Traumatic experiences and posttraumatic stress reactions in children and their parents from Kurdistan and Sweden

This study was conducted to assess trauma scores and posttraumatic stress symptoms among Kurdistanian refugee children and their parents in Sweden and a comparable group of Swedish children and their parents. Comparative Kurdistanian and Swedish samples composed of 32 children each and their parents were interviewed by means of a specially devised trauma instrument (HUTQ-C), to identify traumatic events and to measure trauma scores, and with (PTSS-C) and (HTQ) to diagnose posttraumatic stress syndrome (PTSD) among children and adults, respectively. Although Kurdistanian parents reported considerably more traumatic events than Swedish parents, children in both samples showed more similarities than differences, both with regard to types and levels of traumatic events. Kurdistanian parents showed higher PTSD frequencies than Swedish parents. However, these differences proved to be significant with regard to both the mother's and the father's lifetime and current PTSD symptom scores. Kurdistanian parents have experienced more war traumas and differ with regard to trauma exposure and its consequences when compared with Swedish parents. Children from the two samples showed more similarities than differences with regard to reported trauma and PTSD-related symptoms. These results underline the significance of child-specific factors in trauma and PTSD.     

Traumatic experiences and posttraumatic stress reactions in children and their parents from Kurdistan and Sweden

This study was conducted to assess trauma scores and posttraumatic stress symptoms among Kurdistanian refugee children and their parents in Sweden and a comparable group of Swedish children and their parents. Comparative Kurdistanian and Swedish samples composed of 32 children each and their parents were interviewed by means of a specially devised trauma instrument (HUTQ-C), to identify traumatic events and to measure trauma scores, and with (PTSS-C) and (HTQ) to diagnose posttraumatic stress syndrome (PTSD) among children and adults, respectively. Although Kurdistanian parents reported considerably more traumatic events than Swedish parents, children in both samples showed more similarities than differences, both with regard to types and levels of traumatic events. Kurdistanian parents showed higher PTSD frequencies than Swedish parents. However, these differences proved to be significant with regard to both the mother's and the father's lifetime and current PTSD symptom scores. Kurdistanian parents have experienced more war traumas and differ with regard to trauma exposure and its consequences when compared with Swedish parents. Children from the two samples showed more similarities than differences with regard to reported trauma and PTSD-related symptoms. These results underline the significance of child-specific factors in trauma and PTSD.     

Traumatic experiences and post-traumatic stress disorder in Kurdistanian children and their parents in homeland and exile: an epidemiological approach

The prevalence and correlates of post-traumatic stress disorder (PTSD) were assessed in random samples of school-aged Kurdistanian children and their parents in homeland and exile. Of the 376 eligible children at the two sites, 312 children and their parents (293 mothers and 248 fathers) completed the Harvard-Uppsala Trauma Questionnaire and Posttraumatic Stress Symptom interviews for children, and Harvard Trauma Questionnaire for parents. Unlike their children, fathers showed significantly higher PTSD frequencies in exile than in the homeland. The fathers' PTSD negatively correlated with the living standard and fathers' education, while child PTSD mostly correlated with maternal education and living in exile. Living in exile seems to have a negative impact on fathers' post-traumatic reactions, despite its positive influence on children. High drop-outs in exile limit the conclusions.     

Validation of the PTSD screening cartoon test “Darryl” in a Danish clinical sample of children and adolescents

