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Simons M, Harvey G, McMillan L, Ryan EG, De Young AG, McPhail SM, Kularatna S, Senanayake S, Kimble R, Tyack Z. Implementation outcomes of a digital, trauma-informed care, educational intervention targeting health professionals in a paediatric burns setting: A mixed methods process evaluation. Burns 2024; 50:1690-1703. [PMID: 38664169 DOI: 10.1016/j.burns.2024.03.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 03/05/2024] [Accepted: 03/31/2024] [Indexed: 06/14/2024]
Abstract
Trauma-informed care practices are associated with a culture of safety following traumatic experiences, including medical trauma. An interactive, web-based training package ('Responsive CARE') was developed for voluntary uptake by paediatric burns health professionals to increase staff knowledge about trauma-informed practice. This paper reports on a mixed methods process evaluation conducted alongside a preliminary effectiveness study of 'Responsive CARE'. The process evaluation was conducted using The Consolidated Framework for Implementation Research (CFIR) and a logic model, to examine feasibility of both the intervention and implementation strategy. Health practitioners (including senior managers) delivering care to children and caregivers attending an outpatient burns service were eligible to enrol in 'Responsive CARE'. Qualitative interview data and quantitative metadata were used to evaluate the implementation outcomes (adoption, acceptability, fidelity, feasibility and preliminary effectiveness). Children and caregivers attending an outpatient service for change of burn wound dressing or burn scar management during the 3-month control or 3-month intervention period were eligible to enrol in the effectiveness study. The impact on child pain and distress, as well as cost, was investigated using a pretest-posttest design. Thirteen (from anticipated 50 enrolled) health professionals (all female) with mean 10 years (SD=11) of experience with paediatric burns hospital-based outpatient care completed an average of 65% (range 36% to 88%) of available content. Twenty-five semi-structured interviews were completed with health practitioners (21 female) and with 14 caregivers (11 female). Four themes were identified as influencing feasibility and acceptability of the intervention: 1) Keeping a trauma-informed lens; 2) Ways of incorporating trauma-informed care; 3) Working within system constraints; and 4) Being trauma-informed. Preliminary effectiveness data included 177 participants (median age 2 years, and median total body surface area burn 1%). Causal assumptions within the logic model were unable to be fully tested, secondary to lower-than-expected adoption and fidelity. We found no significant difference for pain, distress and per-patient hospital care costs between groups (pre- and post-intervention). Future implementation strategies should include organizational support to keep a trauma-informed lens and to incorporate trauma-informed principles within a medical model of care. Despite efforts to co-design a staff education intervention and implementation approach focused on stakeholder engagement, adaptations are indicated to both the intervention and implementation strategies to promote uptake highlighting the complexity of changing clinician behaviours.
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Affiliation(s)
- Megan Simons
- Occupational Therapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Queensland, Australia; Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia.
| | - Gillian Harvey
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia; Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Lucinda McMillan
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia
| | - Elizabeth G Ryan
- QCIF Faculty for Advanced Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, Queensland, Australia; Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Queensland, Australia
| | - Alexandra G De Young
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia; School of Psychology, The University of Queensland, Queensland, Australia; Queensland Centre for Perinatal and Infant Mental Health, Children's Health Queensland Hospital and Health Service, Queensland, Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia; Digital Health and Informatics Directorate, Metro South Health, Queensland, Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
| | - Sameera Senanayake
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, Queensland, Australia; Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Queensland, Australia
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Şenol FB, Şenol Y. The effect of drama on psychosocial problems and emotional states of hospitalized children with cancer. J Pediatr Nurs 2024; 77:e276-e282. [PMID: 38670864 DOI: 10.1016/j.pedn.2024.04.041] [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: 12/20/2023] [Revised: 04/13/2024] [Accepted: 04/13/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND AND PURPOSE Hospitalization is a traumatic experience for children. Especially in the case of childhood cancers that require long-term hospitalization, children need psychosocial support. The study aimed to examine the effectiveness of drama in reducing psychosocial problems in hospitalized paediatric children diagnosed with cancer. METHODS The study used a mixed method approach, combining both qualitative and quantitative methods with a single group. Drama sessions prepared according to the Tasks and Skills Model were used to support their psychosocial conditions. The Facial Expression Form, The Assessment Scale for Psychosocial Symptoms in Hospitalized Children, and the Drawing and Writing Technique were used before and after the drama sessions. RESULTS This study differs from others in its use of drama intervention to reduce psychosocial problems in children undergoing cancer treatment. As a result of the study, it was found that there was a decrease in anxiety, hopelessness, anger-aggression and communication difficulties among psychosocial problems and a change in mood towards feeling happy. The study suggests that drama sessions were effective in relieving emotional distress in paediatric cancer patients. CONCLUSION The study suggests that drama sessions were effective in relieving emotional distress in paediatric cancer patients. PRACTICE IMPLICATIONS Applying drama to children undergoing long-term hospital treatment can help alleviate psychosocial problems by reducing stress, emotional suppression, and compensating for trauma.
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Affiliation(s)
- Fatma Betül Şenol
- Department of Special Education, Faculty of Education, Afyon Kocatepe University, Afyonkarahisar 03030, Türkiye.
| | - Yiğit Şenol
- Department of Public Health, Afyonkarahisar Provincial Health Directorate, Afyonkarahisar 03030, Türkiye.
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Ormiston HE, Husmann PR, Wikel KC, Ruark C, Reisinger DL, Curtin MJ. An Exploratory Study of Educators' Perspectives Towards Hospital School Program Support for Children with Special Health Care Needs After Hospitalization. CONTINUITY IN EDUCATION 2024; 5:31-49. [PMID: 38774599 PMCID: PMC11104305 DOI: 10.5334/cie.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/17/2024] [Indexed: 05/24/2024]
Abstract
More than 14 million children in the United States are identified as children with special healthcare needs (CSHCN). Rates of hospitalization for CSHCN with chronic conditions as well as re-admissions have been increasing in recent years. For hospitalized children transitioning back to their school of record, a host of issues may arise such as socioemotional concerns, peer rejection, and being behind in academics. Hospital-based school programs (HBSPs) play an important role in the transition back to a child's school of record. Utilizing a database of inpatient CSHCN at a midwestern children's hospital's HBSP, private and public-school educators associated with the previously hospitalized CSHCN were asked to complete an online survey to gather their perspectives related to the child's transition back to the school of record upon hospital discharge. Overall, educators' perspectives of the HBSP were positive while perceptions related to communication provided by the HBSP were mixed. Educators surveyed reported a lack of training related to working with CSHCN. Finally, accommodations and services offered to students upon return to school focused mostly on academic performance and attendance. Study limitations and implications for practice in schools are discussed.
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Affiliation(s)
| | | | | | | | - Debra L. Reisinger
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, US
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Fava NM, Coxe SJ, Fortenberry JD, Bay-Cheng LY. Sexual Self-Concept After Child Maltreatment: The Role of Resilient Coping and Sexual Experience Among U.S. Young Adults. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:359-373. [PMID: 37847345 DOI: 10.1007/s10508-023-02706-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 09/08/2023] [Accepted: 09/08/2023] [Indexed: 10/18/2023]
Abstract
Evidence supports sexual experience as normative and health-promoting for many, but this picture is less clear for people with histories of adversity. Amazon Mechanical Turk (MTurk) was used to garner data from a sample of 362 young adults (aged 18-25) wherein 44.5% (n = 161) identified as women. We assessed longitudinal associations between child maltreatment and sexual self-concept, as mediated by sexual behaviors and sexual partners, and whether resilient coping moderated these associations using structural equation modeling. Although both child maltreatment and resilient coping were directly associated with aspects of sexual experience, only resilient coping was directly associated with sexual self-concept. In addition, we found support for sexual experience as a mediator between child maltreatment/resilient coping and sexual self-concept. Specifically, cumulative maltreatment was associated with more sexual partners, which was associated with higher sexual self-monitoring. Resilient coping was associated with more sexual partners and more sexual behaviors, which was associated with higher sexual self-monitoring and higher sexual self-consciousness, sexual assertiveness, sexual self-esteem, and sexual motivation, respectively. Thus, sexual behaviors and sexual partners operated independently. Findings contrast messaging that sexual experience is universally risky regardless of maltreatment history. Rather, sexual experience may foster positive sexual self-concept for some. Sexual health advocates must attend to differences between sexual behaviors and sexual partners in relation to sexual well-being, and support resilience in the sexual domain.
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Affiliation(s)
- Nicole M Fava
- School of Social Work, Robert Stempel College of Public Health & Social Work, Center for Children and Families, Florida International University, AHC-5, Room 587, 11200 SW 8th Street, Miami, FL, 33199, USA.
| | - Stefany J Coxe
- Department of Psychology, Center for Children and Families, Florida International University, Miami, FL, USA
| | | | - Laina Y Bay-Cheng
- Psychology Department, LaMarsh Centre for Child & Youth Research, York University, Toronto, ON, Canada
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Barrios P, Enesco I, Varea E. Emotional Experience and Type of Communication in Oncological Children and Their Mothers: Hearing Their Testimonies Through Interviews. Front Psychol 2022; 13:834312. [PMID: 35686067 PMCID: PMC9171433 DOI: 10.3389/fpsyg.2022.834312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/28/2022] [Indexed: 11/13/2022] Open
Abstract
The emotional experience and the type of communication about cancer within the family are important factors for successful coping with pediatric oncology. The main purpose is to study mother’s and children’s emotional experiences concerning cancer, whether they communicate openly about the disease, and relationships between the type of communication and the different emotions expressed by the children. Fifty-two cancer patients aged 6–14 years and their mothers were interviewed in separate sessions about the two central themes of the study: emotional experiences and type of communication. Analyses of response categories were performed to subsequently compare the age-groups and the mother–child responses. According to the results, mothers expressed emotions such as fear, sadness, or anxiety, while children report sadness, pain, but also happiness. Significant positive correlations were observed between mothers’ sadness and older children’s sadness, mothers’ anxiety and children’s fear, and mothers’ anxiety and children’s happiness. Regarding communication type, mothers tend to hide information about the disease from younger children and to provide direct information to the older children. Children usually prefer to communicate their concerns to parents; however, children whose mothers convey anxiety are more likely to prefer to communicate with others. These results support the idea that parents should talk honestly with their children, explaining their illness in an age-appropriate way, and encouraging them to share their emotional experiences. Further studies are needed from a developmental perspective to understand the disease management of children and families.
