Posttraumatic stress disorder symptom trajectories within the first year following emergency department admissions: pooled results from the International Consortium to predict PTSD.

BACKGROUND: Research exploring the longitudinal course of posttraumatic stress disorder (PTSD) symptoms has documented four modal trajectories (low, remitting, high, and delayed), with proportions varying across studies. Heterogeneity could be due to differences in trauma types and patient demographic characteristics. METHODS: This analysis pooled data from six longitudinal studies of adult survivors of civilian-related injuries admitted to general hospital emergency departments (EDs) in six countries (pooled N = 3083). Each study included at least three assessments of the clinician-administered PTSD scale in the first post-trauma year. Latent class growth analysis determined the proportion of participants exhibiting various PTSD symptom trajectories within and across the datasets. Multinomial logistic regression analyses examined demographic characteristics, type of event leading to the injury, and trauma history as predictors of trajectories differentiated by their initial severity and course. RESULTS: Five trajectories were found across the datasets: Low (64.5%), Remitting (16.9%), Moderate (6.7%), High (6.5%), and Delayed (5.5%). Female gender, non-white race, prior interpersonal trauma, and assaultive injuries were associated with increased risk for initial PTSD reactions. Female gender and assaultive injuries were associated with risk for membership in the Delayed (v. Low) trajectory, and lower education, prior interpersonal trauma, and assaultive injuries with risk for membership in the High (v. Remitting) trajectory. CONCLUSIONS: The results suggest that over 30% of civilian-related injury survivors admitted to EDs experience moderate-to-high levels of PTSD symptoms within the first post-trauma year, with those reporting assaultive violence at increased risk of both immediate and longer-term symptoms.

Interdisciplinary Approaches to Examining Postdisaster School Recovery.

This perspectives article uses a postdisaster school recovery research domain to examine two tenets of interdisciplinary research (IDR): integrative problem formulation and synthesis. Advancing interdisciplinary knowledge requires a "roadmap" of commonalities between disciplinary domains and outcomes of interest. Four school recovery domains-child trauma, educational learning outcomes, school safety, and household and community recovery-are presented to highlight common frameworks for IDR. A case study is also used to illustrate the value of interdisciplinary research and mixed-methods approaches, including statistics, geospatial analysis, and spatial statistics, for answering questions regarding how school contexts and location influence school recovery patterns.

Sleep Problems and Posttraumatic Stress: Children Exposed to a Natural Disaster.

OBJECTIVE: Sleep plays a critical role in children's growth and development. This study examined the frequency and persistence of children's sleep problems following a natural disaster, risk factors for children's sleep problems, and the bidirectional relationship between children's sleep problems and posttraumatic stress symptoms (PTSS) over time. METHODS: This study assessed 269 children (53% female, M = 8.70 years, SD = 0.95) exposed to Hurricane Ike at 8 months (Time 1) and 15 months (Time 2) post-disaster. Children completed measures of hurricane exposure and related stressors, stressful life events, sleep problems, and PTSS. RESULTS: Children's sleep problems were significantly correlated from Time 1 to Time 2 (r = .28, p < .001). Risk factors for sleep problems at Time 2 were younger age, sleep problems at Time 1, and PTSS, not including sleep items, at Time 1. Examinations of the bidirectional relationship between sleep problems and PTSS indicated that PTSS significantly predicted later sleep problems, but sleep problems did not significantly predict later PTSS. CONCLUSIONS: Findings demonstrate that PTSS may contribute to the development and course of children's sleep problems post-disaster.

The Potential Unique Impacts of Hope and Resilience on Mental Health and Well-Being in the Wake of Hurricane Harvey.

