Prolonged Grief, Posttraumatic Stress, and Depression Among Bereaved Parents: Prevalence and Response to an Intervention Program.

Bereaved parents may experience diverse psychological symptoms. Possible interventions are not yet well established. In this study, the psychological symptoms of 323 bereaved parents (mean age = 39.97, SD = 7.21, 52.0% female), referred to a 4-week family-oriented rehabilitation (FOR) program, were assessed. The baseline assessments indicated that 160 (49.5%) parents showed symptoms of prolonged grief disorder (PGD). Complicated grief was indicated in 272 (84.2%), depression in 191 (59.1%), and posttraumatic stress disorder in 242 (74.9%) parents. Mothers were at higher risk of complicated grief (p ≤ .001), depression (p = .029), and posttraumatic stress disorder (p = .004), compared to fathers. Significant remissions of symptoms between admission and discharge from the program are presented as symptoms of complicated grief, depression, and posttraumatic stress. The effect sizes ranged between d = 0.68 and 1.22. In addition, significantly fewer parents fulfilled PGD criteria on discharge from the FOR program (p ≤ .001). The special FOR program appears promising with regard to improving the bereaved parents' mental health.

Fertility education for adolescent cancer patients: Gaps in current clinical practice in Europe.

OBJECTIVE: As adolescent cancer patients may suffer from infertility following treatment, fertility counselling is essential. Our aim was to explore the current situation in four European countries in terms of (I) education about the risk for infertility, (II) counselling on fertility preservation, (III) patients' knowledge on fertility, (IV) sufficiency of information and (V) uptake of cryopreservation. METHODS: In total, 113 patients (13-20 years) at 11 study centres completed a self-report questionnaire three and six months after cancer diagnosis. Multivariate logistic regression was used to estimate odds ratios (OR) with 95% confidence intervals (CI). RESULTS: As many as 80.2% of participants reported having received education about the risk for infertility prior to treatment, 73.2% recalled counselling on fertility preservation. Only 52.3% stated they felt sufficiently informed to make a decision. Inability to recall counselling on fertility preservation (OR = 0.03, CI: 0.00-0.47) and female gender (OR = 0.11, CI: 0.03-0.48) was associated with lower use of cryopreservation, whereas older age was associated with higher use. CONCLUSION: Fertility counselling was available to a relatively high proportion of patients, and it did influence the utilisation of cryopreservation. However, many patients did not feel sufficiently informed. Further improvement is needed to enable adolescent cancer patients to make an informed decision on fertility preservation.

Trajectories and possible predictors of treatment outcome for youth receiving trauma-focused cognitive behavioral therapy.

OBJECTIVE: Even though there is strong evidence for the effectiveness of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) for trauma-exposed youth, there are still youth who continue to struggle with posttraumatic stress symptoms (PTSS) after treatment. Investigating treatment trajectories and predictors of symptom change can increase our understanding of factors associated with nonresponse so that trauma treatment can be optimized. METHOD: The sample consisted of 155 youths (M age = 13.9 years, SD = 2.8, 72.3% girls) who received TF-CBT. To examine whether different treatment trajectories could be identified, growth mixture models with linear effects of time were estimated based on Clinical-Administered PTSD-Scale (CAPS-CA) scores at pretreatment, posttreatment and follow-up. We further explored whether gender, age, trauma type, comorbid depression and anxiety, and posttraumatic cognitions were associated with treatment response. RESULTS: The participants' trajectories could best be represented by 2 latent classes; nonresponders (21% of the sample) and responders (79% of the sample). The nonresponder group was characterized by a higher pretreatment PTSS level and slower improvement in PTSS compared with the responder group. Gender was the only significant predictor, where girls were more likely to be assigned to the nonresponder group. CONCLUSIONS: The findings indicate that clinicians need to be aware that girls and youth with high levels of pretreatment PTSS may be at risk of nonresponse. The results support previous findings showing that TF-CBT is suitable across different age groups and can be an effective treatment for youth with a range of traumatic experiences and additional comorbid symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Longitudinal Associations Between Dysfunctional Maltreatment-Related Cognitions and Psychopathology in Children and Adolescents.

