CHIP-Family intervention to improve the psychosocial well-being of young children with congenital heart disease and their families: results of a randomised controlled trial.

OBJECTIVE: Children with congenital heart disease and their families are at risk of psychosocial problems. Emotional and behavioural problems, impaired school functioning, and reduced exercise capacity often occur. To prevent and decrease these problems, we modified and extended the previously established Congenital Heart Disease Intervention Program (CHIP)-School, thereby creating CHIP-Family. CHIP-Family is the first psychosocial intervention with a module for children with congenital heart disease. Through a randomised controlled trial, we examined the effectiveness of CHIP-Family. METHODS: Ninety-three children with congenital heart disease (age M = 5.34 years, SD = 1.27) were randomised to CHIP-Family (n = 49) or care as usual (no psychosocial care; n = 44). CHIP-Family consisted of a 1-day group workshop for parents, children, and siblings and an individual follow-up session for parents. CHIP-Family was delivered by psychologists, paediatric cardiologists, and physiotherapists. At baseline and 6-month follow-up, mothers, fathers, teachers, and the child completed questionnaires to assess psychosocial problems, school functioning, and sports enjoyment. Moreover, at 6-month follow-up, parents completed program satisfaction assessments. RESULTS: Although small improvements in child outcomes were observed in the CHIP-Family group, no statistically significant differences were found between outcomes of the CHIP-Family and care-as-usual group. Mean parent satisfaction ratings ranged from 7.4 to 8.1 (range 0-10). CONCLUSIONS: CHIP-Family yielded high program acceptability ratings. However, compared to care as usual, CHIP-Family did not find the same extent of statistically significant outcomes as CHIP-School. Replication of promising psychological interventions, and examination of when different outcomes are found, is recommended for refining interventions in the future. TRIAL REGISTRY: Dutch Trial Registry number NTR6063, https://www.trialregister.nl/trial/5780.

Long-term effectiveness of eye movement desensitization and reprocessing in children and adolescents with medically related subthreshold post-traumatic stress disorder: a randomized controlled trial.

AIMS: Medical procedures and hospitalizations can be experienced as traumatic and can lead to post-traumatic stress reactions. Eye movement desensitization and reprocessing (EMDR) shows promising results but very few long-term studies have been published. Therefore, our aim was to test the long-term (8 months post-treatment) effectiveness of EMDR in children and adolescents with medically related subthreshold post-traumatic stress disorder (PTSD). METHODS AND RESULTS: Seventy-four children (including 39 with congenital or acquired heart disease) aged 4-15 (M = 9.6 years) with subthreshold PTSD after previous hospitalization were included into a parallel group randomized controlled trial. Participants were randomized to EMDR (n = 37) or care-as-usual (CAU) (n = 37; medical care only). The primary outcome was PTSD symptoms of the child. Secondary outcomes were symptoms of depression and blood-injection-injury (BII) phobia, sleep problems, and health-related quality of life (HrQoL) of the child. Assessments of all outcomes were planned at baseline and 8 weeks and 8 months after the start of EMDR/CAU. We hypothesized that the EMDR group would show significantly more improvements on all outcomes over time. Both groups showed improvements over time on child's symptoms of PTSD (only parent report), depression, BII phobia, sleep problems, and most HrQoL subscales. GEE analyses showed no significant differences between the EMDR group (nT2 = 33, nT3 = 30) and the CAU group (nT2 = 35, nT3 = 32) on the primary outcome. One superior effect of EMDR over time was found for reducing parent-reported BII phobia of the child. CONCLUSION: EMDR did not perform better than CAU in reducing subthreshold PTSD up to 8 months post-treatment in previously hospitalized children. Possible explanations and clinical implications are discussed.

Cumulative Lifetime Adversity and Depression among a National Sample of U.S. Latinx Immigrants: Within-group Differences in Risk and Protective Factors Using Data from the HCHS/SOL Sociocultural Ancillary Study.

