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Bureau A, Berthelot N, Ricard J, Lafrance C, Jomphe V, Dioni A, Fortin-Fabbro É, Boisvert MC, Maziade M. Heterogeneity in the longitudinal courses of global functioning in children at familial risk of major psychiatric disorders: Association with trauma and familial characteristics. Bipolar Disord 2024; 26:265-276. [PMID: 37957788 DOI: 10.1111/bdi.13386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVES The extent to which heterogeneity in childhood risk trajectories may underlie later heterogeneity in schizophrenia (SZ), bipolar disorder (BP), and major depressive disorder (MDD) remains a chief question. Answers may optimally be found by studying the longitudinal trajectories of children born to an affected parent. We aimed to differentiate trajectories of global functioning and their sensitive periods from the age of 6 to 17 years in children at familial risk (FHRs). METHODS First, a latent class mixed model analysis (LCMM) was applied to yearly ratings of the Children's Global Assessment Scale (CGAS) from the age of 6 to 17 years in 170 FHRs born to a parent affected by DSM-IV SZ (N = 37), BP (N = 82) or MDD (N = 51). Then, we compared the obtained Classes or trajectories of FHRs in terms of sex, parental diagnosis, IQ, child clinical status, childhood trauma, polygenic risk score (PRS), and outcome in transition to illness. RESULTS The LCMM on yearly CGAS trajectories identified a 4-class solution showing markedly different childhood and adolescence dynamic courses and temporal vulnerability windows marked by a functioning decline and a degree of specificity in parental diagnosis. Moreover, IQ, trauma exposure, PRS level, and timing of later transition to illness differentiated the trajectories. Almost half (46%) of the FHRs exhibited a good and stable global functioning trajectory. CONCLUSIONS FHRs of major psychiatric disorders show heterogeneous functional decline during development associated with parental diagnosis, polygenic risk loading, and childhood trauma.
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Affiliation(s)
- Alexandre Bureau
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Quebec, Canada
- Cervo Brain Research Centre, Québec, Quebec, Canada
| | - Nicolas Berthelot
- Cervo Brain Research Centre, Québec, Quebec, Canada
- Université du Québec à Trois-Rivières, Department of Nursing Sciences, Trois-Rivieres, Quebec, Canada
| | | | | | | | - Abdoulaye Dioni
- Department of Social and Preventive Medicine, Faculty of Medicine, Université Laval, Québec, Quebec, Canada
| | | | | | - Michel Maziade
- Cervo Brain Research Centre, Québec, Quebec, Canada
- Department of Psychiatry and Neuroscience, Faculty of Medicine, Université Laval, Québec, Quebec, Canada
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2
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Veronese G, Mahamid F, Bdier D, Obaid H, Cavazzoni F. The development and validation of the Palestinian children's traumatic events checklist in a war-torn environment. BMC Psychiatry 2024; 24:254. [PMID: 38570753 PMCID: PMC10988932 DOI: 10.1186/s12888-024-05731-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 03/29/2024] [Indexed: 04/05/2024] Open
Abstract
Traumatic experiences in childhood can lead to trauma symptoms and impaired mental health, especially when children are exposed to war and political violence. Despite significant attention to child's exposure to traumas, few instruments to detect potentially traumatic events have been validated psychometrically. Our study aimed to develop, adapt and validate a user-friendly traumatic events checklist in Palestinian children living in three areas affected by low-intensity war and ongoing political and military violence. 965 Palestinian children (494 males and 471 females) living in the Gaza Strip, West Bank and East Jerusalem were administered with a tailor-made Traumatic Events checklist, Children Impact of Events scale, and Strengths and Difficulties Scale. Exploratory and Confirmatory factor analysis was run to detect the factorial structure of the checklist. Furthermore, ANOVA was performed to identify statistically significant demographic differences among participants. A three factors structure emerged with Political violence-related traumatic experiences (PVTE), military violence against individuals (MVI), and military violence against individuals and families (MVF). Gaza children and adolescents resulted in being the most exposed to potentially traumatic events. The instrument can clearly portray potentially traumatic experiences in children exposed to violent events and adverse childhood experiences.
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Affiliation(s)
- Guido Veronese
- Department of Human Sciences and Education "R.Massa", University of Milano-Bicocca, Milan, Italy
- Department of Psychology, Stellenbosch University, Stellenbosch, South Africa
| | - Fayez Mahamid
- Department of Counseling and Psychology, An-Najah National University, Nablus, Palestine.
| | - Dana Bdier
- Department of Human Sciences and Education "R.Massa", University of Milano-Bicocca, Milan, Italy
- Department of Counseling and Psychology, An-Najah National University, Nablus, Palestine
| | - Hania Obaid
- Department of Human Sciences and Education "R.Massa", University of Milano-Bicocca, Milan, Italy
| | - Federica Cavazzoni
- Department of Human Sciences and Education "R.Massa", University of Milano-Bicocca, Milan, Italy
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3
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Keenan HT, Wade SL, Miron D, Presson AP, Clark AE, Ewing-Cobbs L. Reducing Stress after Trauma (ReSeT): study protocol for a randomized, controlled trial of an online psychoeducational program and video therapy sessions for children hospitalized after trauma. Trials 2023; 24:766. [PMID: 38017574 PMCID: PMC10683223 DOI: 10.1186/s13063-023-07806-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/16/2023] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Post-traumatic stress symptoms develop in a quarter to half of injured children affecting their longer-term psychologic and physical health. Evidence-based care exists for post-traumatic stress; however, it is not readily available in some communities. We have developed an eHealth program consisting of online, interactive educational modules and telehealth therapist support based in trauma-focused cognitive behavioral therapy, the Reducing Stress after Trauma (ReSeT) program. We hypothesize that children with post-traumatic stress who participate in ReSeT will have fewer symptoms compared to the usual care control group. METHODS This is a randomized controlled trial to test the effectiveness of the ReSeT intervention in reducing symptoms of post-traumatic stress compared to a usual care control group. One hundred and six children ages 8-17 years, who were admitted to hospital following an injury, with post-traumatic stress symptoms at 4 weeks post-injury, will be recruited and randomized from the four participating trauma centers. The outcomes compared across groups will be post-traumatic stress symptoms at 10 weeks (primary outcome) controlling for baseline symptoms and at 6 months post-randomization (secondary outcome). DISCUSSION ReSeT is an evidence-based program designed to reduce post-traumatic stress symptoms among injured children using an eHealth platform. Currently, the American College of Surgeons standards suggest that trauma programs identify and treat patients at high risk for mental health needs in the trauma system. If effectiveness is demonstrated, ReSeT could help increase access to evidence-based care for children with post-traumatic stress within the trauma system. TRIAL REGISTRATION ClinicalTrials.gov NCT04838977. 8 April 2021.
