Psychometrics of the PTSD and Depression Screener for Bereaved Youth.

Interventions for bereaved children and families range from supportive counseling, designed to promote social connectedness and expression of feelings and thoughts about the deceased, to intensive trauma/grief-specific therapy, designed to ameliorate symptoms of posttraumatic stress disorder (PTSD) and depression. That said, professionals have few brief assessment instruments to match response and functioning to appropriate interventions. To expedite the screening and referral process for bereaved families, Brown, Goodman, and Swiecicki ( 2008 ) developed the PTSD and Depression Screener for Bereaved Youth, a 19-item measure of bereavement-related history and symptoms of PTSD and depression. The current study is a psychometric evaluation of the Screener for Bereaved Youth. Data were collected from 284 bereaved children, 6-17 years of age (M = 12.4; SD = 2.9). A factor analysis revealed distinct subscales for PTSD (eight items) and depression (four items). The PTSD and depression subscales showed both concurrent and discriminant validity. Endorsement of four items on either subscale was associated with meeting full criteria on more extensive measures of PTSD and depression. These findings are discussed with specific consideration to the multiple systems in which the measure could be used and applications to clinical services.

Evaluating the invariance of the Multigroup Ethnic Identity Measure across foreign-born, second-generation and later-generation college students in the United States.

OBJECTIVES: Past research has established that the Multigroup Ethnic Identity Measure (MEIM) exhibits measurement invariance across diverse ethnic groups. However, relatively little research has evaluated whether this measure is invariant across generational status. Thus, the present study evaluates the invariance of the MEIM across foreign-born, second-generation, and later-generation respondents. METHOD: A large, ethnically diverse sample of college students completed the MEIM as part of an online survey (N = 9,107; 72.8% women; mean age = 20.31 years; SD = 3.38). RESULTS: There is evidence of configural and metric invariance, but there is little evidence of scalar invariance across generational status groups. CONCLUSIONS: This study suggests that the MEIM has an equivalent factor structure across generation groups, indicating it is appropriate to compare the magnitude of associations between the MEIM and other variables across foreign-born, second-generation, and later-generation individuals. However, the lack of scalar invariance suggests that mean-level differences across generational status should be interpreted with caution. (PsycINFO Database Record

Identity in young adulthood: Links with mental health and risky behavior.

The present study was conducted to contribute to our understanding of young adult identity development by deriving latent profiles from intrapersonal and interpersonal indices of identity synthesis and confusion. A sample of 9737 college-attending young adults completed measures of identity, mental health, and health risk behaviors. Four latent profiles emerged: Synthesized (high synthesis, low confusion), Diffused (moderate synthesis, high confusion), Elevated (high synthesis and confusion), and Moderate (moderate synthesis and confusion). The Synthesized profile was associated with the highest well-being and the lowest levels of internalizing, externalizing, and health risks. The Diffused and Elevated profiles were both associated with low well-being and with high internalizing, externalizing, and risky behaviors - with the Elevated profile highest on all of the negative outcomes. The Moderate profile scored intermediately on well-being, internalizing, externalizing, and health risks. These results are discussed in terms of the role of identity within a successful transition to adulthood.

Role of meaning in the prediction of depressive symptoms among trauma-exposed and nontrauma-exposed emerging adults.

OBJECTIVES: This study investigated the role of searching for meaning, finding meaning, trauma exposure, and their interaction in the prediction of depressive symptoms among trauma-exposed and nontrauma-exposed emerging adults. METHOD: Eight thousand seven hundred and eighty-four college students (73% female; mean age of 19.8 years) completed self-report measures. Hierarchical regression analysis was conducted to evaluate the three-way interaction in the prediction of depressive symptoms. RESULTS: Searching for and finding meaning as well as the three-way interaction significantly contributed to the prediction of depression. Specifically, searching for meaning was associated with increased symptoms, irrespective of meaning levels among nontrauma-exposed and low frequency trauma-exposed emerging adults. Among high frequency trauma-exposed individuals, an increase in the search-by-find meaning interaction predicted fewer symptoms. CONCLUSIONS: The findings suggest that searching for and finding meaning are important mechanisms in the prediction of depression among emerging adults facing daily stressors and traumatic events. Clinical implications are discussed.