Natural disasters can lead to mental health problems, such as posttraumatic stress disorder (PTSD). Higher levels of loss and/or disruption and prior trauma exposure constitute risk factors for mental illness, whereas protective factors, including hope and resilience, support positive functioning. The present cross-sectional study used structural equation modeling to examine the relative influence of resilience and hope on mental health and well-being 1-3 months after Hurricane Harvey made landfall in August 2017, among a sample of 829 adults in the Greater Houston, Texas area. Resilience was more strongly associated with reduced PTSD symptoms, ß = -.31, 95% CI [-.42, -.21], than was hope, ß = -.17, 95% CI [-;.30, -.04], whereas hope was more strongly associated with components of well-being, ßs = .47-.63. Hope was positively associated with posttraumatic growth, ß = .30, 95% CI [.19, .41], whereas resilience was negatively associated with posttraumatic growth, ß = -.24, 95% CI [-.35, -.12]. These associations remained consistent after considering risk factors, although more variance in trauma-related outcomes was risk factors were included in the model. The present results suggest that considering the influence of both risk and resilience factors provides an enhanced picture of postdisaster mental health.

Evaluating a screener to quantify PTSD risk using emergency care information: a proof of concept study.

BACKGROUND: Previous work has indicated that post-traumatic stress disorder (PTSD) symptoms, measured by the Clinician-Administered PTSD Scale (CAPS) within 60 days of trauma exposure, can reliably produce likelihood estimates of chronic PTSD among trauma survivors admitted to acute care centers. Administering the CAPS is burdensome, requires skilled professionals, and relies on symptoms that are not fully expressed upon acute care admission. Predicting chronic PTSD from peritraumatic responses, which are obtainable upon acute care admission, has yielded conflicting results, hence the rationale for a stepwise screening-and-prediction practice. This work explores the ability of peritraumatic responses to produce risk likelihood estimates of early CAPS-based PTSD symptoms indicative of chronic PTSD risk. It specifically evaluates the Peritraumatic Dissociative Experiences Questionnaire (PDEQ) as a risk-likelihood estimator. METHODS: We used individual participant data (IPD) from five acute care studies that used both the PDEQ and the CAPS (n = 647). Logistic regression calculated the probability of having CAPS scores ≥ 40 between 30 and 60 days after trauma exposure across the range of initial PDEQ scores, and evaluated the added contribution of age, sex, trauma type, and prior trauma exposure. Brier scores, area under the receiver-operating characteristic curve (AUC), and the mean slope of the calibration line evaluated the accuracy and precision of the predicted probabilities. RESULTS: Twenty percent of the sample had CAPS ≥ 40. PDEQ severity significantly predicted having CAPS ≥ 40 symptoms (p < 0.001). Incremental PDEQ scores produced a reliable estimator of CAPS ≥ 40 likelihood. An individual risk estimation tool incorporating PDEQ and other significant risk indicators is provided. CONCLUSION: Peritraumatic reactions, measured here by the PDEQ, can reliably quantify the likelihood of acute PTSD symptoms predictive of chronic PTSD and requiring clinical attention. Using them as a screener in a stepwise chronic PTSD prediction strategy may reduce the burden of later CAPS-based assessments. Other peritraumatic metrics may perform similarly and their use requires similar validation. TRIAL REGISTRATION: Jerusalem Trauma Outreach and Prevention Study (J-TOPS): NCT00146900.

Correction to: Evaluating a screener to quantify PTSD risk using emergency care information: a proof of concept study.

An amendment to this paper has been published and can be accessed via the original article.

Childhood Abuse and Adulthood IPV, Depression, and High-Risk Drinking in Latinas.

Little is known about relationships between child maltreatment and adulthood intimate partner violence (IPV), depression, and risky drinking in Latinas. 548 Latinas in a sexual health randomized control trial (RCT) self-reported childhood physical, sexual, and emotional abuse, IPV, depression, and risky drinking. Childhood abuse was related to adulthood IPV, OR = 1.27, depression, OR = 2.02, and high-risk drinking, OR = 2.16. Childhood emotional abuse was linked to depression, OR = 2.19; childhood physical abuse to risky drinking, OR = 2.62; and childhood sexual abuse to depression, OR = 2.78 and risky drinking, OR = 2.38. Results may inform prevention/intervention efforts for mental health nurses.

Effects of an evidence-based parenting program on biobehavioral stress among at-risk mothers for child maltreatment: A pilot study.