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Affiliation(s)
- Paula Barrios
- Departamento de Investigación y Psicología en Educación, Complutense University of Madrid, Madrid, Spain
| | - Ileana Enesco
- Departamento de Investigación y Psicología en Educación, Complutense University of Madrid, Madrid, Spain
| | - Elena Varea
- Departamento de Investigación y Psicología en Educación, Complutense University of Madrid, Madrid, Spain
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Woolgar FA, Wilcoxon L, Pathan N, Daubney E, White D, Meiser-Stedman R, Colville GA. Screening for Factors Influencing Parental Psychological Vulnerability During a Child's PICU Admission. Pediatr Crit Care Med 2022; 23:286-295. [PMID: 35081084 DOI: 10.1097/pcc.0000000000002905] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To identify the risks of developing post-traumatic stress disorder (PTSD) and/or depression in parents following their child's PICU admission using a brief screening instrument and to examine the associations with these risks. DESIGN A cross-sectional parental survey. SETTING A general 13-bed PICU at a large teaching hospital. SUBJECTS One hundred and seven parents of 75 children admitted to the PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS All parents completed the 10-item Posttraumatic Adjustment Screen (PAS) before discharge. The PAS assesses risk factors known to be associated with poorer psychological outcome, including psychosocial variables pretrauma and peritrauma, and acute stress. Parents' scores on the PAS indicated that 64 (60%) were at risk of developing PTSD and 80 (75%) were at risk of developing depression following their child's admission. Univariate analyses suggested that psychosocial variables, such as preexisting stressors and a history of previous mental health problems, were more strongly associated with PAS risk scores for PTSD and depression than medical or sociodemographic factors. In logistic regression analyses, a history of previous mental health problems was significantly associated with risk of developing PTSD and depression (p < 0.001) explaining 28% and 43% of the variance in these outcomes. CONCLUSIONS This study suggests that a significant number of parents on PICU are potentially at risk of developing PTSD and/or depression postdischarge and that psychosocial factors, pretrauma and peritrauma, are stronger determinants of this risk, and of acute distress, than other variables. Identification of vulnerable parents during admission, using a measure such as the PAS, could facilitate the targeting of support and monitoring, acutely and postdischarge, at those who might be most likely to benefit.
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Affiliation(s)
- Francesca A Woolgar
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Lucy Wilcoxon
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Nazima Pathan
- Department of Paediatrics, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Esther Daubney
- Department of Paediatrics, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Deborah White
- Department of Paediatrics, Addenbrookes Hospital, Cambridge, United Kingdom
| | - Richard Meiser-Stedman
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Gillian A Colville
- Paediatric Psychology Service, St George's Hospital, London, United Kingdom
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Mental health outcomes in pediatric trauma patients: A 10 year real world analysis using a large database approach. J Pediatr Surg 2022; 57:291-296. [PMID: 34772514 DOI: 10.1016/j.jpedsurg.2021.09.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Traumatic injury is the leading cause of morbidity and mortality among children in the United States. Single institution studies suggest an increased risk of poor mental health outcomes among these patients, but there are few population-based studies assessing this risk. METHODS The IBMⓇ MarketScanⓇ private insurance claims database was used to identify children (6-17yo) with traumatic injuries between 2007 and 2016. Time-to-event analysis was performed to compare rates of PTSD, depression, anxiety, and adjustment disorder among children admitted to the hospital compared to children treated in the emergency department (ED), urgent care (UC), or in the outpatient setting, and to children admitted with uncomplicated appendicitis. RESULTS Among children admitted for traumatic injury, 3.3% developed a subsequent mental health diagnosis, and 1.6% developed PTSD. Children admitted for traumatic injury were at increased risk of developing a mental health condition (HR 1.34, p < 0.001) compared to those admitted for appendicitis. Children treated in the ED or UC for traumatic injury and those treated in the outpatient setting were also at increased risk (HR 1.20 and 1.18, p = 0.006 and p = 0.012, respectively). Among those admitted to the hospital, the risk of subsequent mental health diagnosis increased by 1.5% per day; in the first 31 days of hospitalization, the risk of PTSD diagnosis increased by 13% per day. CONCLUSION Children who sustain a traumatic injury are at increased risk of developing a mental health condition. PTSD rates found in our real world analysis are lower than those found in prospective studies, raising the possibility of under-recognition of PTSD in this population. LEVEL OF EVIDENCE Level II.
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Ramirez MR, Flores JE, Woods-Jaeger B, Cavanaugh JE, Peek-Asa C, Branch C, Bolenbaugh M, Chande V, Pitcher G, Ortega HW, Randell KA, Wetjen K, Roth L, Kenardy J. Comparative Effectiveness of Parent-Based Interventions to Support Injured Children. Pediatrics 2021; 148:peds.2020-046920. [PMID: 34556547 DOI: 10.1542/peds.2020-046920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES A comparative effectiveness trial tested 2 parent-based interventions in improving the psychosocial recovery of hospitalized injured children: (1) Link for Injured Kids (Link), a program of psychological first aid in which parents are taught motivational interviewing and stress-screening skills, and (2) Trauma Education, based on an informational booklet about trauma and its impacts and resources. METHODS A randomized controlled trial was conducted in 4 children's hospitals in the Midwestern United States. Children aged 10 to 17 years admitted for an unintentional injury and a parent were recruited and randomly assigned to Link or Trauma Education. Parents and children completed questionnaires at baseline, 6 weeks, 3 months, and 6 months posthospitalization. Using an intent-to-treat analysis, changes in child-reported posttraumatic stress symptoms, depression, quality of life, and child behaviors were compared between intervention groups. RESULTS Of 795 injured children, 314 children and their parents were enrolled into the study (40%). Link and Trauma Education was associated with improved symptoms of posttraumatic stress, depression, and pediatric quality of life at similar rates over time. However, unlike those in Trauma Education, children in the Link group had notable improvement of child emotional behaviors and mild improvement of conduct and peer behaviors. Compared with Trauma Education, Link was also associated with improved peer behaviors in rural children. CONCLUSION Although children in both programs had reduced posttrauma symptoms over time, Link children, whose parents were trained in communication and referral skills, exhibited a greater reduction in problem behaviors.
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Affiliation(s)
- Marizen R Ramirez
- University of Minnesota, Minneapolis, Minnesota .,University of Iowa, Iowa City, Iowa
| | | | - Briana Woods-Jaeger
- Mercy Children's Hospital, Kansas City, Missouri.,Emory University, Atlanta, Georgia
| | | | | | | | | | | | | | - Henry W Ortega
- Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
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9
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Sadeh Y, Dekel R, Brezner A, Landa J, Silberg T. Child and Family Factors Associated With Posttraumatic Stress Responses Following a Traumatic Medical Event: The Role of Medical Team Support. J Pediatr Psychol 2021; 45:1063-1073. [PMID: 32968802 DOI: 10.1093/jpepsy/jsaa070] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 06/13/2020] [Accepted: 07/23/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES This study examined the contribution of pretrauma psychosocial factors (child emotional functioning, family resources, family functioning, and social support) and environmental factors (mother's posttraumatic stress symptoms [PTSSs], medical team support [MTS]) to PTSSs of injured or seriously ill children within a pediatric rehabilitation setting. It was hypothesized that psychosocial variables would be strongly associated with child's PTSS; that mother's PTSS and MTS would mediate the association between psychosocial factors and child's PTSS; that mother's report on child's PTSS would mediate the association between mother's PTSS and child's PTSS. METHODS Participants were 196 children hospitalized following an injury/illness and assessed M = 47.7 days postevent. Children completed measures of PTSS, mothers completed measures of their own PTSS, child's PTSS, and pretrauma psychosocial factors. Family's therapist completed a MTS measure. Structural equation modeling was employed to evaluate the study hypotheses. RESULTS Pretrauma family structure and resources were associated with child's self-reported PTSS; each pretrauma variable and mother's report of child's PTSS was significantly associated. Although mother's PTSS was not directly associated with child's PTSS, this relationship was mediated by mother's report of child's PTSS. MTS mediated the relationship between pretrauma social support and mother's PTSS. CONCLUSION This study further explicates the utility of a biopsychosocial framework in predicting childhood PTSS. Findings confirm the role of pretrauma factors and environmental factors at the peritrauma period in the development of PTSS following a pediatric injury/illness. Mother's PTSS and MTS may be appropriate targets for prevention and early intervention.
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Affiliation(s)
- Yaara Sadeh
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University.,Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center
| | - Rachel Dekel
- The Louis and Gabi Weisfeld School of Social Work, Bar-Ilan University
| | - Amichai Brezner
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center
| | - Jana Landa
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center.,Sackler Faculty of Medicine, Tel-Aviv University
| | - Tamar Silberg
- Department of Pediatric Rehabilitation, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center.,Holland Bloorview Kids Rehabilitation Hospital.,Department of Psychology, Bar-Ilan University
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10
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Alderfer MA, Logan BA, DiDonato S, Jackson L, Hayes MJ, Sigmon ST. Change Across Time in Cancer-Related Traumatic Stress Symptoms of Siblings of Children with Cancer: A Preliminary Investigation. J Clin Psychol Med Settings 2021; 27:48-53. [PMID: 30993576 DOI: 10.1007/s10880-019-09618-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This pilot study examined changes in cancer-related post-traumatic stress symptoms (PTSS) across time for siblings of children with cancer. Siblings (N = 32; aged 8-18) completed a measure of anxiety, the Child PTSD Symptom Scale (CPSS), and the PTSD section of the Structured Clinical Interview for DSM-IV-TR (SCID) at twelve (SD = .9) and eighteen months (SD = 1.3) post-diagnosis. Moderate-to-severe PTSS was reported by 12 siblings (38%) at T1 and 7 (22%) at T2. Cluster analysis of PTSS data revealed five patterns: Few symptoms, stable across time (31%, n = 10); Mild symptoms, decreasing across time (16%, n = 5); Mild, stable symptoms (28%, n = 9); Moderate/severe symptoms, decreasing across time but remaining moderate (19%, n = 6); and Moderate/severe, stable symptoms (6%, n = 2). SCID data and anxiety scores distinguished siblings in the final two clusters from those with more favorable PTSS levels/trajectories. Additional research with larger samples is needed to validate these trajectories and examine factors that distinguish siblings with consistently elevated cancer-related PTSS from those with mild or significantly improving symptoms.
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Affiliation(s)
- Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health System/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA. .,Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA.
| | - Beth A Logan
- Division of Behavioral Health, Nemours Children's Health System/Alfred I. duPont Hospital for Children, Wilmington, DE, USA.,Hillman Center for Pediatric Transplantation, Children's Hospital of Pittsburgh at UPMC & University of Pittsburgh School of Medicine, Philadelphia, PA, USA
| | - Stephen DiDonato
- Center for Healthcare Delivery Science, Nemours Children's Health System/Alfred I. duPont Hospital for Children, 1600 Rockland Road, Wilmington, DE, 19803, USA.,Community & Trauma Counseling Program at Thomas Jefferson University, Philadelphia, PA, USA
| | - Leela Jackson
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia & Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marie J Hayes
- Department of Psychology, University of Maine, Orono, ME, USA
| | - Sandra T Sigmon
- Department of Psychology, University of Maine, Orono, ME, USA
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11
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Banz BC, Hersey D, Vaca FE. Coupling neuroscience and driving simulation: A systematic review of studies on crash-risk behaviors in young drivers. TRAFFIC INJURY PREVENTION 2020; 22:90-95. [PMID: 33320014 DOI: 10.1080/15389588.2020.1847283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/02/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Motor vehicle crashes are a leading cause of death for adolescents and young adults. The aim of this study is to examine and discuss the state-of-the-art literature which uses neuroscience methods in the context of driving simulation to study adolescent and young adult drivers. METHODS We conducted a systematic English-language literature search of Ovid MEDLINE (1946-2020), PsycINFO (1967-2020), PubMed, Web of Science, SCOPUS, and CINAHL using keywords and MeSH terms. Studies were excluded if participants were not within the ages of 15-25, if the driving simulator did not include a visual monitor/computer monitor/projection screen and steering wheel and foot pedals, or brain data (specifically EEG [electroencephalogram], fNIRS [functional near-infrared spectroscopy], or fMRI [functional magnetic resonance imaging]) was not collected at the same time as driving simulation data. RESULTS Seventy-six full text articles of the 736 studies that met inclusion criteria were included in the final review. The 76 articles used one of the following neuroscience methods: electrophysiology, functional near-infrared spectroscopy, or functional magnetic resonance imaging. In the identified studies, there were primarily two areas of investigation pursued; driving impairment and distraction in driving. Impairment studies primarily explored the areas of drowsy/fatigued driving or alcohol-impaired driving. Studies of distracted driving primarily focused on cognitive load and auditory and visual distractors. CONCLUSIONS Our state of the science systematic review highlights the feasibility for coupling neuroscience with driving simulation to study the neurocorrelates of driving behaviors in the context of young drivers and neuromaturation. Findings show that, to date, most research has focused on examining brain correlates and driving behaviors related to contributing factors for fatal motor vehicle crashes. However, there remains a considerable paucity of research designed to understand underlying brain mechanisms that might otherwise facilitate greater understanding of individual variability of normative and risky driving behavior within the young driving population.
