, Lagos State University College of Medicine Ikeja, Lagos, Nigeria
| | | | - Katarina Dodig-Curkovic
- Medical Faculty Osijek, Faculty for Dental Medicine and Health, University Health Center Osijek, Osijek, Croatia
| | - Tomislav Franic
- Child and Adolescent Psychiatry, School of Medicine, University of Split, Split, Croatia
| | - Vrljicak Davidovic
- Department of Psychiatry, Clinical Hospital Centre Split, Split, Croatia
| | - Mohamad Avicenna
- Faculty of Psychology, State Islamic University Syarif Hidayatullah, Jakarta, Indonesia
| | - Multazam Noor
- Psychiatry department, Dr Soeharto Heerdjan Mental Hospital Jakarta, Jakarta, Indonesia
| | - Laura Nussbaum
- Department of Child and Adolescent Psychiatry, University of Medicine and Pharmacy "Victor Babes", Timisoara, Romania
| | - Abdelaziz Thabet
- School of Public Health, Al Quds University, Gaza Branch, Palestine
| | - Dino Ubalde
- Department of Psychology, St. Dominic College of Asia, City of Bacoor, Philippines
| | - Petar Petrov
- Department of Child and Adolescent Psychiatry, University Hospital St. Marina, Varna, Bulgaria
| | | | | | - Adriana Ribas
- Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rajna Knez
- Department of Women´s and Children´s health, Skaraborgs Hospital, Skövde, Sweden.,Department of Psychiatry and Psychological Medicine, Medical School, University of Rijeka, Rijeka, Croatia.,University of Gothenburg, Sahlgrenska Academy, Institute of Neuroscience and Physiology, Göteborg, Sweden
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15
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Takada S, Kameoka S, Okuyama M, Fujiwara T, Yagi J, Iwadare Y, Honma H, Mashiko H, Nagao K, Fujibayashi T, Asano Y, Yamamoto S, Osawa T, Kato H. Feasibility and psychometric properties of the UCLA PTSD reaction index for DSM-5 in japanese youth: A multi-site study. Asian J Psychiatr 2018; 33:93-98. [PMID: 29549818 DOI: 10.1016/j.ajp.2018.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Revised: 02/06/2018] [Accepted: 03/01/2018] [Indexed: 10/17/2022]
Abstract
The purpose of this study was to determine the reliability and validity of the UCLA PTSD Reaction Index for DSM-5 (PTSD-RI-5) among Japanese youth. This is the first study to explore psychometrics of the DSM-5 version of the PTSD-RI-5, as well as the first multisite study of an Asian population. This article presents psychometric characteristics of the PTSD-RI-5 derived from a sample of Japanese children and adolescents (N = 318). The PTSD-RI-5 total scale displayed good internal consistency reliability (α = 0.85). Correlations of PTSD-RI scores with the posttraumatic stress scores on the TSCC-A for the entire sample provided evidence of convergent validity. The four-factor structure of the PTSD-RI-5 was supported through confirmatory factor analysis in this sample. In conclusion, a DSM-5 version of the PTSD-RI-5 can be regarded as an adequate instrument for clinical and research purposes in Japan.
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Affiliation(s)
- Saeko Takada
- Research Department, Hyogo Institute for Traumatic Stress, 1-3-2 Wakinohama, Kaigandoru, Chuo-ku, Kobe, 651-0073, Japan.
| | - Satomi Kameoka
- Research Department, Hyogo Institute for Traumatic Stress, 1-3-2 Wakinohama, Kaigandoru, Chuo-ku, Kobe, 651-0073, Japan.
| | - Makiko Okuyama
- Department of Psychosocial Medicine, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, 157-8535, Japan.
| | - Takeo Fujiwara
- Department of Global Health Promotion, Tokyo Medical and Dental University, 1-5-45, Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
| | - Junko Yagi
- Department of Neuropsychiatry, Iwate Medical University, 19-1, Uchimaru, Morioka, Iwate, 020-0023, Japan.
| | - Yoshitaka Iwadare
- Department of Child and Adolescent Psychiatry, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1, Kohnodai, Ichikawa, Chiba, 272-8516, Japan.
| | - Hiroaki Honma
- Miyagi Child Center, 1-4-39, Honmachi, Aoba-ku, Sendai, 980-0014, Japan.
| | - Hirohumi Mashiko
- Department of Neuropsychiatry, Fukushima Medical University, 1, Hikarigaoka, Fukushima, 960-1247, Japan.
| | - Keizo Nagao
- Nagao Mental Clinic 379, Hadokoro-coh, Tsu, Mie, 514-0009, Japan.
| | - Takeshi Fujibayashi
- Consultation Division, Fukuoka Children's Advisory Center, 1-28, Jigyohama, Chuo-ku, Fukushima, 810-0065, Japan.
| | - Yasuko Asano
- Consultation Division, Osaka Prefectural Government Child Guidance Center, 28-5, Yasakacho, Neyagawa, Osaka, 572-0838, Japan.
| | - Sayaka Yamamoto
- Research Department, Hyogo Institute for Traumatic Stress, 1-3-2 Wakinohama, Kaigandoru, Chuo-ku, Kobe, 651-0073, Japan.
| | - Tomoko Osawa
- Research Department, Hyogo Institute for Traumatic Stress, 1-3-2 Wakinohama, Kaigandoru, Chuo-ku, Kobe, 651-0073, Japan.
| | - Hiroshi Kato
- Research Department, Hyogo Institute for Traumatic Stress, 1-3-2 Wakinohama, Kaigandoru, Chuo-ku, Kobe, 651-0073, Japan.
