Posttraumatic stress and behavior problems in infants and toddlers with burns

This study assessed posttraumatic stress disorder (PTSD) and behavior problems in young children with burns and examined individual, injury-related, and family-related determinants. Seventy-six children, aged 12-49 months, were assessed at an average of 15 months after their burn injury, using parents as informants on the posttraumatic stress disorder semi-structured interview and observational record for infants and young children and the child behavior checklist. Ten children (13.2%) met the alternative criteria for PTSD proposed by Scheeringa et al. Number of PTSD symptoms were associated with family-related variables (maternal PTSD, quality of family relations). Compared to community norms, children with burns showed less externalizing behavior problems, and internalizing behavior problems were within the normal range. Overall, behavioral adjustment was associated with the quality of family relations (cohesion, expressiveness, conflicts). Whereas behavior was found to be normal in young children with burns, this study provides evidence for a substantial prevalence of PTSD.     

Psychological consequences of pediatric burns from a child and family perspective: A review of the empirical literature

In order to inform clinical practice, we reviewed the empirical literature on emotional, behavioral and social outcomes in children with burns and their families published between 1989 and 2011. A systematic search of the literature yielded 75 articles. Qualitative synthesis of the results showed that child anxiety, traumatic stress reactions, and behavioral problems were considerably prevalent in the first months after the burn event. Among parents, high rates of posttraumatic stress, depressive symptoms, and guilt feelings were found. Cross-sectional studies, often performed many years after the injury, suggest that some children experience long-term psychological problems, such as anxiety, depression, and difficulties with social functioning. However, there was little evidence that behavior in general, self-esteem, or body image were impaired in the total population of children with a history of burns. Long-term family outcome studies suggest that psychological problems persist in a substantial subgroup of parents. Child peritraumatic factors anxiety and pain, parental posttrauma psychological reactions, and family functioning were the most consistently reported factors associated with child outcome. More recent studies have demonstrated that burn severity may have an indirect effect on child postburn psychosocial outcome. Clinical implications, methodological strengths and limitations of the reviewed studies, and directions for future research are discussed.     

Predictors of PTSD in mothers of children undergoing bone marrow transplantation: the role of cognitive and social processes

OBJECTIVE: To investigate the role of cognitive and social processing in posttraumatic stress symptoms and disorder (PTSD) among mothers of children undergoing bone marrow and hematopoietic stem-cell transplantation (BMT/SCT). METHOD: Questionnaires assessing emotional distress, BMT-related fears, and negative responses of family and friends were completed by 90 mothers at the time of the BMT infusion and 3 and 6 months post-BMT. PTSD symptoms were measured 6 months post-BMT by both paper-and-pencil and structured interview methods. RESULTS: Emotional distress, BMT-related fears, and negative responses of family and friends assessed at the time of BMT hospitalization were predictive of later PTSD symptoms. None of these variables prospectively predicted a PTSD diagnosis as measured by the structured interview. CONCLUSIONS: Higher levels of general psychological distress, cognitive interpretations of the threat of the BMT for the child's future functioning, and negative responses of family and friends may place mothers at risk for post-BMT posttraumatic stress symptomatology.     

Brief report: the risk of posttraumatic stress disorder in mothers of children diagnosed with pediatric cancer and type I diabetes

OBJECTIVE: To evaluate the risk of and predictors of enduring and late-onset posttraumatic stress disorder (PTSD) among mothers of children diagnosed with type I diabetes and cancer. METHOD: Mothers (N = 99) of children diagnosed with cancer or diabetes for at least 12 months completed a structured clinical interview for PTSD and self-report measures of PTSD, depression, anxiety, and stressful life events. RESULTS: There was no significant difference in the rate of PTSD between the two groups. Overall, fewer mothers (7%) met criteria for PTSD on the structured clinical interview than those on a self-report measure of PTSD (17%). Mothers who reported more depressive symptoms, anxiety, and stressful life events tended to report significantly more PTSD symptoms. CONCLUSIONS: The findings extend prior research regarding the prevalence rate and predictors of PTSD and PTSD symptoms in pediatric populations. It is recommended that clinicians exercise caution when interpreting prevalence rates for PTSD that are derived from self-report measures.     

