Traumas and posttraumatic stress disorder in a community population of older adolescents

Post-traumatic Stress Disorder in School-age Children: A Nationwide Prospective Birth Cohort Study

Traumatic childhood events are some of the few identifiable and to some extent preventable causes of psychiatric illness. Children exposed to severely stressful events may react with post-traumatic stress disorder (PTSD) and this may impact their level of function in daily life, their future development and mental health. The traumatic stress model suggests that traumatic stress in the family, community violence, and other traumas are regarded as additive environmental factors that can outweigh protective compensatory factors and thus interact with individual vulnerabilities. This study is based on prospective panel data including the whole population of children born in Denmark from 1984 to 1994, who are followed from age 7 to age 18 (N = 679,000) in the window between 2001 and 2012. Risk factors for first-time diagnose with PTSD are analyzed by the discrete time log-odd model. We found a lifetime prevalence of 2.3% PTSD in school-age children (n = 15,636). In accordance with the model, indicators of traumatic stress in the family, family disintegration, community violence, and individual vulnerabilities predicted later diagnose with PTSD. Individual neurodevelopmental disorder - especially autism (adjusted Odds Ratio (OR 7.1) and ADHD (OR 10.7) - were predicative of PTSD. The results cooperated the traumatic stress model. Some results were inconsistent with the traumatic stress model e.g., parental substance abuse were associated with less than expected PTSD in school-age children when adjusted for other risk factors. This indicates that PTSD may be underestimated in these groups. PTSD diagnoses in administrative records underestimate the prevalence, systematically. Efforts to increase PTSD screening may allow for better management.

Sexual abuse and post-traumatic stress disorder in childhood, adolescence and young adulthood: a systematic review and meta-analysis

Child sexual abuse (CSA) has been associated with mental health disorders throughout life during childhood, adolescence and adulthood; one of the most prevalent mental health conditions after CSA is post-traumatic stress disorder (PTSD). The present systematic review and meta-analysis aims to examine the association between CSA and PTSD in children and adolescents, evaluating also the role of potential effect modifiers, such as gender and geographic region. Participants were sexually abused (vs. CSA-free) children, adolescents and young adults, up to 21 years of age, with or without a PTSD diagnosis. Settings of eligible studies spanned school, college, university, community, hospital and non-hospital mental health facilities. Eligible studies were sought in PUBMED, ΕΜΒΑSE, PSYCINFO and GOOGLE SCHOLAR databases; end-of-search was set at August 31, 2020. Random-effects (DerSimonian-Laird) models were used for the pooling of studies. Results were reported as pooled odds ratios (OR) and 95% confidence intervals (95% CIs). Twenty-eight studies were identified, including a total cohort of 28,693 subjects. CSA was strongly associated with PTSD, at a similar extent in boys (pooled OR = 2.86, 95% CI 2.09-3.91) and girls (pooled OR = 2.38, 95% CI 1.76-3.23); meta-regression with gender confirmed the non-significant effect of gender. The association was present in all examined geographic regions. CSA is strongly associated with PTSD in childhood, adolescence and young adulthood, irrespectively of gender. Future studies should opt for thorough assessment of confounders and examine regions with paucity of studies, such as East Asia and Latin America.

Lifetime prevalence, comorbidities, and Sociodemographic predictors of post-traumatic stress disorder (PTSD): the National Epidemiology of Iranian Children and adolescents Psychiatric disorders (IRCAP)

OBJECTIVE

The aims of this study were to (a) evaluate the lifetime prevalence of post-traumatic stress disorder (PTSD) according to sociodemographic characteristics, (b) determine sociodemographic factors associated with PTSD, (c) estimate the lifetime prevalence rates of comorbidities by age and gender, and (d) assess the proportion of traumatic events in the non-PTSD sample and the PTSD sample, according to gender.

METHODS

The data used for the present study were obtained from the IRCAP study which was a cross-sectional, community-based study on 29,250 children and adolescents aged 6-18 years from all provinces of Iran, which was done using multistage cluster sampling. Trained psychologists conducted diagnostic interviews with parents, children, and adolescents using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL).

RESULTS

In this study, the prevalence of PTSD across the sample population was 0.6% (95% CI, 0.5-0.7%). Higher rates of PTSD were observed among girls (0.7%, CI 0.5-0.8%), adolescents aged 15-18 years (0.8%, CI 0.6-1.0%), and participants who had unemployed (1.5%, CI 0.8-2.8%), or farmer fathers (1.1%, CI 0.5-2.5%). Of the participants with PTSD, 65.1% met the criteria for at least one other psychiatric disorder. PTSD had a high rate of comorbidity with oppositional defiant disorder (22.9%, CI 17.5-29.4%), generalized anxiety disorder (20.8%, CI 15.7-27.1%), separation anxiety disorder (20.3%, CI 15.2-26.6%), and major depressive disorder (19.8%, CI 14.8-26.0%). We found 9.5% of non-PTSD sample experienced at least one traumatic event. Witness to domestic violence was the most common traumatic event experienced by 32.8% of PTSD sample.

CONCLUSION

Our results in the prevalence, comorbidities, and sociodemographic factors associated with PTSD supported findings of previous studies that used a structured diagnostic interview. It is recommended to use purposive sampling and to investigate comorbidities of PTSD and type of traumatic events in a large clinical population.

Patterns of Trauma Among Youth Seeking Mental Health Services at a Community-Based Clinic: A Latent Class Analysis Approach

We examine the association between trauma patterns, gender identity, ethnicity, foster care involvement, and mental health needs in a sample of low-income youth. Our community sample included 2,175 clients aged 6 or older (Mage = 11.9), has a closely-even gender ratio (55% female and 45% male and others) and is ethnically diverse (37% Black, 31% Multiracial, 14% Latinx, 9% White, 10% Others). 61% of youth in this sample have involvement with the foster care system. Latent class analysis was used to identify trauma patterns, explore predictors of latent class membership, and estimate the cumulative mental health needs for each trauma class. Results revealed four trauma patterns (Low Trauma, Caregiving Disruption, Community Violence, and Multiple Trauma). Girls were more likely than boys to be in the high-trauma groups. Compared to Black youth, Latinx youth were more likely to be in the Multiple Trauma class, whereas White youth were less likely to be in the high trauma classes. Youth with past or current involvement with the foster care system were more likely than those without to be in the high-trauma classes. Mental health needs for youth in Low Trauma and Caregiving Disruption were comparable, but were highest for those in Community Violence. Contrary to expectation, the Multiple Trauma group did not have the highest-level mental health needs. Interventions for low-income youth can benefit from knowing which trauma patterns are associated with various levels of mental health needs. Newer models of care focusing on building healthy communities may be the way forward.