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Affiliation(s)
- Heather T Keenan
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA.
| | - Shari L Wade
- Cincinnati Children's Hospital Medical Center Division of Pediatric Rehabilitation, Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, USA
| | - Devi Miron
- Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, 1430 Tulane Ave. #8055, New Orleans, LA, 70112, USA
| | - Angela P Presson
- Department of Internal Medicine, University of Utah School of Medicine, 30 N Mario Capecchi Dr. , Salt Lake City, UT, 84112, USA
| | - Amy E Clark
- Department of Pediatrics, University of Utah School of Medicine, 295 Chipeta Way, Salt Lake City, UT, 84108, USA
| | - Linda Ewing-Cobbs
- Children's Learning Institute, McGovern Medical School at UTHealth, 7000 Fannin, Suite 2401, Houston, TX, 77030, USA
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4
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Beese S, Drumm K, Wells-Yoakum K, Postma J, Graves JM. Flexible Resources Key to Neighborhood Resilience for Children: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1791. [PMID: 38002882 PMCID: PMC10670030 DOI: 10.3390/children10111791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/31/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023]
Abstract
Neighborhoods have been the focus of health researchers seeking to develop upstream strategies to mitigate downstream disease development. In recent years, neighborhoods have become a primary target in efforts to promote health and resilience following deleterious social conditions such as the climate crisis, extreme weather events, the global pandemic, and supply chain disruptions. Children are often the most vulnerable populations after experiencing unexpected shocks. To examine and describe conceptually the construct of Neighborhood Resilience, we conducted a comprehensive scoping review using the terms ("resilience" or "resiliency" or "resilient") AND ("neighborhood"), utilizing MEDLINE (through PubMed) and CINAHL (through EBSCOhost) databases, to assess overall neighborhood themes that impact resilience. A total of 57 articles were extracted that met inclusion criteria. Extracted characteristics included study purpose, country of origin, key findings, environmental protective/risk factors. The analysis revealed a positive relationship between neighborhood resource density, neighborhood resiliency, and individual resiliency. This study reports the finding for studies with a population focus of pre-school age and school age children (1.5-18 years of age). Broadly, we identified that the primary goals regarding neighborhood resilience for childhood can be conceptualized as all activities and resources that (a) prevent trauma during childhood development and/or (b) mitigate or heal childhood trauma once it has occurred. This goal conceptually encompasses antecedents that increase protective factors and reduces risk factors for children and their families. This comprehensive look at the literature showed that a neighborhood's ability to build, promote, and maintain resiliency is often largely dependent on the flexible resources (i.e., knowledge, money, power, prestige, and beneficial social connections) that are available.
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Affiliation(s)
- Shawna Beese
- College of Agricultural, Human, and Natural Resources Sciences (CAHNRS), Washington State University, Pullman, WA 99164, USA;
- College of Nursing, Washington State University, Spokane, WA 99201, USA; (J.P.); (J.M.G.)
| | - Kailie Drumm
- Nursing Program, Lower Columbia College, Longview, WA 98632, USA;
| | - Kayla Wells-Yoakum
- College of Agricultural, Human, and Natural Resources Sciences (CAHNRS), Washington State University, Pullman, WA 99164, USA;
| | - Julie Postma
- College of Nursing, Washington State University, Spokane, WA 99201, USA; (J.P.); (J.M.G.)
| | - Janessa M. Graves
- College of Nursing, Washington State University, Spokane, WA 99201, USA; (J.P.); (J.M.G.)
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McBain RK, Levin JS, Matthews S, Qureshi N, Long D, Schickedanz AB, Gilgoff R, Kotz K, Slavich GM, Eberhart NK. The effect of adverse childhood experience training, screening, and response in primary care: a systematic review. EClinicalMedicine 2023; 65:102282. [PMID: 38106557 PMCID: PMC10725064 DOI: 10.1016/j.eclinm.2023.102282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 09/28/2023] [Accepted: 10/03/2023] [Indexed: 12/19/2023] Open
Abstract
Background Adverse childhood experiences (ACEs) can have harmful, long-term health effects. Although primary care providers (PCPs) could help mitigate these effects, no studies have reviewed the impacts of ACE training, screening, and response in primary care. Methods This systematic review searched four electronic databases (PubMed, Web of Science, APA PsycInfo, CINAHL) for peer-reviewed articles on ACE training, screening, and/or response in primary care published between Jan 1, 1998, and May 31, 2023. Searches were limited to primary research articles in the primary care setting that reported provider-related outcomes (knowledge, confidence, screening behavior, clinical care) and/or patient-related outcomes (satisfaction, referral engagement, health outcomes). Summary data were extracted from published reports. Findings Of 6532 records, 58 met inclusion criteria. Fifty-two reported provider-related outcomes; 21 reported patient-related outcomes. 50 included pediatric populations, 12 included adults. A majority discussed screening interventions (n = 40). Equal numbers (n = 25) discussed training and clinical response interventions. Strength of evidence (SOE) was generally low, especially for adult studies. This was due to reliance on observational evidence, small samples, and self-report measures for heterogeneous outcomes. Exceptions with moderate SOE included the effect of training interventions on provider confidence/self-efficacy and the effect of screening interventions on screening uptake and patient satisfaction. Interpretation Primary care represents a potentially strategic setting for addressing ACEs, but evidence on patient- and provider-related outcomes remains scarce. Funding The California Department of Health Care Services and the Office of the California Surgeon General.