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Affiliation(s)
- Barbara C Banz
- Yale Developmental Neurocognitive Driving Simulation Research Center (DrivSim Lab), Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Denise Hersey
- Dana Medical Library, University of Vermont, Burlington, Vermont
| | - Federico E Vaca
- Yale Developmental Neurocognitive Driving Simulation Research Center (DrivSim Lab), Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut
- Child Study Center, Yale University School of Medicine, New Haven, Connecticut
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12
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Walker JR, Teague B, Memarzia J, Meiser-Stedman R. Acute stress disorder in children and adolescents: A systematic review and meta-analysis of prevalence following exposure to a traumatic event. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2020. [DOI: 10.1016/j.jadr.2020.100041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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13
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Simons M, De Young A, McPhail SM, Harvey G, Kenardy J, Kularatna S, Kimble R, Tyack Z. A web-based educational intervention to implement trauma-informed care in a paediatric healthcare setting: protocol for a feasibility study using pre-post mixed methods design. Pilot Feasibility Stud 2020; 6:118. [PMID: 32832097 PMCID: PMC7436985 DOI: 10.1186/s40814-020-00636-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 06/26/2020] [Indexed: 11/22/2022] Open
Abstract
Background Adoption of responsive trauma-informed practices by staff in hospital-based paediatric care may help mitigate downstream costs associated with treatment delivery due to reduced pain and distress for children and care providers, improved health-related quality of life and increased satisfaction with care. A web-based education intervention (termed Responsive CARE) was developed to build self-efficacy of staff in a paediatric medical setting. This protocol paper describes a feasibility study (including preliminary effectiveness) of the implementation of Responsive CARE in a tertiary, outpatient burn clinical setting. Methods A pre-post, mixed methods design will be employed. Children and caregivers attending hospital for change of burn wound dressings or burn scar management during the 3-month control or 3-month intervention period will be eligible, with follow-up to 6-months post-baseline. All children and caregiver/s will receive “standard care” including burn interventions focused on wound healing, scar management, itch management (both pharmacological and non-pharmacological), counselling, age-appropriate procedural support and burn rehabilitation. Health professional participants will be those involved in the management of children with burns during the study period or their senior managers. Health professional participants who attend a weekly educational clinical meeting will be invited to complete the intervention during a 1-month timeframe between the control and intervention period (or upon their commencement in burn outpatients during the intervention period) using an individualised log-in process. A purposive sample of caregivers and health professionals will be sought for participation in semi-structured interviews. Qualitative data will be analysed using Framework analysis. Feasibility will be evaluated via interviews, digital records of intervention usage and technical assistance logs. The primary outcome measures of effectiveness (pain, itch and distress) will be measured using self-report or behavioural observation. Quantitative data will primarily be analysed descriptively and using generalised linear models. Discussion This study will provide insights into factors that impact upon the feasibility of a web-based trauma-informed care education intervention in a clinical practice setting. This knowledge may support other education approaches within healthcare settings related to improving and supporting patients to reduce the risk of healthcare interactions that result in paediatric medical traumatic stress.
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Affiliation(s)
- Megan Simons
- Occupational Therapy Department, Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, 501 Stanley Street, South Brisbane, Queensland 4101 Australia.,Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia
| | - Alexandra De Young
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia.,School of Psychology, The University of Queensland, St Lucia, Queensland 4072 Australia
| | - Steven M McPhail
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059 Australia.,Clinical Informatics Directorate, Metro South Health, 199 Ipswich Road, Woolloongabba, Queensland 4102 Australia
| | - Gillian Harvey
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059 Australia
| | - Justin Kenardy
- School of Psychology, The University of Queensland, St Lucia, Queensland 4072 Australia
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation (AusHSI) and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove, Queensland 4059 Australia
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia
| | - Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, The University of Queensland, 62 Graham Street, South Brisbane, Queensland 4101 Australia
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14
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The Course of Posttraumatic Stress in Children: Examination of Symptom Trajectories and Predictive Factors Following Admission to Pediatric Intensive Care. Pediatr Crit Care Med 2020; 21:e399-e406. [PMID: 32224826 DOI: 10.1097/pcc.0000000000002316] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES This study investigated trauma symptom trajectories of children 2-16 years old following admission to pediatric intensive care and identified factors that predicted a child's trauma symptom trajectory. DESIGN Prospective longitudinal design. SETTING Two tertiary care PICUs in Brisbane, Qld, Australia. PATIENTS Children 2-16 years old admitted to PICU for longer than 8 hours. MEASUREMENTS MAIN RESULTS Maternal reported child posttraumatic stress symptoms (n = 272) on the Trauma Symptom Checklist for Young Children were used to assess posttraumatic stress symptoms up to 12 months post admission. Semiparametric group-based trajectory analyses were completed to identify patterns over time. Age, gender, length of stay, premorbid functioning, maternal perceived threat to life, and maternal acute distress were assessed as potential risk factors. Three likely trajectory groups were identified. The majority of children were resilient (83.8%); however, a significant minority experienced chronic symptoms (12.9%) or elevated stress symptoms which resolved quickly (3.3%). After controlling for other variables, maternal report of premorbid internalizing behavior significantly predicted both chronic (odds ratio, 6.3) and recovery (odds ratio, 38.0) trajectories. Maternal acute distress significantly predicted child chronic symptom trajectories (odds ratio, 5.2). CONCLUSIONS Children with elevated trauma symptoms postintensive care need timely and effective intervention. The majority of children with high levels of acute symptoms will continue to have chronic, ongoing posttraumatic stress symptoms. In addition, acute maternal distress and preexisting internalizing child behavior predict ongoing psychologic distress after discharge from the PICU. Screening in the acute period post-PICU admission may identify children likely to experience ongoing chronic posttraumatic distress symptoms and enable targeted treatment of children at risk. This is the first study to examine symptom trajectories in children following pediatric intensive care admission and includes a sample of very young children.
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15
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Pinquart M. Posttraumatic Stress Symptoms and Disorders in Children and Adolescents with Chronic Physical Illnesses: a Meta-Analysis. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:1-10. [PMID: 32318223 PMCID: PMC7163825 DOI: 10.1007/s40653-018-0222-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The aim of the present meta-analysis was to compare levels of posttraumatic stress symptoms (PTSS) and the prevalence of posttraumatic stress disorders (PTSD) in individuals with and without pediatric chronic physical illnesses, and to analyze correlates of these symptoms. In total, 150 studies were identified that provided relevant data. On average, 11.5% of the participants with pediatric chronic physical illnesses met the criteria of PTSD (Odds Ratio 2.70). PTSS were also more common in this group than in control groups without chronic physical illnesses. While the PTSS levels did not differ across physical diseases, we found positive associations of PTSS with illness severity and duration/intensity of treatment, as well as negative associations with duration of illness, time since last treatment, treatment adherence, and family functioning. We conclude that individuals with pediatric chronic physical illnesses who experienced traumatic events should be screened for PTSS and receive psychological interventions when needed.
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Affiliation(s)
- Martin Pinquart
- Department of Psychology, Philipps University, Gutenbergstr. 18, D-35032 Marburg, Germany
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16
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Kassam-Adams N, Kenardy JA, Delahanty DL, Marsac ML, Meiser-Stedman R, Nixon RDV, Landolt MA, Palmieri PA. Development of an international data repository and research resource: the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive. Eur J Psychotraumatol 2020; 11:1729025. [PMID: 32284820 PMCID: PMC7144287 DOI: 10.1080/20008198.2020.1729025] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 01/29/2020] [Accepted: 02/06/2020] [Indexed: 12/02/2022] Open
Abstract
Background: Studies that identify children after acute trauma and prospectively track risk/protective factors and trauma responses over time are resource-intensive; small sample sizes often limit power and generalizability. The Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive was created to facilitate more robust integrative cross-study data analyses. Objectives: To (a) describe creation of this research resource, including harmonization of key variables; (b) describe key study- and participant-level variables; and (c) examine retention to follow-up across studies. Methods: For the first 30 studies in the Archive, we described study-level (design factors, retention rates) and participant-level (demographic, event, traumatic stress) variables. We used Chi square or ANOVA to examine study- and participant-level variables potentially associated with retention. Results: These 30 prospective studies (N per study = 50 to 568; overall N = 5499) conducted by 15 research teams in 5 countries enrolled children exposed to injury (46%), disaster (24%), violence (13%), traffic accidents (10%), or other acute events. Participants were school-age or adolescent (97%), 60% were male, and approximately half were of minority ethnicity. Using harmonized data from 22 measures, 24% reported significant traumatic stress ≥1 month post-event. Other commonly assessed outcomes included depression (19 studies), internalizing/externalizing symptoms (19), and parent mental health (19). Studies involved 2 to 5 research assessments; 80% of participants were retained for ≥2 assessments. At the study level, greater retention was associated with more planned assessments. At the participant level, adolescents, minority youth, and those of lower socioeconomic status had lower retention rates. Conclusion: This project demonstrates the feasibility and value of bringing together traumatic stress research data and making it available for re-use. As an ongoing research resource, the Archive can promote 'FAIR' data practices and facilitate integrated analyses to advance understanding of child traumatic stress.