Threat-specific maltreatment exposure: Comparison of measurement models and associations with internalizing, externalizing, and PTSD symptoms.

BACKGROUND: Child maltreatment is associated with short- and long-term mental health sequelae. Extant research has demonstrated that exposure characteristics (i.e., severity, frequency, duration, onset) are important in the measurement of maltreatment experiences. Emerging research has highlighted the contributions of these characteristics on symptom outcomes. OBJECTIVE: The current study used multiple exposure characteristics of threat-specific types of maltreatment (i.e., physical abuse, sexual abuse, witnessing domestic violence) to examine three distinct measurement models of maltreatment and their relation to symptoms. PARTICIPANTS AND SETTING: A racially and ethnically diverse sample of treatment-seeking youth (74 % female) ages 4-17 (N = 348) participated in the study. The majority of the youth (61 %) endorsed experiencing more than one type of threat-specific maltreatment. METHOD: Using Structural Equation Modeling, we tested one-factor, three-factor, and bifactor models of maltreatment characteristics, and hypothesized that the bifactor model would yield the best fitting model based on prior studies supporting family violence as an underlying factor for child physical abuse and domestic violence. RESULTS: The bifactor measurement model fit the data better than the three- and one-factor models. In the bifactor structural model that included symptom outcomes, physical abuse was significantly and positively associated with child internalizing and externalizing symptoms, whereas sexual abuse and witnessing domestic violence were associated with externalizing symptoms and PTSD. CONCLUSION: Our findings support the inclusion of multiple exposure characteristics in the measurement of maltreatment and suggest that specific types of threat-specific maltreatment may have distinct associations with mental health sequelae.

Why Do Women Talk About It? Reasons for Disclosure of Sexual Victimization and Associated Symptomology.

Many sexual victimization survivors disclose their experience; however, there is limited research investigating why women disclose this experience and how reasons relate to psychopathology. The current online study aims to further understand the experiences of 142 female survivors (aged 18-29 years) by identifying their reason for disclosure and investigating how reasons relate to self-reported depression and post-traumatic stress disorder (PTSD) symptomology. Qualitative analyses identified two reasons: intentional and elicited disclosures. Hierarchical linear regressions revealed that elicited disclosures were associated with higher PTSD symptomology than intentional disclosures above and beyond relevant covariates, suggesting that disclosure reason is an important factor in the recovery process.

Complex trauma and Trauma-Focused Cognitive-Behavioral Therapy: How do trauma chronicity and PTSD presentation affect treatment outcome?

BACKGROUND: Traumatic experiences are common in youth and can be classified as acute (one incident or short-term) or complex (chronic exposure to multiple traumas) experiences. Posttraumatic stress disorder (PTSD) is a common response to trauma, often co-occurring with other mental health symptoms. According to the International Classification of Diseases, 11th Edition (World Health Organization, 2018), complex PTSD includes difficulties with affect regulation, interpersonal relationships, and self-blame. OBJECTIVE: The aims of this study were to evaluate trauma chronicity and PTSD presentation as moderators of outcomes of trauma-focused cognitive behavior therapy (TF-CBT). PARTICIPANTS AND SETTING: Participants included 176 youth and caregiver dyads who were participants in an ongoing effectiveness study of TF-CBT at a community-based clinic in NYC. METHODS: Multilevel modeling was used to examine longitudinal, within-subject variability. Moderation analyses were used to assess the role of trauma chronicity and levels of PTSD on change in the outcomes. RESULTS: There were no baseline differences between youth with acute versus chronic trauma. At baseline, participants who had PTSD plus 2 or 3 of the ICD-11 Complex PTSD symptom domains had significantly worse functioning than those with simple PTSD. We found significant improvement on most measures of PTSD and complex PTSD domains. Level of improvement was found to vary based on PTSD presentation at baseline. CONCLUSIONS: This is the first study to evaluate both trauma chronicity and PTSD presentation in the context of evidence-based treatment, and findings support the effectiveness of TF-CBT for simple and complex PTSD for youth who have experienced acute and chronic trauma.