Longitudinal Associations Between Community Violence Exposure and Mental Health Problems in Inner-City Youth: Ethnicity and Gender Perspectives

There is a lack of agreement on whether children and adolescents with different cultural/ethnic backgrounds react to trauma in a similar fashion. This study adds to the existing literature by providing ethnicity and gender perspectives on the longitudinal associations between the degree of community violence exposure (CVE) and mental health problems in U.S. inner-city youth. The study was conducted on a representative sample of predominantly ethnic minority youth (N = 2,794; 54.1% female; age 11-16 years old (M [SD] = 12.77 [1.29]); 60.0% African-American, 26.1% Hispanic American, 13.9% White). Self-reported information was obtained on CVE in year 1 and on mental health problems (depressive symptoms, posttraumatic stress, alcohol use, and conduct problems) in year 1 and year 2. Multivariate analyses of covariance (MANCOVA) were used to compare mental health problems in youth from the three ethnic groups in relation to the different degrees of CVE experienced one year prior, while controlling for their baseline mental health problem levels, age, and socio-economic status. Mental health problems in year 2 increased in a similar fashion in relation to the degree of severity of CVE in year 1 in all three ethnic groups. The interaction effects suggested a gender-specific response to CVE, where girls in the three ethnic groups reported higher levels of depression and posttraumatic stress in relation to the same degree of CVE, as compared to boys. Adolescents from different ethnic backgrounds respond similarly to differing degrees of CVE with an increase in mental health problems over time. In response to a similar degree of exposure, girls tend to experience greater levels of internalizing problems than boys. Timely recognition of traumatic exposure and associated mental health problems is important for early prevention and intervention strategies.

Towards assessing subcortical "deep brain" biomarkers of PTSD with functional near-infrared spectroscopy

Assessment of brain function with functional near-infrared spectroscopy (fNIRS) is limited to the outer regions of the cortex. Previously, we demonstrated the feasibility of inferring activity in subcortical "deep brain" regions using cortical functional magnetic resonance imaging (fMRI) and fNIRS activity in healthy adults. Access to subcortical regions subserving emotion and arousal using affordable and portable fNIRS is likely to be transformative for clinical diagnostic and treatment planning. Here, we validate the feasibility of inferring activity in subcortical regions that are central to the pathophysiology of posttraumatic stress disorder (PTSD; i.e. amygdala and hippocampus) using cortical fMRI and simulated fNIRS activity in a sample of adolescents diagnosed with PTSD (N = 20, mean age = 15.3 ± 1.9 years) and age-matched healthy controls (N = 20, mean age = 14.5 ± 2.0 years) as they performed a facial expression task. We tested different prediction models, including linear regression, a multilayer perceptron neural network, and a k-nearest neighbors model. Inference of subcortical fMRI activity with cortical fMRI showed high prediction performance for the amygdala (r > 0.91) and hippocampus (r > 0.95) in both groups. Using fNIRS simulated data, relatively high prediction performance for deep brain regions was maintained in healthy controls (r > 0.79), as well as in youths with PTSD (r > 0.75). The linear regression and neural network models provided the best predictions.

Menstrual Cycle in Trauma-Related Disorders: A Mini-Review

Fluctuations of sex hormones across the menstrual cycle have been linked to exacerbation of symptoms of psychiatric disorders. Women diagnosed with trauma-related disorders such as post-traumatic stress disorder (PTSD) and borderline personality disorder (BPD) have reported worsening of mood symptoms at various phases of their menstrual cycle. There is also considerable overlap between PTSD, BPD, and complex-PTSD (cPTSD) symptoms, suggesting similar biological underpinnings. This mini-review examines the influence of sex hormones and the menstrual cycle on PTSD, BPD, and cPTSD symptoms, and discusses the involvement of the hypothalamic-pituitary-adrenal (HPA) axis. We review literature showing that PTSD and BPD symptoms fluctuate with the menstrual cycle, though the effect of the menstrual cycle phase appears to be inconsistent, warranting future research. Based on the reported phasic vulnerability in individuals with PTSD and BPD, it is plausible to assume that women diagnosed with the newly introduced cPTSD may experience similar difficulties. However, no study to date has addressed this. This review highlights the importance of considering an individual's trauma history as it may influence symptom severity and diagnosis, and the phase of the menstrual cycle at the time of diagnosis. This review also highlights that additional work is needed to clarify the influence of estradiol and progesterone fluctuations on trauma-related symptoms, especially in cPTSD. Continued research on menstrual cycle vulnerability and trauma will lead to better informed management and treatment of PTSD, BPD, and cPTSD.

Parents’ and Teachers’ Knowledge of Trauma and Post-Traumatic Stress Disorder in Children and Adolescents and Their Agreement Towards Screening

Background

Trauma exposure is common in children and adolescents. Parents and other key adults, such as teachers, are necessary to facilitate help-seeking behavior, which involves recognizing trauma and adverse reactions and awareness of accessing treatments. Where screening measures in schools are used to detect post-traumatic stress disorder (PTSD), the attitudes of parents and teachers towards screening need to be considered.

Objective

To examine whether parents and teachers can accurately detect trauma events, symptoms and effective treatments. In addition, to assess how supportive parents and teachers are towards PTSD screening in schools.

Method

A total of 439 parents and 279 teachers completed online questionnaires assessing PTSD knowledge across three domains: traumatic events, PTSD symptoms and evidence-based treatments. Responses of acceptability of using PTSD screening tools in schools were elicited.

Results

Teachers and parents were accurate in recognizing trauma events and PTSD symptoms. However, understanding was inclusive, with events not considered traumatic and non-PTSD diagnostic criteria being endorsed. Trauma-Focussed Cognitive-Behavioral Therapy was recognized as an effective treatment for PTSD, but Eye-Movement Desensitization and Reprocessing was not. Treatments not recommended by health guidelines were frequently endorsed. The majority of participants were supportive of PTSD screening in schools, but a minority were not.

Conclusions

Parents and teachers are able to recognize trauma events and symptoms of PTSD, although this tends to be overly inclusive. Schools could be targeted to promote understanding trauma among parents and teachers. Agreement with screening is encouraging and further research is warranted to understand barriers and facilitators.

Prevalence and Risk Factors of Post-traumatic Stress Disorder Symptoms in Students Aged 8-18 in Wuhan, China 6 Months After the Control of COVID-19

Objectives: To explore the prevalence of post-traumatic stress disorder (PTSD) symptoms and the factors influencing mental health symptoms in students aged 8–18 in Wuhan, China at 6 months after the COVID-19 pandemic was controlled.

Methods: Questionnaires were distributed to students aged 8–18 in Wuhan through an online platform from September to October 2020, and 15,993 valid surveys were returned, resulting in a response rate of 75.4%. The data related to symptoms of PTSD, anxiety, depression, stress and psychological inflexibility levels, as well as demographic information about the population. Hierarchical multiple regression analyses were performed to examine the predictive effects.

Results: In total, 11.5% of the students met the criteria for clinically concerning PTSD symptoms. Psychological inflexibility was associated with PTSD symptoms, depression, anxiety, and stress symptoms (β = 0.45, 0.63, 0.65 and 0.69, respectively, with ΔR² = 0.16, 0.32, 0.34 and 0.39, respectively, p < 0.001) in children and adolescents.

Conclusion: This study investigated the impacts of COVID-19 on the mental health status among students aged 8–18 in Wuhan. Even at 6 months after the outbreak was brought under control, some students were still affected. Psychological inflexibility was correlated with psychological symptoms in students. Therefore, methods to reduce psychological inflexibility may help improve the mental health states of students as part of psychological interventions.