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Affiliation(s)
- Nancy Kassam-Adams
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Justin A Kenardy
- Department of Psychology, University of Queensland, Brisbane, Australia
| | | | - Meghan L Marsac
- Department of Pediatrics, University of Kentucky, Lexington, KY, USA
| | - Richard Meiser-Stedman
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | | | - Markus A Landolt
- Child and Adolescent Health Psychology, University of Zurich, Zurich, Switzerland
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17
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Lenferink LIM, Egberts MR, Kullberg ML, Meentken MG, Zimmermann S, L Mertens Y, A T Schuurmans A, Sadeh Y, Kassam-Adams N, Krause-Utz A. Latent classes of DSM-5 acute stress disorder symptoms in children after single-incident trauma: findings from an international data archive. Eur J Psychotraumatol 2020; 11:1717156. [PMID: 32128042 PMCID: PMC7034476 DOI: 10.1080/20008198.2020.1717156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/15/2022] Open
Abstract
Background: After a potentially traumatic event (PTE), children often show symptoms of acute stress disorder (ASD), which may evolve into posttraumatic stress (PTS) disorder. A growing body of literature has employed latent class analysis (LCA) to disentangle the complex structure underlying PTS symptomatology, distinguishing between homogeneous subgroups based on PTS presentations. So far, little is known about subgroups or classes of ASD reactions in trauma-exposed children. Objective: Our study aimed to identify latent classes of ASD symptoms in children exposed to a single-incident PTE and to identify predictors of class membership (gender, age, cultural background, parental education, trauma type, and trauma history). Method: A sample of 2287 children and adolescents (5-18 years) was derived from the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive, an international archive including studies from the USA, UK, Australia, and Switzerland. LCA was used to determine distinct subgroups based on ASD symptoms. Predictors of class membership were examined using a three-step approach. Results: Our LCA yielded a three-class solution: low (42%), intermediate (43%) and high (15%) ASD symptom severity that differed in terms of impairment and number of endorsed ASD symptoms. Compared to the low symptoms class, children in the intermediate or high severity class were more likely to be of female gender, be younger of age, have parents who had not completed secondary education, and be exposed to a road traffic accident or interpersonal violence (vs. an unintentional injury). Conclusions: These findings provide new information on children at risk for ASD after single-incident trauma, based on a unique set of international data. Classifying children based on latent symptom profiles helps to identify target groups for prevention and intervention after exposure to a PTE.
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Affiliation(s)
- Lonneke I M Lenferink
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Marthe R Egberts
- Department of Clinical Psychology, Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Maya G Meentken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Sarah Zimmermann
- Department of Developmental Psychology and Clinical Psychology across the Lifespan, University of Siegen, Siegen, Germany
| | - Yoki L Mertens
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioral and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Angela A T Schuurmans
- Calm Kids, Center for Child Psychology and Game Therapy, Duiven, The Netherlands.,Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Yaara Sadeh
- The Edmond and Lily Safra Children's Hospital, The Sheba Medical Center, Ramat Gan, Israel.,The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
| | - Nancy Kassam-Adams
- Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Annegret Krause-Utz
- Department of Clinical Psychology, Leiden University, Leiden, The Netherlands.,Leiden Institute for Brain and Cognition, Leiden, The Netherlands
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18
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Foster K, Mitchell R, Van C, Young A, McCloughen A, Curtis K. Resilient, recovering, distressed: A longitudinal qualitative study of parent psychosocial trajectories following child critical injury. Injury 2019; 50:1605-1611. [PMID: 31101410 DOI: 10.1016/j.injury.2019.05.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/02/2019] [Accepted: 05/04/2019] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The psychological distress and risk of mental health problems for parents of children with critical injury is well-established. There has been little exploration, however, of parent experiences and psychosocial trajectories over time following child critical injury. To address this knowledge gap, a longitudinal qualitative study was conducted to explore parent experiences and support needs and identify parent psychosocial trajectories in the 12 months following child critical injury. METHODS Semi- structured in-depth interviews were conducted with 27 parents at three time points over a 12 month period: the immediate hospital period post-child injury, and 6 and 12 months following injury, resulting in a total of 81 interviews. Data were analysed using a longitudinal within and across-case thematic analysis of patterns emerging over time. FINDINGS Three parent trajectory patterns were identified: resilient trajectory where parents were temporarily disrupted by the child's injury and hospitalisation, but recovered their mental and emotional wellbeing quickly, which was maintained over time; recovering trajectory where parents were initially disrupted at the time of injury but their mental and emotional wellbeing fluctuated over time and had not been fully restored by 12 months; and distressed trajectory where parents experienced significant psychosocial disruption due to their child's injury and struggled to adapt and regain their wellbeing over time, remaining emotionally distressed about the circumstances and impacts of the injury on their child and family. Illustrative narratives that represent each trajectory are presented. CONCLUSIONS This is the first qualitative study to report the psychosocial trajectories of parents of critically injured children. Clinical application of insights provided by these trajectories can assist clinicians to use targeted strategies to help strengthen parental adaptation and prevent adverse mental health outcomes, and address families' psychosocial support needs following child injury. Screening for parent psychological distress and post-traumatic stress disorder is needed from the time of the child's admission, and a dedicated trauma support role can facilitate an integrated care approach for children and families with complex needs across the care continuum.
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Affiliation(s)
- Kim Foster
- Australian Catholic University, School of Nursing, Midwifery & Paramedicine, 115 Victoria Parade, Fitzroy, Victoria, 3065, Australia; Northwestern Mental Health, Melbourne Health, Grattan Street, Parkville, Victoria, 3050, Australia; Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown, NSW, 2006, Australia.
| | - Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, Macquarie University, NSW, 2109, Australia
| | - Connie Van
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown, NSW, 2006, Australia
| | - Alexandra Young
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown, NSW, 2006, Australia
| | - Andrea McCloughen
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown, NSW, 2006, Australia
| | - Kate Curtis
- Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, Faculty of Health and Medicine, The University of Sydney, 88 Mallett Street, Camperdown, NSW, 2006, Australia; Illawarra Shoalhaven Local Health District, Wollongong Hospital, Loftus Street, Wollongong, NSW, 2500, Australia; Illawarra Health and Medical Research Institute, Building 32, University of Wollongong, Northfields Avenue, Wollongong, NSW, 2522, Australia; The George Institute for Global Health, Level 5, 1 King Street, Newtown, NSW, 2042, Australia
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19
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de Haan A, Keller F, Ganser HG, Münzer A, Witt A, Goldbeck L. Longitudinal Associations Between Dysfunctional Maltreatment-Related Cognitions and Psychopathology in Children and Adolescents. J Trauma Stress 2019; 32:496-505. [PMID: 31291484 DOI: 10.1002/jts.22422] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 02/08/2019] [Accepted: 02/18/2019] [Indexed: 12/19/2022]
Abstract
Dysfunctional posttraumatic cognitions seem to play an important role in adjustment after traumatic experiences. However, little research has been done on maltreated children and adolescents. Furthermore, possible causal associations between cognitions, posttraumatic stress symptoms, and internalizing and externalizing problems have rarely been investigated. In the current study, 263 maltreated children and adolescents (8-17 years of age) were assessed at baseline and again at time points 6 and either 12 or 18 months later. Cross-lagged panel analyses were used to gain a better understanding of the course of and associations among dysfunctional maltreatment-related cognitions, posttraumatic stress symptoms, and internalizing and externalizing problems. Ratings of all variables significantly decreased over time. Moderate to strong autoregressive paths emerged for all variables, denoting stability. Furthermore, the variables showed moderate to high correlations at every assessment. Posttraumatic stress symptoms moderately predicted dysfunctional maltreatment-related cognitions as well as internalizing and externalizing problems 6 months after baseline. Cross-lagged paths from the cognitions as well as from internalizing and externalizing problems to all other variables were not significant. Age, gender, and maltreatment characteristics did not play a relevant role in these cross-lagged associations when they were included as covariates. Our results underline the cognitive scar model, in which preceding posttraumatic stress symptoms adversely impact cognitions. Posttraumatic stress symptoms appear to be an important target for treatment as their reduction may help decrease internalizing and externalizing problems as well.
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Affiliation(s)
- Anke de Haan
- Department of Psychology, Division of Child and Adolescent Health Psychology, University of Zurich, Zurich, Switzerland.,Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Ferdinand Keller
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Helene G Ganser
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Annika Münzer
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Andreas Witt
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
| | - Lutz Goldbeck
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Ulm, Ulm, Germany
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20
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Meijer L, Finkenauer C, Tierolf B, Lünnemann M, Steketee M. Trajectories of traumatic stress reactions in children exposed to intimate partner violence. CHILD ABUSE & NEGLECT 2019; 93:170-181. [PMID: 31108407 DOI: 10.1016/j.chiabu.2019.04.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 03/28/2019] [Accepted: 04/28/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Understanding different longitudinal patterns of traumatic stress reactions in children exposed to intimate partner violence (IPV) can promote early identification of at-risk children. OBJECTIVE Our study aims to explore trajectories of traumatic stress reactions following childhood IPV exposure, and their relation with parental traumatic stress and child emotional security in the interparental subsystem. PARTICIPANTS AND SETTING The sample comprised 303 children (age 3-10, M = 6.20) from families referred to institutions for IPV. Data were collected at home. METHODS Three waves of parent-reported questionnaire data were analyzed using latent class growth analysis and linear regression. RESULTS Five trajectories were identified: 'resilient', 'moderate stable', 'struggling', 'improving', and 'elevated adjusting'. Only the 'struggling' trajectory had dysfunctional symptom levels at the final wave. Higher parental traumatic stress predicted 'improving' trajectory membership (β = 0.17, p = .033), whereas lower parental traumatic stress (β = -0.20, p = .003) and child emotional insecurity (β = -0.45, p = < .001) predicted 'resilient' trajectory membership. Higher child emotional insecurity predicted membership in trajectories with higher initial traumatic stress (improving: β = 0.26, p < .001; struggling: β = 0.31, p < .001; elevated adjusting: β = 0.27, p < .001). Child emotional security did not buffer the effect of parental traumatic stress on likelihood of dysfunctional trajectory membership (β = 0.04, p =.380). CONCLUSIONS Children exposed to IPV show different trajectories of traumatic stress reactions, partly corresponding to trajectories identified in other populations. Child emotional security and parental traumatic stress predict trajectory membership.
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Affiliation(s)
- Laurien Meijer
- Utrecht University, PO Box 80125, 3508 TC, Utrecht, the Netherlands; Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands.
| | - Catrin Finkenauer
- Utrecht University, PO Box 80125, 3508 TC, Utrecht, the Netherlands; Heidelberglaan 1, 3584 CS, Utrecht, the Netherlands.
| | - Bas Tierolf
- Verwey-Jonker Institute, Kromme Nieuwegracht 6, 3512 HG, Utrecht, the Netherlands; Kromme Nieuwegracht 6, 3512 HG, Utrecht, the Netherlands.
| | - Milou Lünnemann
- Verwey-Jonker Institute, Kromme Nieuwegracht 6, 3512 HG, Utrecht, the Netherlands; Kromme Nieuwegracht 6, 3512 HG, Utrecht, the Netherlands; Erasmus University, PO Box 1738, 3000 DR, Rotterdam, the Netherlands.
| | - Majone Steketee
- Verwey-Jonker Institute, Kromme Nieuwegracht 6, 3512 HG, Utrecht, the Netherlands; Kromme Nieuwegracht 6, 3512 HG, Utrecht, the Netherlands.
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21
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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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22
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McGuire R, Hiller RM, Cobham V, Haag K, Halligan SL. A mixed-methods investigation of parent-child posttrauma discussion and the effects of encouraging engagement. Eur J Psychotraumatol 2019; 10:1644127. [PMID: 31489132 PMCID: PMC6711190 DOI: 10.1080/20008198.2019.1644127] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/14/2019] [Accepted: 06/23/2019] [Indexed: 11/15/2022] Open
Abstract
Recent developments in the child trauma field include preventative interventions that focus on augmenting parental support. However, we have limited knowledge of how parents experience trauma conversations with children. We examined how parents and children experienced both spontaneous trauma conversations and a structured task in which they generated a joint trauma narrative, following the child's experience of an acute trauma. Parent and child ratings of distress during the structured narrative were low for all 127 families that took part, with child ratings of distress being lower overall than parent ratings. Task-related distress was positively associated with parent and child PTSD symptoms. Thematic analysis of semi-structured interviews conducted with a subset of twenty parents identified both facilitators of (e.g. open and honest relationship with child) and barriers to (e.g. parent/child avoidance of discussion) spontaneous trauma-related conversations with their child. Additionally, parents described the structured trauma narrative task as an opportunity to start the conversation with their child, to understand their child's feelings, and for the child to process the trauma. However, the task was also uncomfortable or upsetting for some parents/children, and resulted in parents becoming more overprotective. The findings can inform development of low-dose interventions that encourage families to engage in trauma-related conversations following child experiences of trauma.
