Health, emergency department use, and early identification of young children exposed to trauma.

BACKGROUND: Childhood trauma is an important public health problem with financial, physical health, and mental health repercussions. Emergency departments (EDs) are often the first point of contact for many young children affected by emotionally or psychologically traumatic events (e.g., neglect, separation from primary caregiver, maltreatment, witness to domestic violence within the family, natural disasters). STUDY OBJECTIVES: Describe the prevalence of physical health symptoms, ED use, and health-related problems in young children (birth through 5 years) affected by trauma, and to predict whether or not children experiencing trauma are more likely to be affected by health-related problems. METHODS: Community-based, cross-sectional survey of 208 young children. Traumatic events were assessed by the Traumatic Events Screening Inventory - Parent Report Revised. Child health symptoms and health-related problems were measured using the Caregiver Information Questionnaire, developed by ORC Macro (Atlanta, GA). RESULTS: Seventy-two percent of children had experienced at least one type of traumatic event. Children exposed to trauma were also experiencing recent health-related events, including visits to the ED (32.2%) and the doctor (76.9%) for physical health symptoms, and recurring physical health problems (40.4%). Children previously exposed to high levels of trauma (four or more types of events) were 2.9 times more likely to report having had recently visited the ED for health purposes. CONCLUSIONS: Preventing recurrent trauma or recognizing early trauma exposure is difficult, but essential if long-term negative consequences are to be mitigated or prevented. Within EDs, there are missed opportunities for identification and intervention for trauma-exposed children, as well as great potential for expanding primary and secondary prevention of maltreatment-associated illness, injury, and mortality.

Exposure to traumatic events and health-related quality of life in preschool-aged children.

PURPOSE: To examine the association of lifetime exposure to traumatic events with health-related quality of life (HRQOL) and psychosocial health in children aged 3 through 5 years. METHODS: This study is a community-based, cross-sectional survey of 170 children and their parents. Traumatic events were assessed by the Traumatic Events Screening Inventory-Parent Report Revised using criteria for potentially traumatic events in young childhood outlined by the Zero to Three working group. HRQOL of young children was measured using the 97-item Infant/Toddler Quality of Life Questionnaire, and psychosocial health was measured using the Child Behavior Checklist 1.5-5. RESULTS: One hundred and twenty-three (72 %) of children had experienced at least one type of trauma event. Children who had been exposed to 1-3 types of trauma and those exposed to 4 or more types of trauma had significantly worse HRQOL and psychosocial health than children not exposed to trauma. Significant effect sizes between children exposed to low levels or high levels of traumatic events and children not exposed to trauma ranged from small to large. CONCLUSIONS: Exposure to traumatic events in early childhood is associated with less positive HRQOL and psychosocial health. Cumulative trauma exposure led to significant effects in outcome variables in this population. Interventions to decrease trauma exposure and to reduce significant stress in early childhood associated with exposure to trauma may be appropriate strategies for preventing negative health conditions throughout the life span.

The role of parenting stress in young children's mental health functioning after exposure to family violence.

This study evaluates the associations of young children's exposure to family violence events, parenting stress, and children's mental health functioning. Caregivers provided data for 188 children ages 3 to 5 years attending Head Start programming. Caregivers reported 75% of children had experienced at least 1 type of trauma event, and 27% of children had experienced a family violence event. Child mental health functioning was significantly associated with family violence exposure after controlling for children's age, gender, household income, and other trauma exposure (ß = .14, p = .033). Stress in the parenting role partially mediated the relationship between family violence exposure and young children's mental health functioning (ß = .12, p = .015, 95% confidence interval [0.02, 0.21]). Interventions for young children exposed to family violence should address the needs of the child, as well as the caregiver while also building healthy parent-child relationships to facilitate positive outcomes in children faced with trauma.

Exposure to traumatic events and the behavioral health of children enrolled in an early childhood system of care.

