Barriers to young people seeking help for trauma: A qualitative analysis of Internet forums.

OBJECTIVE: Exposure to trauma is common in childhood and adolescence and is associated with significant psychopathology. Despite being amenable to treatment, many young people suffering trauma-related distress do not disclose or seek help. Multiple barriers to young people help seeking for mental health concerns have been identified, but very little research has focused on help seeking after trauma exposure. We undertook a qualitative analysis of Internet forums in which young people discuss trauma, aiming to understand the barriers preventing them from disclosing and seeking help offline. METHOD: Posts about trauma written in 2016 from five Internet forums targeting young people were analyzed by thematic analysis. RESULTS: Barriers to offline help-seeking for trauma aligned with five key themes: questioning the validity of the trauma response; negative emotions and beliefs about the self; fear of a negative response; difficulties trusting others; and not thinking or talking about the trauma. CONCLUSIONS: Young people conceptualized many barriers as consequences of the trauma, such as avoidance of the trauma memory, and difficulties trusting others, indicating there are trauma-specific barriers to help-seeking. Understanding of, and attempts to minimize, these barriers may facilitate provision of services to vulnerable young people. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Young people's journeys of recovery from trauma: A qualitative study of narratives from Internet forums.

OBJECTIVES: The present study aimed to address to the dearth of research into the phenomenology of recovery among young people exposed to trauma. METHOD: Using an interpretative phenomenological approach, we analyzed Internet forum data to consider how young people experience recovery from trauma. RESULTS: Five domains of recovery were identified: meaningful shifts in the sense of self, gaining control and autonomy, establishing hope and commitment, making meaning out of tragedy, and engaging in normative activities and connecting with others. Participants described the experience of recovery as an ongoing, nonlinear and dialectical process that was not synonymous with cure and often took place in the context of supportive relationships. CONCLUSIONS: While the broad themes of recovery align with those derived from adult literature, the accounts diverge with respect to the content within the domains themselves. The findings suggest that services oriented to trauma-exposed young people need to bolster these internal processes of change, while also attending to their specific developmental needs and capacities. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

"I'm tired of being pulled from pillar to post": A qualitative analysis of barriers to mental health care for trauma-exposed young people.

AIM: Traumatic experiences in childhood are pervasive and associated with a range of deleterious mental health outcomes. Despite this, trauma-exposed young people often do not seek help from mental health services. While barriers to care for general mental health concerns are well established, less is known about those specifically facing young people who have experienced trauma. The present paper sought to examine the barriers in seeking mental health care faced by trauma-exposed young people through a qualitative analysis of online forums where individuals discuss and seek informal support for trauma. METHODS: This study used a qualitative, netnographic design, following the six-step LiLEDDa framework, developed for the analysis of online forums. Posts about trauma written in 2016 from five Internet forums targeting young people were included and analysed via thematic analysis. RESULTS: Barriers to mental health care for trauma-exposed young people were categorized into two interrelated themes: (a) structural and (b) relational barriers. Structural barriers related to practical challenges faced when accessing and engaging with mental health services. Relational barriers focused on interpersonal relationships with mental health service providers and how these influenced experiences of, and consequent engagement with, services. CONCLUSIONS: Trauma-exposed young people appear to experience multiple barriers to mental health care, whereby interactions between structural and relational barriers determine ongoing engagement. Service-wide reform including trauma-informed mental health training for practitioners is urgently needed to improve access to care and engagement for this vulnerable group.

Trajectories and Risk Factors for Pediatric Postconcussive Symptom Recovery.

BACKGROUND: Persistent postconcussive symptoms (PCS) are poorly understood in children. Research has been limited by an assumption that children with concussion are a homogenous group. OBJECTIVE: To identify (i) distinctive postconcussive recovery trajectories in children and (ii) injury-related and psychosocial factors associated with these trajectories. METHODS: This study is part of a larger prospective, longitudinal study. Parents of 169 children (5-18 yr) reported their child's PCS over 3 mo following concussion. PCS above baseline levels formed the primary outcome. Injury-related, demographic, and preinjury information, and child and parent mental health were assessed for association with trajectory groups. Data were analyzed using group-based trajectory modeling, multinomial logistic regression, and chi-squared tests. RESULTS: We identified 5 postconcussive recovery trajectories from acute to 3 mo postinjury. (1) Low Acute Recovered (26.6%): consistently low PCS; (2) Slow to Recover (13.6%): elevated symptoms gradually reducing; (3) High Acute Recovered (29.6%): initially elevated symptoms reducing quickly to baseline; (4) Moderate Persistent (18.3%): consistent, moderate levels of PCS; (5) Severe Persistent (11.8%): persisting high PCS. Higher levels of child internalizing behaviors and greater parental distress were associated with membership to the Severe Persistent group, relative to the Low Acute Recovered group. CONCLUSION: This study indicates variability in postconcussive recovery according to 5 differential trajectories, with groups distinguished by the number of reported symptoms, levels of child internalizing behavior problems, and parental psychological distress. Identification of differential recovery trajectories may allow for targeted early intervention for children at risk of poorer outcomes.

