Comorbidity of PTSD and depression among refugee children during war conflict

BACKGROUND: We examined the prevalence and nature of comorbid post-traumatic stress reactions and depressive symptoms, and the impact of exposure to traumatic events on both types of psychopathology, among Palestinian children during war conflict in the region. METHODS: The 403 children aged 9-15 years, who lived in four refugee camps, were assessed by completing the Gaza Traumatic Events Checklist, the Child Post Traumatic Stress Reaction Index (CPTSD-RI), and the Short Mood and Feelings Questionnaire (MFQ). RESULTS: Children reported experiencing a wide range of traumatic events, both direct experience of violence and through the media. CPTSD-RI and MFQ scores were significantly correlated. Both CPTSD-RI and MFQ scores were independently predicted by the number of experienced traumatic events, and this association remained after adjusting for socioeconomic variables. Exposure to traumatic events strongly predicted MFQ scores while controlling for CPTSD-RI scores. In contrast, the association between traumatic events and CPTSD-RI scores, while controlling for MFQ scores, was weak. The CPTSD-RI items whose frequency was significantly associated with total MFQ scores were: sleep disturbance, somatic complaints, constricted affect, impulse control, and difficulties in concentration. However, not all remaining CPTSD-RI items were significantly associated with exposure to traumatic events, thus raising the possibility that the association between depression and PTSD was due in part to symptom overlap. CONCLUSIONS: Children living in war zones are at high risk of suffering from PTSD and depressive disorders. Exposure to trauma was not found to have a unique association with PTSD. The relationship between PTSD and depressive symptomatology requires further investigation.     

Post-traumatic stress responses following liver transplantation in older children

Eighteen children aged between 7 and 16 years who had undergone a liver transplantation were interviewed using the Child Post-Traumatic Stress Reaction Index (CPTS-RI) to discover if they had post-traumatic stress symptoms. A case control design was used to define which factors were important for the development of post-traumatic stress. Results of a one-way analysis of variance (ANOVA), with post-traumatic stress symptom intensity as measured on the CPTS-RI as the dependent variable, revealed a significant difference between the liver transplantation group compared with children who had a chronic life-threatening illness or had undergone a routine surgical operation. A post hoc (Tukey's HSD test) statistical analysis was performed and significance at the .05 level was found between the liver transplantation group and both the chronic illness group and the routine surgical operation group. Our results indicate that the acute life-threat involved in the liver transplantation contributed to the development of post-traumatic stress. It was thought that dissociation may be important in preventing the resolution of the trauma. Additional investigations are needed with larger numbers in a longitudinal study beginning before the transplant to determine the course of the PTSD symptoms and the appropriate timing of interventions to reduce the harmful effects of these symptoms.     

The assessment and treatment of Post-traumatic Stress Disorder in children and adolescents

Post-traumatic Stress Disorder (PTSD) is a syndrome defined by the intrusive re-experiencing of a trauma, avoidance of traumatic reminders, and persistent physiological arousal. PTSD is associated with high levels of comorbidity and may increase the risk for additional disorders over time. While controversies remain regarding the applicability of the PTSD criteria to very young children, it has proved to be a useful framework for guiding assessment and treatment research with older children and adolescents. This article presents an overview of the literature on the clinical characteristics, assessment, and treatment of PTSD in children and adolescents.     

Post-traumatic coronary occlusion and its consequences in a young child

Summary A 250-kg metal plate fell on a six-year-old boy. The resulting internal, nonpenetrating trauma caused multiple coronary arterial occlusions leading to complete heart block and ischemic changes in the electrocardiogram. Later two left ventricular aneurysms developed that were resected.     

Traumatic experiences and post-traumatic stress reactions in children from Kurdistan and Sweden

This paper examines the types and scores of traumatic experiences, post-traumatic stress symptom and behavioural disorders among Kurdistanian refugee children in Sweden and a comparative Swedish group. The Harvard-Uppsala Trauma Questionnaire for Children (HUTQ-C), the Post-Traumatic Stress Disorder for Children (PTSS-C) and the Child Behaviour Checklist (CBCL) were administered in interview form to 32 children from each sample, controlled for age, gender and trauma levels. No significant differences were found between the 2 samples regarding types of traumatic events, frequencies of post-traumatic stress disorder, post-traumatic stress symptom scores or behavioural problem scores, except in 3 aspects: Kurdistanian children reported more war experience and being lost, while Swedish children presented higher frequencies of leisure-time accidents. CONCLUSION: This study supports the assumption that children differ from adults by showing more similarities than differences regarding traumatic experiences and post-traumatic stress reactions, after being exposed to an equivalent number of reported traumatic events. The refugee children's stay in Sweden can be considered as a healing factor.     

Post-traumatic stress in children following motor vehicle accidents

BACKGROUND: This study examined children's experiences following a motor vehicle accident (MVA). METHODS: Approximately 9 months following the accident, children (n=50) and their parents (n=50) participated in extensive interviews about the accident and in comprehensive, structured diagnostic interviews concerning overall psychological functioning. Additional assessments included post-traumatic stress questionnaires, archival police report records, and emergency treatment medical records. RESULTS: Of the 50 children, 7 children (14%) met criteria for PTSD diagnosis, and an additional 5 children met criteria for specific phobia (10%) related to the automobile accident on the structured diagnostic interview (DICA-R-C; total of 24%). Degree of physical injury predicted more PTSD symptoms, and previous accident experiences predicted fewer symptoms, before and after controlling for other variables. Holding degree of physical injury and age constant revealed that social support predicted fewer PTSD symptoms. CONCLUSIONS: Findings suggest the possible inoculating role of previous accidents and the importance of social support following MVA injury.     

