The Prevalence, Predictors, and Health Consequences of Disagreement in Reports of Child Maltreatment Exposure.

The purpose of this study was to examine the prevalence, predictors, and consequences of disagreement between prospective caregiver and retrospective child reports of childhood physical and emotional maltreatment. The design was a secondary analysis of data from the Avon Longitudinal Study of Parents and Children, a three-decade long UK-based birth cohort. Prospective caregiver reports were in poor to fair agreement with retrospective child reports for physical and emotional maltreatment exposure, with caregivers tending to underreport exposure. Disagreement between reporters was associated with increased risk of depressive symptoms and substance use severity, but decreased risk for mental health diagnoses. Screening measures of childhood maltreatment exposure should take caution against using measures from different reporters interchangeably (i.e., from mother versus child). Disagreement in reports may indicate unmet need for mental health evaluation.

COVID-19 vaccine concerns of health care providers and ancillary staff.

A web-based survey was widely distributed between November 1st-December 27th, 2021, to health care providers and ancillary staff to assess reported COVID-19 vaccination of their children as well as their vaccine concerns. Fewer nurses and laboratory / radiology technicians reported COVID-19 vaccination of their adolescent children and intent to vaccinate their younger children compared to physicians and pharmacists, along with more frequently reported concern about anaphylaxis and infertility. Focused efforts to update ancillary staff as well as all health care providers on emerging COVID-19 vaccine safety information for children is crucial to promote strong COVID-19 vaccine recommendations. IMPACT: Nurses, laboratory technicians and radiology technicians frequently reported concern about anaphylaxis and infertility after COVID-19 vaccination despite reassuring safety data. Education of ancillary staff with emerging safety data is important to strengthen health care provider vaccine recommendations.

Discrimination during childbirth and postpartum care utilization among Black birthing people in California, United States.

BACKGROUND: The purpose of this study was to investigate the relationship between discrimination during childbirth hospitalization and postpartum care utilization among Black birthing people in California, United States. METHODS: This was a secondary analysis of data from the Listening to Mothers in California survey, a population-based survey of individuals with a singleton hospital-based birth in California in 2016. The primary outcome was number of postpartum care visits. The primary exposures were racial, language, and insurance discrimination. A multiple linear regression model was used to estimate associations between discrimination and postpartum care use, adjusting for sociodemographic covariates. RESULTS: Black birthing people in the sample had an average of two postpartum visits. Almost 15% of the sample reported one or more forms of discrimination during hospital-based childbirth. In adjusted models, racial discrimination (ß = 0.09, 95% CI = 0.04-0.14, p < 0.01) and language discrimination (ß = 1.03, 95% CI = 0.98-1.07, p < 0.01) were associated with increased postpartum visits, while insurance discrimination was linked to decreased postpartum visits (ß = -0.96, 95% CI = -1.04 to -0.89, p < 0.01). CONCLUSION: Among Black birthing people in California, the drivers of postpartum care utilization after childbirth are complex. There are multiple negative drivers (e.g., experiencing racial and language discrimination and unmet needs), barriers (e.g., insurance discrimination), and positive drivers (e.g., clinician type and education) that affect postpartum care utilization among Black birthing people.

Examining the Association Between Adverse Childhood Experiences and Lifetime History of Head or Neck Injury and Concussion in Children From the United States.