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Affiliation(s)
- Ryan K. McBain
- Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA
- Division of Healthcare Delivery, RAND Corporation, Washington, DC, USA
| | - Jonathan S. Levin
- Division of Healthcare Delivery, RAND Corporation, Washington, DC, USA
| | - Samantha Matthews
- Division of Healthcare Delivery, RAND Corporation, Santa Monica, CA, USA
| | - Nabeel Qureshi
- Division of Healthcare Delivery, RAND Corporation, Santa Monica, CA, USA
| | - Dayna Long
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Adam B. Schickedanz
- Department of Pediatrics, David Geffen School of Medicine and Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | - Rachel Gilgoff
- UCLA-UCSF ACEs Aware Family Resilience Network, Los Angeles, CA, USA
| | - Krista Kotz
- UCLA-UCSF ACEs Aware Family Resilience Network, Los Angeles, CA, USA
| | - George M. Slavich
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA
| | - Nicole K. Eberhart
- Division of Healthcare Delivery, RAND Corporation, Santa Monica, CA, USA
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Goldenthal HJ, Gouze K, Russo J, Raviv T, Holley C, Cicchetti C. Potentially Traumatic Events, Socioemotional and Adaptive Functioning: Associations with Self-Regulatory Skills in a Community Sample of Primarily Black and Latinx 3-5-year-olds. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01595-w. [PMID: 37646985 DOI: 10.1007/s10578-023-01595-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/15/2023] [Indexed: 09/01/2023]
Abstract
Early childhood is a heightened risk period for exposure to potentially traumatic events (PTEs) and a critical period for the development of foundational self-regulatory competencies that have potential cascading effects on future socioemotional functioning. This cross-sectional study examined associations between PTE exposure and socioemotional and adaptive functioning, and self-regulatory skills, in a community-based sample of 280 primarily Black and Latinx 3-5-year-olds. Results supported direct relations between PTE exposure and socioemotional and adaptive functioning. Attentional regulation was associated with PTEs and internalizing behaviors, externalizing behaviors, and adaptive behaviors. There was also a significant association of emotional regulation on the relationship between PTEs and internalizing and externalizing behaviors, but not adaptive functioning. Findings have implications for early intervention and educational and public policy, including the importance of scaffolding the development of self-regulatory skills among preschoolers with high PTE exposure.
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Affiliation(s)
- Hayley J Goldenthal
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago Medicine, Chicago, IL, USA.
- Department of Pediatrics, Michigan Medicine, Ann Arbor, MI, USA.
| | - Karen Gouze
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Pritzker Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Jaclyn Russo
- School of Education and Human Development, Center for Advanced Study of Teaching and Learning, University of Virginia, Charlottesville, VA, USA
| | - Tali Raviv
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Pritzker Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Carmen Holley
- Pritzker Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Colleen Cicchetti
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Pritzker Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
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7
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Ehrlich PF, Pulcini CD, De Souza HG, Hall M, Andrews A, Zima BT, Fein JA, Chaudhary S, Hoffmann JA, Fleegler EW, Jeffries KN, Goyal MK, Hargarten S, Alpern ER. Mental Health Care Following Firearm and Motor Vehicle-related Injuries: Differences Impacting Our Treatment Strategies. Ann Surg 2022; 276:463-471. [PMID: 35762587 PMCID: PMC9388584 DOI: 10.1097/sla.0000000000005557] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To compare new mental health diagnoses (NMHD) in children after a firearm injury versus following a motor vehicle collision (MVC). BACKGROUND A knowledge gap exists regarding childhood mental health diagnoses following firearm injuries, notably in comparison to other forms of traumatic injury. METHODS We utilized Medicaid MarketScan claims (2010-2016) to conduct a matched case-control study of children ages 3 to 17 years. Children with firearm injuries were matched with up to 3 children with MVC injuries. Severity was determined by injury severity score and emergency department disposition. We used multivariable logistic regression to measure the association of acquiring a NMHD diagnosis in the year postinjury after firearm and MVC mechanisms. RESULTS We matched 1450 children with firearm injuries to 3691 children with MVC injuries. Compared to MVC injuries, children with firearm injuries were more likely to be black, have higher injury severity score, and receive hospital admission from the emergency department ( P <0.001). The adjusted odds ratio (aOR) of NMHD diagnosis was 1.55 [95% confidence interval (95% CI): 1.33-1.80] greater after firearm injuries compared to MVC injuries. The odds of a NMHD were higher among children admitted to the hospital compared to those discharged. The increased odds of NMHD after firearm injuries was driven by increases in substance-related and addictive disorders (aOR: 2.08; 95% CI: 1.63-2.64) and trauma and stressor-related disorders (aOR: 2.07; 95% CI: 1.55-2.76). CONCLUSIONS Children were found to have 50% increased odds of having a NMHD in the year following a firearm injury as compared to MVC. Programmatic interventions are needed to address children's mental health following firearm injuries.