Assessing the existence of dissociative PTSD in sub-acute patients of whiplash

Numerous studies investigating dissociative posttraumatic stress disorder (D-PTSD) have emerged. However, there is a lack of studies investigating D-PTSD following a wider range of traumatic exposure. Thus, the present study investigates D-PTSD using latent class analysis (LCA) in sub-acute patients of whiplash and associated risk factors. The results of LCA showed a three-class solution primarily distributed according to posttraumatic stress disorder (PTSD) symptom severity and thus no indication of D-PTSD. Dissociative symptoms, psychological distress (i.e. anxiety/depression), and pain severity significantly predicted PTSD severity. Combined, the results support the component model of dissociation and PTSD, while still stressing the importance of dissociative symptoms when planning treatment for PTSD.     

Longitudinal association between infant disorganized attachment and childhood posttraumatic stress symptoms

The purpose of this study was to evaluate whether children with a history of disorganized attachment in infancy were more likely than children without a history of disorganized attachment to exhibit symptoms of posttraumatic stress disorder (PTSD) at school age following trauma exposure. The sample consisted of 78 8.5-year-old children from a larger, ongoing prospective study evaluating the effects of intrauterine cocaine exposure (IUCE) on children's growth and development from birth to adolescence. At the 12-month visit, children's attachment status was scored from videotapes of infant-caregiver dyads in Ainsworth's strange situation. At the 8.5-year visit, children were administered the Violence Exposure Scale-Revised, a child-report trauma exposure inventory, and the Diagnostic Interview for Children and Adolescents by an experienced clinical psychologist masked to children's attachment status and IUCE status. Sixteen of the 78 children (21%) were classified as insecure-disorganized/insecure-other at 12 months. Poisson regressions covarying IUCE, gender, and continuity of maternal care indicated that disorganized attachment status at 12 months, compared with nondisorganized attachment status, significantly predicted both higher avoidance cluster PTSD symptoms and higher reexperiencing cluster PTSD symptoms. These findings suggest that the quality of early dyadic relationships may be linked to differences in children's later development of posttraumatic stress symptoms following a traumatic event.     

Screening for preschool posttraumatic stress disorder with the Child Behavior Checklist

OBJECTIVE: To examine the psychometric properties and utility of a Child Behavior Checklist-Posttraumatic Stress Disorder (CBCL-PTSD) Scale to screen for posttraumatic stress disorder (PTSD) in traumatized preschool children. METHOD: Data for this study were drawn from a study of young child trauma and consisted of 62 traumatized children, 23 months through 6 years of age. The children's mothers were interviewed about PTSD symptoms and then completed the Child Behavior Checklist (CBCL). RESULTS: The modified CBCL-PTSD correlated highly with the number of PTSD symptoms from the interview (r = 0.66). The CBCL-PTSD scale predicted PTSD symptoms above and beyond the internalizing and externalizing scales of the CBCL. A cutoff score of nine on this scale possessed the best sensitivity and specificity in classifying those traumatized children who met diagnostic criteria for PTSD. CONCLUSION: The modified CBCL-PTSD scale could be a useful cost-effective tool to screen for PTSD in traumatized, preschool-age children.     

Coping with the stress of parental depression II: adolescent and parent reports of coping and adjustment.

This study examined associations between adolescents' self-reports and parents' reports of adolescents' exposure to family stress, coping, and symptoms of anxiety/depression and aggression in a sample of 78 adolescent offspring of depressed parents. Significant cross-informant correlations were found between adolescents' reports of family stress, their stress responses, and their coping and parents' reports of adolescents' symptoms of anxiety/depression and aggression, but not between parents' reports of adolescents' stress and coping and adolescents' self-reported symptoms. Adolescents' reports of secondary control engagement coping and involuntary engagement stress responses mediated the relation between adolescents' reports of parental stress and parents' reports of adolescents' anxiety/depression symptoms. Moderate levels of correspondence were found in the correlations between parent and adolescent reports of adolescents' exposure to stress, coping, stress responses, and symptoms even after controlling for parents' current depressive symptoms. However, depressed parents reported higher levels of symptoms of anxiety/depression and aggression and more family stress than did their adolescent offspring. Implications for future research on coping and adjustment in offspring of depressed parents are highlighted.     

