Parental posttraumatic stress symptoms as a moderator of child's acute biological response and subsequent posttraumatic stress symptoms in pediatric injury patients

OBJECTIVE: To examine how parental responses following pediatric injury may influence their child's posttraumatic stress symptoms (PTSS). METHODS: Heart rate (HR) from 82 pediatric injury patients was measured during emergency medical services (EMSs) transport and following hospital admission. Twelve-hour urinary cortisol levels were assessed upon admission. Child PTSS and parental PTSS and general distress were assessed 6 weeks and 6 months after trauma. RESULTS: Six-week parental PTSS predicted 6-month child PTSS even after controlling for demographics and general parent distress (DeltaR(2) = .08, p = .03). Parental PTSS moderated the relationship between (a) child cortisol levels and 6-month child PTSS (DeltaR2 = .08, p = .03) and between (b) hospital HR and 6-month child PTSS (DeltaR2 = .09, p = .03). CONCLUSION: The present findings suggest that parental response to trauma may interact with child acute physiological responses to predict persistent child PTSS.     

Brief report: the impact of maternal posttraumatic stress disorder symptoms and child gender on risk for persistent posttraumatic stress disorder symptoms in child trauma victims

OBJECTIVE: To longitudinally examine the impact of maternal posttraumatic stress disorder symptoms (PTSS) on child adjustment following a child's traumatic injury, focusing on child gender differences. METHODS: Forty-one child traumatic injury victims aged 8-18 years and their biological mothers were interviewed over two follow-ups (6 weeks and 7 months). Children were administered the Clinician-Administered Posttraumatic Stress Disorder (PTSD) Scale for Children and Adolescents (CAPS-CA), whereas mothers completed the CAPS. RESULTS: Six weeks post trauma, maternal PTSS were significantly related to PTSS in boys but not in girls. However, at 7 months, maternal PTSS were strongly related to child PTSS in both boys and girls. Significant 6-week maternal distress-child gender interactions suggested that maternal PTSS, especially avoidance, predicted greater 7-month PTSS but that this was primarily because of a significant relationship in females. CONCLUSIONS: Maternal distress was found to negatively impact subsequent child adjustment, particularly in females. These results underscore the importance of considering family-centered interventions for child PTSD, especially in girls.     

Risk of posttraumatic stress symptoms: a comparison of child survivors of pediatric cancer and parental bereavement

OBJECTIVE: To compare the risk of posttraumatic stress (PTS) symptoms and the mediating effect of perceived future threat on the risk of PTS symptoms among survivors of pediatric cancer and children who had a parent die. METHODS: Seventy-eight children (39 survivors of cancer, 39 bereaved) completed self-report measures of PTS symptoms, depression, anxiety, and perceived risk of future threat for the event they experienced. RESULTS: The children who lost a parent reported significantly more PTS symptoms than the survivors of cancer. The effect of group status (survivor of cancer vs. bereaved) on PTS symptomatology was partly mediated by the children's perceived risk of future threat. CONCLUSIONS: The rate of PTS symptoms was found to be higher among children who had lost a parent than among survivors of pediatric cancer. This difference may partly be explained by their perceived risk of a future threat. Clinical implications are discussed.     

Posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in families of adolescent childhood cancer survivors

OBJECTIVE: To describe rates and concordance of posttraumatic stress disorder (PTSD) and posttraumatic stress symptoms (PTSS) in adolescent childhood cancer survivors and their mothers and fathers. METHOD: Participants were 150 adolescent survivors of childhood cancer, 146 mothers, and 103 fathers who completed the Impact of Events Scale-Revised, the Posttraumatic Stress Disorder Reaction Index, and the PTSD module of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fourth edition. RESULTS: PTSS are common in families of childhood cancer survivors. Parents reported more symptomatology than former patients. Mothers and fathers had relatively equal rates of current PTSD and levels of PTSS. Nearly 30% of mothers met diagnostic criteria since their child's diagnosis, with 13.7% currently experiencing PTSD. Nearly 20% of families had at least one parent with current PTSD. Ninety-nine percent of the sample had at least one family member reexperiencing symptoms. CONCLUSIONS: Both PTSD and PTSS help in understanding the experience of adolescent cancer survivors and their families. Within families of childhood cancer survivors, it is likely that some member may be experiencing treatable bothersome memories, arousal, or avoidance specific to the cancer experience.     

