Poly-traumatization and harmful behaviors in a sample of emergency department Psychiatric Intake Response Center youth

Neural reactivity to threat impacts the association between bullying victimization and suicide risk in youth

Bullying victimization is a risk factor for suicidal ideation, suicide behaviors, and death by suicide in youth. However, not all victims of bullying report suicidal thoughts and behaviors, suggesting that there may be certain subgroups who are at high risk for suicide. Neuroimaging studies suggest that individual differences in neurobiological threat reactivity may contribute to increased vulnerability to suicide, particularly in the context of repeated exposure to bullying. The purpose of the present study was to examine the unique and interactive effects of past-year bullying victimization and neural reactivity to threat on suicide risk in youth. Ninety-one youth (ages 16-19) completed self-report measures of past-year bullying victimization and current suicide risk. Participants also completed a task designed to probe neural reactivity to threat. Specifically, participants passively viewed negative or neutral images during functional magnetic resonance imaging. Bilateral anterior insula (AIC) and amygdala (AMYG) reactivity to threat/negative images (>neutral images) was used to capture threat sensitivity. Greater bullying victimization was associated with increased suicide risk. There was also a bullying by AIC reactivity interaction such that among individuals with high AIC reactivity, greater bullying was associated with increased suicide risk. Among individuals with low AIC reactivity, there was no association between bullying and suicide risk. Results suggest that youth with increased AIC reactivity to threat may be particularly vulnerable to suicide in the context of bullying. These individuals may represent a high-risk group for subsequent suicide behavior and AIC function may be a promising objective prevention target.

What about trauma? Accounting for trauma exposure and symptoms in the risk of suicide among adolescents who have been adopted

BACKGROUND

Research suggests that individuals who have been adopted are at increased risk for suicidal behaviors, but this research does not account for the role of trauma.

OBJECTIVES

The study provided rates of trauma exposure among individuals who were adopted with child welfare involvement. The study also examined risk of suicidal ideation (SI) and behaviors (SB) based on adoption status, first as bivariate associations and then in context of trauma exposure and symptoms.

PARTICIPANTS AND SETTING

Participants in the LONGSCAN study were recruited at multiple US sites based on various risk factors for maltreatment. The current study included only those individuals with adequate information at key timepoints (n = 894), 106 (11.9%) of whom were adopted.

METHODS

Measures were collected at multiple timepoints, including caregiver-report, self-report, and review of child welfare records. Data were analyzed through logistic regression and descriptive statistics.

RESULTS

High rates of potentially traumatic experiences were found among individuals who were adopted (over 93%). The bivariate logistic regression replicated previous findings that adolescents who were adopted had increased likelihood of endorsing SI (OR 2.14, 95% CI 1.27-3.60, p = .004) and SB (OR 2.40, 95% CI 1.24-4.63, p = .009) compared to non-adopted peers. However, when polytrauma and traumatic stress symptoms were added to the model, adoption was no longer a significant predictor for SI (OR 1.35, 95% CI 0.70-2.60, p = .369) or SB (OR 1.46, 95% CI 0.68-3.13, p = .332).

CONCLUSIONS

Although much remains to be explored about the association between adoption and risk for suicidal thoughts and behaviors, the current study indicates that traumatic stress plays a critical role.

Influences of victimization and comorbid conditions on substance use disorder outcomes in justice-involved youth: A discrete time survival mixture analysis

To understand how exposure to victimization during adolescence and the presence of comorbid psychological conditions influence substance use treatment entry and substance use disorder diagnosis from 14 to 25 years old among serious juvenile offenders, this study included 1,354 serious juvenile offenders who were prospectively followed over 7 years. Growth mixture modeling was used to assess profiles of early victimization during adolescence (14-17 years). Discrete time survival mixture analysis was used to assess time to treatment entry and substance use disorder diagnosis. Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) were used as predictors of survival time. Mixture models revealed three profiles of victimization: sustained poly-victimization, moderate/decreasing victimization, and low victimization. Youth in the sustained poly-victimization class were more likely to enter treatment earlier and have a substance use diagnosis earlier than other classes. PTSD was a significant predictor of treatment entry for youth in the sustained poly-victimization class, and MDD was a significant predictor of substance use disorder diagnosis for youth in the moderate/decreasing victimization class. Therefore, substance use prevention programming targeted at youth experiencing poly-victimization in early adolescence-especially those who have PTSD or MDD-is needed.