BACKGROUND: Latinx immigrants are exposed to multiple stressors before, during, and after migration. However, most past research has assumed the effects of these stressors are uniform across Latinx groups despite considerable within-group variation. The purpose of this study was to (a) assess the moderating effects of several risk and protective factors on the association between cumulative lifetime adversity and depression among U.S. Latinx immigrants and (b) examine the extent to which risk and protective processes differed between Latinx subgroups. METHOD: Data came from a cross-sectional secondary dataset, called the HCHS/SOL Sociocultural Ancillary Study. The sample (N = 2893) was identified using stratified random probability sampling in four of the largest Latinx metropolitan areas: the Bronx, NY, San Diego, CA, Chicago, IL, and Miami, FL. We included four Latinx subgroups in our study: Puerto Ricans, Cubans, Mexicans, and Dominicans. RESULTS: Results from multi-group regression analyses suggested that social support moderated the association between cumulative lifetime adversity and depression. However, further subgroup analyses showed the moderation effect was only present for Cuban and Dominican immigrants. We also found that perceived discrimination moderated the association between lifetime adversity and depression for Cuban immigrants and ethnic identity moderated the relationship between lifetime adversity and depression for Dominican immigrants. CONCLUSIONS: Our results provide preliminary evidence for the presence of within-group differences in responses to adverse events among Latinx immigrant groups. Results can be used to inform the development of mental health interventions tailored to the specific needs of various Latinx immigrant populations.

CONTEXTO: Los inmigrantes Latinx están expuestos a varios factores que les causan estrés antes, durante, y después de migrar. Sin embargo, casi todas las investigaciones previas han asumido que los efectos de estos factores que causan estrés son uniformes entre todos los grupos inmigrantes Latinx, a pesar de variación considerable dentro del grupo. El propósito de esta investigación fue (a) evaluar los efectos moderativos de los varios factores riesgosos y protectores en la relación entre la adversidad acumulativa de la vida y la depresión entre los inmigrantes Latinx en los estados unidos y (b) examinar hasta qué punto los procesos riesgosos y protectores se distinguían entre los subgrupos Latinx. MÉTODO: Los datos vinieron de un conjunto de datos secundarios transversales llamados el HCHS/SOL Estudio Sociocultural Ancilar. La muestra de personas (N = 2893) fue identificada usando un muestreo aleatorio proporcionalmente estratificado en cuatro de las áreas metropolitanas más grandes de gente Latinx: El Bronx en New York, San Diego, California, Chicago, Illinois, y Miami, Florida. Hemos incluyendo cuatro subgrupos Latinx en nuestra investigación: puertorriqueños, cubanos, mexicanos, y dominicanos. RESULTADOS: Resultados del análisis de regresión multi-grupo sugirieron que el apoyo social moderó la relación entre la adversidad acumulativa de la vida y la depresión. Sin embargo, análisis más a fondo de subgrupos demostraron que el efecto de moderación solo estaba presente para los inmigrantes cubanos y dominicanos. También descubrimos que la discriminación moderó la relación entre la adversidad acumulativa de la vida y la depresión para los inmigrantes cubanos y que la identidad étnica moderó la relación entre la adversidad acumulativa de la vida y la depresión para los inmigrantes dominicanos. CONCLUSIONES: Nuestros resultados proveen evidencia preliminar de la presencia de diferencias dentro del grupo en las repuestas a los eventos adversos entre los subgrupos de inmigrantes Latinx. Los resultados pueden informar el desarrollo de intervenciones de salud mental personalizadas para las necesidades específicas de varias poblaciones de inmigrantes Latinx.

Latent classes of DSM-5 acute stress disorder symptoms in children after single-incident trauma: findings from an international data archive.

Background: After a potentially traumatic event (PTE), children often show symptoms of acute stress disorder (ASD), which may evolve into posttraumatic stress (PTS) disorder. A growing body of literature has employed latent class analysis (LCA) to disentangle the complex structure underlying PTS symptomatology, distinguishing between homogeneous subgroups based on PTS presentations. So far, little is known about subgroups or classes of ASD reactions in trauma-exposed children. Objective: Our study aimed to identify latent classes of ASD symptoms in children exposed to a single-incident PTE and to identify predictors of class membership (gender, age, cultural background, parental education, trauma type, and trauma history). Method: A sample of 2287 children and adolescents (5-18 years) was derived from the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive, an international archive including studies from the USA, UK, Australia, and Switzerland. LCA was used to determine distinct subgroups based on ASD symptoms. Predictors of class membership were examined using a three-step approach. Results: Our LCA yielded a three-class solution: low (42%), intermediate (43%) and high (15%) ASD symptom severity that differed in terms of impairment and number of endorsed ASD symptoms. Compared to the low symptoms class, children in the intermediate or high severity class were more likely to be of female gender, be younger of age, have parents who had not completed secondary education, and be exposed to a road traffic accident or interpersonal violence (vs. an unintentional injury). Conclusions: These findings provide new information on children at risk for ASD after single-incident trauma, based on a unique set of international data. Classifying children based on latent symptom profiles helps to identify target groups for prevention and intervention after exposure to a PTE.