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Affiliation(s)
- Peter F. Ehrlich
- Section of Pediatric Surgery CS Mott Children’s Hospital University of Michigan Ann Arbor, Michigan, USA
| | - Christian D. Pulcini
- Department of Surgery & Pediatrics, University of Vermont Medical Center and Children’s Hospital, Larner College of Medicine at the University of Vermont, Burlington, VT, USA
| | | | - Matt Hall
- Children’s Hospital Association, Lenexa, KS, USA
| | - Annie Andrews
- Department of Pediatrics, Medical College of South Carolina, Charleston, SC, USA
| | - Bonnie T. Zima
- UCLA-Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles, Los Angeles, CA, USA
| | - Joel A. Fein
- Department of Pediatrics, Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA
| | - Sofia Chaudhary
- Department of Pediatrics and Emergency Medicine, Children’s Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA, USA
| | - Jennifer A. Hoffmann
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Eric W. Fleegler
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA, USA
| | - Kristyn N Jeffries
- Department of Pediatrics, Division of Hospital Medicine, Children’s Mercy Hospitals, Kansas City, MO, USA
| | - Monika K. Goyal
- Department of Pediatrics, Children’s National Hospital, George Washington University, Washington, DC, USA
| | - Stephen Hargarten
- Department of Emergency Medicine and the Comprehensive Injury Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Elizabeth R. Alpern
- Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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8
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Ford JD, Spinazzola J, van der Kolk B, Chan G. Toward an empirically based Developmental Trauma Disorder diagnosis and semi-structured interview for children: The DTD field trial replication. Acta Psychiatr Scand 2022; 145:628-639. [PMID: 35266162 DOI: 10.1111/acps.13424] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Developmental trauma disorder (DTD) is a childhood psychiatric syndrome designed to include sequelae of trauma exposure not fully captured by PTSD. This study aimed to determine whether the assessment of DTD with an independent sample of children in mental health treatment will replicate results from an initial validation study. METHODS The DTD semi-structured interview (DTD-SI) was administered to a convenience sample in six sites in the United States (N = 271 children in mental health care, 8-18 years old, 47% female, 41% Black or Latinx) with measures of trauma history, DSM-IV PTSD, probable DSM-IV psychiatric diagnoses, emotion regulation/dysregulation, internalizing/externalizing problems, and quality of life. Confirmatory factor (CFA) and item response theory (IRT) analyses tested DTD's structure and DTD-SI's information value. Bivariate and multivariate analyses tested DTD's criterion and convergent validity. RESULTS A three-factor solution (i.e., emotion/somatic, attentional/behavioral, and self/relational dysregulation) best fit the data (CFI = 0.91; TLI = 0.89; BIC = 357.17; RMSEA = 0.06; SRMR = 0.05). DTD-SI items were informative across race/ethnicity, gender, and age with three exceptions. Emotion dysregulation was the most informative item at low levels of DTD severity. Non-suicidal self-injury was rare but discriminative in identifying children with high levels of DTD severity. Results supported the criterion and convergent validity of the DTD construct. CONCLUSION This replication provides empirical support for DTD as a construct and potential psychiatric syndrome, and the DTD-SI's validity as a clinical research tool.
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Affiliation(s)
- Julian D Ford
- University of Connecticut Medical School Psychiatry Department, Farmington, Connecticut, USA
| | | | | | - Grace Chan
- University of Connecticut Medical School Psychiatry Department, Farmington, Connecticut, USA
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9
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Lindsey M, Sullivan K, Chemtob C, Ancharski K, Jaccard J, Cloitre M, Urquiza A, Timmer S, Okosi M, Kaplan D. A randomized controlled trial to assess the efficacy of Parenting-STAIR in treating maternal PTSD to reduce maltreatment recidivism: protocol for the Safe Mothers, Safe Children study. Trials 2022; 23:432. [PMID: 35606818 PMCID: PMC9125354 DOI: 10.1186/s13063-022-06354-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 04/25/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Child maltreatment recidivism substantially increases the likelihood of adverse life outcomes, but there is little evidence that family preservation services are effective at reducing recidivism. Mothers in child welfare have very high rates of trauma exposure; maternal post-traumatic stress disorder (PTSD) is an intervention target that has the potential to reduce abuse and neglect. The Safe Mothers, Safe Children (SMSC) intervention program involves the delivery of an innovative combination of interventions, including Skills Training in Affective and Interpersonal Regulation (STAIR) and Parent-Child Interaction Therapy (PCIT). The combined intervention, Parenting-STAIR (P-STAIR), targets maternal PTSD and comorbid depression symptoms to reduce the adverse effects of PTSD on parenting, improve positive parenting skills, and prevent maltreatment recidivism. METHODS This study is a two-arm randomized controlled trial: P-STAIR (23 sessions) versus supportive counseling (23 sessions). Participants are mothers receiving child welfare family preservation services (FPS), with a child in the age range of 1-8 years old and meeting diagnostic criteria for PTSD (with/without depression). Clinical assessment occurs at pre-treatment (baseline), two in-treatment assessments (mid-assessment #1 after module 9 and mid-assessment #2 after module 15), post-treatment, and at a 6-month follow-up. Recidivism will be measured using the New York State Child Welfare Registry (NYSCWR). We will enroll a total of 220 participants over 4 years: half (N = 110) randomly assigned to the P-STAIR condition and half (N = 110) to the supportive counseling condition. DISCUSSION This is the first RCT to investigate the efficacy of P-STAIR. The findings for the trial have the potential to contribute to the expansion of evidence-based practices for maternal PTSD, maltreatment, and child welfare.