Dysfunctional posttraumatic cognitions seem to play an important role in adjustment after traumatic experiences. However, little research has been done on maltreated children and adolescents. Furthermore, possible causal associations between cognitions, posttraumatic stress symptoms, and internalizing and externalizing problems have rarely been investigated. In the current study, 263 maltreated children and adolescents (8-17 years of age) were assessed at baseline and again at time points 6 and either 12 or 18 months later. Cross-lagged panel analyses were used to gain a better understanding of the course of and associations among dysfunctional maltreatment-related cognitions, posttraumatic stress symptoms, and internalizing and externalizing problems. Ratings of all variables significantly decreased over time. Moderate to strong autoregressive paths emerged for all variables, denoting stability. Furthermore, the variables showed moderate to high correlations at every assessment. Posttraumatic stress symptoms moderately predicted dysfunctional maltreatment-related cognitions as well as internalizing and externalizing problems 6 months after baseline. Cross-lagged paths from the cognitions as well as from internalizing and externalizing problems to all other variables were not significant. Age, gender, and maltreatment characteristics did not play a relevant role in these cross-lagged associations when they were included as covariates. Our results underline the cognitive scar model, in which preceding posttraumatic stress symptoms adversely impact cognitions. Posttraumatic stress symptoms appear to be an important target for treatment as their reduction may help decrease internalizing and externalizing problems as well.

Spanish Abstracts by Asociación Chilena de Estrés Traumático (ACET) Asociaciones Longitudinales Entre Cogniciones Disfuncionales Relacionadas Con Maltrato Y Psicopatología En Niños Y Adolescentes COGNICIONES DISFUNCIONALES RELACIONADAS CON MALTRATATO Las cogniciones postraumáticas disfuncionales parecen jugar un papel importante en la adaptación después de experiencias traumáticas. Sin embargo, se ha realizado poca investigación en niños y adolescentes maltratados. Además, se ha investigado muy poco las posibles asociaciones causales entre cogniciones, síntomas de estrés postraumático y los problemas de internalización y externalización. En este estudio, 263 niños y adolescentes maltratados (de 8 a 17 años de edad) fueron evaluados al inicio y nuevamente en los períodos de 6 y 12 o 18 meses posteriores. Se utilizaron análisis de casos de cruce desfasado para obtener una mejor comprensión del curso y las asociaciones entre las cogniciones relacionadas con el maltrato disfuncional, los síntomas de estrés postraumático y problemas de internalización y externalización. Las calificaciones de todas las variables disminuyeron significativamente en el tiempo. Trayectorias autorregresivos moderadas a fuertes surgieron para todas las variables, denotando estabilidad. Además, las variables mostraron correlaciones moderadas a altas en cada evaluación. Los síntomas de estrés postraumático predijeron moderadamente cogniciones disfuncionales relacionados con maltrato como también los problemas de internalización y externalización 6 meses después de la evaluación inicial. Trayectorias de cruce desfasado de las cogniciones, como de los problemas de internalización y externalización a todas las demás variables no fueron significativas. Las características de edad, género y maltrato no jugaron un papel relevante en estas asociaciones de cruce desfasado cuando se incluyeron como covariables. Nuestros resultados destacan el modelo de cicatriz cognitiva, en el que los síntomas de estrés postraumático precedente afectan negativamente las cogniciones. Los síntomas de estrés postraumático parecen ser una un objetivo importante para el tratamiento, ya que su reducción puede también ayudar a disminuir los problemas de internalización y de externalización.

Do dysfunctional posttraumatic cognitions play a mediating role in trauma adjustment? Findings from interpersonal and accidental trauma samples of children and adolescents.