Liberatory Media Literacy as Protective Against Posttraumatic Stress for Emerging Adults of Color

Emerging adults (i.e., age 18-25 years) of color in the United States are exposed to race/ethnicity-related traumatic events in online settings. Although an emerging literature documents the mental health consequences of such online exposures among adolescents, the association between these exposures and symptoms of posttraumatic stress disorder (PTSD) remains understudied in emerging adults. Furthermore, little is known about strengths-based factors that may be protective for emerging adults of color faced with such exposures. The current study aimed to fill these gaps by examining the potential of liberatory media literacy (i.e., the ability to critically read, evaluate, support, and create media and technology that represents people of color in their full humanity) to ameliorate the association between exposure to traumatic events online and PTSD symptoms. Emerging adults of color (N = 325, M_age = 22.24, 56.0% male) were recruited to complete a self-report online survey that assessed exposure to race/ethnicity-related traumatic events in online settings, liberatory media literacy, and PTSD symptoms. The results of moderation analysis indicated that increased exposure to traumatic events online was associated with higher PTSD symptoms, β = .22, and that the inclusive media and technology component of liberatory media literacy was protective in this association, β = .19. However, these effects were small, f² = .22-.23. The potential of liberatory media literacy as a strengths-based asset for emerging adults of color are discussed. Increasing inclusive media and technology skills may be an important target for intervention.

Association between traumatic stressful events and schizotypal symptoms among a community-based sample of adolescents: A 2-year longitudinal study

BACKGROUND

Traumatic stressful events (TSEs) are among the most studied risk factors for subsequent schizotypal symptoms. However, specificity and aggregate effects of trauma exposure on schizotypal symptoms remain unclear. This study investigates these relationships among a community-based sample of US adolescents.

MATERIAL AND METHODS

A sub-sample of 426 adolescents (51.6% female) from the Philadelphia Neurodevelopmental Cohort study were selected for longitudinal follow-up based on presence (n = 209) or absence (n = 217) of psychosis spectrum symptoms (PSS). At baseline, they completed assessments of demographic, TSEs, other psychopathology (e.g., PSS, anxiety, depression, and behavioral disorder) and family history of psychopathology. Schizotypal symptom dimensions (cognitive-perceptual, interpersonal and disorganized) were evaluated approximately two years later.

RESULTS

More than half of adolescents experienced at least one type of TSE. Adolescents with assaultive trauma reported about 1.5 times as many symptoms on all three schizotypal symptom dimensions, compared to adolescents with non-assaultive TSE, adjusting for demographic and family history variables. No statistical significance was found after further adjusting for other baseline psychopathology (p > 0.05). There was a significant aggregate effect of TSEs on cognitive-perceptual symptoms with small effect size (p < 0.001, Cohen's f2 = 0.034).

CONCLUSIONS

We found evidence of an association between aggregate TSEs and cognitive-perceptual symptoms, but trauma type was not associated with schizotypal symptom dimensions when controlling for potential confounders. Our findings highlight the importance of considering aggregate TSE effects and potential confounds when examining associations between TSEs and schizotypy. Trauma and psychosis spectrum screening may be important in the effort to provide trauma-informed care.

Prevalence of posttraumatic stress disorder among adolescents in school and its impact on their well-being: a cross-sectional study

INTRODUCTION

anyone can develop posttraumatic stress disorder (PTSD) following a traumatic event; this disorder can develop comorbid PTSD disorders such as anxiety and depression, which could seriously interfere with the daily life of the adolescent who was to be the subject of our study by evaluating the prevalence of PTSD in public schools and also evaluating the impact of this disorder.

METHODS

the survey was carried out during the period from March to June 2017. Participants were selected for a cross-sectional survey. Standardized questionnaires (life events checklist, CPTS-RI, STAIY and CDI) were used. The independent variables were investigated using binary logistic regression analyzes which were performed to investigate factors associated with PTSD.

RESULTS

the number of students was 982 adolescents with an age of 12 to 17 years (14.98 ± 1.49) and the participation rate was 88.69% (n = 871). A high prevalence of PTSD was found with 19.3% (n = 168). The factors independently associated with PTSD included being a girl (adjusted odds ratio (AOR) =2.113, 95% C.I =1.015-4.399, p=0.046), having a middle school level (AOR =5.765, 95% C.I =2.262-14.692, p<0.0001), sleep interrupted (AOR =0.142, 95% C.I =0.027-0.745, p=0.021), guilt (AOR =27.378, 95% C.I =6.835-109.663, p<0.0001), difficulties of memory (AOR =0.157, 95% C.I = 0.071-0.346, p<0.0001), and difficulties of concentration (AOR =0.041, 95% C.I = 0.004-0.392, p=0.006). Among adolescents in school with PTSD, anxiety had 79.1% (n = 133) and depression had 51.1% (n = 86).

CONCLUSION

the prevalence of PTSD and comorbid anxiety and depression was high among educated students. Factors associated with PTSD included being in college, being a girl, and having guilt. It is necessary to adapt suitable treatments immediately after a traumatic event or during the disease.

Depressive Symptom Trajectories and Early Adult Education and Employment: Comparing Longitudinal Cohorts in Canada and the United States

Adolescent depressive symptoms are risk factors for lower education and unemployment in early adulthood. This study examines how the course of symptoms from ages 16–25 influences early adult education and employment in Canada and the USA. Using data from the National Longitudinal Survey of Children and Youth (n = 2348) and the National Longitudinal Survey of Youth 79 Child/Young Adult (n = 3961), four trajectories (low-stable; increasing; decreasing; and increasing then decreasing, i.e., mid-peak) were linked to five outcomes (working with a post-secondary degree; a high school degree; no degree; in school; and NEET, i.e., not in employment, education, or training). In both countries, increasing, decreasing, and mid-peak trajectories were associated with higher odds of working with low educational credentials, and/or NEET relative to low-stable trajectories. In Canada, however, all trajectories had a higher predicted probability of either being in school or working with a post-secondary degree than the other outcomes; in the USA, all trajectory groups were most likely to be working with a high school degree. Higher depressive symptom levels at various points between adolescent and adulthood are associated with working with low education and NEET in Canada and the USA, but Canadians are more likely to have better education and employment outcomes.

Exposure to Gun Violence: Associations with Anxiety, Depressive Symptoms, and Aggression among Male Juvenile Offenders

Objective: To examine whether at-risk male youth experience increases in anxiety, depressive symptoms, and aggression during years when they are exposed to gun violence, adjusting for relevant covariates.Method: Participants were 1,216 male, justice-involved adolescents who were recently arrested for the first time for a moderate offense. They were interviewed 9 times over 5 years. Fixed effects (within-individual) regression models were used to estimate concurrent associations between exposure to gun violence and three outcomes: depressive symptoms, anxiety symptoms, and aggression (both overall and separately for proactive and reactive aggression). The reverse direction (anxiety, depressive symptoms, and aggression predicting gun violence exposure) was also modeled.Results: After controlling for covariates, exposure to gun violence was significantly associated with increases in reactive aggression and, to a lesser extent, increases in proactive aggression. In addition, gun violence exposure was associated with increased anxiety but not depressive symptoms. We found no support for the reverse direction.Conclusions: At-risk males experienced significant increases in anxiety and aggression (particularly reactive aggression) during years when they are exposed to gun violence, even after accounting for several potential confounding factors. The greater impact on reactive aggression suggests that exposure to gun violence may affect self-regulation and/or social information processing. The analyses shed light on the less-visible damage wrought by gun violence and underscore the importance of mental health screening and treatment for youth who have been exposed to violence - especially gun violence - both to assist individual youths and to disrupt cycles of violence.