Trajectories and Predictors of Clinician-Determined Recovery after Child Concussion.

By age 16, 20% of children will suffer a concussion. Many experience persisting post-concussive symptoms (PCS), the cause(s) of which remain unclear. We mapped concussion recovery to 3 months post-injury and explored non-modifiable (e.g., age, sex, pre-injury factors, injury mechanism, acute PCS) and modifiable (post-acute child symptoms) predictors of persisting symptoms in order to identify opportunities for early intervention. We conducted a prospective, longitudinal study in the emergency department of a tertiary, pediatric hospital recruiting children within 48 h of concussion (T0), with follow-up at 2 days (T1), 2 weeks (T2), 1 month (T3), and 3 months (T4). Primary outcome was T2 clinician diagnosis. Clinical history, injury mechanism, acute symptoms, and physical and cognitive function were assessed. Parents rated child behavior and fatigue, and their mental health. We enrolled 256 participants, 72% males: 62 (24.3%) were symptomatic at T2. Recovered and symptomatic groups endorsed similar pre-injury PCS, but group differences were found at T1 across all PCS subscales, except Emotional, where symptoms were not evident until T2. By T2, there was significant PCS reduction, steepest in the "Recovered" group, which also had a lower rate of pre-injury psychiatric diagnoses, acute CT scans and less severe parent-rated PCS at T1 than the symptomatic group. They all demonstrated lower parent-rated PCS and less internalizing behaviors (all, p < 0.01). No differences were detected for child age, sex, injury factors, pre-injury parent-rated PCS, or acute physical and cognitive status. Our findings also highlight the importance of considering both pre- and post-injury mental health status in managing post-concussion.

Protocol for a prospective, longitudinal, cohort study of recovery pathways, acute biomarkers and cost for children with persistent postconcussion symptoms: the Take CARe Biomarkers study.

INTRODUCTION: The majority of children who sustain a concussion will recover quickly, but a significant minority will experience ongoing postconcussive symptoms, known as postconcussion syndrome (PCS). These symptoms include emotional, behavioural, cognitive and physical symptoms and can lead to considerable disability. The neurobiological underpinnings of PCS are poorly understood, limiting potential clinical interventions. As such, patients and families frequently re-present to clinical services, who are often ill equipped to address the multifactorial nature of PCS. This contributes to the high cost of concussion management and the disability of children experiencing PCS. The aims of the present study are: (1) to plot and contrast recovery pathways for children with concussion from time of injury to 3 months postinjury, (ii) evaluate the contribution of acute biomarkers (ie, blood, MRI) to delayed recovery postconcussion and (3) estimate financial costs of child concussion to patients attending the emergency department (ED) of a tertiary children's hospital and factors predicting high cost. METHODS AND ANALYSIS: Take C.A.Re is a prospective, longitudinal study at a tertiary children's hospital, recruiting and assessing 525 patients aged 5-<18 years (400 concussion, 125 orthopaedic injury) who present to the ED with a concussion and following them at 1-4 days, 2 weeks, 1 month and 3 months postinjury. Multiple domains are assessed: preinjury and postinjury, clinical, MRI, blood samples, neuropsychological, psychological and economic. PCS is defined as the presence of ≥2 symptoms on the Post Concussive Symptoms Inventory rated as worse compared with baseline 1 month postinjury. Main analyses comprise longitudinal Generalised Estimating Equation models and regression analyses of predictors of recovery and factors predicting high economic costs. ETHICS AND DISSEMINATION: Ethical approval has been obtained through the Royal Children's Hospital Melbourne Human Research Ethics Committee (33122). We aim to disseminate the findings through international conferences, international peer-reviewed journals and social media. TRIAL REGISTRATION NUMBER: ACTRN12615000316505; Results.