Background: Trauma adjustment varies in children and adolescents. Studies on objective risk factors of posttraumatic stress symptoms (PTSS) yielded inconsistent results. Dysfunctional posttraumatic cognitions (PTCs) might play a mediating role between risk factors and posttraumatic symptomatology. Objective: To investigate the interplay of the characteristics of the trauma (e.g. trauma type), the characteristics of the individual (e.g. age, sex), and the characteristics of the social environment (e.g. parental distress, marital status) on PTSS and depression, taking the child's dysfunctional PTCs into account as a possible mediator. Method: Structural equation modelling was used to better understand trauma adjustment in two heterogeneous samples of children and adolescents: a sample of 114 participants aged 7-16 after accidental trauma and a sample of 113 participants aged 6-17 after interpersonal trauma. Results: In the accidental trauma sample, dysfunctional PTCs mediated the positive associations of younger age and lower parental educational level on child PTSS, but not on depression. In the interpersonal trauma sample, being female positively predicted child depression. Furthermore, parental dysfunctional PTCs positively predicted both child PTSS and depression. No mediation effect of child dysfunctional PTCs was found in the interpersonal trauma sample. Child dysfunctional PTCs moderately to strongly predicted child PTSS and depression in both trauma samples. Conclusions: The impact of the characteristics of the individual and the characteristics of the social environment on child PTSS and depression might depend on the type of trauma experienced. Dysfunctional PTCs mediated between the characteristics of the individual and the characteristics of the social environment and the severity of PTSS in the aftermath of accidental trauma, but not of interpersonal trauma.

El ajuste del trauma varía en niños y adolescentes. Estudios sobre los factores de riesgo objetivos de los síntomas de estrés postraumático (PTSS) han arrojado resultados inconsistentes. Las cogniciones postraumáticas disfuncionales (PTCs) pueden desempeñar un rol mediador entre los factores de riesgo y la sintomatología postraumática.Objetivo: Para investigar la interacción de las características del trauma (por ejemplo, tipo de trauma), las características del individuo (por ejemplo, edad, sexo) y las características del entorno social (por ejemplo, angustia de los padres, estado civil) en los PTSS y depresión, tomando en cuenta las PTCs disfuncionales del niño como un posible mediador.Método: Se utilizó un modelo de ecuación estructural para una mejor comprensión del ajuste del trauma en dos muestras heterogéneas de niños y adolescentes: una muestra de 114 participantes de 7 a 16 años de edad después de un trauma accidental y una muestra de 113 participantes de 6 a 17 años de edad después de un trauma interpersonal.Resultados: En la muestra de trauma accidental, las PTCs disfuncionales mediaron las asociaciones positivas de edades más jóvenes y más bajos niveles educacionales parentales en los PTSS infantiles, pero no en depresión. En la muestra de trauma interpersonal, ser mujer predijo positivamente la depresión infantil. Además, las PTCs disfuncionales de los padres predijeron positivamente tanto los PTSS infantiles como la depresión. No se encontró ningún efecto de mediación de las PTCs disfuncionales de los niños en la muestra de trauma interpersonal. Las PTCs disfuncionales infantiles predijeron, de manera moderada a robusta, los PTSS infantiles y la depresión en ambas muestras.Conclusiones: El impacto de las características individuales y las características del entorno social en los PTSS infantiles y la depresión pueden depender del tipo de trauma experimentado. Las PTCs disfuncionales mediaron entre las características individuales y las características del entorno social y la severidad de los PTSS después de un trauma accidental, pero no tras un trauma interpersonal.

Patient education for children with interstitial lung diseases and their caregivers: A pilot study.

OBJECTIVE: Patient education in children with rare chronic diseases like children's interstitial lung disease (chILD) remains a challenge. AIMS: To develop and evaluate a component-based educational program for individual counselling and to improve patients' and caregivers' self-efficacy and treatment satisfaction. Furthermore, to create chILD-specific educational material and assess physicians' satisfaction with the intervention as well as patients' health-related quality of life (HrQoL). METHODS: The study was conducted in two German centers for pediatric pulmonology, as a single-group intervention with pre-post-follow-up design. RESULTS: Participants (N = 107, age: M = 7.67, SD = 5.90) showed significant improvement of self-efficacy (self-report: t = 2.89, p < 0.01; proxy-report: t = 3.03, p < 0.01), and satisfaction (patients: t = 3.56, p = 0.001; parents t = 6.38, p < 0.001) with the medical consultations. There were no pre-post differences in HrQoL. Participants were highly satisfied with the material and the physicians with the program. CONCLUSIONS: The chILD education-program is a promising strategy to improve patients' and their parents' self-efficacy and treatment-satisfaction. Specific effects of the intervention need to be determined in a randomized controlled trial. PRACTICE IMPLICATION: Healthcare providers managing pediatric patients with chILD, may choose to use a patient education-program specifically tailored to the needs of chILD patients and their families, such as the program described here, which is the first of its kind.