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Affiliation(s)
| | | | - Vanessa Cobham
- School of Psychology, The University of Queensland, Brisbane, Australia.,Children's Health QLD, Child and Youth Mental Health Service, Brisbane, Australia
| | | | - Sarah L Halligan
- Department of Psychology, University of Bath, UK.,Department of Psychiatry, University of Cape Town, Rondebosch, South Africa
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23
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Scratching Below the Surface: Screening for Posttraumatic Stress Symptoms Following Hospitalization With the Pediatric Trauma Service. J Trauma Nurs 2018; 25:228-232. [PMID: 29985855 DOI: 10.1097/jtn.0000000000000377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Significant progress has occurred medically for children who have experienced traumatic injuries; however, attention to their psychological adjustment has only more recently been a focus in research and clinical practice. These needs do not cease at discharge but, instead, require monitoring to determine whether further assessment and/or intervention are required. Our team, inclusive of the Psychology Service and the Trauma Service, identified 2 established screening measures (based on age) that were completed by patients during their outpatient follow-up visits postdischarge. Should a patient screen positive, the Trauma Service referred them to the Psychology Service for further evaluation and possible treatment (i.e., trauma-focused cognitive-behavioral therapy). Of 881 trauma activations, 31 (4%) patients were screened at an outpatient follow-up appointment through pediatric surgery/trauma clinic. Of these completed screening tools, 29% screened positive and warranted a referral to Psychology. Intervention was recommended for the majority of the patients evaluated; however, half of these did not return for this intervention. A collaboration between the Psychology Service and the Trauma Service is a vital step toward providing stepped care for patients after unintentional injuries. This allows for evaluation of patient needs and then a referral source to meet these identified needs. Future directions include increasing the number of screened patients, perhaps with use of technological supports (i.e., REDCap) or expansion into other clinics and consideration of ways to increase family's use of psychological intervention. LEVEL OF EVIDENCE Therapeutic/Care management Level IV.
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24
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Hiller RM, Creswell C, Meiser-Stedman R, Lobo S, Cowdrey F, Lyttle MD, Ehlers A, Halligan SL. A Longitudinal Examination of the Relationship between Trauma-Related Cognitive Factors and Internalising and Externalising Psychopathology in Physically Injured Children. JOURNAL OF ABNORMAL CHILD PSYCHOLOGY 2018; 47:683-693. [PMID: 30264278 PMCID: PMC6439173 DOI: 10.1007/s10802-018-0477-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cognitive models of posttraumatic stress disorder (PTSD) highlight maladaptive posttrauma appraisals, trauma memory qualities, and coping strategies, such as rumination or thought suppression, as key processes that maintain PTSD symptoms. Anxiety, depression and externalising symptoms can also present in children in the aftermath of trauma, yet there has been little empirical investigation of the potential relevance of posttrauma cognitive processes for such difficulties. Here, we examined whether: a) acute maladaptive cognitive processes (specifically, maladaptive appraisals, memory qualities, and cognitive coping) were associated with symptoms of PTSD, internalising, and externalising at 1-month posttrauma (T1); and b) changes in these cognitive processes predicted symptom change at a follow-up assessment 6 months later (T2). We recruited 132 6–13 year old children and their parents from emergency departments following the child’s experience of an acute trauma. Children self-reported on their maladaptive appraisals, trauma-memory and cognitive coping strategies, along with symptoms of PTSD, anxiety and depression. Parents also rated children’s internalising and externalising symptoms. We found each cognitive process to be robustly associated with PTSD and non-PTSD internalising symptoms at T1, and change in each predicted change in symptoms to T2. Maladaptive appraisals and cognitive coping were unique predictors of children’s posttrauma internalising. Effects were partially retained even controlling for co-occurring PTSD symptoms. There was less evidence that trauma-specific cognitive processes were associated with externalising symptoms. Findings suggest aspects of cognitive models of PTSD are applicable to broader posttrauma psychopathology, and have implications for how we understand and target children’s posttrauma psychological adjustment.
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Affiliation(s)
| | - Cathy Creswell
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | | | - Sarah Lobo
- Department of Psychology, University of Bath, Bath, UK
| | - Felicity Cowdrey
- Department of Psychology, University of Bath, Bath, UK.,Oxford Health NHS Foundation Trust, Cotswold House, Specialist Eating Disorder Service, Savernake Hospital, Marlborough, UK
| | - Mark D Lyttle
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK.,Faculty of Health and Applied Sciences, University of West England, Bristol, UK
| | - Anke Ehlers
- Department of Experimental Psychology, University of Oxford, Oxford, UK
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Development and validity of the Burns-Child Adult Medical Procedure Interaction Scale (B-CAMPIS) for young children. Burns 2018; 45:76-87. [PMID: 30274811 DOI: 10.1016/j.burns.2018.08.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 08/13/2018] [Accepted: 08/17/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Young children are at increased risk of burn injury and of procedural distress during the subsequent wound care. There are currently few observational measures validated for use with young children during medical procedures. The aim of this research was to adapt the Child-Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R) to assess parent-young child interactions during burn wound care by including nonverbal behavioral coding. METHOD Eighty-seven families of children (1-6years old) were recruited at their first burn dressing change. Potential behaviors were identified through a literature review, consulting health professionals, and direct observation of parents and children during burn wound care. Nonverbal behaviors were coded live, and verbal behaviors were audio recorded for later assessment. RESULTS Inter-coder reliability was good to excellent for the Burns-CAMPIS (B-CAMPIS). The additional behaviors were correlated with the hypothesized coping, distress, coping-promoting and distress-promoting categories of the CAMPIS-R. Some behaviors differed in frequency across child age groups, with older children demonstrating more verbal behaviors. Convergent validity was demonstrated through correlations with previously validated observational parent-child behavior measures, and parent- and nurse- reported measures of child pain and anxiety. Univariate regression analyses demonstrated the child categories of the B-CAMPIS accounted for equal or more of the variance of parent- and nurse- reported child pain and anxiety, compared to the CAMPIS-R. CONCLUSIONS The B-CAMPIS is a reliable and valid measure, for assessing coping and distress relationships in young children and their families. Pending further validation, the B-CAMPIS assists researchers and clinicians to recognize and target important behaviors to improve young child coping during pediatric burn wound care.
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Fava NM, Bay-Cheng LY, Nochajski TH, Bowker JC, Hayes T. A resilience framework: Sexual health trajectories of youth with maltreatment histories. J Trauma Dissociation 2018; 19:444-460. [PMID: 29601293 DOI: 10.1080/15299732.2018.1451974] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
There is a wealth of knowledge regarding negative sexual outcomes experienced by youth with childhood maltreatment (CM) histories, yet a dearth of research examines healthy sexual development among these youth. This gap exists despite evidence of resilience highlighting alternative and healthy physical, social, and psychological futures for youth who were abused. This study tested whether trajectories of resilience identified in studies of psychological functioning were applicable to sexual health. Using data from the first four waves of the National Longitudinal Study of Adolescent to Adult Health, latent class growth analysis was conducted among individuals with histories of CM (N = 1,437). On average, participants were 15, 16, 21, and 28 years old, respectively, by waves of data collection. About half of the sample was female (55%), the majority were White (66%), and a sizeable portion had experienced multiple forms of CM prior to Wave I (38%). Controlling for CM severity, three distinct sexual health trajectory classes were identified: resilient, survival, and improving, which were differentiated by age and biological sex. Older participants' sexual health was more likely to diminish over time, girls were more likely to show gains in sexual health over time, and significant differences in levels of sexual behaviors between the classes were only present during adolescence. Findings support the need for increased attention on the potential for sexual health despite experiences of CM, and highlight the applicability of resilience theory to youth sexuality.
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Affiliation(s)
- Nicole M Fava
- a Robert Stempel College of Public Health & Social Work , Florida International University , Miami , FL , USA.,e Center for Children and Families , Florida International University , Miami , FL , USA
| | - Laina Y Bay-Cheng
- b School of Social Work , University at Buffalo , Buffalo , NY , USA
| | | | - Julie C Bowker
- c Department of Psychology , University at Buffalo , Buffalo , NY , USA
| | - Timothy Hayes
- d Department of Psychology , Florida International University , Miami , FL , USA.,e Center for Children and Families , Florida International University , Miami , FL , USA
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Galatzer-Levy IR, Huang SH, Bonanno GA. Trajectories of resilience and dysfunction following potential trauma: A review and statistical evaluation. Clin Psychol Rev 2018; 63:41-55. [PMID: 29902711 DOI: 10.1016/j.cpr.2018.05.008] [Citation(s) in RCA: 368] [Impact Index Per Article: 61.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 02/08/2023]
Abstract
Given the rapid proliferation of trajectory-based approaches to study clinical consequences to stress and potentially traumatic events (PTEs), there is a need to evaluate emerging findings. This review examined convergence/divergences across 54 studies in the nature and prevalence of response trajectories, and determined potential sources of bias to improve future research. Of the 67 cases that emerged from the 54 studies, the most consistently observed trajectories following PTEs were resilience (observed in: n = 63 cases), recovery (n = 49), chronic (n = 47), and delayed onset (n = 22). The resilience trajectory was the modal response across studies (average of 65.7% across populations, 95% CI [0.616, 0.698]), followed in prevalence by recovery (20.8% [0.162, 0.258]), chronicity (10.6%, [0.086, 0.127]), and delayed onset (8.9% [0.053, 0.133]). Sources of heterogeneity in estimates primarily resulted from substantive population differences rather than bias, which was observed when prospective data is lacking. Overall, prototypical trajectories have been identified across independent studies in relatively consistent proportions, with resilience being the modal response to adversity. Thus, trajectory models robustly identify clinically relevant patterns of response to potential trauma, and are important for studying determinants, consequences, and modifiers of course following potential trauma.