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16
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Shi X, Zhou Y, Geng F, Li Y, Zhou J, Lei B, Chen S, Chen X, Fan F. Posttraumatic stress disorder symptoms in parents and adolescents after the Wenchuan earthquake: A longitudinal actor-partner interdependence model. J Affect Disord 2018; 226:301-306. [PMID: 29028591 DOI: 10.1016/j.jad.2017.10.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 09/26/2017] [Accepted: 10/01/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Previous research has examined the association between parents' and children's posttraumatic stress disorder symptoms (PTSS) after a variety of traumatic events. However, longitudinal parent-child dyadic studies are scarce. METHODS Independent self-reports were collected from parent-adolescent dyads (n = 688) after the 2008 Wenchuan earthquake. Adolescents (Mean = 15.22 years; 61.63% female) and one of their parents (Mean = 41.04 years; 58.14% female) each reported on their PTSS at 12 (T12m) and 18 months (T18m) following the earthquake. Longitudinal actor-partner interdependence models (APIMs) were used to examine PTSS within dyads. RESULTS The prevalence rates of probable PTSD at T12m and T18m were 18.90% and 11.92% in adolescents; as well as 22.09% and 15.12% in parents, showing a significant decline over time. After adjusted for earthquake exposure, both maternal and paternal PTSS at T12m prospectively predicted adolescent girls' and boys' PTSS at T18m (mother to daughter: β = 0.13; mother to son: β = 0.17; father to daughter: β = 0.17; father to son: β = 0.33), while adolescent girls' and boys' PTSS at T12m only predicted maternal PTSS at T18m (daughter to mother: β = 0.20; son to mother: β = 0.20), but not paternal PTSS at T18m. LIMITATIONS Self-reported measures other than clinical reviews were used to collect data. CONCLUSIONS This study highlights the mutual impacts of adolescent and parental (especially maternal) PTSS after a disaster. Psychological prevention and intervention for adolescent disaster survivors should adopt a whole family approach.
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Affiliation(s)
- Xuliang Shi
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Ya Zhou
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Fulei Geng
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Yuanyuan Li
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Jieying Zhou
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Binbin Lei
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Siyi Chen
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Xiaoyan Chen
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China
| | - Fang Fan
- School of Psychology and Center for Studies of Psychological Application, South China Normal University, Guangzhou, China; Key Laboratory of Mental Health and Cognitive Science of Guangdong Province, Guangzhou, China.
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17
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Wise AE, Delahanty DL. Parental Factors Associated with Child Post-traumatic Stress Following Injury: A Consideration of Intervention Targets. Front Psychol 2017; 8:1412. [PMID: 28878711 PMCID: PMC5572291 DOI: 10.3389/fpsyg.2017.01412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 08/03/2017] [Indexed: 01/19/2023] Open
Abstract
Post-traumatic stress disorder (PTSD) symptoms are relatively common following pediatric traumatic injury and are related to poor long-term child outcomes. However, due to concerns regarding the efficacy of early child preventive interventions, and difficulty intervening with injured and medicated children soon after the event, it is not feasible to provide early psychological interventions to children exposed to traumatic injury. Parental PTSD symptoms and reactions to the child's traumatic injury impact child outcomes and provide potential targets for early intervention to reduce child symptom development without involving the child. The authors conducted a review of the literature using Psycinfo and Pubmed research databases (publication years = 1990-2017) and identified 65 published studies relevant to the topic of the review. The present review considers parent factors [parenting styles, parental post-traumatic pathology (PTS), adaptive and maladaptive coping strategies, and communication regarding the traumatic injury] and their impact on child PTS. We focus specifically on factors amenable to intervention. We further review moderators of these relationships (e.g., child age and gender, parent gender) and conclude that it is unlikely that a one-size-fits-all approach to treatment will be successful. Rather, it is necessary to consider the age and gender of parent child dyads in designing and providing targeted interventions to families following the traumatic injury of a child.
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Affiliation(s)
- Anna E. Wise
- Department of Psychological Sciences, Kent State University, KentOH, United States
| | - Douglas L. Delahanty
- Department of Psychological Sciences, Kent State University, KentOH, United States
- Northeast Ohio Medical University, RootstownOH, United States
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18
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Tutus D, Keller F, Sachser C, Pfeiffer E, Goldbeck L. Change in Parental Depressive Symptoms in Trauma-Focused Cognitive-Behavioral Therapy: Results from a Randomized Controlled Trial. J Child Adolesc Psychopharmacol 2017; 27:200-205. [PMID: 28051337 DOI: 10.1089/cap.2016.0136] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Depressive symptoms are frequently described in parents whose children have been exposed to traumatic events. Hence, including nonoffending parents in trauma-focused cognitive-behavioral therapy (TF-CBT) for children and adolescents may help both children and their parents to cope with the trauma. Up to now, three randomized controlled trials have investigated parental depressive symptoms after TF-CBT. Given the ambiguous results, further effectiveness trials are needed to investigate parental benefit from TF-CBT. The aim of this study is to determine whether TF-CBT is superior to waitlist (WL) regarding change in parental depressive symptoms. METHODS Parents, N = 84, whose children (age 6-17 years) were randomly assigned to either 12 sessions of TF-CBT (n = 40) or to WL condition (n = 44) completed the Beck Depression Inventory-Second Edition (BDI-II) for pre-post comparison. The group difference was tested through repeated-measures analyses of variance (ANOVA). The change in parental depressive symptoms was additionally categorized using the reliable change index. RESULTS Repeated-measures ANOVA indicated a significant time effect F(1, 82) = 2.55, p = 0.02, and no significant time-group interaction F(1, 82) = 1.09, p = 0.30, suggesting a similar reduction in parental depressive symptoms in both groups. Across both conditions, most of the parents remained unchanged (n = 62), some of them improved (n = 17), and a few deteriorated (n = 5). There was no significant difference between the conditions (χ2(2) = 1.74; p = 0.42). CONCLUSION Contrary to findings of several previous studies, our results suggest no superiority of TF-CBT in comparison with WL regarding change in depressive symptoms in parents. This might be due to different types of the child's trauma. Parental benefit from TF-CBT was found in samples of sexually abused, but not in children and adolescents exposed to diverse trauma types.