The current study examined the reliability and validity of a Danish adaptation of “Darryl”, a cartoon‐based measure of DSM‐IV symptoms of post‐traumatic stress disorder (PTSD) in a sample of Danish children and adolescents. Exposure to potentially traumatizing events, PTSD symptoms and diagnostic status were assessed in 65 children between the ages of 7 and 17 years old. Participants were recruited from a crisis centre for battered women and a school for children with emotional and behavioural problems. The study revealed that Darryl has good internal consistency for the overall scale and adequate reliability for each DSM‐IV symptom cluster. Scores from Darryl were significantly correlated with the Clinician Administered PTSD Scale for Children and Adolescents (CAPS‐CA) scores and receiver operating characteristic (ROC) analysis showed that it could significantly predict the presence of a PTSD diagnosis according to the CAPS‐CA. In comparison to the CAPS‐CA, Darryl has comparable psychometric properties and assesses PTSD symptoms in a developmentally appropriate manner. Furthermore, Darryl is quick to administer and was easier for the children in this sample to comprehend than the more traditional measure of PTSD. Overall, Darryl is an effective instrument for screening children at risk of a PTSD diagnosis. The relatively high specificity suggests that screening positive for PTSD using Darryl merits further diagnostic assessment. Copyright © 2016 John Wiley & Sons, Ltd.     

Validity of PTSD in a sample of refugee children: can a separate diagnostic entity be justified?

The objective of this study was to examine the construct validity of PTSD in a sample of refugee children from the Middle East – more specifically, to assess whether associations between traumatic events and specific PTSD symptoms were more outspoken than (1) the associations of PTSD symptoms with non‐traumatic exposures, and (2) the associations of violent exposures with symptoms other than PTSD‐symptoms. Parents of 311 refugee children from the Middle East were interviewed concerning their children's traumatic experiences and mental health symptoms. The specific PTSD symptoms did not cluster in a factor analysis. The PTSD symptom complex was significantly predicted not only by violent exposures (mother tortured, OR 8.2, p < 0.005; father disappeared OR 3.2, p < 0.05) but also by indicators of family interaction and parents' occupational situation. The two identified violent exposures had significant independent associations with a series of symptoms including symptoms other than those of PTSD (r_s ranging from 0.25 to 0.44, p < 0.001). Thus it does not seem sufficient to focus solely on PTSD symptomatology when assessing the mental health needs of refugee children. Copyright © 2006 John Wiley & Sons, Ltd.     

Ten-year follow-up study of PTSD diagnosis, symptom severity and psychosocial indices in aging holocaust survivors

Objective: We performed a longitudinal study of holocaust survivors with and without post‐traumatic stress disorder (PTSD) by assessing symptoms and other measures at two intervals, approximately 10 years apart. Method: The original cohort consisted of 63 community‐dwelling subjects, of whom 40 were available for follow‐up. Results: There was a general diminution in PTSD symptom severity over time. However, in 10% of the subjects (n = 4), new instances of delayed onset PTSD developed between time 1 and time 2. Self‐report ratings at both assessments revealed a worsening of trauma‐related symptoms over time in persons without PTSD at time 1, but an improvement in those with PTSD at time 1. Conclusion: The findings suggest that a nuanced characterization of PTSD trajectory over time is more reflective of PTSD symptomatology than simple diagnostic status at one time. The possibility of delayed onset trajectory complicates any simplistic overall trajectory summarizing the longitudinal course of PTSD.     

New findings on alternative criteria for PTSD in preschool children

OBJECTIVE: An alternative set of criteria for posttraumatic stress disorder (PTSD) for preschool children was analyzed for validity. METHOD: Sixty-two traumatized children and 63 healthy controls, aged 20 months through 6 years, were assessed. The traumatic experiences included motor vehicle collisions, accidental injuries, abuse, and witnessing violence. The number of symptoms required for clusters C and D and the utility of proposed symptoms were systematically analyzed. RESULTS: No cases met the DSM-IV algorithm for PTSD. Cluster B was endorsed 67.9% of the time. The proportion of cases meeting the cluster C threshold was 2% when three symptoms were required, 11% when two symptoms were required, and 39% when one symptom was required. The rate of cluster D was 45% when two symptoms were required and 73% when one symptom was required. Four novel symptoms did not substantially add to the diagnostic validity of the criteria. The optimal algorithm (one cluster B symptom, one cluster C symptom, and two cluster D symptoms) diagnosed PTSD at a rate of 26%. Measures of comorbid symptoms concurrently provided convergent validation to support this revised algorithm. CONCLUSION: Revisions to the DSM-IV PTSD criteria continue to be supported so that highly symptomatic young children can be diagnosed.     