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Mother, father and child traumatic stress reactions after paediatric burn: Within-family co-occurrence and parent-child discrepancies in appraisals of child stress. Burns 2018; 44:861-869. [DOI: 10.1016/j.burns.2018.01.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 11/29/2017] [Accepted: 01/05/2018] [Indexed: 01/31/2023]
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Dikmen-Yildiz P, Ayers S, Phillips L. Longitudinal trajectories of post-traumatic stress disorder (PTSD) after birth and associated risk factors. J Affect Disord 2018; 229:377-385. [PMID: 29331697 DOI: 10.1016/j.jad.2017.12.074] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/21/2017] [Accepted: 12/31/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although longitudinal trajectories of post-traumatic stress disorder (PTSD) are well-established in general trauma populations, very little is known about the trajectories of birth-related PTSD. This study aimed to identify trajectories of birth-related PTSD; determine factors associated with each trajectory; and identify women more likely to develop birth-related PTSD. METHOD 226 women who had traumatic childbirth according to DSM-IV criterion A were drawn from a community sample of 950 women. Measures were taken of PTSD, affective symptoms, fear of childbirth and social support in pregnancy, 4-6 weeks and 6-months postpartum. Information on some obstetric and psychosocial factors were also prospectively obtained. RESULTS Four trajectories were identified: resilience (61.9%), recovery (18.5%), chronic-PTSD (13.7%) and delayed-PTSD (5.8%). Resilience was consistently distinguished from other PTSD trajectories by less affective symptoms at 4-6 weeks postpartum. Poor satisfaction with health professionals was associated with chronic-PTSD and delayed-PTSD. When affective symptoms at 4-6 weeks postpartum were removed from the model, less social support and higher fear of childbirth 4-6 weeks after birth predicted chronic and recovery trajectories; whereas experience of further trauma and low levels of satisfaction with health professionals were predictive of chronic-PTSD and delayed-PTSD, compared to resilience. Additional variables associated with different trajectories included antenatal affective symptoms, caesarean-section, preterm birth and receiving professional help. LIMITATIONS Use of self-report measures, use of DSM-IV criteria for PTSD diagnosis, and no follow-up beyond six months are the main limitations of this study. CONCLUSION Identified factors may inform preventive and treatment interventions for women with traumatic birth experiences.
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Affiliation(s)
- Pelin Dikmen-Yildiz
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK.
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK.
| | - Louise Phillips
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, Northampton Square, London EC1V 0HB, UK.
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van de Schoot R, Sijbrandij M, Depaoli S, Winter SD, Olff M, van Loey NE. Bayesian PTSD-Trajectory Analysis with Informed Priors Based on a Systematic Literature Search and Expert Elicitation. MULTIVARIATE BEHAVIORAL RESEARCH 2018; 53:267-291. [PMID: 29324055 DOI: 10.1080/00273171.2017.1412293] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There is a recent increase in interest of Bayesian analysis. However, little effort has been made thus far to directly incorporate background knowledge via the prior distribution into the analyses. This process might be especially useful in the context of latent growth mixture modeling when one or more of the latent groups are expected to be relatively small due to what we refer to as limited data. We argue that the use of Bayesian statistics has great advantages in limited data situations, but only if background knowledge can be incorporated into the analysis via prior distributions. We highlight these advantages through a data set including patients with burn injuries and analyze trajectories of posttraumatic stress symptoms using the Bayesian framework following the steps of the WAMBS-checklist. In the included example, we illustrate how to obtain background information using previous literature based on a systematic literature search and by using expert knowledge. Finally, we show how to translate this knowledge into prior distributions and we illustrate the importance of conducting a prior sensitivity analysis. Although our example is from the trauma field, the techniques we illustrate can be applied to any field.
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Affiliation(s)
- Rens van de Schoot
- a Department of Methods and Statistics , Utrecht University
- b Optentia Research Program, Faculty of Humanities , North-West University
| | - Marit Sijbrandij
- c Clinical, Neuro- en Developmental Psychology , VU University Amsterdam
| | | | - Sonja D Winter
- a Department of Methods and Statistics , Utrecht University
| | - Miranda Olff
- e Department of Psychiatry, Academic Medical Center , University of Amsterdam
- f Arq Psychotrauma Expert Group , Diemen the Netherlands
| | - Nancy E van Loey
- g Department of Clinical Psychology , Utrecht University
- h Association of Dutch Burns Centers , Department of Behavioral Research
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Brown EA, De Young A, Kimble R, Kenardy J. Review of a Parent’s Influence on Pediatric Procedural Distress and Recovery. Clin Child Fam Psychol Rev 2018; 21:224-245. [DOI: 10.1007/s10567-017-0252-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Rachamim L. FEASIBILITY AND EFFECTIVENESS OF DYADIC PROLONGED EXPOSURE INTERVENTION FOR PREVENTING POSTTRAUMATIC GRIEF IN YOUNG CHILDREN: A CASE REPORT OF TWO SIBLINGS. Infant Ment Health J 2017; 38:680-690. [PMID: 28806862 DOI: 10.1002/imhj.21659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article highlights the feasibility of a dyadic prolonged exposure (DPE) intervention (L. Rachamim, I. Mirochnik, L. Helpman, N. Nacasch, & E. Yadin, ) in a 3-year-old preschooler and in a 6-year-old kindergartener immediately following the traumatic death of their younger sibling. It presents a detailed case description of the DPE treatment addressing traumatic grief and includes transcribed treatment dialogue. At the time of treatment termination, both children and caregivers resumed normal functioning. The results suggest that DPE intervention may ameliorate posttraumatic grief symptoms in young children. Controlled studies of preventive interventions for this population are clearly warranted.
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Affiliation(s)
- Lilach Rachamim
- Interdisciplinary Center Herzliya and the Donald J. Cohen & Irving B. Harris Resilience Center for Trauma and Disaster Intervention
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Truss K, Godfrey C, Takagi M, Babl FE, Bressan S, Hearps S, Clarke C, Dunne K, Anderson V. Trajectories and Risk Factors for Post-Traumatic Stress Symptoms following Pediatric Concussion. J Neurotrauma 2017; 34:2272-2279. [PMID: 28293983 DOI: 10.1089/neu.2016.4842] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A substantial minority of children experience post-traumatic stress symptoms (PTSS) following injury. Research indicates variation in the trajectory of PTSS following pediatric injury, but investigation of PTSS following concussion has assumed homogeneity. This study aimed to identify differential trajectories of PTSS following pediatric concussion and to investigate risk factors, including acute post-concussive symptoms (PCS), associated with these trajectories. A total of 120 children ages 8-18 years reported PTSS for 3 months following concussion diagnosis using the Child PTSD Symptom Scale, with a score of 16 or above indicating probable post-traumatic stress disorder diagnosis. Age, gender, injury mechanism, loss of consciousness, previous concussions, prior hospitalization, prior diagnosis of depression or anxiety, and acute PCS were assessed as risk factors. Data were analyzed using group-based trajectory modeling. Results revealed 16% of children had clinically significant PTSS 2 weeks post-concussion, declining to 10% at 1 month and 6% at 3 months post-injury. Group-based trajectory modeling identified three trajectories of PTSS post-concussion: "resilient" (70%); "recovering" (25%), in which children experienced elevated acute symptoms that declined over time; and "chronic symptomatology" (5%). Due to small size, the chronic group should be interpreted with caution. Higher acute PCS and prior diagnosis of depression or anxiety both significantly increased predicted probability of recovering trajectory group membership. These findings establish that most children are resilient to PTSS following concussion, but that PTSS do occur acutely in a substantial minority of children. The study indicates mental health factors, particularly PTSS, depression, and anxiety, should be considered integral to models of concussion management and treatment.
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Affiliation(s)
- Katherine Truss
- 1 Murdoch Childrens Research Institute , Melbourne, Australia .,2 School of Psychological Sciences, University of Melbourne , Melbourne, Australia
| | - Celia Godfrey
- 1 Murdoch Childrens Research Institute , Melbourne, Australia .,3 Department of Pediatrics, University of Melbourne , Melbourne, Australia
| | - Michael Takagi
- 1 Murdoch Childrens Research Institute , Melbourne, Australia
| | - Franz E Babl
- 1 Murdoch Childrens Research Institute , Melbourne, Australia .,3 Department of Pediatrics, University of Melbourne , Melbourne, Australia .,4 Emergency Department, Royal Children's Hospital , Melbourne, Australia
| | - Silvia Bressan
- 1 Murdoch Childrens Research Institute , Melbourne, Australia .,5 Department of Women's and Children's Health, University of Padova , Padova, Italy
| | - Stephen Hearps
- 1 Murdoch Childrens Research Institute , Melbourne, Australia
| | | | - Kevin Dunne
- 1 Murdoch Childrens Research Institute , Melbourne, Australia .,3 Department of Pediatrics, University of Melbourne , Melbourne, Australia .,6 Department of Rehabilitation Medicine, Royal Children's Hospital , Melbourne, Australia
| | - Vicki Anderson
- 1 Murdoch Childrens Research Institute , Melbourne, Australia .,2 School of Psychological Sciences, University of Melbourne , Melbourne, Australia .,7 Psychology Service, Royal Children's Hospital , Melbourne, Australia
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Meiser‐Stedman R, Smith P, McKinnon A, Dixon C, Trickey D, Ehlers A, Clark DM, Boyle A, Watson P, Goodyer I, Dalgleish T. Cognitive therapy as an early treatment for post-traumatic stress disorder in children and adolescents: a randomized controlled trial addressing preliminary efficacy and mechanisms of action. J Child Psychol Psychiatry 2017; 58:623-633. [PMID: 27976374 PMCID: PMC5362068 DOI: 10.1111/jcpp.12673] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2016] [Indexed: 01/03/2023]
Abstract
BACKGROUND Few efficacious early treatments for post-traumatic stress disorder (PTSD) in children and adolescents exist. Previous trials have intervened within the first month post-trauma and focused on secondary prevention of later post-traumatic stress; however, considerable natural recovery may still occur up to 6-months post-trauma. No trials have addressed the early treatment of established PTSD (i.e. 2- to 6-months post-trauma). METHODS Twenty-nine youth (8-17 years) with PTSD (according to age-appropriate DSM-IV or ICD-10 diagnostic criteria) after a single-event trauma in the previous 2-6 months were randomly allocated to Cognitive Therapy for PTSD (CT-PTSD; n = 14) or waiting list (WL; n = 15) for 10 weeks. RESULTS Significantly more participants were free of PTSD after CT-PTSD (71%) than WL (27%) at posttreatment (intent-to-treat, 95% CI for difference .04-.71). CT-PTSD yielded greater improvement on child-report questionnaire measures of PTSD, depression and anxiety; clinician-rated functioning; and parent-reported outcomes. Recovery after CT-PTSD was maintained at 6- and 12-month posttreatment. Beneficial effects of CT-PTSD were mediated through changes in appraisals and safety-seeking behaviours, as predicted by cognitive models of PTSD. CT-PTSD was considered acceptable on the basis of low dropout and high treatment credibility and therapist alliance ratings. CONCLUSIONS This trial provides preliminary support for the efficacy and acceptability of CT-PTSD as an early treatment for PTSD in youth. Moreover, the trial did not support the extension of 'watchful waiting' into the 2- to 6-month post-trauma window, as significant improvements in the WL arm (particularly in terms of functioning and depression) were not observed. Replication in larger samples is needed, but attention to recruitment issues will be required.