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Affiliation(s)
- Dunja Tutus
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm , Ulm, Germany
| | - Ferdinand Keller
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm , Ulm, Germany
| | - Cedric Sachser
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm , Ulm, Germany
| | - Elisa Pfeiffer
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm , Ulm, Germany
| | - Lutz Goldbeck
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm , Ulm, Germany
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19
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Neill EL, Weems CF, Scheeringa MS. CBT for Child PTSD is Associated with Reductions in Maternal Depression: Evidence for Bidirectional Effects. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 47:410-420. [DOI: 10.1080/15374416.2016.1212359] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Erin L. Neill
- Department of Human Development and Family Studies, Iowa State University
| | - Carl F. Weems
- Department of Human Development and Family Studies, Iowa State University
| | - Michael S. Scheeringa
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine
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20
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Tutus D, Goldbeck L. Posttraumatic symptoms and cognitions in parents of children and adolescents with PTSD. Eur Child Adolesc Psychiatry 2016; 25:997-1005. [PMID: 26832950 DOI: 10.1007/s00787-016-0821-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 01/18/2016] [Indexed: 10/22/2022]
Abstract
Parents may develop symptoms of distress and dysfunctional cognitions in response to their child's exposure to traumatic events. Additionally, they may also be affected by their own traumatic experiences. This study investigated the frequency of traumatic experiences and of symptoms of posttraumatic stress and depression in a sample of parents of children and adolescents with posttraumatic stress disorder (PTSD). Furthermore, we explored the association of parental symptoms with their dysfunctional cognitions related to their child's trauma. Parents (N = 113) of children and adolescents with PTSD completed the Posttraumatic Diagnostic Scale (PDS), the Beck depression inventory (BDI-II), the State-Trait Anxiety Inventory, and the Posttraumatic Cognitions Inventory. Correlations between symptom measures and dysfunctional cognitions were calculated. The majority (78.8 %) of the parents reported their own potentially traumatic experiences. Furthermore, 33.6 % evaluated their child's trauma as the worst event, 34.5 % rated their own experiences as their worst event, and 26.5 % indicated that their own worst traumatic event was the same type as their child's trauma. The frequency of clinically elevated parental symptoms on the PDS was 48.6 %, and on the BDI-II 32.7 %. Parental symptoms were independent of the reference person of the parental traumatic index event. However, they did correlate significantly with their dysfunctional cognitions (between r = 0.44 and 0.69, p < 0.01). Many parents report their own traumatic experiences and a significant proportion has its own clinically relevant symptoms of distress. Parental psychological symptoms are moderately associated with their dysfunctional cognitions. The results emphasize the need to consider parental distress when treating pediatric PTSD.
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Affiliation(s)
- D Tutus
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhoevelstr. 1, Ulm, Germany.
| | - L Goldbeck
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Steinhoevelstr. 1, Ulm, Germany
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21
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Abstract
There is widespread support for the hypothesis that, post-disaster, children's mental health is impacted--at least in part--via the impact on parents, parenting, parent-child interactions, and the family environment. To some degree, the enthusiasm with which this hypothesis is held outstrips the evidence examining it. The current paper critically evaluates the empirical evidence for this hypothesis and concludes that although limited (both in terms of number of existing studies and methodological flaws), the extant literature indicates some parent-related variables, as well as some aspects of the family environment are likely to constitute risk or protective factors for children. Given that parenting is modifiable, it is proposed that the identified parent- and family-related factors represent important therapeutic targets, and a universal post-disaster parenting intervention (Disaster Recovery Triple P) is described.
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22
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Thakur A, Creedon J, Zeanah CH. Trauma- and Stressor-Related Disorders Among Children and Adolescents. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2016; 14:34-45. [PMID: 31975792 PMCID: PMC6524445 DOI: 10.1176/appi.focus.20150026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
DSM-5 introduced a clustering of disorders designated "trauma- and stressor-related disorders." These disorders are unique in that the etiology is specified as part of the diagnostic criteria. In this review, the authors consider how some of these disorders manifest for children and adolescents. In posttraumatic stress disorder and related disorders, the child is exposed to one or more frightening, traumatic events. In attachment disorders, the child experiences severe social neglect. With this framework in mind, the authors consider details of several prominent trauma- and stressor-related disorders that arise in response to either excessive, unwanted input or inadequate, necessary input among children and adolescents.
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Affiliation(s)
- Akanksha Thakur
- The authors are with the Section of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
| | - Jennifer Creedon
- The authors are with the Section of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
| | - Charles H Zeanah
- The authors are with the Section of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
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23
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Managing stress in schools: teachers coping with special education children. INTERNATIONAL JOURNAL ON DISABILITY AND HUMAN DEVELOPMENT 2016. [DOI: 10.1515/ijdhd-2014-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
AbstractTeaching is one of the most stressful professions worldwide. This study aimed to explore how teachers cope with teaching – in regular classes – special education children who get some assistance through special integration programs in their schools but no additional assistance in their regular classes. More specifically, I examined coping strategies in two cultural groups of teachers – Jews and Arabs. Furthermore, I investigated how the different coping strategies explain stress reactions of state anxiety and state anger in the two cultures in the background of this special situation. Six hundred and thirty-four Jewish and Arab teachers (80% Jews) completed self-report questionnaires, including Cope, state anxiety and state anger in their free time during the period of November 2010 to January 2011. Significant differences were revealed among Jewish and Arab teachers in usage of coping strategies. Although both Jews and Arabs used mostly “problem solving” strategies, Jewish teachers used these strategies more compared to their Jewish counter-parts, while Arab teachers used more “emotional coping” and “disengagement” strategies. The relationships between the different coping strategies and stress reactions were mostly in the same direction for both groups. However, the strengths of the relationships were significantly different. The obtained variance of anxiety and anger by coping strategies was greater among Jewish teachers than among their Arabs counterparts. The results are discussed in relationship to the Stress and Coping Theory of Lazarus and Folkman. Emphasis is placed on the uniqueness of each culture and how each culture translates interaction with stressful situations into coping strategies.
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24
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Garcia DM, Sheehan MC. Extreme Weather-driven Disasters and Children’s Health. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2015; 46:79-105. [DOI: 10.1177/0020731415625254] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Extreme weather events such as heat waves, extreme precipitation, and storm surges are likely to become more frequent and intense with climate change. Extreme weather-driven disasters (EWDDs) cause a substantial burden of childhood mortality and morbidity worldwide. We reviewed the published literature on EWDDs and their health impacts on children, and developed a conceptual model based on complex systems thinking to identify the health risks, vulnerabilities, and capacities of children in the context of EWDDs as a means of informing areas for adaptive intervention. We found that direct and indirect physical and mental impacts of EWDDs on child health are abundant and interrelate in complex ways. The literature review and modeling demonstrated the centrality of resilience at the level of the child and his or her direct environment, suggesting that mental health status may play a key role in a child’s experience of numerous other health outcomes of EWDDs. EWDDs interact with environmental and social systems and with individual children and their contexts in complex ways, the impacts of which are nonlinear and difficult to predict. Traditional perspectives on climate change-driven health impacts often overlook complex bio-psychosocial interactions, suggesting a need to work on preventive strategies to reduce vulnerability and build individual child resilience.