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.     

The emotional Stroop task and posttraumatic stress disorder: a meta-analysis

Posttraumatic stress disorder (PTSD) is associated with significant impairment and lowered quality of life. The emotional Stroop task (EST) has been one means of elucidating some of the core deficits in PTSD, but this literature has remained inconsistent. We conducted a meta-analysis of EST studies in PTSD populations in order to synthesize this body of research. Twenty-six studies were included with 538 PTSD participants, 254 non-trauma exposed control participants (NTC), and 276 trauma exposed control participants (TC). PTSD-relevant words impaired EST performance more among PTSD groups and TC groups compared to NTC groups. PTSD groups and TC groups did not differ. When examining within-subject effect sizes, PTSD-relevant words and generally threatening words impaired EST performance relative to neutral words among PTSD groups, and only PTSD-relevant words impaired performance among the TC groups. These patterns were not found among the NTC groups. Moderator analyses suggested that these effects were significantly greater in blocked designs compared to randomized designs, toward unmasked compared to masked stimuli, and among samples exposed to assaultive traumas compared to samples exposed to non-assaultive traumas. Theoretical and clinical implications are discussed.     

Prevalence and risk factors of postpartum posttraumatic stress disorder: A meta-analysis

Research has demonstrated that women develop postpartum PTSD. Prevalence of postpartum PTSD has ranged from 1% to 30%, and many risk factors have been identified as predictors of postpartum PTSD. While qualitative reviews have identified patterns of risk, the lack of quantitative reviews prevents the field from identifying specific risk factors and making a single estimate of the prevalence of postpartum PTSD. The current meta-analysis investigated prevalence and risk factors of postpartum PTSD, both due to childbirth and other events, among community and targeted samples. Prevalence of postpartum PTSD in community samples was estimated to be 3.1% and in at-risk samples at 15.7%. Important risk factors in community samples included current depression, labor experiences such as interactions with medical staff, as well as a history of psychopathology. In at-risk samples, impactful risk factors included current depression and infant complications. Further research should investigate how attitudes towards pregnancy and childbirth may interact with women's experiences during delivery. Additionally, studies need to begin to evaluate possible long-term effects that these symptoms may have on women and their families.     

Comparing parental distress,family functioning,and the role of social support for caregivers with and without a child with juvenile rheumatoid arthritis

OBJECTIVE: To assess parental distress, family functioning, and social support among parents of children with a lifetime diagnosis of juvenile rheumatoid arthritis (JRA) and comparison families. METHODS: Parents of 64 children with JRA (64 mothers, 46 fathers) completed questionnaires and in-home interviews along with 64 matched comparison families. Average time since diagnosis for children with JRA was 70 months. RESULTS: Families of children with JRA generally reported levels of parental distress, family functioning, and social support similar to those for comparison families. More mothers of children with JRA exceeded the clinical cutoff on the SCL-90-R than comparison mothers. Although disease characteristics and social support did not distinguish subgroups of parents at greater risk for problems, family supportiveness and conflict were associated with caseness for mothers of children with JRA. CONCLUSIONS: Families of children with JRA exhibited substantial resilience over the long term. Further multisite study of children recently diagnosed and with more severe forms of JRA is warranted to determine intervention needs, especially for mothers.     

The role of perceived threat during emergency department cardiac evaluation and the age-posttraumatic stress disorder link

Evaluation for acute coronary syndrome (ACS) can trigger posttraumatic stress symptoms (PSS). Research suggests that younger, versus older, individuals may be at elevated risk for PSS after ACS evaluation. It has been proposed that younger individuals may be at greater risk because they perceive the suspected ACS event as more threatening than their older counterparts; however, this has yet to be tested. We examined whether perceived threat during ACS evaluation mediated the association between age and PSS after ACS evaluation in an observational cohort study of patients presenting to the emergency department (ED) with suspected ACS. Demographics and perceived threat were assessed in the ED. PSS were measured upon inpatient transfer or by phone 3 days later. The analytic sample comprised 871 adult participants. Multiple linear regression was used to examine (1) associations of age and perceived threat with PSS and (2) whether perceived threat mediated the association. Bootstrapping with percentile-based confidence intervals (CIs) was used to test the indirect effect. Each year of age was associated with lower PSS (b = ? 0.12, p < .001), independent of covariates. Older age was associated with lower perceived threat during ACS evaluation (b = ? 0.05, p < .001). Greater threat perceptions predicted greater PSS (b = 0.94, p < .0001). The indirect effect (? 0.04) was statistically significant (95% CI ? 0.07, ? 0.02). Younger, versus older, individuals are at risk for greater PSS after ACS evaluation, and elevated perceived threat partially mediated this association. Understanding age differences in PSS development risk and the potential impact of age on threat perceptions may help inform ED treatment.     