The impact of maltreatment characteristics and revicitimization on functioning trajectories in children and adolescents: A growth mixture model analysis.

Person-centered approaches are considered promising methods for a deeper understanding of the causes and consequences of maltreatment. So far, only few studies have employed such approaches in the study of maltreatment. The aim of the present study was to examine the impact of maltreatment-related variables on trajectories after maltreatment. Growth mixture modelling (GMM) was used to examine different trajectories of functioning in 206 children and adolescents (M = 9.8 years) with a history of child maltreatment. Trajectories were analyzed in regards to maltreatment characteristics and revictimization using multinomial logistic regression. The participants were followed up over a 12 months period including three assessments. Four trajectories were identified: resilient (22.9%), worsening (15.1%), recovering (32.2%), chronic (29.8%). Revictimization (OR: 2.6-5.5), a longer period between first and last reported incident of maltreatment (OR: 0.033 - 0.038) and consequently the age at first (OR: 0.039 - 0.054) and age at last reported incident (OR: 20.3-26.9) were significant predictors of a worsening functioning trajectory. Having experienced neglect predicted a worsening trajectory in contrast to a chronic and resilient trajectory (OR = 4.8-5.2). Findings suggest that a clinical follow-up of children with a history of maltreatment is crucial as this population represents a high risk sample. A worsening trajectory was closely associated with revictimization. Functioning trajectories seem to be directly linked to chronicity and timing of maltreatment. Implications are discussed.

[Experiences with an intercultural training for professionals from child-welfare services working with children and adolescents following child abuse and neglect]. / Erfahrungen mit einem kultur- und migrationsspezifischen Workshop für Fachkräfte der Kinder- und Jugend- hilfe in der Arbeit mit misshandelten Kindern und Jugendlichen.

Experiences with an intercultural training for professionals from child-welfare services working with children and adolescents following child abuse and neglect Abstract. Background: As part of a multicenter study evaluating measures to improve access to evidenced-based treatment for children and adolescents following child abuse and neglect, we introduced and evaluated migration-adapted services, including a one-day intercultural training. Key issues were the dissemination of information concerning migration and acculturation, trauma and mental health to immigrant families as well as the development of exercises on intercultural competence and culturally sensitive work. Method: Near the end of the research project we gathered experiences and opinions concerning the work with immigrant families using an online survey in a subgroup of case managers working in the project (professionals in child-welfare services). This article presents two case report illustrating the practical relevance of the training's content. Results: Overall, the training was rated positively. In the opinion of the case managers, especially language barriers and cultural diversity should be considered while working with immigrant families. The case reports show that the training sensitized and supported the case managers supported the case managers when dealing with differing illness concepts, differing illness concepts, culture-sensitive assessment, or work with language mediators. Conclusions: The case management work also demonstrated the limitations of the psychosocial care system; the further dissemination of intercultural knowledge is important.

Parental dysfunctional posttraumatic cognitions in trauma-focused cognitive behavioral therapy for children and adolescents.