Predicting child PTSD: the relationship between acute stress disorder and PTSD in injured children

OBJECTIVE: To examine the prevalence of acute stress disorder (ASD) and posttraumatic stress disorder (PTSD) in injured children and to evaluate the utility of ASD as a predictor of PTSD. METHOD: Children hospitalized for injuries sustained in a traffic crash were enrolled in a prospective study. ASD was assessed in 243 children within 1 month after injury, and PTSD was assessed in 177 of these children 3 or more months after injury. The relationship between ASD and PTSD was examined via correlations between symptom severity scores and calculation of sensitivity, specificity, and positive and negative predictive values for categorical prediction of PTSD from ASD or subsets of ASD symptoms. RESULTS: Eight percent of children met the symptom criteria for ASD and another 14% had subsyndromal ASD; 6% met the symptom criteria for PTSD and another 11% had subsyndromal PTSD. ASD and PTSD symptom severity were associated. Sensitivity was low for prediction of child PTSD from child ASD. Subsyndromal ASD was a more effective predictor of PTSD. CONCLUSIONS: A substantial minority of injured children are affected by traumatic stress disorders. ASD in children may not be an optimal categorical predictor of PTSD. With increasing attention to early posttrauma services for children, empirically valid assessment/triage models deserve further study.     

Psychological effects of the November 1999 earthquake in Turkey: an epidemiological study

OBJECTIVE: This study assessed the traumatic stress symptoms and related factors in two towns affected by two earthquakes, which killed 20000 people in 1999 in Turkey. METHOD: A total of 430 people in selected households were seen 18 months after the earthquake. They were given a self-report questionnaire assessing post-traumatic stress (PTSD) and depressive symptoms, demographics and trauma exposure. RESULTS: The rates of PTSD and depression were higher in the site closer to the epicenter. The traumatic stress symptom checklist scores were predicted by fear during earthquake, loss of friends and neighbours, female gender, lower education and living in rented accomodation. Depression was predicted by study site, death of relatives and past psychiatric illness. CONCLUSION: These results show that severe earthquakes can cause long-lasting morbidity. Our previous findings that showed a differential prediction for depressive and traumatic stress symptoms after earthquakes are also supported.     

Impact of traumatic and violent victimization experiences in individuals with schizophrenia and schizoaffective disorder

Individuals with schizophrenia or schizoaffective disorder (SZ) experience more violent victimization and noninterpersonal traumatic experiences than the general population. Earlier studies, however, have generally excluded one or grouped together victimization and trauma experiences into single outcome variables, which may obscure their contributory role to SZ symptoms. This issue is important because there is some evidence that intentionally induced violence produces higher rates of psychopathology than nonintentional traumatic experiences. We examined the independent contribution of both types of victimization experiences on SZ patients' symptomatology. We were also interested in determining whether SZ patients' pattern of acute symptom presentation could discriminate between SZ patients with and without posttraumatic stress disorder (PTSD) comorbidity. SZ inpatients (n = 70) were assessed for the presence of comorbid PTSD diagnosis, violent victimization, and noninterpersonal traumatic experiences. Patients were also rated on SZ symptom severity and general psychopathology measures. Past violent victimization experiences predicted severity of dysphoria and anxiety in SZ. Past traumatic experiences, however, predicted severity of psychosis. Victimization predicted severity of patients' autistic/cognitive symptoms. SZ patients with comorbid PTSD presented with significantly more anxiety and dysphoria symptoms and SZ illness chronicity than their non-PTSD counterparts. Discriminant function analysis revealed that the severity of positive, dysphoric, autistic/cognitive, and anxiety symptoms differentiated comorbid PTSD patients from their non-PTSD counterparts, with an overall 72.9% classification rate. Past traumatic and victimization experiences are significantly associated with SZ patients' symptom severity and illness course in partially overlapping domains. Use of common assessment strategies may be employed to increase detection of PTSD in SZ patients presenting for acute treatment.     