OBJECTIVE: Our objective was to determine whether there is an association between adverse childhood experiences (ACEs) and lifetime history of early childhood mild head or neck injury and concussion in a nationally representative US cohort. SETTING AND DESIGN: This is a cross-sectional study using data from the Adolescent Brain Cognitive Development (ABCD) Study (data release 3.0), a prospective investigation of child brain development and health. PARTICIPANTS: There were 11 878 children aged 9 or 10 years at baseline, recruited from 21 school-based sites in the United States. After excluding children with missing questionnaires for the primary exposure variable and children with severe brain injuries involving more than 30-minute loss of consciousness, the final sample size was 11 230 children. MEASURES: The primary exposure variable was ACEs. We measured eight ACEs: sexual abuse, physical abuse, emotional neglect, parent domestic violence, parent substance use disorder, parental mental illness, parent criminal involvement, and parent divorce. The primary outcomes were head or neck injury and concussion, measured using the Ohio State University Traumatic Brain Injury Screen-Identification Method Short Form. RESULTS: The sample (N = 11 230) was 52% boys with a mean age of 9.9 years (SD = 0.62 years). The racial and ethnic makeup was reflective of national demographics. Having a higher overall ACE count was associated with higher odds of head or neck injury, with greater odds with more ACEs reported. Children with 2 ACEs had 24% greater odds of head or neck injury (AOR = 1.24, 95% confidence interval [CI] = 1.06-1.45) and 64% greater odds of concussion (AOR = 1.64, 95% CI = 1.18-2.22), and children with 4 or more ACEs had 70% greater odds of head or neck injury (AOR = 1.7, 95% CI = 1.14, 2.49) and 140% greater odds of concussion (AOR = 2.4, 95% CI = 1.15-4.47). The individual ACE categories of sexual abuse, parent domestic violence, parental mental illness, and parent criminal involvement were significantly associated with increased risk of head or neck injury and parental mental illness with increased risk of concussion. CONCLUSIONS AND RELEVANCE: ACEs are associated with early childhood mild head or neck injury and concussion and should be integrated in head injury prevention and intervention efforts.

Preparing nurse scientists for health services and policy research: Five-year outcomes of interprofessional postdoctoral training in the National Clinician Scholars Program.

BACKGROUND: The National Clinician Scholars Program (NCSP) is an interprofessional postdoctoral fellowship for physicians and nurses with a PhD. or DNP focused on health services research, policy, and leadership. PURPOSE: To evaluate 5-year outcomes of nurse postdoctoral scholars in the NCSP. METHODS: We describe the 5-year outcomes of nurse fellows and graduates from six NCSP sites (positions, number of peer-reviewed publications, citations, and h-index). CONCLUSION: There were 53 nurses in the sample (34 alumni, 19 fellows). Approximately half (47%, n = 16) of alumni had tenure-track faculty positions and had bibliometric performance indicators (such as h-indices) 2 to 4 times greater than those previously reported for assistant professors in nursing schools nationally. NCSP nurse scholars and alumni also had an impact on community partnerships, health equity, and health policy DISCUSSION: This study highlights the potential of interprofessional postdoctoral fellowships such as the NCSP to prepare nurse scientists for health care leadership roles.

Engaging Same-Day Peer Ambassadors to Increase Coronavirus Disease 2019 Vaccination Among People Experiencing Unsheltered Homelessness in Los Angeles County: A Hybrid Feasibility-Evaluation Study.

BACKGROUND: This study aimed to evaluate the feasibility and acceptability of engaging unhoused peer ambassadors (PAs) in coronavirus disease 2019 (COVID-19) vaccination efforts to reach people experiencing unsheltered homelessness in Los Angeles County. METHODS: From August to December 2021, vaccinated PAs aged ≥18 years who could provide informed consent were recruited during vaccination events for same-day participation. Events were held at encampments, service providers (eg, housing agencies, food lines, and mobile showers), and roving locations around Los Angeles. PAs were asked to join outreach alongside community health workers and shared their experience getting vaccinated, receiving a $25 gift card for each hour they participated. Postevent surveys evaluated how many PAs enrolled and how long they participated. In October 2021, we added a preliminary effectiveness evaluation of how many additional vaccinations were attributable to PAs. Staff who enrolled the PAs estimated the number of additional people vaccinated because of talking with the PA. RESULTS: A total of 117 PAs were enrolled at 103 events, participating for an average of 2 hours. At events with the effectiveness evaluation, 197 additional people were vaccinated over 167 PA hours ($21.19 gift card cost per additional person vaccinated), accounting for >25% of all vaccines given at these events. DISCUSSION: Recruiting same-day unhoused PAs is a feasible, acceptable, and preliminarily effective technique to increase COVID-19 vaccination in unsheltered settings. The findings can inform delivery of other health services for people experiencing homelessness.

