Complex posttraumatic stress disorder in adolescence: A two-year follow-up study.

BACKGROUND: Complex posttraumatic stress disorder is a new diagnosis in the 11th edition of the International Classification of Diseases (ICD-11). There is a need for a better understanding of complex PTSD in children and adolescents. OBJECTIVE: The study aimed to estimate the factors associated with chronic complex PTSD versus recovery of complex PTSD in adolescents in a 2-year follow-up study. METHOD: In total, 66 adolescents, mean age 14.5, 73% female, identified as having complex PTSD using self-report at baseline recruited from a general population sample, were included in the study. The International Trauma Questionnaire - Child and Adolescent Version (ITQ-CA) was used for the assessment of complex PTSD. RESULTS: Overall, 36% of the study sample has been identified as having chronic complex PTSD over 2 years, 10% met the criteria for PTSD at a 2-year follow-up, and 54% recovered. A higher risk for chronic complex PTSD was associated with exposure to more traumatic events and more life-stressors over the 2 years, low social network, low positive social support, bullying at school, and loneliness. CONCLUSION: The study found that around one-third of the traumatized youth had a prolonged trajectory of complex PTSD symptoms, which were associated with negative life experiences and social difficulties.

Internet-based stress recovery intervention for adolescents: study protocol for a randomized controlled trial.

BACKGROUND: Research reveals a high prevalence of stressors in adolescence. Mental health in adolescence is highly related to life-stressors exposure and difficulties in adjusting to stressors. Therefore, interventions for recovery from stress are in high demand. The study aims to evaluate the efficacy of the Internet-based stress recovery intervention for adolescents. METHODS: A two-arm randomized controlled trial (RCT) on the efficacy of the FOREST-A-an Internet-based stress recovery intervention for adolescents-will be conducted. The FOREST-A is an adapted version of stress recovery intervention initially developed for healthcare workers. FOREST-A is a third-wave cognitive behavioral therapy and mindfulness-based Internet-delivered 4-week psychosocial intervention, which comprises six modules: Introduction, Relaxation, Psychological detachment, Mastery, Control, and Summary. The intervention will be evaluated using the two-arm RCT with intervention and care as usual (CAU) condition at pre-test, post-test, and 3-month follow-up. The measured outcomes will be stress recovery, adjustment disorder, generalized anxiety and depression symptoms, psychological well-being, and perceived positive social support. DISCUSSION: The study will contribute to the development of Internet interventions-easily and broadly accessible tools-for the enhancement of adolescents' stress recovery skills. Based on the study's findings, further development of the FOREST-A, including upscaling and implementation, is foreseen. TRIAL REGISTRATION: ClinicalTrials.gov NCT05688254. Registered on January 6, 2023.

Resilience trajectories and links with childhood maltreatment in adolescence: a latent growth modeling approach.

BACKGROUND: The current definitions of resilience can be addressed as a process, an outcome, or a trait. Empirical studies should be carried out to determine the most appropriate definition for it. Therefore, the main aim of the current study was to investigate changes in adolescents' resilience over two years and explore the links between resilience and different forms of child maltreatment. METHODS: The three-wave longitudinal study "Stress and resilience in adolescence" (STAR-A) sample was comprised of a general school-based sample of Lithuanian adolescents [baseline N = 1295, 56.7% females; M(SD)age = 14.24 (1.26)]. Resilience was measured using the 14-item Resilience Scale (RS-14), lifetime exposure to maltreatment was measured at wave 1 using a questionnaire developed by the Norwegian Center for Violence and Traumatic Stress Studies (NKVTS), risk of psychopathology-using the Strengths and Difficulties Questionnaire (SDQ). The changes in resilience scores over the period of two years were investigated using the latent growth modeling approach. RESULTS: The analyses revealed two classes of resilience-stable higher and stable lower. We found that experience of at least one form of abuse was significantly more prevalent in the lower resilience group in comparison to the higher resilience group. Also, adolescents with lower resilience had a higher probability of psychopathology. CONCLUSIONS: This study provided meaningful insights into the stability of resilience over time in adolescence and its relation to various types of child maltreatment. Experiences of maltreatment, as well as risk for psychopathology, were linked to lower resilience in adolescence.

Exploring the links between various traumatic experiences and ICD-11 PTSD and Complex PTSD: A cross-sectional study.