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Affiliation(s)
- Michael Lindsey
- Silver School of Social Work, New York University, New York, NY, USA. .,McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY, USA.
| | - Kathrine Sullivan
- grid.137628.90000 0004 1936 8753Silver School of Social Work, New York University, New York, NY USA
| | - Claude Chemtob
- grid.137628.90000 0004 1936 8753Silver School of Social Work, New York University, New York, NY USA ,grid.137628.90000 0004 1936 8753Grossman School of Medicine, New York University, New York, NY USA
| | - Kelly Ancharski
- grid.137628.90000 0004 1936 8753McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY USA
| | - James Jaccard
- grid.137628.90000 0004 1936 8753Silver School of Social Work, New York University, New York, NY USA
| | - Marylène Cloitre
- grid.240324.30000 0001 2109 4251Institute for Trauma and Stress, New York University Langone Medical Center, New York, NY USA ,grid.168010.e0000000419368956National Center for PTSD Dissemination and Training Division, Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA USA
| | - Anthony Urquiza
- grid.27860.3b0000 0004 1936 9684CAARE Diagnostic & Treatment Center, Department of Pediatrics, University of California, Sacramento, CA USA
| | - Susan Timmer
- grid.27860.3b0000 0004 1936 9684CAARE Diagnostic & Treatment Center, Department of Pediatrics, University of California, Sacramento, CA USA
| | - Mercedes Okosi
- grid.137628.90000 0004 1936 8753McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY USA
| | - Debra Kaplan
- grid.137628.90000 0004 1936 8753McSilver Institute for Poverty Policy and Research, Silver School of Social Work, New York University, New York, NY USA
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10
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Buka SL, Beers LS, Biel MG, Counts NZ, Hudziak J, Parade SH, Paris R, Seifer R, Drury SS. The Family is the Patient: Promoting Early Childhood Mental Health in Pediatric Care. Pediatrics 2022; 149:186907. [PMID: 35503309 PMCID: PMC9847420 DOI: 10.1542/peds.2021-053509l] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2021] [Indexed: 01/21/2023] Open
Abstract
Advances in developmental psychology, child psychiatry, and allied disciplines have pointed to events and experiences in the early years as the origin of many adult mental health challenges. Yet, children's mental health services still largely lack a developmental or prevention-focused orientation, with most referrals to mental health professionals occurring late, once problems are well established. An early childhood mental health system rooted in the principles of life-course health development would take a very different approach to designing, testing, and implementing prevention and intervention strategies directed toward early child mental health. Priorities for such a system include supporting healthy family environments, parent-child and family relationships, parents' emotional/behavioral health, and family routines as a means of providing the best possible neurobiological foundation for mental health across the life span. The system would include proactive, trauma-informed, multidisciplinary care, with integrated mental health and social services support embedded in pediatric primary care settings. Novel intervention approaches in need of further research include 2-generational dyadic interventions designed to improve the mental health of parents and children, mental health-oriented telemedicine, and contingency management (CM) strategies. Integral to this Life Course Health Development reformulation is a commitment by all organizations supporting children to primordial and primary prevention strategies to reduce racial and socioeconomic disparities in all settings. We contend that it is the family, not the individual child, that ought to be the identified target of these redesigned approaches, delivered through a transformed pediatric system with anticipated benefits for multiple health outcomes across the life course.
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Affiliation(s)
- Stephen L. Buka
- Department of Epidemiology, Brown University School of Public Health, Providence, Rhode Island,Address correspondence to Stephen Buka, ScD, Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Providence, RI 02912. E-mail:
| | - Lee S. Beers
- Children’s National Hospital, Washington, District of Columbia,Child Health Advocacy Institute, Washington, District of Columbia
| | - Matthew G. Biel
- Departments of Psychiatry and Pediatrics, Georgetown University School of Medicine, Georgetown University Medical Center, Washington, District of Columbia
| | - Nathaniel Z. Counts
- Mental Health America, Alexandria, Virginia,Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, The Bronx, New York
| | - James Hudziak
- Division of Child Psychiatry, Vermont Center for Children, Youth, and Families, Larner College of Medicine, University of Vermont, Burlington, Vermont
| | - Stephanie H. Parade
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island,Bradley/Hasbro Children’s Research Center, Bradley Hospital, East Providence, Rhode Island
| | - Ruth Paris
- Boston University School of Social Work, Boston, Massachusetts
| | - Ronald Seifer
- Frank Porter Graham Child Development Institute, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Stacy S. Drury
- Departments of Psychiatry,Pediatrics, Tulane University, New Orleans, Louisiana,Children’s Hospital New Orleans, New Orleans, Louisiana
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11
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Khanijahani A, Sualp K. Adverse Childhood Experiences, Neighborhood Support, and Internalizing and Externalizing Mental Disorders among 6-17 years old US Children: Evidence from a Population-Based Study. Community Ment Health J 2022; 58:166-178. [PMID: 33709281 DOI: 10.1007/s10597-021-00808-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 02/23/2021] [Indexed: 11/24/2022]
Abstract
We pooled data from four years (2016-2019) of the National Survey of Children's Health (NSCH) and included a nationally representative sample of 6 to 17 years old US children (N = 94,369; Mean age = 11.53 years, Standard Deviation [SD] = 3.53). Among 6-17-year-old US children, about 48% had a lifelong exposure to at least one of nine Adverse Childhood Experiences (ACEs), and 18.7% had a current diagnosis of at least one of four mental disorders. We examined the association between ACEs, neighborhood support, and mental disorders using several logistic regression models. More types of lifelong ACEs and lower neighborhood support were associated with a higher diagnosis of internalizing (anxiety/depression) and externalizing (ADHD/behavior problems) mental disorders (odds ratio [OR] > 1, and p < .001 for all relationships). After controlling for neighborhood support in the models, the odds ratios for ACEs attenuated but remained significant in all models regardless of mental disorder type or age group. However, the odds ratios for neighborhood support were larger for the association with ADHD/behavior problems than anxiety/depression. Moreover, odds ratios for neighborhood support levels were higher for older children (12-17 years old) compared to younger (6-11 years old) children. Higher neighborhood support appears to mitigate the adverse effects of ACEs on mental disorders, especially externalizing mental disorders (anxiety/depression) among adolescents (12-17 years old).