Concordance between patient-centered and adaptive behavior outcome measures after applied behavior analysis for autism.

BACKGROUND: Applied behavior analysis (ABA) is an evidence-based approach to autism spectrum disorder that has been shown in clinical trials to improve child functional status. There is substantial focus in ABA on setting and tracking individualized goals that are patient-centered, but limited research on how to measure progress on such patient-centered outcomes. PURPOSE: The purpose of this investigation was to assess concordance between patient-centered and standard outcome measures of treatment progress in a real-world clinical sample of children receiving ABA for autism spectrum disorder. METHODS: This observational study used a clinical sample of children ages 3 to 16 years (N = 154) who received 24 months of ABA from an integrated health system. Concordance between three outcome measures after ABA was assessed using a correlation matrix: (1) patient-centered measures of progress on individualized treatment goals, (2) caregiver-centered measure of progress on treatment participation goals, and (3) the Vineland Adaptive Behavior Scales adaptive behavior composite. RESULTS: There was limited concordance among measures at both 12 and 24 months of ABA. None of the patient-centered measures showed significant positive correlation with adaptive behavior composite difference scores at either 12 or 24 months, nor did the caregiver measure. The percentage of children achieving clinically meaningful gain on patient-centered goal measures increased between 12 and 24 months of ABA, while the percentage of children achieving clinically meaningful gains in adaptive behavior declined during the same time period. CONCLUSIONS: In a health system implementation of ABA, there was limited concordance between patient-centered and standard measures of clinically meaningful treatment progress for children with ASD. Clinicians should have ongoing dialogue with patients and parents/caregivers to ensure that interventions for ASD are resulting in progress towards outcomes that are meaningful to patients and families.

COVID-19 Experiences and Mental Health Among Graduate and Undergraduate Nursing Students in Los Angeles.

BACKGROUND: Nurses and nursing students are at risk for negative mental health as a result of significant work stressors from the COVID-19 pandemic. AIMS: The purpose of this study was to (1) describe the mental health of nursing students during the COVID-19 pandemic, (2) investigate relationships between stressful COVID-19 experiences and mental health, and (3) examine correlates of mental health service use. METHOD: This observational study used a web-based survey to assess COVID-19 experiences, self-reported mental health, and mental health service utilization among nursing students in Los Angeles in spring 2021 (N = 174, 30.1% response rate). The survey used measures of stressful COVID-19 experiences (personal COVID-19 illness, hospitalization of close friends or family, and death of close friends or family), loneliness, resilience, depression, anxiety, COVID-19-related traumatic stress, and utilization of campus and noncampus mental health services. RESULTS: Students had high levels of depression (30%), anxiety (38%), and traumatic stress (30%). There was no relationship between stressful COVID-19 experiences and mental health, but loneliness was associated with higher odds of mental health problems and resilience with lower odds. Mental health problems were not associated with use of campus or noncampus mental health services. Students with primary caregiving responsibilities (OR = 0.22, 95% CI [0.05, 0.87]) and students who identified as Asian/Pacific Islander (OR = 0.24, 95% CI [0.09, 0.70]) had lower odds of mental health service utilization. CONCLUSIONS: Resilience and loneliness affect nursing student risk for negative mental health as a result of the COVID-19 pandemic. Targeted, accessible mental health support within nursing education programs may be warranted.

Firearm laws and the network of firearm movement among US states.

BACKGROUND: The movement of firearm across state lines may decrease the effectiveness of state-level firearm laws. Yet, how state-level firearm policies affect cross-state movement have not yet been widely explored. This study aims to characterize the interstate movement of firearms and its relationship with state-level firearm policies. METHODS: We analyzed the network of interstate firearm movement using Bureau of Alcohol, Tobacco, Firearms, and Explosives firearm trace data (2010-2017). We constructed the network of firearm movement between 50 states. We used zero-inflated negative binomial regression to estimate the relationship between the number of a state's firearm laws and number of states for which it was the source of 100 or more firearms, adjusting for state characteristics. We used a similar model to examine the relationship between firearm laws and the number of states for which a given state was the destination of 100 or more firearms. RESULTS: Over the 8-year period, states had an average of 26 (Standard Deviation [SD] 25.2) firearm laws. On average, a state was the source of 100 or more crime-related firearms for 2.2 (SD 2.7) states and was the destination of 100 or more crime-related firearms for 2.2 (SD 3.4) states. Greater number of firearm laws was associated with states being the source of 100 or more firearms to fewer states (Incidence Rate Ratio [IRR] 0.58 per SD, p < 0.001) and being the destination of 100 or more firearms from more states (IRR1.73 per SD, p < 0.001). CONCLUSIONS: Restrictive state-level firearm policies are associated with less movement of firearms to other states, but with more movement of firearms from outside states. The effectiveness of state-level firearm-restricting laws is complicated by a network of interstate firearm movement.