Sexual Victimization Disclosure: A Cluster Analysis Approach to Understanding Victimization Experiences in Disclosers and Non-Disclosers.

Research has used cluster analysis to identify clusters, or groups, of sexual victimization survivors who share similar assault experiences. However, researchers have not investigated whether disclosure status is a key component of the survivors' experience. The current study identified two clusters among 174 disclosing and non-disclosing sexual victimization survivors. Cluster One (n = 74) included an incapacitated assault by a lesser-known perpetrator and disclosure of the event. Cluster Two (n = 100) included a verbally instigated assault by a well-known perpetrator and nondisclosure of the event. Follow up independent t-tests revealed that women in Cluster One had significantly higher depression and posttraumatic stress disorder (PTSD) symptoms than women in Cluster Two. Results support prior research identifying clusters of victimization based on assault characteristics and suggest that disclosure status is a key variable in the recovery process. Specific implications for clinicians, policy makers, and the community are discussed.

Factor structure of the Youth Coping In Traumatic Times (YCITT) scale.

The objective of the present study is to determine if a brief measure of coping strategies administered to children and adolescents after a mass traumatic event - Youth Coping In Traumatic Times (YCITT) - has a factor structure similar to that of a lengthier, widely used scale, the How I Coped Under Pressure Scale (HICUPS). The YCITT was developed for the New York City - Board of Education WTC Study, conducted 6 months after 9/11. Confirmatory Factor Analyses (CFA) and Exploratory Factor Analysis (EFA) were performed in two randomly selected sub-samples of youth in grades 6-12 (sub-sample 1, n=2249; sub-sample 2, n=2315). In sub-sample 1, CFA indicated acceptable fit of a four-factor solution based on the HICUPS (distraction, active coping, support seeking and avoidance) and EFA yielded a nearly identical solution. In sub-sample 2, CFA indicated that the fit of the HICUPS-based factor solution and the solution derived from the EFA in sub-sample 1 were very similar, with both indicating acceptable model fit. In conclusion, the brief YCITT has a factor structure, which is similar to that of the HICUPS. When used in large-scale assessments of future mass traumatic events, the measure can provide relevant information about youth coping strategies across four key coping domains.

Trauma-Focused Cognitive-Behavioral Therapy: The role of caregivers.

BACKGROUND: Childhood trauma exposure is unfortunately common and is associated with the development of posttraumatic stress disorder (PTSD) as well as a number of other serious medical and mental and health disorders. After experiencing trauma, children depend on their non-offending parents to believe and support them, reframe the meaning of the trauma, and to keep them safe from future harm. Parents are often negatively impacted by their child's trauma which may contribute to the child's risk for developing PTSD and related problems. Including parents in treatment may enhance child outcomes. METHODS: Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT) is an evidence-based child and adolescent trauma treatment model that integrally includes non-offending parents or caregivers throughout treatment (hereafter referred to as "caregivers"). This article describes TF-CBT's underlying concepts, principles and core components, as well as the role of caregiver inclusion in this model, and evaluates the extant evidence for caregiver factors in predicting TF-CBT outcomes. RESULTS: Several studies suggest that inclusion of non-offending caregivers is associated with TF-CBT outcomes, and that this may occur through enhancing caregiver support of the child and/or reducing caregivers' trauma-related maladaptive cognitions. LIMITATIONS: Few studies have evaluated whether caregiver factors served as formal treatment mediators. CONCLUSIONS: Including non-offending caregivers in TF-CBT can improve youth outcomes.

Why Women Are Not Talking About It: Reasons for Nondisclosure of Sexual Victimization and Associated Symptoms of Posttraumatic Stress Disorder and Depression.