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Affiliation(s)
- Ahmad Khanijahani
- Department of Health Administration and Public Health, John G. Rangos School of Health Sciences, Duquesne University, Pittsburgh, PA, USA.
| | - Kenan Sualp
- Department of Public Affairs, University of Central Florida, Orlando, FL, USA
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12
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Jones LM, Nolte K, O'Brien AJ, Trumbell JM, Mitchell KJ. Factors Related to Providers Screening Children for Behavioral Health Risks in Primary Care Settings. J Pediatr Nurs 2021; 59:37-44. [PMID: 33460878 DOI: 10.1016/j.pedn.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 12/17/2020] [Accepted: 12/17/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To provide information from a large sample of pediatric and family medicine primary care providers on practices in screening children for behavioral health risks. DESIGN AND METHODS Participants were a sample of physicians (n=319) and nurse practitioners (n=292) from across the U.S. who completed a confidential online survey about screening practices through a computer-assisted self-interview. RESULTS Almost all respondents (89%) reported screening children for depression/anxiety and behavior problems. Child substance use (82%), family social support (74%), significant household changes (73%), bullying (72%), child abuse (62%) and domestic violence (52%) were also asked about regularly, although with high rates of informal screening methods. Caregiver mental health (49%), caregiver substance use (35%), family financial strain (33%) and transportation difficulties (27%) were screened less frequently. Screening was associated with higher rates of referral for risk-related problems, and was more likely when providers reported greater confidence providing support to clients, perceived community resource availability as higher, and worked in systems with integrated primary care and behavioral health. CONCLUSIONS Findings suggest a great amount of diversity in how providers screen for behavioral health risks. There is reluctance to screen when options for addressing the problems are seen as limited. Research is needed to better guide healthcare providers in determining the right context and methods for screening social risks. PRACTICE IMPLICATIONS Protocols for screening adverse childhood events (ACES) and other social risk factors should be accompanied by adequate training and efforts to improve community resource and support networks.
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Affiliation(s)
- Lisa M Jones
- Crimes against Children Research Center, University of New Hampshire, Durham, NH, United States of America.
| | - Kerry Nolte
- Nursing, University of New Hampshire, Durham, NH, United States of America.
| | - Alyssa J O'Brien
- Nursing, University of New Hampshire, Durham, NH, United States of America.
| | - Jill M Trumbell
- Human Development & Family Studies, University of New Hampshire, Durham, NH, United States of America.
| | - Kimberly J Mitchell
- Crimes against Children Research Center, University of New Hampshire, Durham, NH, United States of America.
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13
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Finkelhor D, Turner H, LaSelva D. Receipt of Behavioral Health Services Among US Children and Youth With Adverse Childhood Experiences or Mental Health Symptoms. JAMA Netw Open 2021; 4:e211435. [PMID: 33720370 PMCID: PMC7961308 DOI: 10.1001/jamanetworkopen.2021.1435] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/21/2021] [Indexed: 02/04/2023] Open
Abstract
Importance Epidemiological literature on children's mental health and children's adverse childhood experiences (ACEs) have consistently pointed to widespread, unaddressed, and treatable high-risk conditions among children. Objective To estimate the proportion of children with either high levels of ACEs and/or high levels of mental health symptoms who were not receiving services from behavioral health professionals. Design, Setting, and Participants This cross-sectional study included 11 896 children who participated in 3 National Surveys of Children's Exposure to Violence (NatSCEV), which were nationally representative surveys conducted in 2008, 2011, and 2014. The surveys entailed telephone interviews with youth aged 10 to 17 years and caregivers of children aged 2 to 9 years. Data were analyzed from February to August 2020. Main Outcomes and Measures Nationally representative samples were obtained from a mix of random digit dial and address-based sampling methods. The primary outcome was the proportion of children with high ACEs, high distress symptoms, and both who were receiving clinical contact, broken down by demographic characteristics. Results Of the 11 896 children, 4045 (34.0%) participated in the 2008 NatSCEV; 4112 (34.6%) in the 2011 NatSCEV; and 3738 (31.4%) in the 2014 NatSCEV; 5532 (46.5%) were aged 2 to 9 years (2785 [50.4%] aged 2-5 years; 2693 [48.7%] girls; 3521 [63.7%] White children), and 6365 (53.5%) were aged 10 to 17 years (3612 [56.7%] aged 14-17 years; 3117 [49.0%] female participants; 4297 [67.5%] White individuals). Among participants aged 2 to 9 years, no clinical contact was reported for 57% (95% CI, 51%-62%) of the high ACE group, 53% (95% CI, 48%-58%) of the high distress symptom group, and 41% (95% CI, 32%-51%) of the group with high levels on both indicators. Among participants aged 10 to 17 years, the group with no clinical contact comprised 63% (95% CI, 56%-69%) of the high ACE group, 52% (95% CI, 46%-57%) of the high distress symptom group, and 62% (95% CI, 51%-71%) of youth scoring high on both indicators. Among racial groups, odds of contact were very low for Black children aged 2 to 9 years with high ACEs compared with non-Hispanic White children with the same age and exposure (odds ratio, 0.26; 95% CI, 0.14-0.49). Conclusions and Relevance In this cross-sectional study combining findings from 3 US national surveys, large portions of children at high risk because of adversity or mental health symptoms were not receiving clinical services. Better ways are needed to find these at-risk populations and help them obtain relevant intervention resources.