Adolescent Psychiatric Emergencies Precipitated by the COVID-19 Pandemic.

The purpose of this retrospective case series was to describe adolescent psychiatric emergencies precipitated by the coronavirus disease 2019 (COVID-19) pandemic. This study used a sample of adolescents admitted to a safety net psychiatric hospital in Los Angeles, California, between March and May 2020. Medical records and involuntary psychiatric holds were reviewed to determine if the events precipitating the psychiatric crisis were related to the pandemic (eligible N = 14). COVID-19-precipitated admissions were 24% of total admissions from March 15 to May 31, 2020; however, total admissions during this time period were reduced from the same time period in prior years. Most hospitalizations were precipitated by shelter-in-place stressors for adolescents with a psychiatric history, but for 28.6% of the sample, this was their first mental health encounter. The COVID-19 pandemic and corresponding shelter-in-place orders may precipitate psychiatric emergencies among adolescents with and without existing mental health disorders. [Journal of Psychosocial Nursing and Mental Health Services, 59(7), 17-21.].

The Impact of Attachment-Disrupting Adverse Childhood Experiences on Child Behavioral Health.

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.

Longitudinal Associations Between Healthcare Resources, Policy, and Firearm-Related Suicide and Homicide from 2012 to 2016.

BACKGROUND: Firearm-related violence is a leading cause of mortality in the United States (US). Prior research suggests that public policy plays a role in firearm mortality, but the role of healthcare resources (physicians, insurance coverage) within the US policy context has not yet been studied. OBJECTIVE: To examine how healthcare resources and social/firearm policy affect firearm-related suicide and homicide rates in the US. DESIGN: Longitudinal, ecological study. SETTING: US. PARTICIPANTS: US states from 2012 to 2016 (N = 242). MEASUREMENT: The outcome variables were age-adjusted, firearm-related suicide and homicide rates. Predictor variables were healthcare resources (physicians, Medicaid benefits generosity) and policy context (social policy, firearm policy) with covariates for sociodemographic factors. RESULTS: Healthcare provider variables did not have significant associations to firearm-related suicide or homicide. In fully saturated models, more worker protection laws, greater average population density, more alcohol regulation, and more firearm prohibition policies were associated with fewer firearm-related suicides. Higher generosity of Medicaid benefits was associated with fewer firearm-related homicides. Poverty rate was a predictor of both outcomes. LIMITATIONS: This state-level study cannot make individual-level inferences. Only proxy variables were available for measuring gun ownership and actual gun ownership rates may not have been ideally captured at the state level. CONCLUSIONS: At the state level, there are protective associations of certain social, healthcare, and firearm policies to firearm-related suicide and homicide rates. Healthcare resources play a role in population-level firearm outcomes but alone are not sufficient to decrease firearm-related homicide or suicide.

A qualitative needs assessment of human trafficking in Ethiopia: recommendations for a comprehensive, coordinated response.