OBJECTIVE: Trauma-therapy in children and adolescents often involves the inclusion of their parents. A multi-informant approach was used to investigate whether trauma-focused cognitive-behavioral therapy (TF-CBT) changes dysfunctional posttraumatic cognitions (PTCs) in participating parents. This, in turn, may mediate their child's posttraumatic stress symptoms (PTSS) posttreatment. METHOD: Children and adolescents (6-17 years old) were assigned to either a TF-CBT (n = 57) or a waitlist (n = 56) condition, within a multisite randomized controlled trial conducted in Germany. They were assessed using the Clinician Administered PTSD Scale for Children and Adolescents, version for DSM-IV and they completed the University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index for Children and Adolescents (UCLA). Their parents completed the UCLA, caregiver report, and the Posttraumatic Cognitions Inventory to rate their dysfunctional PTCs related to their child's trauma. The mediation hypothesis was tested using a multiple mediation model. RESULTS: The change in parental PTCs was stronger in the TF-CBT condition (b = 13.19, 95% confidence interval [CI] [2.89, 23.49]). It mediated the relationship between the group (TF-CBT vs. waitlist) and the caregiver report on the child's PTSS (b = -.08, 95% CI [-.15, -.01]), but not the child's PTSS, assessed using the interview (b = .01, 95% CI [-.14, .17]) and the self-report questionnaire (b = .01, 95% CI [-.08, .10]), posttreatment. CONCLUSIONS: TF-CBT helped participating parents to challenge their dysfunctional PTCs related to their child's trauma. The change in parental PTCs only mediated their perception of their child's PTSS but not their child's self-perception or the clinical evaluation of their child's PTSS. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Screen Time, Physical Activity and Self-Esteem in Children: The Ulm Birth Cohort Study.

Screen time is a central activity of children’s daily life and jeopardizes mental health. However, results appear inconclusive and are often based on small cross-sectional studies. We aimed to investigate the temporal sequence of the association between screen time and self-esteem taking into account further indirect effects through family or friendship relationship. In our population-based birth cohort study (baseline November 2000⁻November 2001, Ulm, Germany), these relationships were explored in n = 519 11- and 13-year-old children and their parents who both provided information on children’s screen time: time spent watching television or videos (TV), time spent on computers, video game consoles, mobile devices, or cell phones; so called “other screen time”, and children’s self-esteem (KINDL-R). Time watching TV (self-reported) at age 11 was negatively associated with girls’ self-esteem at the same age but positively with an increase of self-esteem between age 11 and 13. However, the latter association was restricted to low to moderate TV viewers. In boys, a higher increase of other screen time between age 11 and age 13 was associated with lower self-reported self-esteem at age 13. Additionally, friendship relationship mediated the association between watching TV and self-esteem in girls. For parental reports similar associations were observed. These findings indicate that time sequence and potential mediators need further investigation in cohort studies with multiple assessments of screen time and self-esteem.

Effectiveness of a trauma-focused group intervention for young refugees: a randomized controlled trial.

BACKGROUND: As access to evidence-based treatments for young refugees with posttraumatic stress symptoms (PTSS) is limited, we developed the trauma-focused group intervention Mein Weg to be delivered by trained social workers. A recently published pilot study delivered preliminary evidence of the intervention with regard to symptom reduction and its feasibility. The aim of this study was, therefore, to determine whether the intervention, in addition to usual care (UC), is more effective in reducing PTSS (primary outcome) compared to UC alone. METHODS: A parallel group randomized controlled trial was conducted in seven German child and adolescent welfare agencies. Participants were randomly assigned to either six sessions Mein Weg (n = 50; Mage  = 17.00, 94% male) or UC (n = 49; Mage  = 16.92, 92% male). Mixed effect models, with fixed effects of group and time as well as their interaction, were performed on the relevant outcome measures. This trial was registered in the German Clinical Trials Registry (#DRKS00010915, https://www.drks.de/drks_web/). RESULTS: Intention-to-treat analyses showed that Mein Weg was significantly superior to UC regarding symptom improvement of self-reported PTSS (Mein Weg: d = .61, UC: d = .15) and depression (Mein Weg: d = .63, UC: d = -.06), but not regarding caregiver-reported symptoms and self-reported dysfunctional posttraumatic cognitions. CONCLUSIONS: Mein Weg is effective for young refugees according to self-reports and can be viewed as a valuable component in a stepped care approach for this vulnerable population. The findings need to be replicated with independent clinical assessments.

Development and validation of a health-related quality of life questionnaire for pediatric patients with interstitial lung disease.

