Emotional reactivity, trauma-related distress, and suicidal ideation among adolescent inpatient survivors of sexual abuse

Adolescent psychiatric inpatients suffer high rates of childhood sexual abuse, trauma-related distress, and suicidality. This study evaluated the hypothesis that three domains of resiliency (i.e., Sense of Mastery, Sense of Relatedness, and Emotional Reactivity) would mediate the effect of trauma-related distress upon suicidal ideation, while accounting for symptoms of depression, and that the indirect effect of trauma-related distress upon suicidal ideation would be greater among survivors of childhood sexual abuse. Chart review patients included 550 adolescents admitted to a public psychiatric hospital in a Northwestern US State from 2010 to 2015. Adolescents completed self-report measures of trauma-related distress, depression, resiliency, and suicidal ideation. Half of the adolescents in this study reported past history of childhood sexual abuse, and more than half disclosed history of attempted suicide. There was a group noninvariant indirect effect of trauma-related distress upon suicidal ideation via emotional reactivity among survivors of childhood sexual abuse (β = 0.10, 95% ACI: 0.04 to .17), as well as a group invariant direct effect of depression symptoms (β = 0.88, p < .001). The other two domains of resiliency, sense of mastery and sense of relatedness did not mediate the association between trauma-related distress and suicidal ideation. These findings demonstrate the importance of emotional reactivity with regard to suicidal ideation, as well as the association between depression symptoms and suicidal ideation in this clinical population, and suggest the potential utility of skills-based interventions, and the need for trauma-informed policy and procedures in adolescent psychiatric inpatient settings.

Improvements in personal resiliency among youth who have completed trauma-focused cognitive behavioral therapy: A preliminary examination

This preliminary investigation assessed whether different aspects of personal resiliency improved for youth (7-17 years old) impacted by child sexual abuse (CSA) after completing trauma-focused cognitive behavioral therapy (TF-CBT). The Resiliency Scales for Children and Adolescents (RSCA; Prince-Embury, 2007) were administered to 157 youth before and after participating in TF-CBT with their nonoffending caregivers. Hierarchal regression analyses were performed to ascertain whether pretest RSCA resiliency scores moderated decreases in the posttraumatic stress and self-reported depressive symptoms at posttreatment. The RSCA scales did not moderate any of the improvements on the PTSD and depression outcome measures. Paired t-tests between the mean pre- and posttest RSCA Sense of Mastery (MAS), Sense of Relatedness (REL), and Emotional Reactivity (REA) scores demonstrated significant (ps<0.001) improvements on these measures over time. Using residualized posttest scores for the three RSCA scales to assess improvement, significant correlations were found between changes in resiliency and various residualized outcome scores for posttraumatic stress disorder (PTSD) and depression measures. Decreases in the REA scores and increases in the MAS and REL scores were related to fewer symptoms of hypervigilance and less self-reported depression after completing TF-CBT. Only improvements in the REL scores were associated with fewer symptoms of re-experiencing after treatment. The results were discussed as indicating that significant improvements in personal resiliency had occurred over time with effect sizes less than those found for posttraumatic stress symptoms, but comparable to those found for self-reported depression reductions. Limitations and future research recommendations are discussed.

Violence Exposure and Victimization Among Rural Adolescents

Violence exposure is a serious public health concern for adolescents in schools today. Violence exposure can be quite severe and frequent with multiple acts of indirect and direct victimization having lasting effects on the physical, emotional, and intellectual well-being of adolescents. The purpose of the present study is to examine the rates of violence exposure and the relative risk for multiple exposures among adolescent youth living in rural communities. Results confirm that adolescents who live in rural areas were frequent victims of violence exposure and that males were more likely to be the victims than females. Moreover, the relative risk for multiple exposures either indirectly, directly, or in combination reveal that in all instances amplification of risk occurs. The study is an important first step in understanding the rates of violence exposure and victimization experienced by adolescent youth in rural Canada with implications for school-based programming presented.