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Affiliation(s)
| | - Mary C. Sheehan
- Johns Hopkins Bloomberg School of Public Health, Maryland, USA
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25
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Slobodin O, de Jong JTVM. Family interventions in traumatized immigrants and refugees: A systematic review. Transcult Psychiatry 2015; 52:723-42. [PMID: 26047828 DOI: 10.1177/1363461515588855] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The importance of the family as a unit in the aftermath of trauma necessitates the use of family interventions among immigrants and refugees. While abundant clinical material suggests that family-based trauma interventions are applicable across cultures, very little is known about the extent to which family treatment modalities are effective for immigrants and refugees. We conducted a systematic review of intervention studies that have been designed or modified specifically for traumatized immigrant and refugee families. The terms "trauma," "family," and "immigrants/refugees/culture" were used along with different terms for "intervention." Studies with no research methodology were excluded. Only 6 experimental studies met our inclusion criteria; 4 of them describe school-based interventions and 2 present multifamily support groups. The shortage of research in this area does not allow clear conclusions about the effectiveness of family interventions for traumatized immigrants or refugees. The complexity of employing methodologically rigorous research in small communities is discussed. Future trials should go beyond the individualistic approach and focus on posttraumatic stress disorder to address family-level processes, such as family relationship, communication, and resilience.
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26
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Wolmer L, Hamiel D, Versano-Eisman T, Slone M, Margalit N, Laor N. Preschool Israeli Children Exposed to Rocket Attacks: Assessment, Risk, and Resilience. J Trauma Stress 2015; 28:441-7. [PMID: 26401837 DOI: 10.1002/jts.22040] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Preschool children are among the most vulnerable populations to adversity. This study described the effects of 4 weeks of daily exposure to rocket attacks on children living on Israel's southern border. Participants enrolled in this study were 122 preschool children (50% boys) between the ages 3 and 6 years from 10 kindergartens. We assessed mothers' report of children's symptoms according to the DSM-IV and alternative criteria resembling the DSM-5 criteria for posttraumatic stress disorder (PTSD), general adaptation, traumatic exposure, and stressful life events 3 months after the war. The prevalence of PTSD was lower when the diagnosis was derived from the DSM-IV (4%) than from the DSM-5 criteria (14%). Mothers of children with 4 or more stressful life events reported more functional impairment in social, occupational, and other important areas of functioning compared to children with 0 or 1 stressful life event. Children with more severe exposure showed more severe symptoms and mothers had more concerns about the child's functioning (η(p)(2) = .09-.25). Stressful life events and exposure to traumatic experiences accounted for 32% of the variance in PTSD and 19% of the variance in the adaptation scale. Results were explored in terms of risk and resilience factors.
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Affiliation(s)
- Leo Wolmer
- Donald J. Cohen & Irving B. Harris Resilience Center, Israel.,School of Psychology, Interdisciplinary Center (IDC) Herzliya, Israel
| | - Daniel Hamiel
- Donald J. Cohen & Irving B. Harris Resilience Center, Israel.,School of Psychology, Interdisciplinary Center (IDC) Herzliya, Israel.,Tel Aviv-Brull Community Mental Health Center, Tel-Aviv, Israel
| | | | - Michelle Slone
- School of Psychological Sciences, Tel-Aviv University, Israel
| | - Nitzan Margalit
- Donald J. Cohen & Irving B. Harris Resilience Center, Israel
| | - Nathaniel Laor
- Donald J. Cohen & Irving B. Harris Resilience Center, Israel.,Tel Aviv-Brull Community Mental Health Center, Tel-Aviv, Israel.,Sackler Faculty of Medicine, Tel-Aviv University, Israel.,Child Study Center, Yale University, New Haven, Connecticut, USA
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Scheeringa MS, Myers L, Putnam FW, Zeanah CH. Maternal Factors as Moderators or Mediators of PTSD Symptoms in Very Young Children: A Two-Year Prospective Study. JOURNAL OF FAMILY VIOLENCE 2015; 30:633-642. [PMID: 26120248 PMCID: PMC4479421 DOI: 10.1007/s10896-015-9695-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Research has suggested that parenting behaviors and other parental factors impact the long-term outcome of children's posttraumatic stress disorder (PTSD) symptoms. In a sample of 62 children between the ages of one and six who experienced life-threatening traumas, PTSD was measured prospectively two years apart. Seven maternal factors were measured in a multi-method, multi-informant design. Both moderation and mediation models, with different theoretical and mechanism implications, were tested. Moderation models were not significant. Mediation models were significant when the mediator variable was maternal symptoms of PTSD or depression (measured at Time 1), self-report of maternal escape/avoidance coping (measured at Time 2), or self-report emotional sensitivity (measured at Time 2). Greater maternal emotional sensitivity was associated with greater Time 2 PTSD symptoms among children. Observational measures of emotional sensitivity as the mediator were not supported. Correlation of parents' and children's symptoms is a robust finding, however caution is warranted in attributing children's PTSD symptoms to insensitive parenting.
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Affiliation(s)
| | - Leann Myers
- Tulane University School of Public Health and Tropical Medicine
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28
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Kerns CE, Elkins RM, Carpenter AL, Chou T, Green JG, Comer JS. Caregiver distress, shared traumatic exposure, and child adjustment among area youth following the 2013 Boston Marathon bombing. J Affect Disord 2014; 167:50-5. [PMID: 25082114 PMCID: PMC4128573 DOI: 10.1016/j.jad.2014.05.040] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/23/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Disasters are associated with myriad negative outcomes in youth, including posttraumatic stress disorder and related psychopathology. Prior work suggests links between caregiver distress and child mental health outcomes following community traumas, but the extent to which caregiver distress is directly linked to post-disaster child functioning, or whether such associations may simply be due to shared traumatic exposure, remains unclear. METHODS The current study examined relationships among caregiver distress, caregiver-child shared traumatic exposure, and child outcomes in Boston-area families (N=460) during the six months following the 2013 Boston Marathon bombing. Parents completed surveys about their and their child׳s potentially traumatic experiences during the bombing and subsequent manhunt. Post-attack caregiver distress and child psychological functioning were also assessed. RESULTS After accounting for caregiver-child shared traumatic exposure, significant associations were retained between caregiver distress and child functioning across several domains. Furthermore, after accounting for caregiver traumatic exposure, caregiver distress moderated relationships between child traumatic exposure and child posttraumatic stress and conduct problems, such that associations between child traumatic exposure and child posttraumatic stress and conduct problems were particularly strong among children of highly distressed caregivers. LIMITATIONS The cross-sectional design did not permit evaluations across time, and population-based methods were not applied. CONCLUSIONS Findings clarify links between caregiver distress and child psychopathology in the aftermath of disaster and can inform optimal allocation of clinical resources targeting disaster-affected youth and their families.