Parental stress is an important risk factor for child maltreatment (CM) perpetration. Evidence-based, parent-training programs can decrease CM perpetration risk and reduce self-reported parental stress; however, little is known about how such programs impact physiological stress correlates. In this quasi-experimental pilot study, maternal biobehavioral responses were measured in response to SafeCare®, an evidence-based program targeting CM, often implemented by social workers in child welfare settings. Maternal participants (N = 18) were recruited to complete SafeCare and repeated within-subject assessments pre- and post-intervention. Analyses examined associations between self-reported parental stress and mental health symptomology with stress markers for cortisol, alpha-amylase, and dihydroepiandrosterone at baseline and follow-up. Baseline correlation analyses showed strong associations between parental stress, salivary cortisol levels, and alpha-amylase. At follow-up, significant correlations were found between parental stress and alpha-amylase for intervention completers (n = 7). Completers on average exhibited decreases across self-reported parental stress and global distress symptomology and improvements in salivary cortisol and alpha-amylase levels. Participants with impaired cortisol levels at baseline were within normal limits post-intervention. These pilot findings suggest that salivary cortisol and alpha-amylase are compelling physiological correlates of parental stress among high-risk parents. Results also support short-term, positive effects of SafeCare in potentially regulating physiological stress systems among at-risk mothers.

The Impact of Natural Disasters on Youth: A Focus on Emerging Research beyond Internalizing Disorders.

PURPOSE OF REVIEW: This paper reviews youth outcomes following exposure to natural disaster, with a focus on three relatively understudied outcomes: externalizing behavior problems, physical health, and posttraumatic growth. Recent, high-impact studies focusing on each outcome are summarized. RECENT FINDINGS: Studies highlighted in this review utilize innovative and comprehensive approaches to improve our current understanding of youth broad-based physical and mental health outcomes beyond PTSD. The review concludes with recommendations to advance the field of youth disaster research by exploring how disasters may impact children across multiple domains, as well as using cutting edge ecobiological approaches and advanced modeling strategies to better understand how youth adjust and thrive following natural disaster.

Posttraumatic Stress Symptom Trajectories Among Children After Disaster Exposure: A Review.

Natural disasters, such as hurricanes and floods, are increasing in frequency and scope. Youth exposed to disasters are at risk for developing posttraumatic stress symptoms (PTSS). However, not all youth who report initially elevated PTSS report persistent PTSS that last beyond the first three to six months postdisaster. Thus, it is crucial to understand how and why youth differ in their patterns of PTSS. This study reviewed the literature on children's postdisaster PTSS, evaluating the typical number and types of patterns for children's PTSS trajectories, as well as risk and protective factors predicting trajectory membership. This review identified eight empirical studies on youth PTSS trajectories following natural disasters; these studies included 8,306 children aged 3 to 18 years. All studies identified resilience, recovery, and chronic trajectories. Evidence for a delayed trajectory was mixed. Proportions of children falling into each trajectory varied widely across studies, but overall, resilience was the most prevalent trajectory. These findings were consistent across study factors (i.e., analytic strategy, assessment timing, and study selection criteria). Female gender, disaster exposure, negative coping, and lack of social support were significant risk factors for chronic trajectories across several studies. Future research should combine individual level participant data across studies of children's responses to disasters to better understand PTSS trajectories.

Psychological Distress Mediates the Effect of Alexithymia on 2-Year Change in HIV Viral Load.

PURPOSE: Individuals with trait alexithymia (AL) display poor cognitive assimilation of thoughts, feelings, and emotions. This may result in the persistence of stress, anxiety, and depressive disorders. The cumulative effect of this psychological distress is also linked clinical markers of human immunodeficiency virus (HIV) disease progression. This study examines the indirect effect of AL on HIV viral load as a function of baseline levels and change in psychological distress. METHODS: N = 123 HIV positive adults aged 37.9 ± 9.2 years provided blood samples for HIV-1 viral RNA and CD4 T lymphocytes along with self-reported stress, anxiety, and depression every 6 months for 2 years. A second-order conditional latent growth model was used to represent baseline and 2-year change in cumulative levels of psychological distress and to test the indirect effect of baseline levels of trait AL on change in HIV-1 viral load through this latent measure. RESULTS: AL was associated with baseline and latent change in psychological distress. Furthermore, baseline psychological distress predicted 2-year change in HIV-1 viral RNA after controlling for viral load at baseline. Altogether, trait AL had a significant indirect effect on change in viral load (ß = 0.16, p = 0.03) as a function of baseline levels of distress. CONCLUSION: Identification and communication of thoughts, feelings, and emotions are important for long-term psychological adaptation in HIV. Greater psychological distress, in turn, allows for persistence of peripheral viral replication.