Antecedentes: después de un evento potencialmente traumático (EPT), los niños a menudo muestran síntomas de trastorno de estrés agudo (TEA), el cual, puede evolucionar a un trastorno de estrés postraumático (TEPT). Un creciente cuerpo de literatura ha empleado el análisis de clase latente (LCA por sus siglas en ingles) para desenredar la compleja estructura subyacente a la sintomatología de TEPT, distinguiendo entre subgrupos homogéneos basados en presentaciones de TEPT. Hasta ahora, se sabe poco sobre los subgrupos o clases de reacciones TEA en niños expuestos a traumas.Objetivo: Nuestro estudio tuvo como objetivo identificar clases latentes de síntomas de TEA en niños expuestos a un solo incidente de EPT e identificar predictores de pertenencia a la clase (género, edad, antecedentes culturales, educación de los padres, tipo de trauma e historial de trauma).Método: se obtuvo una muestra de 2287 niños y adolescentes (5­18 años) de los estudios Prospectivos del Archivo de Datos de recuperación y Trauma Infantil agudo (PACT/R, en sus siglas en inglés), un archivo internacional que incluye estudios de Estados Unidos, Reino Unido, Australia y Suiza. Se utilizó LCA para determinar distintos subgrupos basados en los síntomas de TEA. Los predictores de pertenencia a la clase se examinaron mediante análisis de regresión logística ponderada.Resultados: Nuestro LCA arrojó una solución de tres clases: gravedad de los síntomas de TEA baja (42%), intermedia (43%) y alta (15%) que difería en términos de deterioro y número de síntomas de TEA atribuidos. En comparación con la clase baja e intermedia, los niños en la clase de gravedad alta tenían más probabilidades de ser de género femenino, de menor edad, tener padres que no habían completado la educación secundaria y estar expuestos a la violencia interpersonal (versus a eventos médicos no interpersonales). Pertenecer a una minoría étnica se asoció con la pertenencia a la clase de "síntomas intermedios" en comparación con la clase de "síntomas bajos".Conclusiones: Estos hallazgos brindan nueva información sobre los niños en riesgo de TEA después de un incidente traumático único, en base a un conjunto único de datos internacionales. La clasificación de los niños según los perfiles de síntomas latentes ayuda a identificar los grupos objetivo para la prevención e intervención después de la exposición a un EPT.

EMDR for children with medically related subthreshold PTSD: short-term effects on PTSD, blood-injection-injury phobia, depression and sleep.

Background: Paediatric illness, injury and medical procedures are potentially traumatic experiences with a range of possible negative psychosocial consequences. To prevent psychosocial impairment and improve medical adherence, evidence-based psychotherapy should be offered if indicated. Eye movement desensitization and reprocessing (EMDR) has been found to reduce symptoms of posttraumatic stress disorder (PTSD) in adults. The evidence for the use with children is promising. Furthermore, recent studies indicate its effectiveness for the treatment of other psychological symptomatology. However, the effectiveness of EMDR in children with subthreshold PTSD after medically related trauma has not yet been investigated. Objective: Investigating the short-term effectiveness of EMDR on posttraumatic stress, anxiety, depression and sleep problems in children with subthreshold PTSD after hospitalization through a randomized controlled trial (RCT). Method: Following baseline screening of 420 children from various Dutch hospitals, 74 children (4-15 years old) with medically related subthreshold PTSD were randomized to EMDR (n = 37) or care-as-usual (CAU; n = 37). Follow-up assessment took place after M = 9.7 weeks. Generalized Estimating Equation (GEE) analyses were performed to examine the effectiveness of EMDR compared to CAU. Results: Children in both groups improved significantly over time on all outcomes. However, the EMDR group improved significantly more as to child-reported symptoms of blood-injection-injury (BII) phobia and depression, and child-, and parent-reported sleep problems of the child. There was no superior effect of EMDR compared to CAU on subthreshold PTSD symptom reduction. Conclusions: EMDR did not perform better than CAU in reducing PTSD symptoms in a paediatric sample of children with subthreshold PTSD after hospitalization. However, the study results indicate that EMDR might be superior in reducing symptoms of blood-injection-injury phobia, depression and sleep problems.