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Affiliation(s)
| | | | | | - Tommy Chou
- Florida International University, Miami, FL
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29
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Lai BS, Hadi F, Llabre MM. Parent and child distress after war exposure. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2014; 53:333-47. [PMID: 24702278 DOI: 10.1111/bjc.12049] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Revised: 02/12/2014] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The purpose of this study was to examine multiple distress symptoms (i.e., post-traumatic stress [PTS], anxiety, depression) among parents and children exposed to the Gulf Crisis in 1990-1991. Profiles of parent distress were identified, and the relationship between parent distress and specific child distress symptoms was examined. DESIGN Parents and children were assessed at one time point. METHODS Participants included 151 children (Mage = 10.62 years; 51% female) and 140 parents (Mage = 40 years; 81% female). RESULTS Utilizing latent profile analysis, three parallel profiles of parent distress were identified: low distress, moderate distress, and high distress. Parent distress was a risk factor for child depression, but it was not a risk factor for child PTS or anxiety. CONCLUSIONS Findings support the importance of broadening the scope of research conducted after exposure to traumatic events to include the assessment of anxiety and depression, as well as PTS, among both parents and children. Additional implications for research and clinical work are discussed. PRACTITIONER POINTS Findings support the importance of screening for multiple distress symptoms among both children and parents after war exposure. Based on our findings, clinicians may want to consider including parents in therapy for children reporting psychological distress, especially depression symptoms, after exposure to traumatic events. This study was cross-sectional. Thus, we are not able to infer direction or causality. The generalizability of our study should be interpreted with caution, as findings will need to be replicated across other populations and other cultures.
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Affiliation(s)
- Betty S Lai
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, Georgia, USA
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30
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Lambert JE, Holzer J, Hasbun A. Association between parents' PTSD severity and children's psychological distress: a meta-analysis. J Trauma Stress 2014; 27:9-17. [PMID: 24464491 DOI: 10.1002/jts.21891] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The authors conducted a meta-analysis of studies on the correlation between parents' PTSD symptom severity and children's psychological status. An extensive search of the literature yielded 550 studies that were screened for inclusion criteria (i.e., parent assessed for PTSD, child assessed for distress or behavioral problems, associations between parent PTSD and child status examined). Sixty-two studies were further reviewed, resulting in a final sample of 42 studies. Results yielded a moderate overall effect size r = .35. The authors compared effect sizes for studies where only the parent was exposed to a potentially traumatic event to studies where both parents and children were exposed. A series of moderators related to sample characteristics (sex of parent, type of traumatic event) and study methods (self-report vs. diagnostic interview, type of child assessment administered) were also evaluated. The only significant moderator was type of trauma; the effect size was larger for studies with parent-child dyads who were both exposed to interpersonal trauma (r = .46) than for combat veterans and their children (r = .27) and civilian parent-child dyads who were both exposed to war (r = .25). Results support the importance of considering the family context of trauma survivors and highlight areas for future research.
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Affiliation(s)
- Jessica E Lambert
- California School of Professional Psychology at Alliant International University, San Diego, California, USA
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31
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Cobham VE, McDermott B. Perceived parenting change and child posttraumatic stress following a natural disaster. J Child Adolesc Psychopharmacol 2014; 24:18-23. [PMID: 24494740 DOI: 10.1089/cap.2013.0051] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Recent research suggests that not only parental psychopathology, but also parenting practices, have a role to play in the development of child posttraumatic stress symptoms (PTSS) following a natural disaster. The current study aimed to investigate the relationship between parents' perceptions of their parenting in the aftermath of a natural disaster, and child PTSS. METHODS A cross-sectional design was used to explore the associations among child PTSS, parents' perceptions of altered (more anxious) parenting, and parental disaster-related distress (altered cognitions and behaviors) in 874 elementary school children (ages 8-12 years) and their parents following a severe storm of cyclonic proportions. With parental consent, school-based screening was conducted in impacted communities 3 months after the storm. Children completed a screening questionnaire consisting of the Child Trauma Screening Questionnaire (CTSQ; used for identifying children at risk for posttraumatic stress disorder [PTSD]), as well as a range of questions assessing disaster exposure and threat perception. Parents completed questions relating to their perceptions of changes in their parenting since the storm, as well as two items relating to their own disaster-related distress. RESULTS Independent of other significant associations with child PTSS (such as age, gender, and disaster exposure), a high level of parent-perceived altered parenting appeared to put children at increased risk for PTSS 3 months after the disaster. However, when the sample was stratified for the presence or absence of altered parent cognitions and behaviors following the storm, altered parenting was found to have a unique relationship with child PTSS only when parents reported altered disaster-related cognitions and behaviors. CONCLUSIONS When parents report disaster-related cognitions and behaviors, their perception of altered parenting practices (becoming more protective, less granting of autonomy, and communicating a sense of current danger) is associated with child PTSS. Although it is not possible to draw conclusions about the direction of these relationships, this study identifies parenting practices that may constitute important targets for intervention.
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Affiliation(s)
- Vanessa E Cobham
- 1 School of Psychology, University of Queensland , Brisbane, Queensland, Australia
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32
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Braun-Lewensohn O, Sagy S. Community resilience and sense of coherence as protective factors in explaining stress reactions: comparing cities and rural communities during missiles attacks. Community Ment Health J 2014; 50:229-34. [PMID: 23748598 DOI: 10.1007/s10597-013-9623-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 06/03/2013] [Indexed: 02/05/2023]
Abstract
Based on the salutogenic theory, the aim of this study was to examine sense of coherence and communal resiliency as related to stress reactions during missile attacks. Data were gathered in August 2011 while missiles were being shot from Gaza to the Negev communities in Israel from approximately 150 participants, aged 15-85. Participants lived in cities and different types of small rural villages. Self reported questionnaires were administered via the internet and included demographic data, coping resource of sense of coherence and community resiliency as coping resources, as well as state anxiety, state anger and psychological distress as stress reaction outcomes. Overall, the participants in our study reported strong personal and communal resources and relatively low levels of stress reactions. Personal and communal resources were linked negatively to the different stress reactions. However, some differences emerged when we compared participants from different types of communities. The most resilient group was composed of people who lived in the rural and communal communities. Differences also emerged on patterns of relationships between the community resource and state anxiety. While among the rural citizens, community resilience was strongly linked to anxiety, no relationships were revealed in the urban citizens group.