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Affiliation(s)
- David Finkelhor
- Crimes Against Children Research Center, University of New Hampshire, Durham
| | - Heather Turner
- Crimes Against Children Research Center, University of New Hampshire, Durham
| | - Deirdre LaSelva
- Department of Sociology, University of New Hampshire, Durham
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14
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Sala-Hamrick KJ, Isakson B, De Gonzalez SDC, Cooper A, Buchan J, Aceves J, Van Orton E, Holtz J, Waggoner DM. Trauma-Informed Pediatric Primary Care: Facilitators and Challenges to the Implementation Process. J Behav Health Serv Res 2021; 48:363-381. [DOI: 10.1007/s11414-020-09741-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2020] [Indexed: 11/30/2022]
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15
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Berken JA, Heard-Garris N, Wakschlag LS. Guardians at the Gate: Early Adversity, Neurocognitive Development, and the Role of the Pediatrician in the Era of COVID-19. Front Pediatr 2021; 9:665335. [PMID: 33937157 PMCID: PMC8079717 DOI: 10.3389/fped.2021.665335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 03/22/2021] [Indexed: 01/22/2023] Open
Abstract
Adverse childhood experiences (ACEs) profoundly impact neurocognitive development. Specifically, when these events occur during critical periods of brain plasticity, a time of significant synaptogenesis, neural pruning, and myelination, typical neurodevelopment can become derailed. Adverse childhood experiences promote morphological changes in neuronal microcircuitry which may lead to diminished cognitive flexibility, inattention, increased impulsivity, decreased school readiness, and disruptive behaviors. In this regard, the current COVID-19 pandemic represents an especially complex adverse experience that disturbs a child's social milieu and support network, likely interfering with brain maturation and executive function. Here, we take a neurodevelopmental approach to argue for the critical role that pediatricians must fulfill in mitigating the potentially detrimental consequences of COVID-19. We call for ACE screening and anticipatory guidance in the primary care setting, and the use of validated interventions and skills to bolster resilience, when ACEs are identified. We present a clinical workflow for the physician to proactively assess, identify, stratify, and address the severity of ACEs worsened by COVID-19. We discuss home-based activities and resources for children and adolescents to promote stress reduction, connectiveness, and self-awareness and create a more positive environment to maximize neurodevelopmental potential in the face of the ongoing pandemic.
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Affiliation(s)
- Jonathan A Berken
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.,Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States
| | - Nia Heard-Garris
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Division of Academic General Pediatrics, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago and Northwestern University Feinberg School of Medicine, Chicago, IL, United States.,Mary Ann & J. Milburn Smith Child Health, Outreach, Research, and Evaluation Center, Stanley Manne Children's Research Institute, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States
| | - Lauren S Wakschlag
- Institute for Innovations in Developmental Sciences, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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16
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Baek IC, Jo S, Kim EJ, Lee GR, Lee DH, Jeon HJ. A Review of Suicide Risk Assessment Tools and Their Measured Psychometric Properties in Korea. Front Psychiatry 2021; 12:679779. [PMID: 34239463 PMCID: PMC8258346 DOI: 10.3389/fpsyt.2021.679779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022] Open
Abstract
While there has been a slew of review studies on suicide measurement tools until now, there were not any reviews focusing on suicide assessment tools available in Korea. This review aimed to examine the psychometric properties of tools developed in Korea or the translated versions from the original tools in their foreign language and to identify potential improvements and supplements for these tools. A literature search was done using the Korean academic information search service, Research Information Service System, to identify the suicide measures to be included in this review. Abstracts were screened to identify which measures were used to assess suicide-related factors. Based on the established inclusion and exclusion criteria, 18 tools remained and we assessed their psychometric properties. The current review indicated several major findings. First, many of the tools did not report predictive validity and even those with predictive validity were based on past suicide attempts. Second, some of the tools overlooked the interactive component for the cause of suicide. In addition, information to supplement the self-reported and clinician-administered reports by collecting reports from the subjects' families and acquaintances is needed. It is also important to develop a screening tool that examines other aspects of an individual's personal life, including unemployment, bereavement, divorce, and childhood trauma. Moreover, tools that have been studied in more diverse groups of the population are needed to increase external validity. Finally, the linguistic translation of the tools into Korean needs to consider other cultural, social, and psychological factors of the sample of interest.
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Affiliation(s)
- In-Chul Baek
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Soobin Jo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Eun Ji Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Korea Psychological Autopsy Center (KPAC), Seoul, South Korea
| | - Ga Ryoung Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, South Korea
| | - Dong Hun Lee
- Department of Education, Traumatic Stress Center, Sungkyunkwan University College of Education, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.,Korea Psychological Autopsy Center (KPAC), Seoul, South Korea.,Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, South Korea
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17
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Onigu-Otite E, Idicula S. Introducing ACEs (Adverse Childhood Experiences) and Resilience to First-Year Medical Students. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2020; 16:10964. [PMID: 32964120 PMCID: PMC7499813 DOI: 10.15766/mep_2374-8265.10964] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Adverse childhood experiences (ACEs) are associated with negative mental and physical health outcomes and predictive of higher sociodemographic risk. Introducing ACEs into undergraduate medical education is key to prevention, early recognition, and intervention. METHODS In a 1-hour lecture, held live and viewed online, we delivered a condensed introduction to ACEs to first-year medical students. Live-classroom participants completed pre-/postsession questionnaires self-assessing their knowledge of 10 content areas on a 5-point Likert scale. We analyzed quantitative data to determine mean scores and differences. We synthesized qualitative data obtained from feedback. RESULTS One hundred twenty-four students, including 32 live-classroom attendees and 92 online viewers, participated in this activity. Self-assessment scores increased in all content areas measured, with a mean increase of 1.5 (p < .0001). The most significant increases occurred in identifying household dysfunction as ACEs (increase of 2.3), calculating an ACE score (increase of 2.2), differentiating between child abuse acts of commission and omission (increase of 1.9), describing resilience (increase of 1.7), and recognizing the link between ACEs and chronic medical conditions (increase of 1.4). Participants found the lecture informative, appreciating the use of the case illustrating how ACEs impact health and an interactive slide on the risks conferred by cumulative ACEs. Learners welcomed the positive message of resilience. DISCUSSION Introducing ACEs in medical student education is feasible. Educating the next generation of health providers on ACEs while highlighting prevention and resilience and teaching trauma-informed care is crucial. This lecture can be readily incorporated into medical student curricula.