Background: The 11th revision of the International Classification of Diseases (ICD-11) included two distinct trauma-related diagnoses-Posttraumatic Stress Disorder (PTSD) and Complex Posttraumatic Stress Disorder (CPTSD). The initial diagnostic factor for both disorders is exposure to a traumatic event. This study aimed to explore whether exposure to different traumatic experiences distinguish risk for PTSD and CPTSD. Methods: The study sample comprised 158 trauma-exposed participants, M(SD)age = 33.61(9.73). The Life Events Checklist-Revised (LEC-R) was used to evaluate trauma exposure, and the International Trauma Questionnaire (ITQ) was used to assess risk for ICD-11 PTSD and CPTSD. Multinomial logistic regression was used to determine traumatic events as predictors of risk for PTSD and CPTSD. Results: Analysis revealed that sexual abuse experienced in childhood or adulthood was associated with both PTSD and CPTSD. History of other unwanted sexual experiences and childhood physical abuse predicted CPTSD compared to PTSD, whereas exposure to natural disasters predicted PTSD compared to CPTSD. Conclusions: The results showed that experiences of certain traumatic events, such as sexual trauma, childhood physical abuse or natural disasters, might help distinguish risk for PTSD and CPTSD. Nevertheless, future studies on specific aspects of trauma exposure are necessary.

The mediating role of complex posttraumatic stress and borderline pattern symptoms on the association between sexual abuse and suicide risk.

BACKGROUND: The 11th revision of the International Classification of Diseases (ICD-11) includes a new diagnosis of complex posttraumatic stress disorder (CPTSD). There has been very little research investigating associations between CPTSD symptoms and suicide risk following sexual abuse. This and questions concerning similarities and differences between CPTSD and borderline personality disorder (BPD), led to the current study that aimed to explore indirect associations between sexual abuse and suicide risk through the symptoms of CPTSD and borderline traits. METHODS: The study sample comprised 103 adults with a history of traumatic experiences (Mage = 32.64, SDage = 9.36; 83.5% female). In total, 26.3% of the participants reported experiencing sexual abuse during their lifetime. The clinician-administered International Trauma Interview (ITI) was used for the assessment of ICD-11 CPTSD symptoms. Self-report measures were used for the evaluation of borderline pattern (BP) symptoms and suicide risk. Mediation analyses were performed to evaluate the mediating effects of CPTSD and BP symptoms for the association between sexual trauma and suicide risk. RESULTS: In a parallel mediation model, CPTSD and BP symptoms mediated the association between sexual abuse and suicide risk, following adjustment for the covariates of age, gender, and whether the traumatic experience occurred in childhood or adulthood. Around 73% of participants who met diagnostic criteria for CPTSD reported previous suicide attempt(s). CONCLUSIONS: Suicide risk assessment and intervention should be an important part of the management of victims of sexual abuse with CPTSD and BP symptoms.

Validation of the International Trauma Interview (ITI) for the Clinical Assessment of ICD-11 Posttraumatic Stress Disorder (PTSD) and Complex PTSD (CPTSD) in a Lithuanian Sample.

Background: The 11th revision of the International Classification of Diseases (ICD-11) includes a new diagnosis of complex posttraumatic stress disorder (CPTSD). The International Trauma Interview (ITI) is a novel clinician-administered diagnostic interview for the assessment of ICD-11 PTSD and CPTSD. Objective: The aim of this study was to evaluate the psychometric properties of the ITI in a Lithuanian sample in relation to interrater agreement, latent structure, internal reliability, as well as convergent and discriminant validity. Method: In total, 103 adults with a history of various traumatic experiences participated in the study. The sample was predominantly female (83.5%), with a mean age of 32.64 years (SD = 9.36). For the assessment of ICD-11 PTSD and CPTSD, the ITI and the self-report International Trauma Questionnaire (ITQ) were used. Mental health indicators, such as depression, anxiety, and dissociation, were measured using self-report questionnaires. The latent structure of the ITI was evaluated using confirmatory factor analysis (CFA). In order to test the convergent and discriminant validity of the ITI we conducted a structural equation model (SEM). Results: Overall, based on the ITI, 18.4% of participants fulfilled diagnostic criteria for PTSD and 21.4% for CPTSD. A second-order two-factor CFA model of the ITI PTSD and disturbances in self-organization (DSO) symptoms demonstrated a good fit. The associations with various mental health indicators supported the convergent and discriminant validity of the ITI. The clinician-administered ITI and self-report ITQ had poor to moderate diagnostic agreement across different symptom clusters. Conclusion: The ITI is a reliable and valid tool for assessing and diagnosing ICD-11 PTSD and CPTSD.