Peritraumatic Dissociation and Emotions as Predictors of PTSD Symptoms Following Childbirth

ABSTRACT

The current study investigated the contributive role of perinatal dissociative and perinatal emotional responses to the development of PTSD symptoms following childbirth. Method: Using a prospective, longitudinal design, 140 women were studied who were followed from the first week after delivery to three months postpartum. Results: Three women (2.1%) met criteria for PTSD and 21.4% reported a traumatic childbirth experience. Both perinatal negative emotional reactions and perinatal dissociative reactions were the predictors of PTSD symptoms at three months postpartum. The effect of perinatal dissociation, however, was partially mediated by perinatal emotional reactions. Conclusion: Posttraumatic stress disorder can be a consequence of the experience of childbirth. Women who reported high levels of negative emotions during and shortly after childbirth were more likely to develop PTSD symptoms than women who did not. Women who experienced an instrumental delivery and also reported higher levels of psychoform perinatal dissociation, were at higher risk than women who reported higher levels of perinatal dissociation during a spontaneous delivery. These findings add to the growing body of literature regarding traumatic childbirth and indicate that perinatal dissociative and emotional phenomena are associated with posttraumatic stress.     

Childhood posttraumatic stress disorder and efforts to cope after Hurricane Floyd

The authors report on the level of posttraumatic stress disorder (PTSD) experienced by fourth-grade children 6 months after Hurricane Floyd and describe the children's efforts to cope with their stress. All of the children they studied were directly affected by the hurricane, secondary to the destruction of their school by floodwaters. The homes of 37% of these children were also flooded. Ninety-five percent of the children experienced at least mild symptoms of PTSD, and 71% had symptoms that were moderate to very severe. Children who reported that their homes were flooded were 3 times more likely to report symptoms than those whose homes were not flooded, and the girls were twice as likely as the boys to report symptoms. The high PTSD prevalence rates are comparable to findings from other studies involving violence in which 94% of the victims reported experiencing symptoms. For further analyses, the authors used symptom clusters of hyperarousal, numbing/avoidance, and reexperiencing symptoms.     

Brief report: children's responses to trauma- and nontrauma-related hospital admission: a comparison study

OBJECTIVE: This study aims to investigate and compare psychological responses in children and parents 1 month after trauma- and nontrauma-related hospital admission. METHODS: Two hundred and five children aged 7-16 years (and their parents) were assessed for posttraumatic stress disorder (PTSD), other psychopathology, and distress 1 month after trauma-related (Trauma Group; n = 101) and nontrauma-related hospital admission (Non-Trauma Group; n = 104). RESULTS: Clinically elevated PTSD symptom levels were more prevalent in children admitted for trauma-related (18%) than nontrauma-related reasons (4%). Parents also experienced posttraumatic distress, although rates of clinically elevated symptom levels did not differ between the Trauma (11%) and Non-Trauma (8%) groups. Other pathology and distress in children and parents were comparable across groups. CONCLUSIONS: Children experienced greater posttraumatic distress following trauma-related hospital admission, while parents' experience of their child's hospitalization is equally distressing regardless of the reason for admission.     

青少年创伤后应激障碍症状与父母教养方式的关系:心理弹性的中介作用

目的:考察汶川地震后青少年创伤后应激障碍症状与父母教养方式、心理弹性的关系。方法:震后18个月,采用创伤后应激障碍自评量表、心理弹性量表、父母教养方式问卷、自编一般人口学及地震暴露情况调查表,对都江堰地区规模最大的某高中的二年级学生进行调查,收回有效问卷984份。结果:都江堰地区青少年震后18个月PTSD症状的检出率为13.3%,在性别、是否独生子女及不同地震暴露程度间存在显著差异;心理弹性在父母关怀、父母过度保护与PTSD症状之间存在部分中介作用,中介效应占总效应的比例分别为25.6%、15.6%,心理弹性在父母冷漠与PTSD症状之间存在完全中介作用。结论:父母对孩子较多的关怀和较少的控制干涉有利于培养青少年的心理弹性,对震后PTSD症状具有保护作用。     

Posttraumatic stress disorder in parents of children with newly diagnosed type 1 diabetes