The mediating role of daytime sleepiness between problematic smartphone use and post-traumatic symptoms in COVID-19 home-refined adolescents

Background

COVID-19 was first recognized in late 2019 in China, at which time school closures forced most students to isolate at home or maintain social distance, both of which increased smartphone use, daytime sleepiness and post traumatic disorder (PTSD) risks. However, to date, no research has fully explored these behavioral risks or the consequences.

Methods

Two thousand and ninety home-confined students from two Chinese high schools participated in an online-based questionnaire battery that assessed their sociodemographic characteristics, COVID-19 related exposures, daytime sleepiness, problematic smartphone use, and PTSD. The subsequent data were subjected to mediation analysis, and structural equation models (SEM) were employed to explore the variable relationships.

Results

The problematic smartphone use, daytime sleepiness and PTSD prevalence were respectively 16.4%, 20.2% and 6.9%. The number of COVID-19 related exposure was directly associated with problematic smartphone use and PTSD symptoms. Problematic smartphone use was found to be a mediator between COVID-19 related exposure and PTSD symptoms, and daytime sleepiness was found to partially mediate the associations between problematic smartphone use and PTSD.

Conclusions

The more exposure associated with the pandemic, the more psychological and behavioral problems the adolescents had. The relatively high rate of problematic smartphone use in home isolated adolescents possibly increased the risk of daytime sleepiness and psychological problems. Therefore, targeted improvements are needed to reduce the risk of psychological problems and daytime sleepiness in adolescents.

Eye movement desensitization and reprocessing: The state of the art of efficacy in children and adolescent with post traumatic stress disorder

BACKGROUND

PTSD in youth is more common and debilitating than it was previously thought. This untreated condition is highly correlated to critical mental health condition, such as depression, anxiety disruptive-behaviours, and substance use disorders. Despite the growing number of studies investigating Eye Movement Desensitization and Reprocessing (EMDR) treatment for posttraumatic stress disorder (PTSD) in childhood and adolescent, results have not been systematically revised since 2017. The aim of this work is to systematically reviewed all randomized controlled trials (RCTs) evaluating the effect of EMDR on PTSD symptoms in children and adolescent and asses whether EMDR therapy was effective to improve anxious and/or depressive symptoms.

METHODS

In a short series of articles, we will review the efficacy of EMDR on children and adolescent with PTSD and comorbid symptoms. The present brief review will focus on randomized controlled trials with an EMDR group condition compared to a control group published until January 2020.

RESULTS

eight studies (n = 150) met our inclusion criteria. Preliminary analyses showed that EMDR has a comparable efficacy to cognitive behavior therapy (CBT) in reducing PTSD, anxiety symptoms, depressive symptoms and was superior to waitlist/placebo condition. Moreover EMDR seems to be more effective in a shorter period of time.

CONCLUSION

despite the small number of studies, the preliminary results suggest that EMDR therapy could be an effective treatment for children and adolescent with PTSD and anxious and/or depressive symptoms. Further research is needed to support these results.

Pathways to post-traumatic stress disorder and alcohol dependence: Trauma, executive functioning, and family history of alcoholism in adolescents and young adults

INTRODUCTION

Family history (FH) of alcohol dependence is likely to increase the risk of trauma exposure, post-traumatic stress disorder (PTSD), and alcohol dependence. FH of alcohol dependence and trauma has been separately shown to adversely affect planning/problem-solving aspects of executive function. However, few studies have examined these risk factors in an integrated model.

METHODS

Using data from trauma-exposed individuals from the Collaborative Study on the Genetics of Alcoholism prospective cohort (N = 1,860), comprising offspring from alcohol-dependent high-risk and comparison families (mean age [SE] = 21.9 [4.2]), we investigated associations of trauma (nonsexual assaultive, nonassaultive, sexual assaultive) with DSM-IV PTSD and alcohol dependence symptom counts, and planning/problem-solving abilities assessed using the Tower of London Test (TOLT). Moderating effects of family history density of alcohol use disorder (FHD) on these associations and sex differences were explored.

RESULTS

Family history density was positively associated with PTSD in female participants who endorsed a sexual assaultive trauma. Exposure to nonsexual assaultive trauma was associated with more excess moves made on the TOLT.

CONCLUSION

Findings from this study demonstrate associations with PTSD and alcohol dependence symptom counts, as well as poor problem-solving ability in trauma-exposed individuals from families densely affected with alcohol dependence, depending on trauma type, FHD, and sex. This suggests that having a FH of alcohol dependence and exposure to trauma during adolescence may be associated with more PTSD and alcohol dependence symptoms, and poor problem-solving abilities in adulthood.

Intervention Response to the Trauma-Exposed, Justice-Involved Female Youth: A Narrative Review of Effectiveness in Reducing Recidivism

This study aims to examine current research about trauma-exposed, justice-involved (TEJI) female youth, and evaluate the current literature regarding the effectiveness of gender-specific interventions aimed at reducing their recidivism. Preferred reporting items for systematic reviews and meta-analyses (PRISMA) methodology was utilized to examine quantitative and qualitative literature, published from 2000 through March 2020, about interventions for female justice-involved youth with trauma exposure. Analysis of selected studies utilized an integrated framework based on Andrew’s Risk-Need-Responsivity (RNR) model and Lipsey’s factors of effectiveness, which reviewed studies showing the relationship between female justice-involved youth with mental health symptomologies and trauma. The findings show that effective intervention for this population targets the youth’s negative internal mechanisms related to trauma-subsequent psychosocial problems. These studies suggest that trauma-sensitive modalities have the potential to mitigate the further risk of problematic external behaviors. All studies had limited sample sizes, low follow-up rates, and unknown long-term outcomes. Future research should explore dimensions of sustainability and achieving stability in relation to intervention setting. Selecting the proper venue and facilitator for quality implementation and stability of setting is critical in delivering effective therapies. Modifications in public expectations of juvenile justice policy and practice, from disciplinary to therapeutic approaches, is needed.

Women's greater late-life depression: Traumatic experiences or GxE?

OBJECTIVES

This study examined the role of traumatic life experiences, and their interaction with genetic risk, in explaining gender differences in late life depression.

METHODS

Data were from the 2008-through-2014 waves of the Health and Retirement Study, nationally representative of U.S. adults over age 50. Analysis was restricted to white participants. Newly available polygenic risk scores indexed genetic propensity for depression. Linear growth models examined gender effects on depression, as well as their mediation by environmental and genetic risk.

RESULTS

Across-person results suggested greater depression among older white women than men. No disparities were found in within-person change. Women also did not have more traumatic life experiences. Nor did the few factors they reported more than men influence depression, or mediate the gender difference in this outcome. The sole exception was childhood parental physical abuse. This early experience mediated about a quarter of the gender disparity-but only at mean or high genetic vulnerability. In contrast, adulthood traumas common among women interacted negatively with polygenic risk-such that they mediated the gender effect only at low levels of the latter.