PURPOSE: Children's interstitial lung disease (chILD) is often associated with multiple burdens and chronic impairment of health-related quality of life. Patient reported outcomes describe the patients' perspective on medical conditions and their treatments. We aimed to develop and evaluate the psychometric properties of a chILD-specific PRO (chILD-QoL) as an instrument for monitoring the patients' health status. METHODS: Items were generated through focus groups with parents, patients, and interviews with pediatric pulmonologists. After a pretest of the German pilot version, the questionnaire was refined and translated into four European languages. Psychometric properties of the questionnaire were analyzed within a multi-center collaborative throughout Europe involving 180 parents of children with an interstitial lung disease and 65 pediatric patients. RESULTS: The final instrument is available in different developmentally adapted versions from infancy to adolescence, comprising between 5 and 11 items. The scales showed high internal consistency (Cronbachs'α between 0.85 and 0.94). Convergent validity was indicated by moderate to high correlations (r = 0.43-0.91) with the Pediatric Quality of Life Questionnaire (PedsQL™ 4.0 Core module). Lower scores were significantly associated with dyspnoea (tproxy = 3.18, P = 0.002), tachypnoea (tproxy = 2.95, P = 0.002), and with worse clinical course of lung disease (tself = 3.96, P < 0.05) as reported by the physicians. CONCLUSIONS: The results indicate the reliability and validity of the chILD-QoL for pediatric patients with interstitial lung diseases. It can be used for screening and monitoring subjective health status as perceived by the patients and/or their caregivers, as well as for evaluation of health-related quality of life in clinical trials and intervention research.

Treatment expectancy, working alliance, and outcome of Trauma-Focused Cognitive Behavioral Therapy with children and adolescents.

BACKGROUND: It has been shown that positive treatment expectancy (TE) and good working alliance increase psychotherapeutic success in adult patients, either directly or mediated by other common treatment factors like collaboration. However, the effects of TE in psychotherapy with children, adolescents and their caregivers are mostly unknown. Due to characteristics of the disorder such as avoidant behavior, common factors may be especially important in evidence-based treatment of posttraumatic stress symptoms (PTSS), e.g. for the initiation of exposure based techniques. METHODS: TE, collaboration, working alliance and PTSS were assessed in 65 children and adolescents (age M = 12.5; SD = 2.9) and their caregivers. Patients' and caregivers' TE were assessed before initiation of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Patients' and caregivers' working alliance, as well as patients' collaboration were assessed at mid-treatment, patients' PTSS at pre- and post-treatment. Path analysis tested both direct and indirect effects (by collaboration and working alliance) of pre-treatment TE on post-treatment PTSS, and on PTSS difference scores. RESULTS: Patients' or caregivers' TE did not directly predict PTSS after TF-CBT. Post-treatment PTSS was not predicted by patients' or caregivers' TE via patients' collaboration or patients' or caregivers' working alliance. Caregivers' working alliance with therapists significantly contributed to the reduction of PTSS in children and adolescents (post-treatment PTSS: ß = - 0.553; p < 0.001; PTSS difference score: ß = 0.335; p = 0.031). CONCLUSIONS: TE seems less important than caregivers' working alliance in TF-CBT for decreasing PTSS. Future studies should assess TE and working alliance repeatedly during treatment and from different perspectives to understand their effects on outcome. The inclusion of a supportive caregiver and the formation of a good relationship between therapists and caregivers can be regarded as essential for treatment success in children and adolescents with PTSS.

Comparing the dimensional structure and diagnostic algorithms between DSM-5 and ICD-11 PTSD in children and adolescents.