OBJECTIVE: To determine rates of posttraumatic stress disorder (PTSD) and symptoms in mothers and fathers of children with newly diagnosed type 1 diabetes. METHODS: Parents of 38 children with newly diagnosed type 1 diabetes were assessed with the Posttraumatic Diagnostic Scale 6 weeks after diagnosis. RESULTS: Twenty-four percent of the mothers and 22% of the fathers met full diagnostic criteria for current PTSD. In addition, 51% of the mothers and 41% of the fathers met criteria for partial or subclinical PTSD. Co-occurence of PTSD in couples was very low. Posttraumatic stress symptomatology did not correlate with age and gender of the child, socioeconomic status, family structure, or length of hospital stay. CONCLUSIONS: The findings support applicability of a posttraumatic stress model for investigating the psychological impact of type 1 diabetes on parents.     

Commentary on Braude's “Dissociation and Latent Abilities

ABSTRACT

This retrospective study investigated peritraumatic predictors (peritraumatic dissociation, negative emotions and physical anxiety symptoms experienced at the time of the traumatic event) of posttraumatic stress disorder (PTSD) symptoms among 98 French-speaking university students. Participants rated their lifetime experiences of traumatic events and, in response to their “most stressful” event, completed measures of PTSD symptoms and peritraumatic reactions. Approximately 67% of respondents (N = 75) reported at least one traumatic event. Negative emotions, peritraumatic dissociation, and physical anxiety symptoms at the time of the trauma were strong predictors of PTSD symptoms. These variables explained 38% of the variance in PTSD symptoms. Results are discussed with respect to immediate reactions to traumatic events as potential precursors of PTSD symptomatology.     

An 18-month longitudinal study of posttraumatic disorders in children who were taken hostage in their school

OBJECTIVE: The objective of our investigation was to study the course of direct and indirect posttraumatic disorders over 18 months in children after they were taken hostage in their school. METHODS: Twenty-six young hostages were evaluated by using standardized clinical interviews and self-administered questionnaires (State and Trait Anxiety Inventory for Children [STAIC]and Revised Impact of Event Scale [IES]) 2, 4, 7, and 18 months after the event. They were compared with 21 children from the same school who were not taken hostage (indirect exposure). RESULTS: Symptoms of acute stress were observed in 25 (96%) of the children who were directly involved in the traumatic event. After 2 months, 18 children had developed disorders according to criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, including 7 cases of full posttraumatic stress disorder (PTSD), 11 cases of subclinical PTSD, 3 cases of separation anxiety, 1 case of specific phobia, and 2 cases of major depressive disorder. Anxiety scores (STAIC) decreased between 2 and 4 months and then stabilized, whereas symptoms of avoidance (IES-avoidance) decreased gradually throughout the follow-up period, and symptoms of repetition (IES-intrusion) decreased less markedly. Children who were indirectly exposed to the trauma also manifested protracted posttraumatic symptomatology (two full cases of PTSD and six cases of subclinical PTSD), but their IES-intrusion scores were significantly lower at 7 months than those of children who were directly exposed, and the severity of their symptoms diminished over time. Girls tended to show a higher level of anxiety and more features of intrusion than boys. Psychological debriefing did not prevent occurrence of the disorders, but children who were not debriefed had the worst outcomes. CONCLUSIONS: Even after a short event and even if they are not directly exposed, children under the age of 9 years can develop high rates of posttraumatic disorders that follow a protracted course despite early intervention and careful monitoring.     

Caregiver traumatization adversely impacts young children's mental representations on the MacArthur Story Stem Battery

The aim of our study was to investigate the impact of maternal exposure to family violence, maltreatment, and related posttraumatic stress disorder (PTSD) on young children's mental representations of self and caregivers. Participant mothers (n=24) and children (n=25) were recruited from a referred sample when they were 4-7 years old. Maternal report and child story stem narratives were used. Mother's experience of domestic violence and severity of violence-related PTSD symptoms robustly predicted more dysregulated aggression, attentional bias to danger and distress, as well as more avoidance of and withdrawal from conflicts presented in the children's story stems. Less narrative coherence was also noted. Traumatized mothers experience and symptoms prior to their child's turning 4 years old adversely affected their child's mental representations from 4-7 years.     