DISCUSSION

Traumatic life experiences and their genetic interactions appear to have minimal utility in explaining women's greater depression-at least among white older adults. Careful work is needed on the extent to which these factors underlie other social disparities in mental health.

Meta-analysis: Exposure to Early Life Stress and Risk for Depression in Childhood and Adolescence

OBJECTIVE

Early life stress (ELS) is associated with increased risk for the development of major depressive disorder (MDD) in adulthood; however, the degree to which ELS is associated with an early onset of MDD (ie, during childhood or adolescence) is not known. In this meta-analysis, we estimated the associations between ELS and the risk for onset of MDD before age 18 years. In addition, we examined the associations between eight specific forms of ELS (ie, sexual abuse, physical abuse, poverty, physical illness/injury, death of a family member, domestic violence, natural disaster, and emotional abuse) and risk for youth-onset MDD.

METHOD

We conducted a systematic search in scientific databases for studies that assessed both ELS and the presence or absence of MDD before age 18 years. We identified 62 journal articles with a total of 44,066 unique participants. We assessed study quality using the Newcastle-Ottawa Scale. When heterogeneous effect sizes were detected, we tested whether demographic and/or methodological factors moderated the association between ELS and MDD.

RESULTS

Using a random-effects meta-analysis, we found that individuals who experienced ELS were more likely to develop MDD before the age of 18 years than were individuals without a history of ELS (odds ratio = 2.50; 95% confidence interval 2.08, 3.00). Separate meta-analyses revealed a range of associations with MDD: whereas some types of ELS (eg, poverty) were not associated with MDD, other types (eg, emotional abuse) were associated more strongly with MDD than was ELS considered more broadly.

CONCLUSION

These findings provide important evidence that the adverse effect of ELS on MDD risk manifests early in development, prior to adulthood, and varies by type of ELS.

Associations among trauma exposure, post-traumatic stress disorder, and depression symptoms in adolescent survivors of the 2013 Lushan earthquake

BACKGROUND

Post-traumatic stress disorder (PTSD) frequently occurs in survivors of natural disasters, while symptom of depression is related mostly to interpersonal trauma. These conditions are highly correlated and strongly impact adolescent quality of life. This study aimed to explore the relationship among trauma exposure, PTSD symptoms, and/or depression symptoms in adolescent survivors of the 2013 Lushan (China) earthquake.

METHODS

A cross-sectional survey of 2921 adolescents in the Longmenshan seismic fault zone was conducted three years after the Lushan earthquake. Participants were evaluated using the Earthquake Experience Scale, the Adolescent Self-rating Life Events Checklist (ASLEC), the Children's Revised Impact of Event Scale (CRIES-13), and the Depression Self-Rating Scale (KADS-6). Stepwise regression was used to explore relationships between trauma exposure and PTSD or depression symptoms.

RESULTS

There was a strong correlation between PTSD and depression symptoms, with a 10.7% comorbidity. Earthquake-related exposure, negative life events, prior exposure to the 2008 Wenchuan (China) earthquake, and being left behind by parents all contributed to PTSD and depressive symptoms. Earthquake exposures contributed mainly to PTSD symptoms, while interpersonal traumas contributed mainly to depression symptoms.

CONCLUSION

PTSD and depression symptoms strongly correlate in adolescent survivors of the 2013 Lushan earthquake. The high comorbidity between PTSD and depression symptoms may reflect shared risk factors. Natural disasters are more likely to cause PTSD symptoms, while interpersonal traumas are more likely to cause depression symptoms.

Symptoms of posttraumatic stress disorder among targets of school bullying

BACKGROUND

The aim of this study was to investigate whether bullying among students is associated with symptoms of posttraumatic stress disorder (PTSD), and whether associations are comparable to other traumatic events leading to PTSD.

METHODS

Data were collected from 219 German children and adolescents: 150 students from grade six to ten and 69 patients from an outpatient clinic for PTSD as a comparison group. Symptoms of PTSD were assessed using the Children's Revised Impact of Event Scale (CRIES) and the Posttraumatic Symptom Scale (PTSS-10). A 2 × 5 factorial analysis of variance (ANOVA) with the factors gender (male, female) and group (control, conflict, moderate bullying, severe bullying, traumatized) was used to test for significant differences in reported PTSD symptoms.

RESULTS

Results showed that 69 (46.0%) students from the school sample had experienced bullying, 43 (28.7%) in a moderate and 26 (17.3%) in a severe way. About 50% of the severe bullying group reached the critical cut-off point for suspected PTSD. While the scores for symptoms of PTSD were significantly higher in bullied versus non-bullied students, no significant differences were found between patients from the PTSD clinic and students who experienced severe bullying.

CONCLUSIONS

Our findings suggest that bullying at school is highly associated with symptoms of PTSD. Thus, prevention of bullying in school may reduce traumatic experiences and consequent PTSD development.

Interpersonal Trauma Exposure, Trauma Symptoms, and Severity of Substance Use Disorder among Youth Entering Outpatient Substance Abuse Treatment

A substantial body of literature has found associations between interpersonal victimization, trauma symptoms, and substance use disorders (SUD) among adolescents. Secondary data analysis was conducted on structured interview data collected by treatment providers as 172 adolescents (ages 12-19) entered outpatient substance abuse treatment. Results indicate high prevalence rates of interpersonal trauma exposure: 71.5% self-reported trauma exposure, specifically direct physical abuse or assault, sexual abuse or assault, and/or witnessing intimate partner violence of a parent. Severity of SUD, as measured by number of DSM-5 criteria endorsed, was not only associated with the number of types of criterion A events for Posttraumatic Stress Disorder but also more self-reported internalizing problems. There was no significant relationship between the severity of SUD and the severity of trauma symptoms at treatment intake, gender, or attention problems. Ongoing assessment of possible trauma symptoms is recommended throughout substance abuse treatment with youth who have reported trauma exposure, as well as continued screening of trauma exposure.

Practitioner Review: Posttraumatic stress disorder and its treatment in children and adolescents

Important advances in understanding traumatic stress reactions in children and young people have been made in recent years. The aim of this review was to synthesise selected recent research findings, with a focus on their relevance to clinical practice. We therefore address: findings on the epidemiology of trauma exposure and Posttraumatic Stress Disorder (PTSD); recent changes to diagnostic classification; implications for screening and assessment of traumatic stress reactions; and treatment outcome studies including interventions for acute and chronic PTSD, dissemination of effective treatments into community settings, and early interventions. We conclude with recommendations for clinical practice and suggestions for future areas of research.

School factors related to the emotional wellbeing and resettlement outcomes of students from refugee backgrounds: protocol for a systematic review

BACKGROUND

Schools can play a vital role in the resettlement of refugee children and their families. Yet, the body of research examining school environmental factors that support the mental health and acculturation of refugee children is methodologically heterogeneous, investigates numerous and disparate school factors, and is often "hidden" in broader qualitative studies. This limits the capacity to apply the findings in a practical manner.