Approaches to the Assessment of Children in the Context of Disasters.

Children exposed to disasters are a vulnerable population, making the assessment of children post-disaster an important issue. Utilizing a Multiple Gating Stepped Care framework, we highlight recent literature related to post-disaster assessment and intervention for children. In particular, we focus on screening, clinical evaluation, and feedback-informed service delivery. Screening allows large populations of children to be assessed at a relatively low cost. Children identified by screening as being at risk may then be assessed through more in-depth clinical evaluations, in order to assess clinical symptoms, strengths, and stressors, and to make determinations about appropriate interventions. Continued assessment during therapy provides important feedback for the delivery of appropriate care. New formats for assessment, as well as issues related to identifying sources for assessment, are discussed. Recommendations for future directions are provided.

Schools and Disasters: Safety and Mental Health Assessment and Interventions for Children.

This article draws on experiences and lessons from global disasters and utilizes the United Nations Comprehensive School Safety Framework to highlight the necessary role of safe schools in protecting children, as well as adult staff, from the immediate threats and long-term implications of disasters. Specifically, we focus on three well-established pillars of school safety: Pillar I: Safe Learning Facilities; Pillar II: Disaster Management; and Pillar III: Risk Reduction and Resilience Education. In addition, we propose a potential fourth pillar, which underscores the function of schools in postdisaster mental health assessment and intervention for children. We argue that schools offer a central location and trusted institutional space for mental health assessment and intervention after disasters. We also examine the important linkages between schools, child mental health, and household and family recovery. We conclude with recommendations for filling gaps in research and practice related to ensuring the safety of schools and the associated health and well-being of children in the face of future disasters.

Trauma and Child Health: An Introduction to the Special Issue.

Potentially traumatic events are common occurrences that can lead to significant psychological distress, and yet, there has been remarkably little attention to the associations between traumatic events and youth's physical health. The articles contained in this Special Issue of the Journal of Pediatric Psychology represent a significant step forward in the establishment of "Trauma and Child Health" as a major area of study within the field of pediatric psychology. In this introductory article, we briefly describe several contextual issues that may help to set the stage for the articles contained in this Special Issue. These contextual issues include the most common types of traumatic events that are studied, as well as the features of traumatic events that may affect physical and mental health outcomes, such as whether casualties or interpersonal violence is involved.

Psychological distress in young adults exposed to war-related trauma in childhood.

We tested a conceptual model of the effect of war-trauma exposure in childhood on psychological distress in young adulthood. Participants included 151 urban Kuwaiti children (51% female; M age = 10.62 years) exposed to the 1990-1991 Gulf crisis (assessed in 1993); participants also included 140 parents (81% female; M age mothers = 36.50 years; M age fathers = 41 years). In 2003, 120 participants were reassessed as young adults (50% female; M age = 21.19 years). The conceptual model was evaluated with structural equations. War-trauma exposure was associated with psychological distress in children and parents, but parents reported larger effects than children. Parents' psychological distress did not contribute to children's psychological distress. Children's psychological distress did not dissipate over time. Social support may function as a potential mediator of the effect of war-trauma exposure on psychological distress. Findings support the importance of early detection and treatment of children exposed to war trauma. Findings also implicate social support as a factor to consider in clinical interventions for children exposed to war trauma.

Cyber victimization by peers: Prospective associations with adolescent social anxiety and depressive symptoms.