In contrast to the DSM-5, which expanded the posttraumatic stress disorder (PTSD) symptom profile to 20 symptoms, a workgroup of the upcoming ICD-11 suggested a reduced symptom profile with six symptoms for PTSD. Therefore, the objective of the study was to investigate the dimensional structure of DSM-5 and ICD-11 PTSD in a clinical sample of trauma-exposed children and adolescents and to compare the diagnostic rates of PTSD between diagnostic systems. The study sample consisted of 475 self-reports and 424 caregiver-reports on the child and adolescent trauma screen (CATS), which were collected at pediatric mental health clinics in the US, Norway and Germany. The factor structure of the PTSD construct as defined in the DSM-5 and in alternative models of both DSM-5 and ICD-11 was investigated using confirmatory factor analyses (CFA). To evaluate differences in PTSD prevalence, McNemar's tests for correlated proportions were used. CFA results demonstrated excellent model fit for the proposed ICD-11 model of PTSD. For the DSM-5 models we found the best fit for the hybrid model. Diagnostic rates were significantly lower according to ICD-11 (self-report: 23.4%; caregiver-report: 16.5%) compared with the DSM-5 (self-report: 37.8%; caregiver-report: 31.8%). Agreement was low between diagnostic systems. Study findings provide support for an alternative latent dimensionality of DSM-5 PTSD in children and adolescents. The conceptualization of ICD-11 PTSD shows an excellent fit. Inconsistent PTSD constructs and significantly diverging diagnostic rates between DSM-5 and the ICD-11 will result in major challenges for researchers and clinicians in the field of psychotraumatology.

Outcomes of an enhancement study with additional psychoeducational sessions for healthy siblings of a child with cancer during inpatient family-oriented rehabilitation.

OBJECTIVE: Chronic illness of a child puts healthy children of the family at risk of distress. Previous studies have demonstrated that healthy children's psychological symptoms can be reduced when the child knows more about the disease. So far, there is limited evidence of the effectiveness of psychoeducational interventions for healthy children. AIMS: To compare the effectiveness of an inpatient family-oriented rehabilitation program with vs without additional psychoeducational sessions for healthy children of families with children with cancer. PATIENTS AND METHODS: We performed a controlled study in 4 German family-oriented rehabilitation clinics. The outcomes of n = 73 healthy children (mean age: M = 9.55; SD = 3.14; range: 4-18), who participated in 5 additional psychoeducational sessions, were compared with the outcomes of n = 111 healthy children (mean age: M = 8.85; SD = 3.28; range: 4-17), who underwent the usual inpatient rehabilitation program. Primary outcomes were the healthy children's cancer-specific knowledge and their emotional symptoms. Secondary outcomes were family satisfaction and quality of life. RESULTS: Intention-to-treat analyses showed that both groups improved significantly from preintervention to postintervention. Improvements comprised knowledge about cancer (F(1,174) = 11.03, p < 0.001), self-reported emotional symptoms (F(1,135) = 31.68, p < 0.001), and parent-proxy-reported emotional symptoms (F(1,179) = 37.07, p < 0.001). The additional psycho-educational program did not significantly enhance the outcomes. The same pattern of significant improvement in both conditions emerged for all secondary outcomes. The immediate effects of the intervention persisted until 2 months after discharge from the rehabilitation program. CONCLUSIONS: Inpatient family-oriented rehabilitation is effective in improving multiple psychosocial outcomes of healthy children in families which have a child with cancer. Additional psycho-educational sessions did not show any substantial additional improvement.

International management platform for children's interstitial lung disease (chILD-EU).

BACKGROUND: Children's interstitial lung diseases (chILD) cover many rare entities, frequently not diagnosed or studied in detail. There is a great need for specialised advice and for internationally agreed subclassification of entities collected in a register.Our objective was to implement an international management platform with independent multidisciplinary review of cases at presentation for long-term follow-up and to test if this would allow for more accurate diagnosis. Also, quality and reproducibility of a diagnostic subclassification system were assessed using a collection of 25 complex chILD cases. METHODS: A web-based chILD management platform with a registry and biobank was successfully designed and implemented. RESULTS: Over a 3-year period, 575 patients were included for observation spanning a wide spectrum of chILD. In 346 patients, multidisciplinary reviews were completed by teams at five international sites (Munich 51%, London 12%, Hannover 31%, Ankara 1% and Paris 5%). In 13%, the diagnosis reached by the referring team was not confirmed by peer review. Among these, the diagnosis initially given was wrong (27%), imprecise (50%) or significant information was added (23%).The ability of nine expert clinicians to subcategorise the final diagnosis into the chILD-EU register classification had an overall exact inter-rater agreement of 59% on first assessment and after training, 64%. Only 10% of the 'wrong' answers resulted in allocation to an incorrect category. Subcategorisation proved useful but training is needed for optimal implementation. CONCLUSIONS: We have shown that chILD-EU has generated a platform to help the clinical assessment of chILD. TRIAL REGISTRATION NUMBER: Results, NCT02852928.

