Assessing We-Disease Appraisals of Health Problems: Development and Validation of the We-Disease Questionnaire.

In couples dealing with health problems, we-disease appraisals can influence dyadic coping strategies to alleviate distress. This study describes the development and validation of a self-report scale to assess we-disease appraisals of health problems. The newly developed We-Disease Questionnaire (WDQ) was administered in three samples: parents of children with type 1 diabetes (n = 240) or cancer (n = 125) and individuals with visual impairment and their partners (n = 216). Reliability was measured by coefficient omega. To assess construct validity, correlations with other measures of individual and dyadic adjustment were examined. Descriptive statistics across all samples were compared. A 4-item version of the WDQ demonstrated good reliability and validity and showed meaningful associations with established scales. We-disease appraisals were highest among parents of children with cancer and lowest among couples with visual impairment. The WDQ is a reliable and valid measure that can be used across different health problems.

The differential impact of the DSM-5 post-traumatic stress symptoms on functional impairment in traumatized children and adolescents.

BACKGROUND: This study aims to provide a better understanding of the individual impact of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) post-traumatic stress symptoms (PTSS) on functional impairment in trauma-exposed children and adolescents. Identifying PTSS that have the most impact on functional impairment can broaden our understanding of post-trauma reactions and guide the selection of treatment components and techniques required to help patients to restore functioning following trauma exposure. METHOD: Utilizing relative importance analyses, unique shared variance of each DSM-5 PTSS with functional impairment were estimated in clinical samples of 3400 Norwegian (Mage = 14.18, SDage = 2.49, rangeage = 7-17) and 747 US (Mage = 10.76, SDage = 3.10, rangeage = 7-17) children and adolescents from naturalistic settings. RESULTS: Negative beliefs, detachment from others, inability to experience positive emotions, and diminished interest in activities within the symptom cluster negative alterations in cognitions and mood, and the hyperarousal symptom concentration problems accounted for the largest proportions of unique variance explained in functional impairment in both samples. Further, the hyperarousal symptom irritability showed a unique high association with functional impairment in the US sample. CONCLUSION: As negative beliefs, emotional numbing symptoms, concentration problems and irritability may be especially related to functional impairment in traumatized children and adolescents, monitoring and targeting these symptoms throughout therapy might be of particular importance to restore functioning as early as possible and to facilitate overall recovery.

Age-related similarities and differences in networks of acute trauma-related stress symptoms in younger and older preschool children.

Background: Prior research on trauma-exposed preschool children has found various levels of trauma-related stress symptoms depending on age, which might be explained by developmental factors. Objective: This study uses network analysis to extend prior research and compare symptom presentation in younger and older preschoolers in the acute phase (first 4 weeks) following a potentially traumatic event. Method: Parent-reported trauma-related acute stress symptoms were assessed using the Pediatric Emotional Distress Scale - Early Screener via www.kidtrauma.com. First, the overall symptom severity and symptom levels were compared between younger (1-3 years) and older (4-6 years) preschoolers. Further, two Gaussian graphical models of stress symptoms in younger (n = 242; Mage = 2.3 years; SDage = 0.6 years) and older preschoolers (n = 299; Mage = 4.8 years; SDage = 0.7 years) were modelled and compared. Results: Overall symptom severity did not differ between the groups. Symptom levels for developmental regression and avoidance of talking about the event were higher in older preschoolers. The network structures of the younger and the older preschoolers were largely similar. Highly central symptoms in both networks were trauma-unrelated fear and anger. The connections between fear of reminders and clinginess and trauma-unrelated fear and clinginess were stronger in the older preschoolers' network. The connections between worry and sadness and withdrawal; fear of reminders and creation of games, stories, and pictures; and whininess and clinginess were all stronger in the younger preschoolers' network. Conclusions: Trauma-related stress symptomatology of younger and older preschoolers may not differ greatly in the acute phase. Trauma-unrelated fear and anger seem to be central symptoms in both groups. However, examining symptom-level associations across age groups revealed differential connections that might arise from developmental differences. If replicated in longitudinal and within-subject studies, these findings could help tailor interventions for trauma-exposed preschoolers in the acute phase.