Antecedentes: La 11ª revisión de la Clasificación Internacional de Enfermedades (CIE-11) incluye un nuevo diagnóstico de trastorno de estrés postraumático complejo (TEPT-C). La Entrevista Internacional de Trauma (ITI en su sigla en inglés) es una nueva entrevista diagnóstica administrada por un clínico para la evaluación del TEPT y el TEPT-C de la CIE-11.Objetivo: El objetivo de este estudio fue evaluar las propiedades psicométricas de la ITI en una muestra lituana en relación con el acuerdo entre evaluadores, la estructura latente, la confiabilidad interna, así como la validez convergente y discriminante.Método: En total, participaron en el estudio 103 adultos con antecedentes de diversas experiencias traumáticas. La muestra fue predominantemente femenina (83.5%), con una edad media de 32.64 años (DE = 9.36). Para la evaluación del TEPT y TEPT-C de la CIE-11, se utilizaron la ITI y el Cuestionario Internacional de Trauma (ITQ en su sigla en inglés) de autoinforme. Los indicadores de salud mental, como la depresión, la ansiedad y la disociación, se midieron mediante cuestionarios de autoinforme. La estructura latente de la ITI se evaluó mediante análisis factorial confirmatorio (AFC). Para probar la validez convergente y discriminante de la ITI, llevamos a cabo un modelo de ecuaciones estructurales (SEM).Resultados: En general, según la ITI, el 18.4% de los participantes cumplió con los criterios diagnósticos de TEPT y el 21.4% de TEPT-C. El modelo AFC de dos factores de segundo orden de la ITI de TEPT y los síntomas de trastornos en la autoorganización (DSO) demostraron un buen ajuste. Las asociaciones con varios indicadores de salud mental apoyaron la validez convergente y discriminante de la ITI. La ITI administrada por un clínico y el ITQ autoinformado tuvieron una concordancia de diagnóstico pobre a moderada en diferentes grupos de síntomas.Conclusión: La ITI es una herramienta fiable y válida para evaluar y diagnosticar TEPT y TEPT-C según la CIE-11.

Trauma exposure and factors associated with ICD-11 PTSD and complex PTSD in the Lithuanian general population.

BACKGROUND: After the inclusion of a novel diagnosis of Complex Posttraumatic Stress Disorder (CPTSD) in the 11th edition of the International Classification of Diseases (ICD-11), there is a growing need for research focused on not only studying the underlying risk factors of this disorder but also differentiating the risk factors of Posttraumatic Stress Disorder (PTSD) and CPTSD to understand better the factors leading to CPTSD onset and symptom maintenance. AIMS: This study aimed to explore the prevalence of traumatic experiences, trauma-related disorders and risk factors associated with ICD-11 PTSD and CPTSD in a population-based Lithuanian sample using the International Trauma Questionnaire (ITQ). METHODS: The study sample included 885 participants (age M[SD] = 37.96 [14.67], 63.4% female). The Life Events Checklist was used to measure trauma exposure, PTSD and CPTSD symptoms were measured by the Lithuanian ITQ version. The Disclosure of Trauma Questionnaire (DTQ) was used to measure the urge or reluctance to talk about trauma. RESULTS: The prevalence of at least one traumatic experience in the study sample was 81.4%. The prevalence of PTSD and CPTSD among the general population in Lithuania was 5.8% and 1.8%, respectively. Accumulative lifetime trauma exposure, sexual assault and assault with a weapon were significant predictors for both PTSD and CPTSD. Participants from the CPTSD group reported greater reluctance to disclose trauma and stronger emotional reactions than no diagnosis and PTSD groups. Results also indicate that the Lithuanian ITQ version is a valid measure for screening PTSD and CPTSD in the general population. CONCLUSION: Previous history of trauma and interpersonal trauma were associated with posttraumatic stress disorders but did not differentiate between PTSD and CPTSD in our study. However, social trauma-related factors, such as trauma disclosure, were associated with stronger CPTSD symptoms.