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Affiliation(s)
- Orna Braun-Lewensohn
- Conflict Management and Conflict Resolution Program, Department of Interdisciplinary Studies, Ben Gurion University, POB 653, Beer Sheva, Israel,
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33
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Gil-Rivas V. The Impact of Disaster on Children and Adolescents: A Gender-Informed Perspective. HUMANITARIAN SOLUTIONS IN THE 21ST CENTURY 2014. [DOI: 10.1007/978-3-319-05882-5_1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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34
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Pfefferbaum B, Shaw JA. Practice parameter on disaster preparedness. J Am Acad Child Adolesc Psychiatry 2013; 52:1224-38. [PMID: 24157398 DOI: 10.1016/j.jaac.2013.08.014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 08/10/2013] [Indexed: 12/01/2022]
Abstract
This Practice Parameter identifies best approaches to the assessment and management of children and adolescents across all phases of a disaster. Delivered within a disaster system of care, many interventions are appropriate for implementation in the weeks and months after a disaster. These include psychological first aid, family outreach, psychoeducation, social support, screening, and anxiety reduction techniques. The clinician should assess and monitor risk and protective factors across all phases of a disaster. Schools are a natural site for conducting assessments and delivering services to children. Multimodal approaches using social support, psychoeducation, and cognitive behavioral techniques have the strongest evidence base. Psychopharmacologic interventions are not generally used but may be necessary as an adjunct to other interventions for children with severe reactions or coexisting psychiatric conditions.
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35
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Leen-Feldner EW, Feldner MT, Knapp A, Bunaciu L, Blumenthal H, Amstadter AB. Offspring psychological and biological correlates of parental posttraumatic stress: review of the literature and research agenda. Clin Psychol Rev 2013; 33:1106-33. [PMID: 24100080 DOI: 10.1016/j.cpr.2013.09.001] [Citation(s) in RCA: 135] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 09/06/2013] [Accepted: 09/06/2013] [Indexed: 11/16/2022]
Abstract
Millions of individuals with posttraumatic stress disorder (PTSD) are parents. A burgeoning literature suggests that offspring of parents with this condition may be at increased risk for psychological problems. The current paper provides an integrative and comprehensive review of the diverse research literature examining the sequelae of parental posttraumatic stress among offspring. Over 100 studies that evaluated psychological and/or biological variables among children of parents with PTSD are reviewed. Findings suggest parental symptoms of posttraumatic stress are uniquely related to an array of offspring outcomes, including internalizing-type problems, general behavioral problems, and altered hypothalamic-pituitary-adrenal axis functioning. Although very little work has directly evaluated mechanisms of transmission, there is increasing support for genetic and epigenetic effects as well as parenting behaviors. These and other mechanisms are discussed; drawing upon findings from other literatures to consider how parental PTSD may impart psychobiological vulnerability upon offspring. We conclude with a detailed discussion of the methodological strengths and challenges of the extant research, along with a recommended agenda for future research in this important area of study.
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36
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Wong SS, Kletter H, Wong Y, Carrion VG. A prospective study on the association between caregiver psychological symptomatology and symptom clusters of pediatric posttraumatic stress disorder. J Trauma Stress 2013; 26:385-91. [PMID: 23737297 DOI: 10.1002/jts.21816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
This study investigated the influence of caregiver psychological symptoms on posttraumatic stress disorder (PTSD) symptoms in traumatized children. One-hundred eleven children and caretakers were assessed in this study. Children (N = 59) with a history of exposure to interpersonal violence were evaluated for reexperiencing, avoidance/numbing, and hyperarousal symptom clusters using the Clinician-Administered PTSD Scale for Children and Adolescents (CAPS-CA). The 52 primary caregivers were evaluated using the Symptom Checklist-90-Revised (SCL-90-R) on 9 domains of psychological symptomatology: anxiety, depression, hostility, interpersonal sensitivity, obsessive-compulsive disorder, paranoid ideation, phobic anxiety, psychoticism, and somatization. At 14-month follow-up, 45 of the children were re-evaluated with the CAPS-CA. Caregiver psychological symptoms in the domains of anxiety, depression, interpersonal sensitivity, obsessive-compulsive disorder, and paranoid ideation were associated with less improvement in total pediatric PTSD symptoms. Analysis of PTSD symptoms by cluster showed that greater caregiver symptomatology in the domains of anxiety, depression, interpersonal sensitivity, and obsessive-compulsive disorder were associated with less improvement in the hyperarousal symptom cluster. These results suggest caregiver symptomatology may be specifically associated with hyperarousal symptoms in pediatric trauma.
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Affiliation(s)
- Shane Shucheng Wong
- Early Life Stress Research Program, Stanford University School of Medicine, Stanford, CA94305, USA
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37
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Gil-Rivas V, Kilmer RP. Children's adjustment following Hurricane Katrina: the role of primary caregivers. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2013; 83:413-21. [PMID: 23889031 PMCID: PMC3752914 DOI: 10.1111/ajop.12016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Hurricane Katrina severely disrupted the lives of many children and families in the central Gulf Coast of the United States. Face-to-face interviews with child-caregiver dyads were conducted at approximately 1 year posthurricane (T1) and 6-10 months later (T2). The contribution of several factors-caregiver's self-reported symptomatology and coping advice and child perceptions of caregiver distress, unavailability, warmth, and caregiver-child conflict-to child-reported posttraumatic stress symptoms (PTSS) and depressive symptoms was examined. Findings provide partial support for the importance of the caregiving context to children's adjustment. Specifically, higher levels of caregiver-child conflict at T1 were associated with more PTSS at T2, controlling for baseline symptoms. In contrast, higher levels of caregiver education were negatively related to child PTSS at T2. After adjusting for objective hurricane exposure and symptoms at T1, none of the caregiving variables was related to child-reported depressive symptoms at T2. The implications of these findings for efforts to promote children's adjustment after disaster are discussed.