Allocation of family responsibility for illness management in pediatric HIV

Objective The purpose of the study is to describe allocationof responsibility for illness management in families of childrenand adolescents perinatally infected with HIV. Methods Atotal of 123 youth (ages 8–18) and caregivers completedfamily responsibility and medication adherence questionnairesas part of a substudy of Pediatric AIDS Clinical Trials Groupprotocol 219c. Results Approximately one-fourth ofthe youth reported being fully responsible for taking medications.A smaller percentage of caregivers reported full youth responsibility.Older youth and caregivers of older youth reported higher degreeof youth responsibility for medication-related tasks, thoughage was unrelated to adherence. Caregiver report of greaterresponsibility for medications was associated with better adherence. Conclusions Caregiversare likely to transition responsibility for HIV care to olderyouth but this transition was not always successful as evidencedby poor medication adherence. Interventions supporting successfultransition may improve adherence and subsequently health outcomesin pediatric HIV.     

Seated movement indexes emotion and its regulation in posttraumatic stress disorder

This paper reports the results of a study that administered an emotion regulation task to Operation Enduring Freedom/Operation Iraqi Freedom veterans diagnosed with posttraumatic stress disorder (27) and to healthy controls (23). Seated movement and postural responses were transduced with a sensitive accelerometer attached to the underside of a low‐mass cantilevered chair. Consistent with prior studies in which subjects stood on force plates, aversive photographs induced attenuation of nondirectional movement in patients and controls. Regarding seated postural responses, controls leaned towards neutral photographs and away from aversive ones, while participants with PTSD did the opposite. Regulation had no impact on seated movement but was associated with a seated postural withdrawal from the computer screen.     

Driving cognitions,rumination, and posttraumatic stress disorder in road traffic accidents survivors

This study evaluated the relationships between driving cognitions (i.e., panic‐related cognitions, accident‐related cognitions, and social‐related cognitions), rumination, and posttraumatic stress disorder (PTSD) symptoms in a sample of road traffic accidents (RTAs) survivors. We also investigated the indirect effect of driving cognitions on PTSD symptoms through rumination. The sample included 633 drivers (62% were men; Mage = 36.09; standard deviation [SD] = 11.42 years). The participants completed scales measuring driving cognitions, rumination, and PTSD symptoms, as well as providing their demographic information. The results showed that all three types of driving cognitions assessed in the present study and rumination were significantly positively associated with PTSD symptoms. Furthermore, rumination mediated the relation between social‐related cognitions and PTSD symptoms. The implications for PTSD treatment and future research are discussed.     

Psychotherapy for military-related posttraumatic stress disorder: Review of the evidence

Approximately 20% of the two million troops who have deployed to Iraq and Afghanistan may require treatment for posttraumatic stress disorder (PTSD). We review treatment outcome studies on individual outpatient therapy for military-related PTSD, and consider the extent to which veterans initiate and complete available PTSD treatments. We conclude with considerations for future research.     

Autonomic and cortical reactivity in acute and chronic posttraumatic stress

This study investigated attention (P300 amplitude) and orienting (skin conductance amplitude) to auditory tones in a standard oddball task in early trauma-exposed groups (Acute Stress Disorder: ASD) (n=12) or no ASD (n=13), compared to individuals with chronic posttraumatic stress disorder (PTSD) (n=17) and non-trauma-exposed controls (n=17). Individuals with ASD displayed significantly higher SCR and P3 amplitudes to target tones than individuals with PTSD, non-traumatized controls, and traumatized controls. These findings suggest that attention and orienting responses are greater to neutral, task-relevant target tones in ASD than PTSD and traumatized and non-traumatized controls.     