Antecedentes: Investigaciones previas sobre niños preescolares expuestos al trauma han encontrado varios niveles de síntomas de estrés relacionados al trauma dependiendo de la edad, los cuales pueden ser explicados por factores del desarrollo.Objetivo: Este estudio usa análisis en red para ampliar las investigaciones anteriores y comparar la presentación de síntomas en preescolares mayores y menores en la fase aguda (primeras 4 semanas).Método: Se evaluaron los síntomas de estrés agudo relacionados a trauma reportados por los padres a través de la escala de Sufrimiento Emocional Pediátrico ­ Early Screener www.kidtrauma.com. Primero, se comparó la severidad general de los síntomas y el nivel de los síntomas entre niños preescolares menores (1-3 años) y mayores (4-6 años). Luego, se modelaron y compararon dos modelos gráficos gaussianos de síntomas de estrés en preescolares menores (n = 242; Medad = 2.3 años; DEedad = 0.6 años) y mayores (n = 299; Medad = 4.8 años; DEedad = 0.7 años).Resultados: No hubo diferencias en la severidad general de los síntomas entre los grupos. Los niveles de síntomas para regresión del desarrollo y evasión de conversaciones sobre el tema, fueron más altos en los preescolares mayores. Las estructuras en red de los preescolares menores y mayores fueron mayormente similares. Los síntomas altamente centrales en ambas redes fueron el miedo y la ira no relacionados con el trauma. Las conexiones entre el miedo de recordatorios y apego excesivo fueron más fuertes en la red de los preescolares mayores. Las conexiones entre preocupación y tristeza y retraimiento; miedo de recordatorios y creación de juegos, historias y dibujos; y quejumbrosidad y apego excesivo, fueron todas más fuertes en la red de los preescolares menores.Conclusiones: Este estudio indica que la sintomatología de estrés relacionado a trauma en los preescolares menores y mayores no variaría de manera importante en la fase aguda. El miedo y la ira no relacionados al trauma parecen ser síntomas centrales en ambos grupos. Sin embargo, tras examinar asociaciones en los niveles de síntomas entre los grupos etarios, se revelaron conexiones diferenciales que podrían emerger a raíz de diferencias en el desarrollo. Si estos hallazgos se replicaran en estudios longitudinales y estudios controlados, podrían ayudar a adaptar las intervenciones para niños preescolares expuestos a trauma en la fase aguda.

The importance of the DSM-5 posttraumatic stress disorder symptoms of cognitions and mood in traumatized children and adolescents: two network approaches.

BACKGROUND: The aim of this study is to provide a better understanding of the central symptoms of DSM-5 posttraumatic stress disorder (PTSD) in children and adolescents from the perspective of the child and its caregiver. Identifying core symptoms of PTSD can help clinicians to understand what may be relevant targets for treatment. PTSD may present itself differently in children and adolescents compared to adults, and no study so far has investigated the DSM-5 PTSD conceptualization using network analysis. METHODS: The network structure of DSM-5 PTSD was investigated in a clinical sample of n = 475 self-reports of children and adolescents and n = 424 caregiver-reports using (a) regularized partial correlation models and (b) a Bayesian approach computing directed acyclic graphs (DAGs). RESULTS: (a) The 20 DSM-5 PTSD symptoms were positively connected within the self-report and the caregiver-report sample. The most central symptoms were negative trauma-related cognitions and persistent negative emotional state for the self-report and negative trauma-related cognitions, intrusive thoughts or memories and exaggerated startle response for the caregiver-report. (b) Similarly, symptoms in the negative alterations in cognitions and mood cluster (NACM) have emerged as key drivers of other symptoms in traumatized children and adolescents. CONCLUSIONS: As the symptoms in the DSM-5 NACM cluster were central in our regularized partial correlation networks and also appeared to be the driving forces in the DAGs, these might represent important symptoms within PTSD symptomatology and may offer key targets in PTSD treatment for children and adolescents.