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Affiliation(s)
- Richard Meiser‐Stedman
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
- Department of Clinical PsychologyUniversity of East AngliaNorwichUK
| | - Patrick Smith
- Institute of Psychiatry, Psychology and NeuroscienceKing's College LondonLondonUK
| | - Anna McKinnon
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
- Present address: Macquarie UniversitySydneyNSWAustralia
| | - Clare Dixon
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
- Present address: University of BathBathUK
| | | | | | | | - Adrian Boyle
- Cambridge University Hospitals NHS Foundation TrustCambridgeUK
| | - Peter Watson
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
| | | | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences UnitCambridgeUK
- Cambridgeshire and Peterborough NHS Foundation TrustCambridgeUK
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Ionio C, Salvatici E, Confalonieri E, Milani L, Mascheroni E, Riva E, Giovannini M. Mothers and fathers facing their children’s phenylketonuria. CHILDRENS HEALTH CARE 2017. [DOI: 10.1080/02739615.2016.1275643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Chiara Ionio
- CRIdee, Department of Psychology, Università Cattolica, Milano, Italy
| | - Elisabetta Salvatici
- Clinical Department of Pediatrics, S. Paolo Hospital, University of Milan, Milan, Italy
| | | | - Luca Milani
- CRIdee, Department of Psychology, Università Cattolica, Milano, Italy
| | | | - Enrica Riva
- Clinical Department of Pediatrics, S. Paolo Hospital, University of Milan, Milan, Italy
| | - Marcello Giovannini
- Clinical Department of Pediatrics, S. Paolo Hospital, University of Milan, Milan, Italy
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Meiser-Stedman R, McKinnon A, Dixon C, Boyle A, Smith P, Dalgleish T. Acute stress disorder and the transition to posttraumatic stress disorder in children and adolescents: Prevalence, course, prognosis, diagnostic suitability, and risk markers. Depress Anxiety 2017; 34:348-355. [PMID: 28135019 PMCID: PMC5381710 DOI: 10.1002/da.22602] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 12/09/2016] [Accepted: 12/24/2016] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Early recovery from trauma exposure in youth is poorly understood. This prospective longitudinal study examined the early course of traumatic stress responses in recently trauma-exposed youth, evaluated the revised DSM-5 acute stress disorder (ASD) and PTSD diagnoses and alternative diagnoses, and identified risk factors for persistent traumatic stress. METHOD Participants were 8- to 17-year-old emergency departments attendees exposed to single incident traumas. Structured clinical interviews were undertaken at 2 (n = 226) and 9 weeks (n = 208) posttrauma. RESULTS Using the revised criteria in DSM-5, 14.2% met criteria for ASD at week 2 and 9.6% met criteria for PTSD at week 9. These prevalences were similar to the corresponding DSM-IV diagnoses (18.6% ASD at week 2; 8.7% PTSD at week 9). Using the same diagnostic criteria (DSM-IV or DSM-5) across assessments (i.e., "2-week PTSD") suggested that caseness declined in prevalence by approximately half. Overlap between DSM-IV and DSM-5 ASD and DSM-5 preschool child PTSD diagnoses was considerable. Two diagnoses were strongly predictive of corresponding week 9 diagnoses. Youth with ASD who subsequently had PTSD reported more negative alterations in cognition and mood at 2 weeks than those youth who did not develop PTSD. CONCLUSIONS Youth exposed to single-event traumas experience considerable natural recovery in the first months posttrauma. Using DSM-5 criteria, ASD may not capture all clinically significant traumatic stress in the acute phase and is only moderately sensitive for later PTSD. Future research needs to address the role and etiology of negative alterations in cognition and mood symptoms.
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Affiliation(s)
- Richard Meiser-Stedman
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge.,Department of Clinical Psychology, University of East Anglia, Norwich, UK
| | - Anna McKinnon
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge
| | - Clare Dixon
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge
| | - Adrian Boyle
- Cambridge University Hospitals NHS Foundation Trust
| | - Patrick Smith
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London
| | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, Cambridge.,Cambridgeshire and Peterborough NHS Foundation Trust
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Veronese G, Pepe A, Jaradah A, Al Muranak F, Hamdouna H. Modelling life satisfaction and adjustment to trauma in children exposed to ongoing military violence: An exploratory study in Palestine. CHILD ABUSE & NEGLECT 2017; 63:61-72. [PMID: 27907846 DOI: 10.1016/j.chiabu.2016.11.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 11/10/2016] [Accepted: 11/21/2016] [Indexed: 06/06/2023]
Abstract
Exposure to war and ongoing political violence increases mental health risks among children, especially in terms of posttraumatic stress disorder (PTSD), and depressive or somatic symptoms. However, an exclusive focus on negative functioning can lead to underestimating the coping abilities and natural potential for adjusting to trauma of war-affected children at different developmental phases. Using structural equation modelling, we tested the extent to which data gathered in a predominantly nonclinical sample of Palestinian children (N=1276) living in refugee camps supported a conceptual model in which the relationship between subjective wellbeing and the effects of trauma is mainly top-down in direction. The cross-sectional design adopted showed that feelings of life satisfaction contributed to better affect balance in children (aged 6-11 years), which in turn, mitigated the impact of traumatic events. These findings point up the importance of dimensions of subjective well-being in children involved in traumatic events and may inspire intervention and treatment focused on the ability to activate positive emotions as a crucial resource for dealing with traumatic reactions.
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Kangaslampi S, Punamäki RL, Qouta S, Diab M, Peltonen K. Psychosocial Group Intervention Among War-Affected Children: An Analysis of Changes in Posttraumatic Cognitions. J Trauma Stress 2016; 29:546-555. [PMID: 27859680 DOI: 10.1002/jts.22149] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/08/2022]
Abstract
Cognitive theories point to reduction in dysfunctional posttraumatic cognitions (PTCs) as one mechanism involved in recovery from posttraumatic stress symptoms (PTSS), yet research findings have shown individual differences in the recovery process. We tested the cognitive mediation hypothesis above in a previously published psychosocial group intervention among war-affected children. We also examined heterogeneity in children's PTCs during the intervention. We used a cluster randomized trial of Smith et al.'s (2002) teaching recovery techniques (TRT) intervention among 482 Palestinians 10-13 years of age (n = 242 for intervention group, n = 240 for control group). Children reported PTSS, PTCs, and depressive symptoms at baseline, midpoint, postintervention, and at 6-month follow-up. Path analysis results showed that TRT was not effective in reducing dysfunctional PTCs, and the reductions did not mediate intervention effects on PTSS. Using latent class growth analysis, we chose the model with 3 differing trajectories in the intervention group: high, decreasing, moderate, downward trending, and severe, stable levels of PTCs. Higher PTSS and depressive symptoms at baseline were associated with membership in the severe, stable trajectory. The intervention did not produce the kind of beneficial cognitive change needed in the cognitive mediation conceptualization. Nevertheless, cognitive changes differed substantially across children during the intervention, and were associated with their preintervention mental health status. These findings call for more detailed examination of the process of cognitive mediation.
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Affiliation(s)
- Samuli Kangaslampi
- School of Social Sciences and Humanities / Psychology, University of Tampere, Tampere, Finland
| | - Raija-Leena Punamäki
- School of Social Sciences and Humanities / Psychology, University of Tampere, Tampere, Finland
| | - Samir Qouta
- Faculty of Education, Islamic University of Gaza, Gaza City, Palestine
| | - Marwan Diab
- Gaza Community Mental Health Programme, Gaza City, Palestine
| | - Kirsi Peltonen
- School of Social Sciences and Humanities / Psychology, University of Tampere, Tampere, Finland
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Reinelt T, Vasileva M, Petermann F. Psychische Auffälligkeiten von Flüchtlingskindern. KINDHEIT UND ENTWICKLUNG 2016. [DOI: 10.1026/0942-5403/a000207] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Zusammenfassung. Die gestiegenen Flüchtlingszahlen in den letzten Jahren werden von einer erhöhten Forschungstätigkeit begleitet. Viele dieser Studien in der Klinischen Kinderpsychologie und Kinder-/Jugendpsychiatrie beschäftigen sich dabei mit psychischen Auffälligkeiten bei Flüchtlingskindern, insbesondere der Posttraumatischen Belastungsstörung und depressiven Symptomen. Als Ursache dieser Auffälligkeiten werden dabei vor allem traumatisierende Erlebnisse vor oder während der Flucht angenommen. Diese traumafokussierte Sichtweise greift jedoch zu kurz, da sie (a) Prozesse von Resilienz (b) den Einfluss von Akkulturation auf das psychische Befinden und (c) die unmittelbare Erfüllung von primären Grundbedürfnissen nach einer Flucht vernachlässigt.
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Affiliation(s)
- Tilman Reinelt
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Mira Vasileva
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - Franz Petermann
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
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Cosco TD, Kaushal A, Hardy R, Richards M, Kuh D, Stafford M. Operationalising resilience in longitudinal studies: a systematic review of methodological approaches. J Epidemiol Community Health 2016; 71:98-104. [PMID: 27502781 PMCID: PMC5256275 DOI: 10.1136/jech-2015-206980] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2015] [Revised: 06/07/2016] [Accepted: 07/19/2016] [Indexed: 11/24/2022]
Abstract
Over the life course, we are invariably faced with some form of adversity. The process of positively adapting to adverse events is known as ‘resilience’. Despite the acknowledgement of 2 common components of resilience, that is, adversity and positive adaptation, no consensus operational definition has been agreed. Resilience operationalisations have been reviewed in a cross-sectional context; however, a review of longitudinal methods of operationalising resilience has not been conducted. The present study conducts a systematic review across Scopus and Web of Science capturing studies of ageing that posited operational definitions of resilience in longitudinal studies of ageing. Thirty-six studies met inclusion criteria. Non-acute events, for example, cancer, were the most common form of adversity identified and psychological components, for example, the absence of depression, the most common forms of positive adaptation. Of the included studies, 4 used psychometrically driven methods, that is, repeated administration of established resilience metrics, 9 used definition-driven methods, that is, a priori establishment of resilience components and criteria, and 23 used data-driven methods, that is, techniques that identify resilient individuals using latent variable models. Acknowledging the strengths and limitations of each operationalisation is integral to the appropriate application of these methods to life course and longitudinal resilience research.
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Affiliation(s)
- T D Cosco
- MRC Unit for Lifelong Health and Ageing, London, UK
| | - A Kaushal
- MRC Unit for Lifelong Health and Ageing, London, UK
| | - R Hardy
- MRC Unit for Lifelong Health and Ageing, London, UK
| | - M Richards
- MRC Unit for Lifelong Health and Ageing, London, UK
| | - D Kuh
- MRC Unit for Lifelong Health and Ageing, London, UK
| | - M Stafford
- MRC Unit for Lifelong Health and Ageing, London, UK
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Hiller RM, Meiser‐Stedman R, Fearon P, Lobo S, McKinnon A, Fraser A, Halligan SL. Research Review: Changes in the prevalence and symptom severity of child post-traumatic stress disorder in the year following trauma - a meta-analytic study. J Child Psychol Psychiatry 2016; 57:884-98. [PMID: 27169987 PMCID: PMC4982080 DOI: 10.1111/jcpp.12566] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Understanding the natural course of child and adolescent posttraumatic stress disorder (PTSD) has significant implications for the identification of, and intervention for, at-risk youth. We used a meta-analytic approach to examine longitudinal changes in youth PTSD prevalence and symptoms over the first 12 months posttrauma. METHODS We conducted a systematic review to identify longitudinal studies of PTSD in young people (5-18 years old), excluding treatment trials. The search yielded 27 peer-reviewed studies and one unpublished dataset for analysis of pooled prevalence estimates, relative prevalence reduction and standardised mean symptom change. Key moderators were also explored, including age, proportion of boys in the sample, initial prevalence of PTSD and PTSD measurement type. RESULTS Analyses demonstrated moderate declines in PTSD prevalence and symptom severity over the first 3-6 months posttrauma. From 1 to 6 months posttrauma, the prevalence of PTSD reduced by approximately 50%. Symptoms also showed moderate decline, particularly across the first 3 months posttrauma. There was little evidence of further change in prevalence or symptom severity after 6 months, suggesting that it is unlikely a child would lose a PTSD diagnosis without intervention beyond this point. CONCLUSIONS The current findings provide key information about the likelihood of posttrauma recovery in the absence of intervention and have important implications for our understanding of child and adolescent PTSD. Results are discussed with reference to the timing of PTSD screening and the potential role of early interventions. Findings particularly highlight the importance of future research to develop our understanding of what factors prevent the action of normal recovery from the 'acute' posttrauma period.