Type D personality and posttraumatic stress disorder in victims of violence: a cross-sectional exploration

The current study explored the relationship between type D personality and posttraumatic stress disorder (PTSD) among victims of violence (n = 189). The basic premise underlying the type D concept is that it is not the experience of negative emotions per se that renders individuals at risk of maladjustment in the face of adversity, but the way they are dealt with. Particularly the combination of high negative affectivity and social inhibition (i.e., the non-expression of emotions and inhibition of behaviours in social interactions) is assumed to be maladaptive. It was hypothesized that a high score on negative affectivity (i.e., above a pre-determined cut-off score) would only contribute to PTSD in the presence of a high score on social inhibition (also above a pre-determined cut-off score). Univariate results indicated that type D subjects (type Ds) reported higher PTSD symptom levels than those characterized by high negative affectivity/low social inhibition or low negative affectivity. Type Ds more often suffered from probable PTSD than non-type Ds. In multivariate analyses, type D personality was associated with an increased risk of probable PTSD above and beyond background variables, while high negative affectivity/low social inhibition was not. Results were discussed in light of victim support practices and study limitations.     

Drawing current posttraumatic stress disorder models into the cultural sphere: The development of the ‘threat to the conceptual self’ model

Current models of posttraumatic stress disorder (PTSD) represent significant advances in our understanding of psychological processes involved in the development and maintenance of PTSD. However, these models may be limited theoretically and clinically given they have not considered cultural differences in self-construal. Cultural differences in self-construal have been found to impact on, and in many cases govern, the very psychological processes implicated by the PTSD models. The objective of this paper is to discuss some of the current models of PTSD and their associated psychological processes that have links to the self. Second, the paper reviews the literature highlighting the impact of cultural differences in self-construal on these processes. The paper, then, uses these links to draw the PTSD models into the cultural sphere. A model, ‘Threat to the Conceptual Self’ model, is developed. This is a working model that accounts for these two bodies of literature and suggests how cultural differences in the conceptual self may play a role in the etiology and maintenance of PTSD. Finally, clinical implications are discussed.     

Parental distress, family functioning, and social support in families with and without a child with neurofibromatosis 1

Objective To compare parental adjustment, social support, andfamily functioning between families of children with neurofibromatosis1 (NF1) and a group of demographically similar comparison families,and to examine the impact of disease severity. Methods Questionnaireswere completed at home by parents of 54 children with NF1 (54mothers and 42 fathers) and 51 comparison children (49 mothersand 32 fathers). Results Few differences between groups wereidentified for parental distress, social support, or familyenvironment. Greater neurological impairment in children withNF1 was associated with greater distress, more family conflict,less positive mealtime interactions, and less social supportfrom the perspectives of mothers. Conclusions Overall, parentsof children with NF1 appear similar to parents of comparisonchildren. Mothers who have children with NF1 characterized bygreater neurological impairment may be at risk for more difficulties.Future work exploring long-term adjustment for these mothersas well as interventions to ameliorate any potential difficultiesmay be appropriate.     

The work of an accident and emergency department

In a six month period 2,379 new patients were treated in a designated major accident centre. Of these cases two thirds (67·9 per cent) were thought to be appropriate for management by general practitioners. I suggest that these cases are properly treated in an accident and emergency department and that these departments should be developed as part of the primary health care teams.     

Offspring psychological and biological correlates of parental posttraumatic stress: Review of the literature and research agenda

Millions of individuals with posttraumatic stress disorder (PTSD) are parents. A burgeoning literature suggests that offspring of parents with this condition may be at increased risk for psychological problems. The current paper provides an integrative and comprehensive review of the diverse research literature examining the sequelae of parental posttraumatic stress among offspring. Over 100 studies that evaluated psychological and/or biological variables among children of parents with PTSD are reviewed. Findings suggest parental symptoms of posttraumatic stress are uniquely related to an array of offspring outcomes, including internalizing-type problems, general behavioral problems, and altered hypothalamic-pituitary-adrenal axis functioning. Although very little work has directly evaluated mechanisms of transmission, there is increasing support for genetic and epigenetic effects as well as parenting behaviors. These and other mechanisms are discussed; drawing upon findings from other literatures to consider how parental PTSD may impart psychobiological vulnerability upon offspring. We conclude with a detailed discussion of the methodological strengths and challenges of the extant research, along with a recommended agenda for future research in this important area of study.