Reliability and validity of a child-specific cross-cultural instrument for assessing posttraumatic stress disorder

 The Posttraumatic Stress Symptoms in Children (PTSS-C) was developed as a cross-cultural semi-structured interview to diagnose posttraumatic stress disorder (PTSD) and to identify PTSD-non-related posttraumatic stress symptoms in children after various traumatic experiences. The psychometric properties were studied in two different child populations in Iraqi Kurdistan (the survivors of the military operation “Anfal”, and the orphans), in a sample of Kurdistanian refugee children in Sweden, and in a comparison sample of Swedish children. The instrument yielded satisfactory internal consistency, high interrater agreement, and excellent validity on cross-validation with the Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI) and the Diagnostic Interview for Children and Adolescents (DICA) according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Accepted: 14 March 2000     

Posttraumatic stress in children exposed to family violence and single-event trauma

OBJECTIVE: To examine posttraumatic stress disorder (PTSD) and other comorbid forms of psychopathology in a sample of children exposed to chronic abuse and single-event trauma. METHOD: School-age children (N = 337) were assessed for exposure to traumatic events (family violence, violent crime, death or illness of someone close to child, accidents) and posttraumatic stress symptoms. Children and mothers received structured diagnostic interviews to assess child psychopathology. RESULTS: Children from violent households were no more likely to report an extrafamilial traumatic stressor than children from nonviolent homes. Among the children reporting a traumatic event, 24.6% met the diagnostic criteria for PTSD. The leading precipitating event for PTSD symptoms was death or illness of someone close to the child (log odds = 4.3). Family violence, violent crime, but not accidents also resulted in PTSD. Children with PTSD displayed comorbidity across different symptom classes, most notably phobias and separation anxiety. CONCLUSIONS: Both type I and type II trauma can result in PTSD in about one quarter of children. Children with posttraumatic stress symptoms had many other forms of comorbid psychopathology, indicating a global and diffuse impact of trauma on children.     

Mediating role of peritraumatic dissociation and depression on post-MVA distress: path analysis

Background: The aim of this study was to examine the role of pre‐trauma, traumatic event, and peri‐traumatic psychological characteristics on post‐motor vehicle accident (MVA) Posttraumatic Stress Disorder (PTSD) and depression. Methods: The sample comprised 333 (54% female) hospital accident and emergency attendees who completed a self‐report postal screening survey approximately 1‐month post‐accident and 128 (62% female) participants who completed a follow‐up survey at 3‐months. Results: Path analysis (Model 1) showed that dissociation partially mediated the relationship between past emotional problems and initial post‐MVA distress, as well as between fear of dying and levels of distress. Level of alertness and perceived accident severity had no direct effects on post‐MVA distress. However, higher levels of exposure contributed to distress predominantly in the presence of high levels of fear and subsequent dissociative experiences. When ongoing PTSD and depression symptoms were included (Model 2), feeling depressed/sad at 1‐month was the strongest predictor of both PTSD and depression symptom severity at 3‐months post‐MVA, explaining 53% and 40% of the variance, respectively. Dissociation remained an important mediating variable at both time points. Conclusions: These models show the influence of previous emotional vulnerability factors and the important mediating role of peri‐traumatic experiences (in the presence of fear due to increased levels of accident severity) on post‐MVA morbidity. Additionally, MVA survivors who report feeling depressed/sad 1‐month after their accident are at greater risk of developing both PTSD and depression. Depression and Anxiety 28:218–226, 2011. © 2011 Wiley‐Liss, Inc.     