Disclosure of traumatic experiences is typically encouraged and associated with positive outcomes. However, there is limited research on nondisclosure of sexual trauma and consequent symptomology. This online study of undergraduate females examines reasons for nondisclosure and associated symptoms of posttraumatic stress disorder (PTSD) and depression. Of 221 participants who reported sexual victimization, 25% had not previously disclosed it. Four reasons for nondisclosure were identified: shame, minimization of experience, fear of consequences, and privacy. Nondisclosers who minimized the experience and nondisclosers low on shame reported fewer PTSD symptoms than disclosers. These findings suggest that reasons for nondisclosure are associated with symptomology.

An Exploratory Trial of Cognitive-Behavioral vs Client-Centered Therapies for Child-Mother Dyads Bereaved from Terrorism.

The study was an evaluation of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT; Cohen et al. 2017) with child-caregiver dyads who experienced the death of a loved one from terrorism, using a hybrid efficacy/effectiveness design in which there were no required minimum symptom levels. Forty children ages 4-17 years old whose fathers died in the line of duty on 9/11/2001 and their mothers participated in an RCT comparing TF-CBT and Client-Centered Therapy (CCT). At baseline, mothers' PTSD, depression, and prolonged grief symptoms were highly elevated, whereas children's were at normative levels. Using intent-to-treat analysis, condition-by-time interactions showed significantly greater symptom reduction for mothers receiving CBT than those receiving CCT. For the children, both treatments led to significant symptom improvements.

Negative Responses to Disclosure of Sexual Victimization and Victims' Symptoms of PTSD and Depression: The Protective Role of Ethnic Identity.

College-aged women experience high rates of sexual victimization. Their postassault symptoms are associated with the types of responses they receive from the people to whom they disclose these experiences. Negative responses are pervasive and associated with poorer outcomes. The current study examined whether a strong sense of ethnic identity and comfort with the mainstream culture moderate the association between negative responses to the first disclosure of sexual victimization and symptoms of posttraumatic stress disorder (PTSD) and depression. A diverse sample (10% Black/African American, 51% White, 39% Other, and 66% Hispanic) of undergraduate women was recruited from two urban, Eastern United States universities for this online study. Participants reported histories of sexual victimization, demographics, responses to sexual assault disclosure (i.e., victim blame, treating the victim differently, taking control, distraction, and egocentric reactions), symptoms of PTSD and depression, and their ethnic identity and mainstream cultural comfort. Thirty-seven percent (n = 221) endorsed an experience of sexual victimization, and 165 disclosed it to someone. Hierarchical ordinary least squares regressions revealed that a stronger sense of ethnic identity was associated with fewer symptoms of PTSD for those women who experienced higher levels of control, distraction, and egocentric responses from the first disclosure recipient. A strong sense of affiliation with the mainstream culture did not protect survivors who reported receiving negative responses to disclosure against symptoms of PTSD or depression. Ethnic affiliation may protect women against PTSD when they receive high levels of negative messages about sexual victimization experiences.

Caregiver Report of Child Symptoms Predicts Attrition in Abuse-Specific Cognitive Behavioral Therapies.

A common critique of empirically supported treatments for abuse-related psychopathology is attrition during critical phases of therapy (i.e., exposure). The goal of this study was to examine whether child and caregiver symptoms were predictive of attrition among families in abuse-specific cognitive-behavioral therapies (CBTs). Children ( N = 104) and their caregivers completed baseline assessments of internalizing symptoms, externalizing problems, and post-traumatic stress disorder (PTSD) and were enrolled in abuse-specific CBTs. Logistic regressions were conducted with baseline symptoms as predictor variables and treatment status (attrition vs. completion) as the criterion variable. Caregiver report of child internalizing symptoms showed the predicted quadratic relation to attrition. Caregiver report of child externalizing symptoms at moderate and high (vs. low) levels was associated with attrition. Child self-report and caregiver self-report of symptoms were not associated with the dyad's attrition. These results underscore the importance of attending to caregivers' initial perceptions of children's symptoms in abuse-specific therapy.

Children's resilience and trauma-specific cognitive behavioral therapy: Comparing resilience as an outcome, a trait, and a process.