Antecedentes: La enfermedad pediátrica, injuria y procedimientos médicos son experiencias potencialmente traumáticas con un rango de posibles consecuencias psicosociales negativas. Para prevenir el deterioro psicosocial y mejorar la adherencia médica, se debe ofrecer psicoterapia basada en evidencia si está indicada. Se ha observado que la Desensibilización y Reprocesamiento por Movimientos Oculares (EMDR) reduce los síntomas del Trastorno de Estrés Postraumático (TEPT) en adultos. La evidencia para su uso en niños es promisoria. Asimismo, estudios recientes indican su efectividad para el tratamiento de otra sintomatología psicológica. No obstante, la efectividad de la EMDR en niños con TEPT subumbral posterior a trauma médicamente relacionado aún no ha sido estudiada.Objetivo: Investigar la efectividad a corto plazo de la EMDR en estrés postraumático, ansiedad, depresión y alteraciones del sueño en niños con TEPT subumbral posterior a hospitalización, a través de un ensayo controlado aleatorizado (ECA).Método: Seguimiento de una muestra de 420 niños provenientes de varios hospitales holandeses, 74 niños (4­15 años de edad) con TEPT subumbral médicamente relacionado fueron aleatorizados a EMDR (n=37) o tratamiento habitual (TH, n=37). La evaluación posterior tuvo lugar tras M=9,7 semanas. Se realizó un análisis de ecuaciones de estimación generalizadas (EEG) para examinar la efectividad de EMDR comparado con TH.Resultados: Los niños en ambos grupos mejoraron significativamente a lo largo del tiempo en todas las variables. No obstante, el grupo EMDR mejoró significativamente más en los síntomas reportados por los niños respecto a belonefobia y depresión, y en alteraciones del sueño de los niños reportadas tanto por ellos como por sus padres. No hubo efecto superior de EMDR comparado con TH en la reducción de síntomas de TEPT subumbral.Conclusiones: EMDR no actuó mejor que TH en la reducción de síntomas de TEPT en niños en una muestra pediátrica de niños con TEPT subumbral posterior a hospitalización. Sin embargo, los resultados del estudio indican que EMDR podría ser superior en la reducción de síntomas de belonefobia, depresión y alteraciones del sueño.

Eye movement desensitization and reprocessing (EMDR) in children and adolescents with subthreshold PTSD after medically related trauma: design of a randomized controlled trial.

Background: Three in every 10 children and adolescents admitted to a hospital or undergoing medical treatment develop subthreshold symptoms of posttraumatic stress disorder (PTSD). When untreated, subthreshold PTSD can have a serious impact on psychosocial functioning, quality of life and long-term psychopathology. However, research investigating subthreshold PTSD and its treatment following paediatric medical interventions and/or hospitalization is scarce. Eye Movement Desensitization and Reprocessing (EMDR) is a fast and non-invasive psychosocial treatment for posttraumatic stress complaints. However, the effectiveness of EMDR in paediatric patients with subthreshold PTSD has not previously been systematically investigated. Objective: Describing the design of a randomized controlled trial (RCT) set up to evaluate the effectiveness of EMDR in children with subthreshold PTSD after hospitalization. Method: Children aged 4-15 years who have undergone a one-time (trauma type I) or repeated (trauma type II) hospitalization up to five years ago will be included. Participating children will be first screened with a standardized questionnaire for PTSD-symptoms. Subsequently, children with subthreshold PTSD will be randomly assigned to (1) approximately six sessions of standardized EMDR or (2) care as usual (CAU). Children with full diagnostic PTSD do not participate in the RCT, but are referred for direct treatment. Follow-up measurements will take place after eight weeks and eight months. Discussion: Considering the scarce evidence for the effectiveness of EMDR in children with medically related trauma, clinicans, researchers and children treated in hospitals can benefit from this study. Potential strengths and limitations of this study are discussed. Trial Registration: Netherlands Trial Register NTR5801.