BACKGROUND: Human trafficking is a global human rights violation that has profound health, economic, and social impacts. There has been little investigation of service needs and response options for human trafficking survivors in Ethiopia. The purpose of this study was to understand the potential service needs and response options for human trafficking in Ethiopia from multiple stakeholder perspectives. METHODS: We conducted a qualitative needs assessment and used content analysis to analyze individual interviews with key stakeholder groups including service providers, academics, lawyers, and non-government organization (NGO) workers between the summer of 2015 - spring of 2016. RESULTS: In total, 17 individuals participated and content analysis elicited four overarching themes related to post-trafficking needs, including mental health considerations, barriers and facilitators to providing survivor services, survivor service needs, and comprehensive care models. CONCLUSIONS: This qualitative needs assessment suggests that trafficking survivors may require professional and community services throughout their trafficking experiences, including medical care, economic and job opportunities, legal advocacy, and mental health services. Interventions should harness preexisting community strengths such as Ethiopia's "social healing system," health extension workers, and mobile technology. Future studies should explore tailored interventions and comprehensive models of care implemented within the pre-existing healthcare, social service, and community structures.

The impact of gun violence restraining order laws in the U.S. and firearm suicide among older adults: a longitudinal state-level analysis, 2012-2016.

BACKGROUND: Older adults complete suicide at a disproportionately higher rate compared to the general population, with firearms the most common means of suicide. State gun laws may be a policy remedy. Less is known about Gun Violence Restricting Order (GVRO) laws, which allow for removal of firearms from people deemed to be a danger to themselves or others, and their effects on suicide rates among older adults. The purpose of this study was to examine the association of state firearm laws with the incidence of firearm, non-firearm-related, and total suicide among older adults, with a focus on GVRO laws. METHODS: This is a longitudinal study of US states using data from 2012 to 2016. The outcome variables were firearm, non-firearm and total suicide rates among older adults. Predictor variables were [1] total number of gun laws to assess for impact of overall firearm legislation at the state level, and [2] GVRO laws. RESULTS: The total number of firearm laws, as well as GVRO laws, were negatively associated with firearm-related suicide rate among older adults ages 55-64 and > 65 years-old (p < 0.001). There was a small but significant positive association of total number of firearm laws to non-firearm-related suicide rates and a negative association with total suicide rate. GVRO laws were not significantly associated with non-firearm-related suicide and were negatively associated with total suicide rate. CONCLUSION: Stricter firearm legislation, as well as GVRO laws, are protective against firearm-relate suicides among older adults.

The relationship of nursing practice laws to suicide and homicide rates: a longitudinal analysis of US states from 2012 to 2016.

BACKGROUND: Nursing resources can have a protective effect on patient outcomes, but nurses and nursing scope of practice have not been studied in relation to injury outcomes. The purpose of this study was to examine whether scope of practice and ease of practice laws for nurse practitioners and registered nurses are associated with suicide and homicide rates in the United States. METHODS: This state-level analysis used data from 2012 to 2016. The outcome variables were age-adjusted suicide and homicide rates. The predictor variables were NP scope of practice by state (limited, partial, or full) and RN ease of practice (state RN licensure compact membership status). Covariates were state sociodemographic, healthcare, and firearm/firearm policy context variables that have a known relationship with the outcomes. RESULTS: Full scope of practice for NPs was associated with lower rates of suicide and homicide, with stronger associations for suicide. Likewise, greater ease of practice for RNs was associated with lower suicide and homicide rates. CONCLUSIONS: Findings suggest that nurses are an important component of the healthcare ecosystem as it relates to injury outcomes. Laws supporting full nursing practice may have a protective effect on population health in the area of injuries and future studies should explore this relationship further.

Autism Insurance Mandates in the US: Comparison of Mandated Commercial Insurance Benefits Across States.

INTRODUCTION: Autism mandates are laws that require commercial insurers to cover certain evidence-based treatments for Autism Spectrum Disorder (ASD). The purpose of this study was to review state variability in autism insurance mandates and the benefits they cover and to discuss recommendations for research and policy to improve ASD services across states. METHODS: Data were extracted from 2001 to 2020 from all 50 states plus the District of Columbia (N = 51) from policy text. News articles and websites of ASD advocacy organizations were also reviewed to ensure inclusion of the most recent policy changes. Descriptive statistics and heatmaps were used to characterize the autism mandate landscape and visualize variability in benefit parameters across states. RESULTS: Autism mandates vary greatly in benefit parameters across US states, but there is a common set of benefits that most states have adopted. These include coverage of provider-recommended ASD services except for medical equipment, coverage up to an age limit of 18 to 21, an annual dollar limit of $36,000 with no restriction on the number of hours or visits, no lifetime cap on benefits, and requirement of BCBA® certification or its equivalent for providers of ABA. DISCUSSION: There is a need for continued research evaluating the impact of autism mandates and benefit parameters on access to care, service utilization, and clinical outcomes for the ASD population. Stakeholder engagement and understanding the impact of autism mandates on clinical and patient-centered outcomes may provide direction for policy advocacy and public health initiatives.