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Affiliation(s)
- Edore Onigu-Otite
- Associate Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine; Associate Course Director, Behavioral Sciences Foundations Course, School of Medicine, Baylor College of Medicine
- Corresponding author:
| | - Sindhu Idicula
- Assistant Professor, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine; Course Director, Behavioral Sciences Foundations Course, School of Medicine, Baylor College of Medicine
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18
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Choi KR, Stewart T, Fein E, McCreary M, Kenan KN, Davies JD, Naureckas S, Zima BT. The Impact of Attachment-Disrupting Adverse Childhood Experiences on Child Behavioral Health. J Pediatr 2020; 221:224-229. [PMID: 32446486 DOI: 10.1016/j.jpeds.2020.03.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/08/2020] [Accepted: 03/03/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To describe patterns of overall, within-household, and community adverse childhood experiences (ACEs) among children in vulnerable neighborhoods and to identify which individual ACEs, over and above overall ACE level, predict need for behavioral health services. STUDY DESIGN This was a cross-sectional study that used a sample of 257 children ages 3-16 years who were seeking primary care services with co-located mental healthcare services at 1 of 2 clinics in Chicago, Illinois. The outcome variable was need for behavioral health services (Pediatric Symptom Checklist score ≥28). The independent variables were ACEs, measured with an adapted, 28-item version of the Traumatic Events Screening Inventory. RESULTS Six ACE items were individually predictive of a clinical-range Pediatric Symptom Checklist score after adjusting for sociodemographic covariates: emotional abuse or neglect (OR 2.93, 95% CI 1.32-6.52, P < .01), natural disaster (OR 3.89, 95% CI 1.18-12.76, P = .02), forced separation from a parent or caregiver (OR 2.95, 95% CI 1.50-5.83, P < .01), incarceration of a family member (OR 2.43, 95% CI 1.20-4.93, P = .01), physical attack (OR 2.84, 95% CI 1.32-6.11, P < .01), and community violence (OR 2.35, 95% CI 1.18-4.65, P = .01). After adjusting for overall ACE level, only 1 item remained statistically significant: forced separation from a parent or caregiver (OR 2.44, 95% CI 1.19-5.01, P = .02). CONCLUSIONS ACEs that disrupt attachment relationships between children and their caregivers are a significant predictor of risk for child emotional or behavioral problems.
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Affiliation(s)
- Kristen R Choi
- School of Nursing, University of California, Los Angeles, CA.
| | | | - Eric Fein
- Harbor-UCLA Medical Center, David Geffen School of Medicine at UCLA
| | - Michael McCreary
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Kristen N Kenan
- Department of Pediatrics, University of Illinois Hospital and Health Sciences System
| | | | - Sara Naureckas
- Erie Family Health Centers, Northwestern University Feinberg School of Medicine
| | - Bonnie T Zima
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
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19
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Barnes AJ, Anthony BJ, Karatekin C, Lingras KA, Mercado R, Thompson LA. Identifying adverse childhood experiences in pediatrics to prevent chronic health conditions. Pediatr Res 2020; 87:362-370. [PMID: 31622974 PMCID: PMC6962546 DOI: 10.1038/s41390-019-0613-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 08/16/2019] [Accepted: 09/25/2019] [Indexed: 02/07/2023]
Abstract
Despite evidence that over 40% of youth in the United States have one or more adverse childhood experiences (ACEs), and that ACEs have cumulative, pernicious effects on lifelong health, few primary care clinicians routinely ask about ACEs. Lack of standardized and accurate clinical assessments for ACEs, combined with no point-of-care biomarkers of the "toxic stress" caused by ACEs, hampers prevention of the health consequences of ACEs. Thus, there is no consensus regarding how to identify, screen, and track ACEs, and whether early identification of toxic stress can prevent disease. In this review, we aim to clarify why, for whom, when, and how to identify ACEs in pediatric clinical care. To do so, we examine the evidence for such identification; describe the efficacy and accuracy of potential screening instruments; discuss current trends in, and potential barriers to, the identification of ACEs and the prevention of downstream effects; and recommend next steps for research, practice, and policy.
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Affiliation(s)
- Andrew J Barnes
- Department of Pediatrics, University of Minnesota, St Paul, MN, USA.
| | - Bruno J Anthony
- Department of Psychiatry, University of Colorado School of Medicine, Aurora, CO, USA
| | - Canan Karatekin
- Institute of Child Development, University of Minnesota, St Paul, MN, USA
| | - Katherine A Lingras
- Department of Psychiatry and Behavioral Sciences, University of Minnesota, St Paul, MN, USA
| | - Rebeccah Mercado
- Departments of Pediatrics, Health Outcomes and Policy, University of Florida, Gainesville, FL, USA
| | - Lindsay Acheson Thompson
- Departments of Pediatrics, Health Outcomes and Policy, University of Florida, Gainesville, FL, USA
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