Usual Care for Maltreatment-Related Pediatric Posttraumatic Stress Disorder in Germany.

Child maltreatment represents a major risk factor for the development of emotional and behavioral problems, especially posttraumatic stress disorder (PTSD). While effective trauma-focused treatments are available, little is known about the usual mental healthcare for abused youths in Germany. The present study compared the utilization of mental healthcare in abused youths who had developed a PTSD (N = 95) with a group presenting other mental disorders (N = 146). Semistructured interviews were used to assess maltreatment histories, current mental health, and healthcare utilization. In addition, potential child factors associated with access to mental healthcare (age and level of functioning) were examined. Results showed that 65 % of both diagnostic groups currently fail to use any mental healthcare service. Of the participants with PTSD, 43 (45 %) had never received any mental healthcare intervention. Investigations on potential barriers are necessary to close the huge gap between clinical services and evidence-based, trauma-focused interventions.

Evaluation of a Trauma-Focused Group Intervention for Unaccompanied Young Refugees: A Pilot Study.

Recent research has shown that unaccompanied young refugees (UYR) encounter a wide range of traumatic events during preflight, flight, and resettlement. Although many UYR are resourceful, many develop posttraumatic stress symptoms (PTSS). However, only a small number of vulnerable UYR have access to trauma-focused interventions. Trauma-focused group interventions, adapted to the needs of UYR, may be one way of improving their mental health. A total of 29 male UYR between 14 and 18 years of age, mainly from Afghanistan, participated in the evaluation study of a trauma-focused group intervention entitled Mein Weg (My Way). The intervention included six sessions of psychoeducation, relaxation, trauma narrative, and cognitive restructuring. Pre-post comparisons of PTSS assessed by the Child and Adolescent Trauma Screen (CATS) were used. At study entry, participants endorsed, on average, eight traumatic events. After the group intervention, the participants reported significantly fewer overall PTSS preintervention mean = 27.6, SD = 7.9; postintervention mean = 20.7, SD = 6.3; t(28) = 4.2, p = .001, Cohen's d = 0.97. Improvement was especially pronounced in the domains of reexperiencing and avoidance, as well as negative alterations in cognitions and mood. There were 14 participants preintervention and 7 postintervention who fulfilled the PTSD criteria. This pilot study presented initial evidence of the efficacy of the trauma-focused group intervention with regard to PTSS reduction.

[Family-Based Trauma-Focused Cognitive Behavioral Therapy with Three Siblings of a Refugee Family]. / Familienorientierte traumafokussierte Verhaltenstherapie mit drei Geschwisterkindern einer Flüchtlingsfamilie.

Family-Based Trauma-Focused Cognitive Behavioral Therapy with Three Siblings of a Refugee Family The possibility and relevance of a joint trauma-therapy with siblings has yet received little attention in research and clinical practice. The following case study presents a joint family-based trauma-focused therapy process with a refugee family. All three siblings suffered from post-traumatic stress disorder (PTSD) before treatment. The treatment followed the manual of Trauma Focused Cognitive Behavioral Therapy (TF-CBT; Cohen, Mannarino, Deblinger, 2009). Measures were the short version of the Child and Adolescent Trauma Screen (CATS 7-17), as well as the Teacher's Report Form (TRF). After 18 treatment sessions together with the mother, all three children did no longer meet PTSD criteria. Benefits of the joint therapy were for all three siblings to be sharing and imitating each other's coping strategies. Furthermore, the protective factor of social support after experiencing a traumatic event became evident. The apprehension of the therapist not being sufficiently neutral towards all three siblings was not observed.