The Psychological Impact of War and the Refugee Situation on South Sudanese Children in Refugee Camps in Northern Uganda: An Exploratory Study

This paper presents the results of an exploratory study on the psychosocial effects of the war situation and subsequent flight on South Sudanese children who were compared to a group of Ugandan children who did not have these experiences of war and flight. In addition to the independent variables such as sociodemographic variables and traumatic events and daily life stress, the dependent variable psychological consequences--according to parents and children themselves--as well as the influence of the mediating factors of social support and coping behaviour are presented. Results showed that Sudanese refugee children had experienced significantly more traumatic events and suffered more daily hassles than the Ugandese comparison group. They were less satisfied with the social support they received. At the same time, they used more coping modes. Compared to Ugandan children, the Sudanese reported significantly more PTSD-like complaints, behavioural problems, and depressive symptoms.     

Prevalence, comorbidity and course of trauma reactions in young burn-injured children

Background: Infants, toddlers and preschoolers are the highest risk group for burn injury. However, to date this population has been largely neglected. This study examined the prevalence, onset, comorbidity and recovery patterns of posttrauma reactions in young children with burns. Methods: Parents of 130 unintentionally burned children (1–6 years) participated in the study. The Diagnostic Infant Preschool Assessment was conducted with parents at 1 and 6 months postinjury. Results: The majority of children were resilient. However, 35% were diagnosed with at least one psychological disorder, there was a high rate of comorbidity with posttraumatic stress disorder, and 8% of children did not experience recovery in distress levels over the course of 6 months. Conclusions: These outcomes are likely to have serious repercussions for a young child’s medical and psychosocial recovery as well as their normal developmental trajectories. It is recommended that screening, prevention and early intervention resources are incorporated into paediatric health care settings to optimise children’s psychological adjustment following burn injury.     

Practitioner review: assessment and treatment of refugee children and adolescents who have experienced war-related trauma

BACKGROUND: Increasingly clinicians are being asked to assess and treat young refugees, who have experienced traumatic events due to war and organised violence. However, evidence-based guidance remains scarce. METHOD: Published studies on the mental health difficulties of refugee children and adolescents, associated risk and protective factors, as well as effective interventions, particularly those designed to reduce war-related post-traumatic stress disorder (PTSD) symptoms, were identified and reviewed. The findings are summarised. RESULTS: Young refugees are frequently subjected to multiple traumatic events and severe losses, as well as ongoing stressors within the host country. Although young refugees are often resilient, many experience mental health difficulties, including PTSD, depression, anxiety and grief. An awareness of relevant risk and protective factors is important. A phased model of intervention is often useful and the need for a holistic approach crucial. Promising treatments for alleviating symptoms of war-related PTSD include cognitive behavioural treatment (CBT), testimonial psychotherapy, narrative exposure therapy (NET) and eye movement desensitisation and reprocessing (EMDR). Knowledge of the particular needs of unaccompanied asylum-seeking children (UASC), working with interpreters, cross-cultural differences, medico-legal report writing and the importance of clinician self-care is also necessary. CONCLUSION: More research is required in order to expand our limited knowledge base.     

Post-traumatic stress syndrome in children]

Post traumatic stress disorder occurs in children as well as in adults following a stressful traumatic event, either unique and exceptionally severe, or recurrent as in abused children. The main symptoms are repetition, avoidance and neurovegetative activation. Prevention and recognition of this disorder are important. Parents must be sensitized to the necessity of an early management.     

War exposure and maternal reactions in the psychological adjustment of children from Bosnia-Hercegovina

As part of a UNICEF-sponsored Psychosocial Programme in Bosnia, data were collected from a representative sample of 339 children aged 9-14 years, their mothers, and their teachers in order to investigate risk and moderating factors in children's psychological reactions to war. Self-report data from children revealed high levels of post-traumatic stress symptoms and grief reactions, but normal levels of depression and anxiety. Mothers' self-reports also indicated high levels of post-traumatic stress reactions, but normal levels of depression and anxiety. Child distress was related to both their level of exposure and to maternal reactions. Structural equation modeling was used to quantify the relationships between these risk factors and child distress, and to examine putative pathways to account for the association between child and maternal health. Children's adjustment was associated significantly with both exposure (phi = .37) and maternal mental health (phi = .37). Modeling also revealed a significant distorting effect of mother's own mental health on behavioural ratings of her child (psi = .59). Although evidence exists for an association between maternal mental health and mother rating errors, there is also a substantive association between maternal mental health and children's adjustment following war.     

Psychological screening of children for post-traumatic stress disorder

One hundred and seventy children attending a hospital accident and emergency department following everyday trauma were interviewed and completed the Post-traumatic Stress Disorder (PTSD) screening battery suggested by Yule and Udwin (1991). Diagnostic interviews (CAPS-C) confirmed that 39 (22.9%) fulfilled the DSM-IV criteria for PTSD. There were significant differences between children with and without PTSD on each individual component of the screening battery. Various criteria for caseness were evaluated and at 6 weeks post trauma the screen identified up to 90% of children diagnosed with PTSD and 73% with borderline conditions. A subset of 36 children were reassessed 8 months post trauma and all children with persistent PTSD were correctly identified by initial screen scores. The limitations of the study and the role of screening for PTSD in the absence of proven psychological interventions are discussed.