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Affiliation(s)
| | | | - Pasco Fearon
- Department of Clinical, Educational and Health PsychologyUniversity College LondonLondonUK
| | - Sarah Lobo
- Department of PsychologyUniversity of BathBathUK
| | - Anna McKinnon
- Department of PsychologyMacquarie UniversitySydneyAustralia
| | - Abigail Fraser
- MRC Integrative Epidemiology UnitSchool of Social and Community MedicineUniversity of BristolBristolUK
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43
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Phipps S, Long A, Willard VW, Okado Y, Hudson M, Huang Q, Zhang H, Noll R. Parents of Children With Cancer: At-Risk or Resilient? J Pediatr Psychol 2015; 40:914-25. [PMID: 25997639 PMCID: PMC4580762 DOI: 10.1093/jpepsy/jsv047] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Revised: 04/22/2015] [Accepted: 04/22/2015] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To examine adjustment in parents of children with cancer using a design that minimizes focusing effects and allows for direct comparison with parents of healthy children. METHOD Parents of 305 children with cancer and a demographically similar sample of 231 parents of healthy children were evaluated using diagnostic interviews for posttraumatic stress disorder (PTSD), and questionnaire measures of posttraumatic stress symptoms (PTSS) and psychological growth (PG), as well as measures of global psychological functioning. RESULTS Rates of current and lifetime PTSD in parents of children with cancer were low, and did not differ from comparison parents. Likewise, levels of PTSS were not significantly different from comparison parents, but differed as a function of time since diagnosis, with parents of children who were ≥ 5 years from diagnosis reporting significantly lower PTSS than comparison parents. PG was higher in parents of children with cancer than in comparison parents regardless of time since diagnosis. CONCLUSION Parents of children with cancer demonstrate resilience to this challenge.
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Affiliation(s)
| | | | | | | | | | - Qinlei Huang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, and
| | - Hui Zhang
- Department of Biostatistics, St. Jude Children's Research Hospital, Memphis, TN, and
| | - Robert Noll
- Department of Pediatrics, University of Pittsburgh
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44
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La Greca AM, Comer JS, Lai BS. Commentary: Key Issues, Concluding Thoughts, and Future Directions for the Study of Trauma and Child Health. J Pediatr Psychol 2015; 41:149-58. [PMID: 26416828 DOI: 10.1093/jpepsy/jsv088] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 08/18/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - Betty S Lai
- Division of Epidemiology and Biostatistics, School of Public Health, Georgia State University
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Price J, Kassam-Adams N, Alderfer MA, Christofferson J, Kazak AE. Systematic Review: A Reevaluation and Update of the Integrative (Trajectory) Model of Pediatric Medical Traumatic Stress. J Pediatr Psychol 2015; 41:86-97. [PMID: 26319585 DOI: 10.1093/jpepsy/jsv074] [Citation(s) in RCA: 181] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 07/21/2015] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The objective of this systematic review is to reevaluate and update the Integrative Model of Pediatric Medical Traumatic Stress (PMTS; Kazak et al., 2006), which provides a conceptual framework for traumatic stress responses across pediatric illnesses and injuries. METHODS Using established systematic review guidelines, we searched PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and PubMed (producing 216 PMTS papers published since 2005), extracted findings for review, and organized and interpreted findings within the Integrative Model framework. RESULTS Recent PMTS research has included additional pediatric populations, used advanced longitudinal modeling techniques, clarified relations between parent and child PMTS, and considered effects of PMTS on health outcomes. Results support and extend the model's five assumptions, and suggest a sixth assumption related to health outcomes and PMTS. CONCLUSIONS Based on new evidence, the renamed Integrative Trajectory Model includes phases corresponding with medical events, adds family-centered trajectories, reaffirms a competency-based framework, and suggests updated assessment and intervention implications.
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Affiliation(s)
- Julia Price
- Center for Healthcare Delivery Science, Nemours Children's Health System, Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University
| | - Nancy Kassam-Adams
- Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, and Division of Emergency Medicine, The Children's Hospital of Philadelphia
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Health System, Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University
| | | | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children's Health System, Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University,
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Kenardy JA, Cox CM, Brown FL. A Web-Based Early Intervention Can Prevent Long-Term PTS Reactions in Children With High Initial Distress Following Accidental Injury. J Trauma Stress 2015; 28:366-9. [PMID: 26271018 DOI: 10.1002/jts.22025] [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: 11/12/2022]
Abstract
The present study explored the targeting of a preventative information provision intervention delivered to children following accidental injury by assessing the impact of initial traumatic distress on response to treatment. Analyses were based on baseline and 6-month outcome of child traumatic stress in a control (n = 28) and an intervention group (n = 31). Moderation of treatment outcome by initial levels of child traumatic stress was assessed through multiple hierarchical regression analyses. Results indicated the interaction between treatment provision and initial level of posttraumatic stress significantly predicted 6-month outcome (β = -.42, p = .019). When initial distress was high, children in the control group demonstrated an increase in trauma symptoms, and had significantly higher trauma symptoms at follow-up than those in the treatment group (d = 0.94, p = .008). When initial distress was not elevated, no significant differences were noted between the groups. These results indicate that a preventative early intervention may be best targeted at children presenting with the specific risk factor of high initial distress.
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Affiliation(s)
- Justin A Kenardy
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Catherine M Cox
- Centre of National Research on Disability and Rehabilitation Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Felicity L Brown
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
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Bonanno GA, Romero SA, Klein SI. The Temporal Elements of Psychological Resilience: An Integrative Framework for the Study of Individuals, Families, and Communities. PSYCHOLOGICAL INQUIRY 2015. [DOI: 10.1080/1047840x.2015.992677] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Maslow CB, Caramanica K, Welch AE, Stellman SD, Brackbill RM, Farfel MR. Trajectories of Scores on a Screening Instrument for PTSD Among World Trade Center Rescue, Recovery, and Clean-Up Workers. J Trauma Stress 2015; 28:198-205. [PMID: 25990986 DOI: 10.1002/jts.22011] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The longitudinal course of posttraumatic stress disorder (PTSD) over 8-9 years was examined among 16,488 rescue and recovery workers who responded to the events of September 11, 2001 (9/11) at the World Trade Center (WTC; New York, NY), and were enrolled in the World Trade Center Health Registry. Latent class growth analysis identified 5 groups of rescue and recovery workers with similar score trajectories at 3 administrations of the PTSD Checklist (PCL): low-stable (53.3%), moderate- stable (28.7%), moderate-increasing (6.4%), high-decreasing (7.7%), and high-stable (4.0%). Relative to the low-stable group, membership in higher risk groups was associated with 9/11-related exposures including duration of WTC work, with adjusted odds ratios ranging from 1.3 to 2.0, witnessing of horrific events (range = 1.3 to 2.1), being injured (range = 1.4 to 2.3), perceiving threat to life or safety (range = 2.2 to 5.2), bereavement (range = 1.6 to 4.8), and job loss due to 9/11 (range = 2.4 to 15.8). Within groups, higher PCL scores were associated with adverse social circumstances including lower social support, with B coefficients ranging from 0.2 to 0.6, divorce, separation, or widowhood (range = 0.4-0.7), and unemployment (range = 0.4-0.5). Given baseline, exposure-related, and contextual influences that affect divergent PTSD trajectories, screening for both PTSD and adverse circumstances should occur immediately, and at regular intervals postdisaster.
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Affiliation(s)
- Carey B Maslow
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Kimberly Caramanica
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Alice E Welch
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Steven D Stellman
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA
| | - Robert M Brackbill
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
| | - Mark R Farfel
- New York City Department of Health and Mental Hygiene, World Trade Center Health Registry, Long Island City, New York, USA
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Alisic E, Barrett A, Bowles P, Conroy R, Mehl MR. Topical Review: Families Coping With Child Trauma: A Naturalistic Observation Methodology. J Pediatr Psychol 2015; 41:117-27. [PMID: 25797943 DOI: 10.1093/jpepsy/jsv016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 02/04/2015] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE To introduce a novel, naturalistic observational methodology (the Electronically Activated Recorder; EAR) as an opportunity to better understand the central role of the family environment in children's recovery from trauma. METHODS Discussion of current research methods and a systematic literature review of EAR studies on health and well-being. RESULTS Surveys, experience sampling, and the EAR method each provide different opportunities and challenges for studying family interactions. We identified 17 articles describing relevant EAR studies. These investigated questions of emotional well-being, communicative behaviors, and interpersonal relationships, predominantly in adults. 5 articles reported innovative research in children, triangulating EAR-observed behavioral data (e.g., on child conflict at home) with neuroendocrine assay, sociodemographic information, and parent report. Finally, we discussed psychometric, practical, and ethical considerations for conducting EAR research with children and families. CONCLUSIONS Naturalistic observation methods such as the EAR have potential for pediatric psychology studies regarding trauma and the family environment.
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Affiliation(s)
- Eva Alisic
- Monash Injury Research Institute, Monash University, Murdoch Childrens Research Institute, Melbourne,
| | - Anna Barrett
- Monash Injury Research Institute, Monash University
| | - Peter Bowles
- Monash Injury Research Institute, Monash University, Murdoch Childrens Research Institute, Melbourne
| | - Rowena Conroy
- Murdoch Childrens Research Institute, Melbourne, Psychology Service, The Royal Children's Hospital, Melbourne, and
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50
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Miller-Graff LE, Howell KH. Posttraumatic stress symptom trajectories among children exposed to violence. J Trauma Stress 2015; 28:17-24. [PMID: 25644072 DOI: 10.1002/jts.21989] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Little research has examined the developmental course of posttraumatic stress symptoms (PTSS) in children. The current study aimed to identify developmental trajectories of PTSS in childhood and to examine predictors of symptom presentation in 1,178 children from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) studies, a consortium of studies focusing on the causes and effects of child maltreatment. Most children had a history of documented reports with Child Protective Services (CPS) and all were identified as living in high-risk environments. Using group-based trajectory modeling, 3 unique developmental trajectories were identified: Resilient, Clinical-Improving (PTSS in the clinical range at baseline then declining over time), and Borderline-Stable (chronically subclinical PTSS). Children in the Clinical-Improving group were more likely than children in the Resilient group to have reports of physical abuse (RRR = 1.76), emotional abuse (RRR = 2.55), neglect (RRR = 1.57), and exposure to violence at home and in the community (RRR = 1.04). Children in the Borderline-Stable group were more likely than children in the Resilient group to have a CPS history of neglect (RRR = 2.44) and exposure to violence at home and in the community (RRR = 1.04). Many children living in high-risk environments exhibit resilience to PTSS, but exposure to witnessed violence and neglect appear to put children at chronic risk for poor adjustment. These children may require more intensive, integrated clinical services that attend to multiple adverse experiences.
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Affiliation(s)
- Laura E Miller-Graff
- Department of Psychology, Kroc Institute for International Peace Studies, University of Notre Dame, Notre Dame, Indiana, USA
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