Peer victimization that occurs via electronic media, also termed cybervictimization, is a growing area of concern for adolescents. The current study evaluated the short-term prospective relationship between cybervictimization and adolescents' symptoms of social anxiety and depression over a six-week period. Participants were 839 high-school aged adolescents (14-18 years; 58% female; 73% Hispanic White), who completed measures of traditional peer victimization, cybervictimization, depression, and social anxiety at two time points. Findings supported the distinctiveness of cybervictimization as a unique form of peer victimization. Furthermore, only cybervictimization was associated with increased levels of depressive symptoms over time, and only relational victimization was associated with increased social anxiety over time, after controlling for the comorbidity of social anxiety and depression among youth. Cybervictimization appears to be a unique form of victimization that contributes to adolescents' depressive symptoms and may be important to target in clinical and preventive interventions for adolescent depression.

Hurricane Katrina: Maternal Depression Trajectories and Child Outcomes.

BACKGROUND: The authors examined depression trajectories over two years among mothers exposed to Hurricane Katrina. Risk and protective factors for depression trajectories, as well as associations with child outcomes were analyzed. METHOD: This study included 283 mothers (age at time 1, M = 39.20 years, SD = 7.21; 62% African American). Mothers were assessed at four time points over two years following Hurricane Katrina. Mothers reported posttraumatic stress symptoms, hurricane exposure, traumatic life events, and social support at time 1. Depressive symptoms were modeled at times 2, 3, and 4. Youth reported their distress symptoms (posttraumatic stress, depression, and anxiety) at time 4. RESULTS: Latent class growth analyses identified three maternal depression trajectories among mothers exposed to Hurricane Katrina: low (61%), resilient (29%), and chronic (10%). Social support was identified as a protective factor among mothers. CONCLUSIONS: Three main trajectories of maternal depression following Hurricane Katrina were identified. Social support was protective for mothers. Identified trajectories were not associated with children's distress outcomes. These results have implications for disaster responses, screening efforts, and interventions targeted towards families. Future studies warrant the investigation of additional risk and protective factors that can affect maternal and child outcomes.

Parent and child distress after war exposure.

OBJECTIVES: The purpose of this study was to examine multiple distress symptoms (i.e., post-traumatic stress [PTS], anxiety, depression) among parents and children exposed to the Gulf Crisis in 1990-1991. Profiles of parent distress were identified, and the relationship between parent distress and specific child distress symptoms was examined. DESIGN: Parents and children were assessed at one time point. METHODS: Participants included 151 children (Mage = 10.62 years; 51% female) and 140 parents (Mage = 40 years; 81% female). RESULTS: Utilizing latent profile analysis, three parallel profiles of parent distress were identified: low distress, moderate distress, and high distress. Parent distress was a risk factor for child depression, but it was not a risk factor for child PTS or anxiety. CONCLUSIONS: Findings support the importance of broadening the scope of research conducted after exposure to traumatic events to include the assessment of anxiety and depression, as well as PTS, among both parents and children. Additional implications for research and clinical work are discussed. PRACTITIONER POINTS: Findings support the importance of screening for multiple distress symptoms among both children and parents after war exposure. Based on our findings, clinicians may want to consider including parents in therapy for children reporting psychological distress, especially depression symptoms, after exposure to traumatic events. This study was cross-sectional. Thus, we are not able to infer direction or causality. The generalizability of our study should be interpreted with caution, as findings will need to be replicated across other populations and other cultures.

Risk Factors for Intimate Partner Violence in the Context of Disasters: A Systematic Review.

Women are at increased risk for experiencing intimate partner violence (IPV) in the context of disasters. However, the factors that increase this risk are not well understood. The purpose of the current study was to systematically review the literature on IPV in the context of disasters. The first aim was to identify risk factors predicting women's exposure to IPV. The second aim was to identify disaster-specific risk factors for IPV. The third aim was to construct a social ecological framework of risk factors for IPV in disasters at the individual, relationship/household, community, and structural levels. A systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines (PRISMA; Moher et al., 2009). Articles were identified using keywords in seven ProQuest databases. Of the 67 articles identified for full-text review, 24 were eligible for inclusion. Studies were evaluated based on critical appraisal of methodology using an adapted version of the Mixed Methods Appraisals Tool (MMAT; Hong et al., 2018). Findings suggest that disasters give rise to unique risk factors across social ecologies which interact with pre-existing characteristics of social vulnerability to increase women's risk of IPV. Findings inform violence prevention strategies within the context of disaster response and therefore have implications for research, policy, and practice.