METHODS

Based on PRISMA statement principles, we review the relevant literature to investigate the relationship between school climate and the emotional wellbeing and resettlement outcomes of refugee students. Six electronic databases will be systematically searched: MEDLINE, PsycINFO, Embase, CINAL, Web of Science, and ERIC, supplemented by a systematic review of the grey literature, relevant international websites, and sequential, site-specific internet searches. Finally, subject area experts will be consulted and backward and forward citation searches of included articles will be completed. Two independent reviewers will screen identified articles against eligibility criteria and extract data for included studies. Quality of included studies will be assessed using the Mixed Methods Appraisal Tool (MMAT) for mixed studies reviews. Data will be synthesised using a convergent qualitative narrative approach.

DISCUSSION

Given the centrality of school in the daily lives of resettled refugee children, it is vital to assess the impact of school climate on the psychosocial wellbeing and resettlement trajectories of this population. This review will identify evidence-based school factors which support good mental health and resettlement outcomes for refugee students and make recommendations for translation of this knowledge into the school environment.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42017077570.

The epidemiology of trauma and post-traumatic stress disorder in a representative cohort of young people in England and Wales

BACKGROUND

Despite the emphasis placed on childhood trauma in psychiatry, comparatively little is known about the epidemiology of trauma and trauma-related psychopathology in young people. We therefore aimed to evaluate the prevalence, clinical features, and risk factors associated with trauma exposure and post-traumatic stress disorder (PTSD) in young people.

METHODS

We carried out a comprehensive epidemiological study based on participants from the Environmental Risk Longitudinal Twin Study, a population-representative birth-cohort of 2232 children born in England and Wales in 1994-95. At the follow-up home visit at age 18 years, participants were assessed with structured interviews for trauma exposure, PTSD, other psychopathology, risk events, functional impairment, and service use. Risk factors for PTSD were measured prospectively over four previous assessments between age 5 and 12 years. The key outcomes were the prevalence, clinical features, and risk factors associated with trauma exposure and PTSD. We also derived and tested the internal validity of a PTSD risk calculator.

FINDINGS

We found that 642 (31·1%) of 2064 participants reported trauma exposure and 160 (7·8%) of 2063 experienced PTSD by age 18 years. Trauma-exposed participants had high rates of psychopathology (187 [29·2%] of 641 for major depressive episode, 146 [22·9%] of 638 for conduct disorder, and 102 [15·9%] of 641 for alcohol dependence), risk events (160 [25·0%] of 641 for self-harm, 53 [8·3%] of 640 for suicide attempt, and 42 [6·6%] of 640 for violent offence), and functional impairment. Participants with lifetime PTSD had even higher rates of psychopathology (87 [54·7%] of 159 for major depressive episode, 43 [27·0%] of 159 for conduct disorder, and 41 [25·6%] of 160 for alcohol dependence), risk events (78 [48·8%] of 160 for self-harm, 32 [20·1%] of 159 for suicide attempt, and 19 [11·9%] of 159 for violent offence), and functional impairment. However, only 33 (20·6%) of 160 participants with PTSD received help from mental health professionals. The PTSD risk calculator had an internally validated area under the receiver operating characteristic curve of 0·74, indicating adequate discrimination of trauma-exposed participants with and without PTSD, and internally validated calibration-in-the-large of -0·10 and calibration slope of 0·90, indicating adequate calibration.

INTERPRETATION

Trauma exposure and PTSD are associated with complex psychiatric presentations, high risk, and significant impairment in young people. Improved screening, reduced barriers to care provision, and comprehensive clinical assessment are needed to ensure that trauma-exposed young people and those with PTSD receive appropriate treatment.

FUNDING

The Medical Research Council, the National Institute of Child Health and Development, the Jacobs Foundation, the Nuffield Foundation, the National Society for Prevention of Cruelty to Children, the Economic and Social Research Council, the National Institute for Health Research, MQ, and Canadian Institutes for Advanced Research.

Psychopathology and Quality of Life in Traumatized or Victimized Underage Individuals as Factors for Forensic Multilevel Assessment-A Pilot Investigation

Background: Psychological sequels to criminal violence can be long lasting and severe. They are in many countries not sufficiently considered in court cases as an important circumstance that could be used to assess the severity of the crime, also guiding redress, compensation, and rehabilitation of the victim, and-in children-child custody considerations. So far, the focus of forensic assessment has often been limited to diagnostic categories, especially "posttraumatic stress disorder" (PTSD), a diagnosis that presently is subjected to rapidly changing definitions both in and between diagnostic systems. Other indicators such as quality of life (QoL) might be of equal importance as compared to clinical or research diagnostic categories to understand and evaluate the impact of a crime and the amount of help needed and, in the legal context, redress to be asked. Symptoms might differ depending on the crime encountered. Objective and Methods: QoL and general symptom patterns including a PTSD diagnosis were assessed in a group of 10- to 17-year-old minors with (n = 33) and without (n = 49) PTSD diagnosis who all had experienced sexual abuse, physical abuse, death of a parent, or their parents' divorce, using standardized diagnostic instruments. Results: PTSD patients reported a significantly lower QoL than non-PTSD controls. Reported symptom patterns with potential impact on life, such as intrusive thoughts, differed between the victims of different crime types, with the highest rates of both intrusive symptoms and combined symptom profile in victims of sexual abuse. Data indicate that the changes between older and present criteria and between DSM and recently published ICD 11 might help identify different groups and symptom profiles. Conclusion: Specific trauma-related symptom profiles integrating the type of crime encountered and its individual impact on QoL may help improve future forensic assessment and guide compensation and rehabilitation plans. Carefully designed studies are now needed to further explore the use and forensic usability of complex indicators and the impact of violence in different forensic settings.

Violent interpersonal trauma predicts aggressive thoughts and behaviors towards self and others: findings from the National Comorbidity Survey-Adolescent Supplement

PURPOSE

The purpose of the current study is to examine the relation between adolescent traumatic event exposure and aggression directed towards the self and others. Theoretical perspectives underscore the particularly pernicious effects of violent traumas intentionally perpetrated by others in terms of negative posttraumatic outcomes. However, a careful comparison of trauma type in relation to aggression has not been done with youth. The current project, therefore, examined differences between youth with a history of violent interpersonal trauma (VIT) compared to those with a non-violent trauma type history in terms of aggressive behavior directed towards others as well as aggressive self-directed thoughts (suicidal ideation).

METHOD

The sample was drawn from the National Comorbidity Survey-Replication and consisted of 1928 adolescents (M = 15.4; SD = 1.47 years), each assigned to one of four age- and gender-matched trauma history groups.

RESULTS

Consistent with hypotheses, among trauma-exposed youth, those who had experienced or witnessed a VIT (compared to those reporting a non-VIT only) evidenced elevated aggression, even after controlling for a number of theoretically relevant covariates (e.g., gender, age, household income, demographic factors).

CONCLUSION

Results indicate that youth with a history of VIT may be at unique risk for experiencing aggression directed towards others and the self compared to those without this specific trauma history. This is important because trauma type is an easily assessed indicator of potentially elevated risk for these types of deleterious outcomes. Findings are situated in a research agenda aimed at continuing to refine our understanding of the link between interpersonal trauma and aggression.