PTSD after traumatic injury: an investigation of the impact of injury severity and peritraumatic moderators

Presence of injury is often examined as a risk factor for posttraumatic stress disorder (PTSD); however, results have been mixed regarding the relationship between injury severity and PTSD symptoms (PTSS). The present study examined subjective and objective injury severity ratings in traumatic injury victims to determine if they differentially predict PTSS. Results demonstrated that subjective, not objective, injury severity predicted PTSS at six weeks and three months post-trauma. The moderating impact of peritraumatic factors was also examined. Peritraumatic dissociation moderated the impact of subjective injury severity on PTSS. Findings indicate that subjective injury severity should be incorporated into early screeners for PTSD risk.     

The Role of Anxiety Control and Treatment Implications of Informant Agreement on Child PTSD Symptoms

The goal of this study is to examine parent and child agreement of child posttraumatic stress disorder (PTSD) symptoms pre- and posttreatment, as well as potential moderators of agreement including treatment responder status, child anxiety control, and parent self-reported PTSD symptoms. We examined child self-reported and parent-reported child PTSD symptoms from the Diagnostic Interview Schedule for Children. Of the 141 parent–child pairs, the mean age of children was 12.72 (SD = 3.40), 53% were female, and 54% were Black. A subsample of participants (n = 47) was assessed after completion of a cognitive behavioral therapy treatment for PTSD. Moderate levels of agreement were found at baseline, though Criterion D (increased arousal) symptoms had lower levels of agreement than the other symptom clusters. Symptom agreement was lower at posttreatment. Treatment responders had higher levels of baseline informant agreement than treatment nonresponders. Child perceived anxiety control significantly moderated informant agreement, such that pairs with children who had high levels of perceived control of their anxiety had lower PTSD symptom agreement where children reported lower symptoms relative to their parents. Contrary to expectations, parent self-reported PTSD did not moderate parent–child symptom agreement. Factors associated with higher parent–child agreement of child PTSD symptoms were being a PTSD treatment responder and children with lower perceived anxiety control. These findings have potential implications for determining those who may benefit from greater symptom monitoring over the course of intervention and potential alternative intervention approaches.     

Acute stress disorder after burn injury: a predictor of posttraumatic stress disorder?

OBJECTIVES: The principal goals of this study were to determine whether ASD predicted chronic PTSD and whether dissociation is more characteristic of the acute-trauma period than PTSD symptoms. METHODS: Eighty-three hospitalized adult burn patients were assessed with structured interviews and self-report measures within 2 weeks of injury and again at least 6 months postburn. RESULTS: Nineteen percent had ASD. Dissociative symptoms were not more common or more severe than PTSD symptoms. Thirty-six percent had chronic PTSD. While ASD predicted chronic PTSD, meeting the symptom criteria for PTSD within 2 weeks postburn also predicted chronic PTSD. CONCLUSIONS: Our data support the inclusion of an ASD diagnosis in the DSM, which would allow the diagnosis of symptoms in the first month posttrauma as a psychiatric disorder but questions whether dissociation is more characteristic of the acute trauma period than the PTSD symptom clusters.     

Trauma exposure and mental health outcomes among Central American and Mexican children held in immigration detention at the United States–Mexico border

We explored the associations between early-life adversity and migration-related stress on the mental health of Central American and Mexican migrating children held in United States immigration detention facilities. Migrating children have high rates of trauma exposure prior to and during migration. Early-life adversity increases risk for developing mental health disorders. Forced separation of migrating children from their parents at the United States–Mexico border potentially exacerbates this risk. We sought to determine whether exposure to trauma prior to immigration and specific features of immigration detention were associated with posttraumatic stress symptomatology. We interviewed parents of 84 migrating children (ages 1–17) after families were released from immigration detention facilities to assess children's migration- and detention-related experiences. A modified version of the University of California Los Angeles Posttraumatic Stress Disorder (PTSD) Reaction Index was administered to assess children's PTSD symptoms and document trauma exposure. A total of 97.4% of children experienced at least one premigration traumatic event. PTSD symptom severity was most strongly predicted by premigration trauma and duration of parent–child separation. This study contributes to a growing empirical literature documenting that early-life adversity increases risk of developing mental health disorders, particularly following additional stress exposure, and that remaining with parents during immigration detention may help mitigate children's stress response.