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Affiliation(s)
- Virginia Gil-Rivas
- Department of Psychology, University of North Carolina at Charlotte, 9201 University City Blvd., Charlotte, NC 28223-0001, USA.
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38
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Steinberg AM, Brymer MJ, Kim S, Briggs EC, Ippen CG, Ostrowski SA, Gully KJ, Pynoos RS. Psychometric properties of the UCLA PTSD reaction index: part I. J Trauma Stress 2013; 26:1-9. [PMID: 23417873 DOI: 10.1002/jts.21780] [Citation(s) in RCA: 246] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article presents psychometric characteristics of the UCLA PTSD Reaction Index for DSM IV (PTSD-RI) derived from a large sample of children and adolescents (N = 6,291) evaluated at National Child Traumatic Stress Network centers. Overall mean total PTSD-RI score for girls was significantly higher as compared with boys. Age-related differences were found in that overall mean total PTSD-RI scores and within sex groups were higher among those aged 7-9 years and 16-18 years. There were no significant differences in mean total PTSD-RI scores across racial/ethnic groups. The PTSD-RI total scale displayed good to excellent internal consistency reliability across age ranges, sex, and racial/ethnic groups (α = .88-.91). Correlations of PTSD-RI scores with PTS subscale scores on the TSCC-A for the entire sample and within sex, age, and ethnic/racial groups provided evidence of convergent validity, although not discriminant validity. In contradistinction to previously reported 4-factor models, an exploratory factor analysis revealed 3 factors that mostly reflected the underlying dimensions of PTSD in DSM IV. PTSD-RI scores were associated with increased odds ratios for functional/behavior problems (odds ratio [OR] = 1-1.80). These findings are striking in light of the wide range of trauma exposures, age, and race/ethnicity among subjects.
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Affiliation(s)
- Alan M Steinberg
- Department of Psychiatry and Biobehavioral Sciences, UCLA/Duke University National Center for Child Traumatic Stress, University of California, Los Angeles, CA 90064, USA
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39
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Weems CF, Scheeringa M. Maternal depression and treatment gains following a cognitive behavioral intervention for posttraumatic stress in preschool children. J Anxiety Disord 2013; 27:140-6. [PMID: 23376601 PMCID: PMC3578069 DOI: 10.1016/j.janxdis.2012.11.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Revised: 11/02/2012] [Accepted: 11/24/2012] [Indexed: 12/21/2022]
Abstract
The evidence base for cognitive behavioral therapy (CBT) to treat child emotional and behavioral symptoms following exposure to trauma in youth is compelling, but relatively few studies are available on preschool children and on moderators of treatment outcomes. This paper examines maternal and child characteristics as moderators of posttraumatic stress (PTS) treatment outcomes in preschool children. Outcome data from a previously published randomized trial in three to six year old preschool children with diagnostic interview data from participating mothers were used. Hypotheses were tested via hierarchical linear modeling. Maternal depression was associated with higher initial child posttraumatic stress disorder (PTSD) symptoms, and was associated with increasing PTSD symptom trends at follow up suggesting potential child PTSD symptom relapse. Maternal PTSD symptoms similarly predicted differential child separation anxiety symptom change but not child PTSD symptom change. Targeting dyads with child PTSD symptoms and maternal depression or PTSD symptoms with enhanced interventions may be a useful strategy to improve treatment maintenance.
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40
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Framework for research on children's reactions to disasters and terrorist events. Prehosp Disaster Med 2012; 27:567-76. [PMID: 23034149 DOI: 10.1017/s1049023x12001343] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Clinical work and research relative to child mental health during and following disaster are especially challenging due to the complex child maturational processes and family and social contexts of children's lives. The effects of disasters and terrorist events on children and adolescents necessitate diligent and responsible preparation and implementation of research endeavors. Disasters present numerous practical and methodological barriers that may influence the selection of participants, timing of assessments, and constructs being investigated. This article describes an efficient approach to guide both novice and experienced researchers as they prepare to conduct disaster research involving children. The approach is based on five fundamental research questions: "Why?, Who?, When?, What?, and How?" Addressing each of the "four Ws" will assist researchers in determining "How" to construct and implement a study from start to finish. A simple diagram of the five questions guides the reader through the components involved in studying children's reactions to disasters. The use of this approach is illustrated with examples from disaster mental health studies in children, thus simultaneously providing a review of the literature.
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41
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Blom M, Oberink R. The validity of the DSM-IV PTSD criteria in children and adolescents: a review. Clin Child Psychol Psychiatry 2012; 17:571-601. [PMID: 22287553 DOI: 10.1177/1359104511426408] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE DSM-V is on its way and doubts have been raised regarding the validity of pediatric PTSD. It is the goal of the current review to critically review the empirical literature on PTSD in youth. METHOD A search of PsycINFO, PubMed and reference lists was conducted. Empirical information considered relevant regarding the validity of the criteria was collected. RESULTS/CONCLUSIONS The validity of the symptom criteria and clusters varies, with the Avoidance/Numbing cluster outperforming the Re-experiencing-and Arousal cluster. Factor analytic findings suggest that Arousal criterion D4 should be placed within the Re-experiencing cluster, and that the Avoidance/Numbing cluster should be split up. Some non-DSM-IV PTSD symptoms, among which guilt, have considerable validity in trauma-exposed youth and their inclusion in DSM-V PTSD should be considered. As for preschool children, alternative criteria are recommended that are more developmentally sensitive.
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Affiliation(s)
- Marloes Blom
- University of Amsterdam, Department of Clinical Psychology, The Netherlands.