Barriers and consultation needs regarding implementation of evidence-based treatment in community agencies

There is growing recognition of the gap between research and practice in mental health settings, and community agencies now face significant pressure from multiple stakeholders to engage in evidence-based practices. Unfortunately, little is known about the barriers that exist among agencies involved in formal implementation efforts or their perceptions about how implementation experts can best support change. This study reports the results of a survey of 263 individuals across 32 agencies involved in a state-wide effort to increase access to an evidence-based trauma-focused treatment for children. Quantitative and qualitative results identified lack of time and secondary trauma as significant barriers to implementation and areas in which agencies desired consultation and support. Qualitative responses further suggested the importance of addressing client/structural barriers, staff turnover, and continued intervention training. Findings inform the development of a structured consultation process for community agencies focused on addressing the multiple barriers that can interfere with implementation of evidence-based treatment.

Prevalence and predictors of PTSD and depression among adolescent victims of the Summer 2016 tornado in Yancheng City

The aim of this study was to investigate the prevalence rate of probable posttraumatic stress disorder (PTSD) and depression in the adolescents who experienced the 2016 Yancheng tornado 3 months ago, as well as to analyze the related risk factors. A total of 247 tornado adolescent survivors were recruited to complete child PTSD symptom scale and Center for Epidemiologic Studies Depression Scale for Children. Results showed that 57.5% and 58.7% of the participants reported suspected symptoms of PTSD and depression respectively. PTSD is highly comorbid with depression. Risk factors of these two disorders were age and tornado exposure. Finally, the implications of intervention and prevention of mental health problems among adolescents who experienced tornado were discussed.

Prolonged exposure therapy and supportive counselling for posttraumatic stress disorder in adolescents in a community-based sample, including experiences of stakeholders: study protocol for a comparative randomized controlled trial using task-shifting

BACKGROUND

There is a dearth of empirical evidence on the effectiveness of pharmacological and non-pharmacological treatments for adolescents with posttraumatic stress disorder (PTSD) in developing countries. The primary aim of the study is to examine the effects of prolonged exposure therapy compared with supportive counseling for adolescents with PTSD delivered by nurses trained as counselors.

METHODS/DESIGN

A single-blind randomized clinical trial comprising 90 adolescents with PTSD using a permuted block design will be utilized. Nurses previously naïve to prolonged exposure and supportive counselling will be trained to provide these treatments at the adolescents' high schools. Data collection will last from March 2014 to December 2017 and annually thereafter, dependent on the availability of funding. Participants will receive seven to fourteen 60 min sessions of prolonged exposure treatment (n = 45) or supportive counselling (n = 45). All assessments will be conducted before treatment, at mid-treatment, immediately after treatment completion, at 3-, 6-, and 12-month follow-up, and annually thereafter. It is hypothesized that PE-A will be superior to SC in reducing PTSD symptoms at post-treatment as measured by the CPSS-I administered by an independent evaluator. It is further hypothesized that PE-A treatment gains will be maintained at 3-, 6- and 12-month follow-ups and annually thereafter.

DISCUSSION

While early indications are that PE-A is an effective treatment for PTSD in adolescents, this study will help determine the effectiveness of PE-A in a South African, community setting (school-based) when task-shifted to nurses, as compared to SC.

TRIAL REGISTRATION

Pan African Clinical Trials Registry: PACTR201511001345372 , retrospectively registered 11 November 2015.

Educational Instructors' Attitudes Toward Juvenile Inmates: The Effect of the Inmate's Role in a Criminal Event and the Instructors' Belief in a Just World

The aim of the present study was to examine factors that affect educational instructors' attitudes toward juvenile inmates in corrective educational facilities. Educational instructors play an important role in the rehabilitation of juvenile inmates, and their attitudes may affect the adolescents' chances of rehabilitation. We adopted an ecological perspective and explored the relationship between instructors' belief in a just world (BJW) and the role of inmates in a criminal event (offender/victim). The study included 196 educational instructors. They answered a questionnaire on their background, BJW levels, and attitudes toward juvenile inmates. Results show that educational instructors perceived "victim" inmates as significantly more delinquent and less treatable than "offender" inmates, and that a BJW affected attitudes toward juvenile inmates. The theoretical and applied implications of these findings are discussed in this article.

Posttraumatic Stress Disorder Symptoms Among Trauma-Exposed Inpatient Adolescents: The Role of Emotional Nonacceptance and Anxiety Symptom Severity

The present investigation examined the role of anxiety symptom severity in the relation between emotional nonacceptance and posttraumatic stress disorder (PTSD) symptoms in a diverse sample of trauma-exposed adolescents admitted for acute psychiatric care at an inpatient state hospital (N = 50; 52.0% women; 44% white; mean [SD] age, 15.1 [0.51] years; range, 12-17 years). Anxiety symptom severity partially accounted for the association between emotional nonacceptance and PTSD total symptoms, and fully accounted for the association between emotional nonacceptance and PTSD symptom cluster severity, even after controlling for covariates. Reverse model testing provided confidence in the direction of hypothesized effects. These findings add to a body of literature underscoring the detrimental effect of nonaccepting reactions to negative emotions in the context of PTSD and provide preliminary support for a possible underlying role of anxiety symptom severity in the association between emotional nonacceptance and PTSD symptoms.

Trajectories of post-traumatic stress and externalizing psychopathology among maltreated foster care youth: A parallel process latent growth curve model

Few longitudinal studies have analyzed how violence exposure (e.g. child maltreatment, witnessing community violence) influence both externalizing and Post-Traumatic Stress (PTS) symptoms among children in foster care. Data from three waves of the National Survey of Child and Adolescent Well-Being (1999-2007) (NSCAW; National Data Archive on Child Abuse and Neglect, 2002) were analyzed to investigate the change trajectories of both externalizing and PTS symptomatology among children with a substantiated report of child maltreatment by Child Protective Services (CPS) between October 1999 and December 2000. This study uses data collected at three time points: baseline and approximately 18 (Wave 3) and 36 (Wave 4) months post-baseline. The Child Behavior Checklist (CBCL) scale measured externalizing symptoms and the Post Traumatic Stress Disorder section of a version of the Trauma Symptom Checklist for Children (TSCC) provided the measure of current trauma-related symptoms or distress. Analyses were conducted using a parallel process growth curve model with a sample of n=280 maltreated youth between the ages of 8 and 15 following home removal. Findings revealed that initial levels of externalizing and PTS symptomatology were both significantly and positively related and co-develop over time. Externalizing symptom severity remained in the borderline range during the first two years in out-of-home care. Both direct and indirect forms of interpersonal violence exposure were associated with initial level of externalizing symptom and PTS symptom severity, respectively. Taken together, our results suggest an underlying process that links early violence exposure to the co-development and cumulative impact of PTS on externalizing behavior above and beyond experiences of maltreatment. We conclude by discussing the key points of intervention that result from a more nuanced understanding of the longitudinal relationship between PTS and externalizing symptoms and the effect of complex trauma on growth in these symptoms over time.

Machine learning methods to predict child posttraumatic stress: a proof of concept study

BACKGROUND

The care of traumatized children would benefit significantly from accurate predictive models for Posttraumatic Stress Disorder (PTSD), using information available around the time of trauma. Machine Learning (ML) computational methods have yielded strong results in recent applications across many diseases and data types, yet they have not been previously applied to childhood PTSD. Since these methods have not been applied to this complex and debilitating disorder, there is a great deal that remains to be learned about their application. The first step is to prove the concept: Can ML methods - as applied in other fields - produce predictive classification models for childhood PTSD? Additionally, we seek to determine if specific variables can be identified - from the aforementioned predictive classification models - with putative causal relations to PTSD.