Does pediatric post‐traumatic stress disorder alter the brain? Systematic review and meta‐analysis of structural and functional magnetic resonance imaging studies

Several studies have recently demonstrated that the volumes of specific brain regions are reduced in children and adolescents with post‐traumatic stress disorder (PTSD) compared with those of healthy controls. Our study investigated the potential association between early traumatic experiences and altered brain regions and functions. We conducted a systematic review of the scientific literature regarding functional magnetic resonance imaging and a meta‐analysis of structural magnetic resonance imaging studies that investigated cerebral region volumes in pediatric patients with PTSD. We searched for articles from 2000 to 2014 in the PsycINFO, PubMed, Medline, Lilacs, and ISI (Web of Knowledge) databases. All data regarding the amygdala, hippocampus, corpus callosum, brain, and intracranial volumes that fit the inclusion criteria were extracted and combined in a meta‐analysis that assessed differences between groups. The meta‐analysis found reduced total corpus callosum areas and reduced total cerebral and intracranial volumes in the patients with PTSD. The total hippocampus (left and right hippocampus) and gray matter volumes of the amygdala and frontal lobe were also reduced, but these differences were not significant. The functional studies revealed differences in brain region activation in response to stimuli in the post‐traumatic stress symptoms/PTSD group. Our results confirmed that the pediatric patients with PTSD exhibited structural and functional brain abnormalities and that some of the abnormalities occurred in different brain regions than those observed in adults.     

The SCOFF-c: psychometric properties of the Catalan version in a Spanish adolescent sample

OBJECTIVE: Anxiety sensitivity (AS) is the fear of the physical symptoms of anxiety and related symptoms. Longitudinal studies support AS as a vulnerability factor for development of anxiety disorders. This study aimed to investigate AS as a vulnerability factor in the development of childhood posttraumatic stress disorder (PTSD) following traumatic experiences. METHODS: The study included 81 children 8-15 years of age who experienced the 1999 earthquake in Bolu, Turkey. The earthquake survivors were compared to a randomized group of age- and sex-matched controls 5 years after the earthquake. Both the subject and control groups were administered the Childhood Anxiety Sensitivity Index (CASI), State and Trait Anxiety Inventory for Children (STAI-C), and Child Depression Inventory (CDI), while the PTSD symptoms of the subjects were assessed using the Child Posttraumatic Stress Reaction Index (CPTS-RI). RESULTS: Subjects and controls did not differ significantly in CASI, STAI-C, or CDI scores. Multiple regression analysis showed that both trait anxiety and CASI scores predicted CPTS-RI scores of the subjects; the prediction by CASI scores was over and above the effect of trait anxiety. CONCLUSION: The results of this study support the hypothesis that AS may be a constitutional factor, which might increase the risk of PTSD following traumatic experiences.     

Exposure to war trauma and PTSD among parents and children in the Gaza strip

Objective Exposure to war trauma has been independently associated with posttraumatic stress (PTSD) and other emotional disorders in children and adults. The aim of this study was to establish the relationship between ongoing war traumatic experiences, PTSD and anxiety symptoms in children, accounting for their parents’ equivalent mental health responses. Methods The study was conducted in the Gaza Strip, in areas under ongoing shelling and other acts of military violence. The sample included 100 families, with 200 parents and 197 children aged 9–18 years. Parents and children completed measures of experience of traumatic events (Gaza Traumatic Checklist), PTSD (Children’s Revised Impact of Events Scale, PTSD Checklist for parents), and anxiety (Revised Children’s Manifest Anxiety Scale, and Taylor Manifest Anxiety Scale for parents). Results Both children and parents reported a high number of experienced traumatic events, and high rates of PTSD and anxiety scores above previously established cut-offs. Among children, trauma exposure was significantly associated with total and subscales PTSD scores, and with anxiety scores. In contrast, trauma exposure was significantly associated with PTSD intrusion symptoms in parents. Both war trauma and parents’ emotional responses were significantly associated with children’s PTSD and anxiety symptoms. Conclusions Exposure to war trauma impacts on both parents’ and children’s mental health, whose emotional responses are inter-related. Both universal and targeted interventions should preferably involve families. These could be provided by non-governmental organizations in the first instance.     