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42
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Morris A, Gabert-Quillen C, Delahanty D. The association between parent PTSD/depression symptoms and child PTSD symptoms: a meta-analysis. J Pediatr Psychol 2012; 37:1076-88. [PMID: 23019132 DOI: 10.1093/jpepsy/jss091] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The present article presents a meta-analysis of studies examining the association between parent posttraumatic stress disorder (PTSD)/depression symptoms and child PTSD symptoms (PTSS) after a child's exposure to a traumatic event while considering multiple moderating factors to explain heterogeneity of effect sizes. METHODS 35 studies were included: 32 involving the association between parent and child PTSS and 9 involving the association between parent depression and child PTSS. RESULTS Across existing studies, both parent and child PTSS (r = 0.31) and parent depression and child PTSS (r = 0.32) yielded significant effect sizes. Parent gender, assessment type (interview vs. questionnaire), differences in assessment type for parents and children, and study design (cross-sectional vs. longitudinal) moderated the relationship between parent and child PTSS. CONCLUSIONS The current findings confirm the associations between parental posttraumatic responses and child PTSS and highlight important moderating factors to include in future studies of child PTSS.
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Affiliation(s)
- Adam Morris
- Department of Psychology, Kent State University, 342 Kent Hall, Kent, OH 44242, USA
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Braun-Lewensohn O. Inclusion in Israel: coping resources and job satisfaction as explanatory factors of stress in two cultural groups. JOURNAL OF RESEARCH IN SPECIAL EDUCATIONAL NEEDS 2012. [DOI: 10.1111/j.1471-3802.2012.01241.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Wooding S, Raphael B. Psychological Impact of Disasters and Terrorism on Children and Adolescents: Experiences from Australia. Prehosp Disaster Med 2012; 19:10-20. [PMID: 15453155 DOI: 10.1017/s1049023x00001436] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractRecent acts of terrorism have emphasised the need for research to further establish not only the nature of the impact of disaster and terrorism on the population, but also further define methods of effective intervention. Those affected, and often overlooked, include children and adolescents, yet, our knowledge of the impact upon the younger members of our community limited. The literature is evolving, and there are a small number of valuable studies that can inform a response to the mental health needs of this younger population.This article reviews some of the psychological impacts of disaster and terrorism upon children and adolescents, and considers both risk and protective factors. The importance of a developmental approach to children's understanding of disaster, particularly death and the nature of grief and loss are discussed as is the distinction between the phenomenology of bereavement and trauma. Family and community support are highlighted as protective factors, and a number of recent, valuable recommendations for intervention including psychological first aid and cognitive-behavioral therapy are described. Finally, the complex role of the media and the degree that children should exposed to images of violence and disaster is considered. Disasters, whether they are natural or human-made always will be with us. It is necessary that a public-health approach that not only prepares for such scenarios, but responds by maximising the use of existing systems and agency linkages, taken.
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Affiliation(s)
- Sally Wooding
- Centre for Mental Health, NSW Health Department, Sydney, Australia.
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Abstract
Exposure to mass trauma has contributed to increasing concern about the well-being of children, families, and communities. In spite of global awareness of the dramatic impact of mass trauma on youth, little is known about how children and adolescents cope with and adapt to disasters and terrorism. While coping has yet to be fully conceptualized as a unified construct, the process of responding to stress includes recognized cognitive, emotional, and behavioral components. Unfortunately, research on the complex process of adaptation in the aftermath of mass trauma is a relatively recent focus. Further study is needed to build consensus in terminology, theory, methods, and assessment techniques to assist researchers and clinicians in measuring children's coping, both generally and within the context of mass trauma. Advancements are needed in the area of coping assessment to identify internal and external factors affecting children's stress responses. Additionally, enhanced understanding of children's disaster coping can inform the development of prevention and intervention programs to promote resilience in the aftermath of traumatic events. This article examines the theoretical and practical issues in assessing coping in children exposed to mass trauma, and includes recommendations to guide assessment and research of children's coping within this specialized context.
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A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clin Psychol Rev 2012; 32:122-38. [DOI: 10.1016/j.cpr.2011.12.001] [Citation(s) in RCA: 475] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2010] [Revised: 11/30/2011] [Accepted: 12/01/2011] [Indexed: 11/24/2022]
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Nygaard E, Wentzel-Larsen T, Hussain A, Heir T. Family structure and posttraumatic stress reactions: a longitudinal study using multilevel analyses. BMC Psychiatry 2011; 11:195. [PMID: 22171549 PMCID: PMC3280194 DOI: 10.1186/1471-244x-11-195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Accepted: 12/15/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is limited research on the relevance of family structures to the development and maintenance of posttraumatic stress following disasters. We longitudinally studied the effects of marital and parental statuses on posttraumatic stress reactions after the 2004 Southeast Asian tsunami and whether persons in the same households had more shared stress reactions than others. METHOD The study included a tourist population of 641 Norwegian adult citizens, many of them from families with children. We measured posttraumatic stress symptoms with the Impact of Event Scale-Revised at 6 months and 2 years post-disaster. Analyses included multilevel methods with mixed effects models. RESULTS Results showed that neither marital nor parental status was significantly related to posttraumatic stress. At both assessments, adults living in the same household reported levels of posttraumatic stress that were more similar to one another than adults who were not living together. Between households, disaster experiences were closely related to the variance in posttraumatic stress symptom levels at both assessments. Within households, however, disaster experiences were less related to the variance in symptom level at 2 years than at 6 months. CONCLUSIONS These results indicate that adult household members may influence one another's posttraumatic stress reactions as well as their interpretations of the disaster experiences over time. Our findings suggest that multilevel methods may provide important information about family processes after disasters.
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Affiliation(s)
- Egil Nygaard
- Norwegian Centre for Violence and Traumatic Stress Studies, Kirkeveien 166, Building 48, 0407 Oslo, Norway.
| | - Tore Wentzel-Larsen
- Norwegian Centre for Violence and Traumatic Stress Studies, Kirkeveien 166, Building 48, 0407 Oslo, Norway,Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaug Torg 4B, 0484 Oslo, Norway
| | - Ajmal Hussain
- Norwegian Centre for Violence and Traumatic Stress Studies, Kirkeveien 166, Building 48, 0407 Oslo, Norway
| | - Trond Heir
- Norwegian Centre for Violence and Traumatic Stress Studies, Kirkeveien 166, Building 48, 0407 Oslo, Norway
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Berger R, Gelkopf M. An intervention for reducing secondary traumatization and improving professional self-efficacy in well baby clinic nurses following war and terror: A random control group trial. Int J Nurs Stud 2011; 48:601-10. [DOI: 10.1016/j.ijnurstu.2010.09.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2010] [Revised: 09/04/2010] [Accepted: 09/07/2010] [Indexed: 10/19/2022]
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