A Second Pandemic: Mental Health Spillover From the Novel Coronavirus (COVID-19).

The novel coronavirus (COVID-19) pandemic has created an unprecedented global health challenge. There is risk that the outbreak will create a "second pandemic" of mental health crises in health systems and communities. Thus, a comprehensive public health response to the pandemic must include (a) attention to the psychological aspects of hospitalization for patients, families, and staff affected by COVID-19; (b) planning for emergency and acute psychiatric patient care if hospitals become overwhelmed with COVID-19 patients; and (c) innovations for providing mental health care in communities while social distancing is required and health system resources are strained. Nurses and nurse leaders must anticipate these mental health challenges, assist with preparedness in health systems and communities, and advocate for a coordinated response to promote mental wellness and resilience.

An Integrative Literature Review of Psychiatric Rapid Response Teams and Their Implementation for De-escalating Behavioral Crises in Nonpsychiatric Hospital Settings.

OBJECTIVE: To synthesize articles exploring the implementation of psychiatric rapid response teams (RRTs) for behavioral crises in hospital settings. BACKGROUND: Psychiatric/behavioral crises in nonpsychiatric hospital settings can lead to restraint use, staff injuries, and poor patient outcomes. Psychiatric RRTs may provide a solution, but they are a new, understudied intervention, and their implementation varies across institutions. METHODS: A systematic, integrative literature review of nursing and biomedical literature yielded 7 articles about psychiatric RRTs. Data were extracted on RRT structure, processes, outcomes, and implementation. RESULTS: Psychiatric RRTs were structured as a nurse-led, interdisciplinary intervention. When implemented using evidence-based models, they reduced security calls, restraint use, and staff injuries while moderately improving staff knowledge and self-efficacy. RRTs that included education, debriefing, and role modeling appeared to increase staff behavioral management skills and eventually reduced the need for RRTs. CONCLUSIONS: Psychiatric RRTs have demonstrated promise in quality improvement projects for reducing adverse outcomes related to behavioral health in hospitals.

Relationships Between Maltreatment, Posttraumatic Symptomatology, and the Dissociative Subtype of PTSD Among Adolescents.

The purpose of this study was to explore relationships between maltreatment, posttraumatic stress disorder, and the dissociative subtype of posttraumatic stress disorder among adolescents. This descriptive study used secondary data from the National Child Traumatic Stress Network Core Data Set. A clinical sample of adolescents exposed to potentially traumatizing events ages 12 to 16 was selected (N = 3081) to explore associations between trauma history characteristics, sociodemographic factors, posttraumatic stress disorder, and the dissociative subtype of PTSD which includes depersonalization and derealization. More than half of adolescents who met criteria for posttraumatic stress disorder also met criteria for the posttraumatic stress disorder dissociative subtype with significant depersonalization/derealization symptoms. No particular maltreatment type was associated with increased odds of posttraumatic stress disorder, with or without the dissociative subtype. All posttraumatic stress disorder-affected adolescents, with or without the dissociative subtype, experienced more overall potentially traumatizing events and maltreatment events than those without a posttraumatic stress disorder diagnosis. Girls and adolescents in residential treatment were more likely to have posttraumatic stress disorder with the dissociative subtype. This study provides evidence about the dissociative subtype of posttraumatic stress disorder among adolescents and provides new directions for research on trauma and dissociation. Future research studies should explore the co-occurrence of posttraumatic stress disorder and dissociation with broader range of dissociative symptoms than only depersonalization/derealization to further understand how to diagnose and treat traumatic stress disorders among adolescents.