Resilience, which is associated with relatively positive outcomes following negative life experiences, is an important research target in the field of child maltreatment (Luthar et al., 2000). The extant literature contains multiple conceptualizations of resilience, which hinders development in research and clinical utility. Three models emerge from the literature: resilience as an immediate outcome (i.e., behavioral or symptom response), resilience as a trait, and resilience as a dynamic process. The current study compared these models in youth undergoing trauma-specific cognitive behavioral therapy. Results provide the most support for resilience as a process, in which increase in resilience preceded associated decrease in posttraumatic stress and depressive symptoms. There was partial support for resilience conceptualized as an outcome, and minimal support for resilience as a trait. Results of the models are compared and discussed in the context of existing literature and in light of potential clinical implications for maltreated youth seeking treatment.

Clinical characteristics and efficacious treatment of posttraumatic stress disorder in children and adolescents.

Children in the United States are exposed to a variety of traumatic events. Psychosocial sequelae to these events vary in their nature and severity. PTSD is a common, debilitating response to traumatic events that may alter the normal developmental course for children. Risk and protective factors in the development of PTSD include child, caregiver, and family characteristics. To date, empirical evidence reveals the efficacy of psychosocial treatments, especially cognitive-behavior therapy. Caregiver involvement in treatment is indicated. Aside from participation in psychosocial interventions, caregivers should be encouraged to convey belief of and empathy for their children, provide a forum for children to discuss the trauma if they choose, and promote coping skills that have been helpful following other stressful events. Emerging studies suggest the potential adjunctive effects of pharmacologic treatments. Additional investigations of the efficacy of school-based group CBT, combined CBT and pharmacotherapy, and CBT for more severely impaired children are warranted. Children and families also might benefit from research on community-based interventions (eg, following disasters, terrorism, war, and community violence) and preventive interventions (designed to prevent the development of PTSD following traumatic events).

Family Violence Exposure and Sexual Risk-Taking Among Latino Emerging Adults: The Role of Posttraumatic Stress Symptomology and Acculturative Stress.

This study proposes that posttraumatic stress symptomology and acculturative stress may further explain the relationship between family violence exposure and sexual risk-taking behaviors among Latino emerging adults (N=1,100). A moderated mediation analysis indicated that lifetime rates of family violence exposure were positively associated with sexual risk-taking via posttraumatic stress symptomology, and this mediation significantly varied as a function of acculturative stress. Overall, the findings of the current study underscore a need for a better understanding of how family violence exposure puts Latino emerging adults at risk for aversive health outcomes and suggest the use of an ecological systemic framework that examines the interactions between family, individual, and cultural systems in relation to health risk-taking behaviors.

Identity Centrality and Psychosocial Functioning: A Person-Centered Approach.

There has been increased recognition that identity operates within several "components" and that not every component is likely to be equally central to one's sense of self. The aim of the current study was to determine the extent to which identity components (i.e., personal, relational, collective, and public) are differentially central to emerging adults' identity. We used a two-step cluster analytic procedure to identify distinct clusters and determine how these configurations might differ in relation to psychosocial functioning (i.e., well-being, externalizing and internalizing symptoms, illicit drug use, risky sex, and impaired driving). The sample consisted of 8,309 college students (72.8% female; M age = 19.94 years, 18-29, SD = 2.01) from 30 U.S. colleges and universities. Analyses identified six unique clusters based on the centrality of the four identity components. The findings indicated that a more well-rounded identity was associated with the most favorable psychosocial functioning. Results are discussed in terms of important directions for identity research and practical implications.

Factor structure and factorial invariance of the Multidimensional Acculturative Stress Inventory.

Using a national data set, this study examined the factor structure and factorial invariance of the Multidimensional Acculturative Stress Inventory (MASI) across Latino and Asian Americans, gender, and nativity (U.S.- vs. foreign-born). Results showed that a 4-factor model of acculturative stress provided good fit to the data. Tests of factorial invariance provided evidence of measurement equivalence across all of the groupings tested. These findings suggest that the MASI operationalizes acculturative stress in an equivalent manner across Latino and Asian American students, gender, and nativity.