METHODS

ML predictive classification methods - with causal discovery feature selection - were applied to a data set of 163 children hospitalized with an injury and PTSD was determined three months after hospital discharge. At the time of hospitalization, 105 risk factor variables were collected spanning a range of biopsychosocial domains.

RESULTS

Seven percent of subjects had a high level of PTSD symptoms. A predictive classification model was discovered with significant predictive accuracy. A predictive model constructed based on subsets of potentially causally relevant features achieves similar predictivity compared to the best predictive model constructed with all variables. Causal Discovery feature selection methods identified 58 variables of which 10 were identified as most stable.

CONCLUSIONS

In this first proof-of-concept application of ML methods to predict childhood Posttraumatic Stress we were able to determine both predictive classification models for childhood PTSD and identify several causal variables. This set of techniques has great potential for enhancing the methodological toolkit in the field and future studies should seek to replicate, refine, and extend the results produced in this study.

Evidence Base Update for Psychosocial Treatments for Children and Adolescents Exposed to Traumatic Events

Child and adolescent trauma exposure is prevalent, with trauma exposure-related symptoms, including posttraumatic stress, depressive, and anxiety symptoms often causing substantial impairment. This article updates the evidence base on psychosocial treatments for child and adolescent trauma exposure completed for this journal by Silverman et al. (2008). For this review, we focus on 37 studies conducted during the seven years since the last review. Treatments are grouped by overall treatment family (e.g., cognitive behavioral therapy), treatment modality (e.g., individual vs. group), and treatment participants (e.g., child only vs. child and parent). All studies were evaluated for methodological rigor according to Journal of Clinical Child & Adolescent Psychology evidence-based treatment evaluation criteria (Southam-Gerow & Prinstein, 2014), with cumulative designations for level of support for each treatment family. Individual CBT with parent involvement, individual CBT, and group CBT were deemed well-established; group CBT with parent involvement and eye movement desensitization and reprocessing (EMDR) were deemed probably efficacious; individual integrated therapy for complex trauma and group mind-body skills were deemed possibly efficacious; individual client-centered play therapy, individual mind-body skills, and individual psychoanalysis were deemed experimental; and group creative expressive + CBT was deemed questionable efficacy. Advances in the evidence base, with comparisons to the state of the science at the time of the Silverman et al. (2008) review, are discussed. Finally, we present dissemination and implementation challenges and areas for future research.

Psychological Treatments for Symptoms of Posttraumatic Stress Disorder in Children, Adolescents, and Young Adults: A Meta-Analysis

Meta-analyses of the treatment of posttraumatic stress disorder (PTSD) in childhood and adolescence are restricted to specific trauma, selected interventions, and methodologically rigorous studies. This large meta-analysis quantifies the effects of psychological treatments for PTSD symptoms in children and adolescents. An extensive literature search yielded a total of 13,040 articles; 135 studies with 150 treatment conditions (N = 9562 participants) met the inclusion criteria (psychological interventions with children and/or adolescents with PTSD symptoms that report quantitative measures of symptom change). The mean effect sizes (ESs) for PTSD symptoms ranged from large to small, depending on the control condition. Cognitive behavioral therapy (CBT) yielded the highest ESs. Age and caretaker involvement were identified as moderators. CBT, especially when conducted in individual treatment with the inclusion of parents, is a highly effective treatment for trauma symptoms. Psychological treatments need to be modified to address younger patients' specific needs.

Trauma and homelessness in youth: Psychopathology and intervention

Youth runaway behavior and homelessness (RHY) in the U.S. is increasingly common, with prevalence estimated at 1-1.7 million youth. RHY have multiple, overlapping problems often including poor physical and mental health, frequent street victimization, and histories of physical and sexual abuse. Further, current street victimization interacts with childhood abuse to produce complex, unique presentations of traumatic symptoms and related disorders in runaway and homeless youth. This review paper explores (1) the role of childhood trauma in the genesis of runaway and homeless behavior, and (2) how childhood trauma interacts with street victimization to create vulnerability to psychopathology. In response to the trauma needs of RHY, we conducted a systematic review of the state of the current literature on trauma-informed interventions for RHY. We conclude that the field currently lacks empirically validated trauma interventions in RHY. However, theoretically plausible frameworks do exist and could be the basis for future research and intervention development.

Caring for juveniles with mental disorders in adult corrections facilities

Although juveniles have developmental, educational, healthcare, and rehabilitation needs that differ from adults, thousands of them have been confined in adult corrections facilities in the past 30 years. This manuscript will review how and why juveniles end up in adult corrections facilities, who they are, their rehabilitative needs, and how they differ from adults in corrections facilities and youths in the juvenile justice system. The importance of providing developmentally-informed mental health services to youths in adult corrections facilities is examined, along with barriers to traditional adolescent psychiatric practice. Recommendations for future directions in adolescent psychiatric care are presented.

Narrative Exposure Therapy: A Proposed Model to Address Intimate Partner Violence-Related PTSD in Parenting and Pregnant Adolescents

Pregnant and parenting adolescents experience high rates of intimate partner violence (IPV) and its sequelae posttraumatic stress disorder (PTSD) and depression. Narrative exposure therapy (NET) is an innovative intervention that has demonstrated strong preliminary evidence in improving mental health. The specific aims of this article are 3-fold: (1) provide a brief background about IPV-related PTSD and depression among pregnant and parenting adolescents; (2) describe NET's theoretical principles, its therapeutic process, and provide a review of existing evidence; and (3) discuss NET as a potential treatment to address the mental health burden among adolescents experiencing IPV-related PTSD and depression.

Treatment of Adolescent PTSD: The Impact of Prolonged Exposure Versus Client-Centered Therapy on Co-Occurring Emotional and Behavioral Problems

The present study evaluated secondary emotional and behavioral outcomes among adolescents who received prolonged exposure (PE-A) or client-centered therapy (CCT) for posttraumatic stress disorder (PTSD) in a randomized controlled trial. Participants were 61 adolescent girls (age: M = 15.33, SD = 1.50 years) with sexual abuse related PTSD seeking treatment at a community mental health clinic. Multilevel modeling was employed to evaluate group differences on the Youth Self-Report (YSR) over acute treatment and 12-month follow-up. Both treatment groups showed significant improvements on all YSR scales from baseline to 12-month follow-up. Adolescents who received PE-A showed significantly greater reductions than those receiving CCT on the Externalizing subscale (d = 0.70), rule-breaking behavior (d = 0.63), aggressive behavior (d = 0.62), and conduct problems (d = 0.78). No treatment differences were found on the Internalizing subscale or among other YSR problem areas. Both PE-A and CCT effectively reduced many co-occurring problems among adolescents with PTSD. Although PE-A focuses on PTSD and not on disruptive behaviors, PE-A was associated with greater sustained changes in externalizing symptoms, supporting broad effects of trauma-focused treatment on associated problem areas.