Posttraumatic symptoms and cognitions in parents of children and adolescents with PTSD

Parents may develop symptoms of distress and dysfunctional cognitions in response to their child’s exposure to traumatic events. Additionally, they may also be affected by their own traumatic experiences. This study investigated the frequency of traumatic experiences and of symptoms of posttraumatic stress and depression in a sample of parents of children and adolescents with posttraumatic stress disorder (PTSD). Furthermore, we explored the association of parental symptoms with their dysfunctional cognitions related to their child’s trauma. Parents (N = 113) of children and adolescents with PTSD completed the Posttraumatic Diagnostic Scale (PDS), the Beck depression inventory (BDI-II), the State-Trait Anxiety Inventory, and the Posttraumatic Cognitions Inventory. Correlations between symptom measures and dysfunctional cognitions were calculated. The majority (78.8 %) of the parents reported their own potentially traumatic experiences. Furthermore, 33.6 % evaluated their child’s trauma as the worst event, 34.5 % rated their own experiences as their worst event, and 26.5 % indicated that their own worst traumatic event was the same type as their child’s trauma. The frequency of clinically elevated parental symptoms on the PDS was 48.6 %, and on the BDI-II 32.7 %. Parental symptoms were independent of the reference person of the parental traumatic index event. However, they did correlate significantly with their dysfunctional cognitions (between r = 0.44 and 0.69, p < 0.01). Many parents report their own traumatic experiences and a significant proportion has its own clinically relevant symptoms of distress. Parental psychological symptoms are moderately associated with their dysfunctional cognitions. The results emphasize the need to consider parental distress when treating pediatric PTSD.     

Peritraumatic Distress Inventory as a predictor of post‐traumatic stress disorder after a severe motor vehicle accident

Aim: The aim of this study was to examine the utility of the Peritraumatic Distress Inventory (PDI) as a predictor of subsequent post‐traumatic stress disorder (PTSD) in severe motor vehicle accident survivors. Methods: Patients consecutively admitted to the intensive care unit were assessed immediately and 1 month after accidents in this prospective study. The predictive value for post‐traumatic stress symptoms at 1 month of the PDI at initial assessment was examined by using multivariate regression analysis. Moreover, the accuracy of the PDI as a predictor of PTSD was determined using receiver operator characteristic curve analysis. Post‐traumatic stress symptoms were assessed using the Impact of Event Scale – Revised questionnaire, and PTSD was assessed using the Clinician‐Administered PTSD Scale. Results: Seventy‐nine patients completed the Impact of Event Scale – Revised questionnaire, and 64 patients participated in a structured interview. Of 64 patients, 13 met the diagnostic criteria of full or partial PTSD. The PDI was an independent predictor of post‐traumatic stress symptoms (P = 0.003). The data indicated that a cut‐off score of 23 maximized the balance between sensitivity (77%) and specificity (82%) in this study. Compared with negative predictive value (93%), positive predictive value was not high (53%). Conclusion: The study suggests the predictive usefulness of the PDI for subsequent PTSD in accident survivors. Its adequate usage should be further elaborated.     

Documented childhood trauma (holocaust): Its sequelae and applications to other traumas

Child Survivors of the Holocaust represent a large group of children who survived extreme traumas. Because their original traumas are well documented and they have been followed up over 50 years, their experiences can help to put into perspective and give validity to the post‐traumatic responses of other traumatised children such as the sexually abused. The traumas and sequelae of Child Survivors are described in their different phases. They are then compared with those in the sexually abused group. The findings are as follows First, the post‐traumatic effects of extreme stress of the Holocaust have varied and complex manifestations with ramifications into the personality, morality and existential meanings of victims. Second, these manifestations are similar in the two groups, lending support to the validity of the sexually abused group. The similar societal prejudices against the two groups are examined. Last it is suggested that more complex and varied diagnoses than PTSD must be considered to cater for the manifestations of post‐traumatic responses in severely traumatised children.