Antecedentes: Alrededor de 3 de cada 10 niños y adolescentes ingresados en un hospital o sometidos a tratamiento médico desarrollan síntomas subumbrales de trastorno de estrés postraumático (TEPT). Cuando no se trata, el TEPT subumbral puede tener un impacto grave en el funcionamiento psicosocial, la calidad de vida, y la psicopatología a largo plazo. Sin embargo, la investigación sobre el TEPT subumbral y su tratamiento después de las intervenciones médicas pediátricas y/o la hospitalización es escasa. La desensibilización y reprocesamiento por movimientos oculares (EMDR) es un tratamiento psicosocial rápido y no invasivo para las quejas de estrés postraumático. Sin embargo, la efectividad del EMDR en pacientes pediátricos con TEPT subumbral no ha sido previamente investigada de manera sistemática.Objetivo: Describir el diseño de un ensayo controlado aleatorizado (RCT, en sus siglas en inglés) establecido para evaluar la efectividad de EMDR en niños con TEPT subumbral después de una hospitalización.Método: Se incluirán niños de 4 a 15 años que hayan sido sometidos a una hospitalización única (trauma tipo I) o repetida (trauma tipo II) hasta en los 5 años previos. Los niños participantes serán evaluados inicialmente con un cuestionario estandarizado para síntomas de TEPT. Posteriormente, los niños con TEPT subumbral serán asignados aleatoriamente a (1) seis sesiones de EMDR estandarizado o (2) cuidados usuales (CAU, por sus siglas en inglés). Los niños con diagnóstico completo de TEPT no participan en el RCT, pero serán derivados para tratamiento directo. Las mediciones de seguimiento se llevarán a cabo después de ocho semanas y ocho meses.Discusión: Teniendo en cuenta la escasa evidencia de la efectividad de EMDR en niños con trauma médico, los clínicos, los investigadores y los niños tratados en hospitales pueden beneficiarse de este estudio. Se discuten las fortalezas y limitaciones potenciales de este estudio.

Mental Health Problems in Parents of Children with Congenital Heart Disease.

This review will provide a concise description of mental health problems in parents of children with a (non-syndromic) congenital heart disease (CHD) during different stressful periods. Predictors of these problems and also implications for clinical practice will be mentioned. Having a child with CHD can be very stressful for parents, who have to face overwhelming emotions and also extra physical, financial, and other practical challenges. Parental distress has been reported in 30-80% of parents and appears not to be related to severity of CHD. Parental mental health, parenting, the parent-child relationship, and parental quality of life can all be affected. Parents, and especially mothers, are at risk of psychological distress, anxiety, depression, somatization, hopelessness, and posttraumatic stress symptoms, which in turn may influence mother's responsiveness. In the long term, the majority of parents adapt successfully to living with a child with CHD, but approximately 40% report a need for psychosocial care. These families may be helped by early psychosocial interventions to alleviate stress and reduce children's emotional and behavioral problems. A holistic approach to early psychosocial interventions should aim at improving coping and enhance parenting. During routine medical checkups, medical professionals should ask about parental stress, family functioning, and psychosocial functioning of the child and, when needed, adequate psychosocial care should be provided.

Medically Related Post-traumatic Stress in Children and Adolescents with Congenital Heart Defects.

Children and adolescents with a congenital heart defect (ConHD) frequently undergo painful or frightening medical procedures and hospitalizations. They often need multiple invasive procedures at a very young age and require regular checkups during their entire life. From other pediatric populations, it is known that these kinds of experiences can result in acute stress reactions and even in post-traumatic stress disorder (PTSD) in the long-term. PTSD and also subthreshold PTSD can lead to serious (psychosocial) impairment. However, limited information is available about PTSD in children with ConHD. Therefore, the aim of this review is to provide a summary of the current literature on post-traumatic stress (PTS) in children and adolescents with ConHD describing the prevalence of PTSD and its predictors/correlates. This review indicates that a range of 12-31% of children undergoing cardiac surgery develop PTSD. A range of 12-14% shows elevated post-traumatic stress symptoms (PTSS). These findings are comparable to those of hospitalized children without ConHD. Noteworthy, most studies used varying self-report questionnaires to measure PTSD and only one study used a semistructured interview. Although all studies point in the same direction of elevated PTSD and PTSS, systematic research is necessary to be able to draw firm conclusions. At present, as far as we know, in most clinics treating patients with ConHD, there is no regular screening for PTS in children with ConHD. In the reviewed literature, there is strong consensus that screening for PTSS and (preventive) psychological care for children and adolescents with ConHD is urgently needed.