Children may be exposed to numerous types of traumatic events that can negatively affect their development. The scope to which studies have examined an array of events among young children has been limited, thereby restricting our understanding of exposure and its relationship to behavioral functioning. The current cross-sectional study describes traumatic event exposure in detail and its relationship to behavioral health among an at-risk sample of young children (N = 184), under 6 years of age, upon enrollment into an early childhood, family-based, mental health system of care. Caregivers completed home-based semistructured interviews that covered children's exposure to 24 different types of traumatic events and behavioral and emotional functioning. Findings indicated that nearly 72% of young children experienced 1 or more types of traumatic events. Multiple regression model results showed that exposure was significantly associated with greater behavioral and emotional challenges with children's age, gender, race/ethnicity, household income, and caregiver's education in the model. These findings highlight the prevalence of traumatic exposures among an at-risk sample of young children in a system of care and suggest that this exposure is associated with behavioral and emotional challenges at a young age.

Spirituality and religiosity in urban adolescents with asthma.

Predictors of multiple dimensions of spirituality/religiosity (S/R) and adolescents' preferences for having S/R (e.g., prayer) addressed in hypothetical medical settings were assessed in a sample of urban adolescents with asthma. Of the 151 adolescents (mean age = 15.8, 60% female, 85% African-American), 81% said that they were religious and spiritual, 58% attended religious services in the past month, and 49% prayed daily. In multivariable models, African-American race/ethnicity and having a religious preference were associated with higher levels of S/R (R (2) = 0.07-0.25, P < .05). Adolescents' preferences for including S/R in the medical setting increased with the severity of the clinical situation (P < .05).

Anxiety and asthma symptoms in urban adolescents with asthma: the mediating role of illness perceptions.

Twenty to 40% of adolescents with asthma experience significant symptoms of anxiety. This study examined the mediational role of illness perceptions in the relationship between anxiety and asthma symptoms in adolescents. One hundred fifty-one urban adolescents (ages 11-18) with asthma completed measures of illness perceptions, and anxiety and asthma symptoms. Using the Baron and Kenny approach and Sobel tests, we examined whether illness perceptions mediated the anxiety-asthma symptom relationship. Three illness perceptions significantly mediated the relationship between anxiety and asthma symptoms, z = 1.97-2.13, p < .05; adjusted R(2) = 0.42-0.51, p < .05. Greater anxiety symptoms were associated with perceptions that asthma negatively impacted one's life and emotions and was difficult to control. These negative illness perceptions were, in turn, related to greater asthma symptoms. Illness perceptions helped explain the anxiety-asthma symptoms link in adolescents. Results suggest that targeting illness perceptions in adolescents with asthma and anxiety may help reduce asthma symptoms.

Religious/Spiritual coping in adolescents with sickle cell disease: a pilot study.

Religious/spiritual (R/S) coping has been associated with health outcomes in chronically ill adults; however, little is known about how adolescents use R/S to cope with a chronic illness such as sickle cell disease (SCD). Using a mixed method approach (quantitative surveys and qualitative interviews), we examined R/S coping, spirituality, and health-related quality of life in 48 adolescents with SCD and 42 parents of adolescents with SCD. Adolescents reported high rates of religious attendance and belief in God, prayed often, and had high levels of spirituality (eg, finding meaning/peace in their lives and deriving comfort from faith). Thirty-five percent of adolescents reported praying once or more a day for symptom management. The most common positive R/S coping strategies used by adolescents were: "Asked forgiveness for my sins" (73% of surveys) and "Sought God's love and care" (73% of surveys). Most parents used R/S coping strategies to cope with their child's illness. R/S coping was not significantly associated with HRQOL (P=NS). R/S coping, particularly prayer, was relevant for adolescents with SCD and their parents. Future studies should assess adolescents' preferences for discussing R/S in the medical setting and whether R/S coping is related to HRQOL in larger samples.

Longitudinal Trajectories of Parenting Stress Among Ethnic Minority Adolescent Mothers.

OBJECTIVES: Parenting stress has been linked with negative outcomes for parents and their infants (e.g., parental depression, negative parenting behaviors, poor attachment). Racial/ethnic minority adolescent mothers have increased risk for experiencing parenting stress compared to their White counterparts. Little is known about the changes in parenting stress over time for this population. METHODS: Growth mixture modeling (GMM) was conducted to determine the growth trajectory classes of 185 African American and Latina/Hispanic adolescent mothers over 2 years. Risk and protective factors (e.g., maternal depression, social support, self-esteem) were examined to determine their influence on parenting stress trajectories. RESULTS: Three distinct trajectories of parenting stress were found: low stable stress (40.90%), decreasing stress (35.78%), and high stable stress (23.28%). Lower maternal depression (OR = 2.35), higher self-esteem (OR = 1.29), lower perceived social support from family (OR = 0.53) and higher perceived support from friends (OR = 1.65) predicted placement into the low stable parenting stress group over the high stable parenting stress group. Adolescents living with family (OR = 2.74) and Latina race/ethnicity (OR = 2.78) also served as predictors of placement into the low stable parenting stress group. Higher self-esteem (OR = 1.66) predicted placement into the decreasing parenting stress group over the high stable parenting stress group. CONCLUSIONS: These findings highlight the importance of perceived peer support by adolescent mothers, regardless of their support family support (e.g., living at home and receiving child care). Considering developmental factors such as peer relationships may be important when working with adolescent mothers.

Children exposed to the arrest of a family member: Associations with mental health.

The arrest of a parent or other family member can be detrimental to children's health. To study the impact of exposure to the arrest of a family member on children's mental health and how said association may change across developmental periods, we examined baseline data for children (birth through 11 years) entering family-based systems of care (SOC). Children exposed to the arrest of a family member had experienced significantly more 5.38 (SD = 2.59) different types of potentially traumatic events (PTE) than children not exposed to arrest 2.84 (SD = 2.56). Multiple regression model results showed that arrest exposure was significantly associated with greater behavioral and emotional challenges after controlling for children's age, gender, race/ethnicity, household income, caregiver's education, parenting factors, and other PTE exposure. Further analyses revealed differences in internalizing and externalizing behaviors associated with arrest exposure across developmental levels. This study highlights some of the mental health challenges for children exposed to the arrest of a family member, while adding to our knowledge of how such an event affects children across different developmental periods. More trauma-informed, developmentally appropriate systems need to be in place at all levels to assist children and families experiencing arrest.

Spiritual well-being and mental health outcomes in adolescents with or without inflammatory bowel disease.

PURPOSE: The purpose of this study was threefold: 1) to describe spiritual well-being (existential and religious well-being) in adolescents with inflammatory bowel disease (IBD) versus healthy peers; 2) to examine associations of spiritual well-being with mental health outcomes (emotional functioning and depressive symptoms); and 3) to assess the differential impact of existential versus religious well-being on mental health. METHODS: A total of 155 adolescents aged 11-19 years from a children's hospital and a university hospital filled out questionnaires including the Spiritual Well-Being Scale, the Children's Depression Inventory-Short Form, and the Pediatric Quality of Life Inventory. Covariates in multivariable models included demographics, disease status, and interactions. RESULTS: Participants' mean (SD) age was 15.1 (2.0) years; 80 (52%) were male; and 121 (78%) were of white ethnicity. Levels of existential and religious well-being were similar between adolescents with IBD and healthy peers. In multivariable analyses, existential well-being was associated with mental health (partial R(2) change = .08-.11, p < .01) above and beyond other characteristics (total R(2) = .23, p < .01). Presence of disease moderated both the relationship between existential well-being and emotional functioning and that between religious well-being and depressive symptoms: that is, the relationships were stronger in adolescents with IBD as compared with healthy peers. Religious well-being was only marginally significantly associated with mental health after controlling for other factors. CONCLUSIONS: Although both healthy adolescents and those with IBD had high levels of spiritual well-being, having IBD moderated the relationship between spiritual well-being and mental health. Meaning/purpose was related to mental health more than was connectedness to the sacred.