Who Gets Protection? A National Study of Multiple Victimization and Child Protection Among Taiwanese Children

This study aims to examine the prevalence of multiple types of child victimization and the effects of multiple types of victimization on children's mental health and behavior in Taiwan. The study also examines the child-protection rate and its correlates among children experiencing various types of victimization. This study collected data with a self-report questionnaire from a national proportionately stratified sample of 6,233 fourth-grade students covering every city and county in Taiwan in 2014. After calculating the 1-year prevalence of child victimization, the study found that bullying was the most prevalent (71%), followed by physical neglect (66%), psychological violence (43%), inter-parental violence (28%), community violence (22%), physical abuse (21%), and sexual violence (9%). As the number of victimization types increased, children were more likely to report greater posttraumatic symptoms, psychiatric symptoms, suicide ideation, self-harm thoughts, and violent behaviors. Gender, neonatal status, parental marital status, and other family risks were significantly associated with elevated incidences of the victimization types. Only 20.6% of the children who had experienced all seven types of victimization had received child protective services. A child was more likely to receive child protective services if he or she had experienced sexual violence, community violence, inter-parental violence exposure, higher family risks, higher suicidal ideation, or living in a single-parent or separated family. In conclusion, this study demonstrates the cumulative effects and the harmful effects that children's experience of multiple types of victimization can have on the children's mental health and behavior. The present findings also raise alarms regarding the severity of under-serving in child-victimization cases. These results underscore the importance of assessing, identifying, and helping children with multiple victimization experiences.

Emergency Department Use Following Pediatric Psychiatric Hospitalization

OBJECTIVE

Emergency department (ED) use has increased disproportionately for pediatric psychiatric care. This study aimed to identify predictors of ED use within 30 days of discharge from a pediatric psychiatric hospitalization.

METHODS

ED use was assessed in the 30 days after discharge. Univariate logistic regression modeling identified predictors of ED use, which were used in subsequent multivariate modeling.

RESULTS

Greater number of trauma types (odds ratio [OR]=1.92, 95% confidence interval [CI]=1.50-2.45, z=2.67, p=0.008), generalized anxiety disorder (OR=3.20, 95% CI=1.78-5.76, z=1.98, p=.048), and longer length of stay (OR=1.05, 95% CI=1.03-1.07, z=2.74, p=0.006) were associated with increased ED use within 30 days of discharge.

CONCLUSIONS

ED use may be an important marker of negative outcomes within 30 days of discharge from pediatric psychiatric hospitalization. Patients with high trauma exposure, anxiety, and acuity marked by increased length of stay may require additional services to prevent unplanned ED use for psychiatric crises.

Childhood poly-victimization and children's health: A nationally representative study

BACKGROUND

Although research on the negative effects of childhood poly-victimization is substantial, few studies have examined the relationship between poly-victimization and younger children's physical health and diseases.

OBJECTIVE

This study examines the associations between poly-victimization and children's health problems requiring medical attention.

METHODS

A national stratified cluster random sampling was used to select and approach 25% of the total primary schools in Taiwan, and 49% of the approached schools agreed to participate in this study. We collected data with a self-report questionnaire from 6233 (4th-grade) students aged 10-11, covering every city and county in Taiwan.

RESULTS

Logistic regression analyses demonstrate a significant dose-response relationship between children's poly-victimization exposure and their health problems including hospitalization, serious injury, surgery, daily-medication requirements, heart murmurs, asthma, dizziness or fainting, allergies, kidney disease, therapies for special needs, smoking, and alcohol use. The results indicate that children's risk of having a health problem grew significantly with each increase in the number of victimization types that children experienced.

CONCLUSIONS

These research findings underscore the effect of poly-victimization on children's health problems requiring medical attention, and stress the need for both proper screening methods for children's exposure to poly-victimization and stronger awareness of poly-victimization's effects on health conditions in healthcare clinics.

Violent Poly-Victimization: The Longitudinal Patterns of Physical and Emotional Victimization Throughout Adolescence (11-17 Years)

In this study, we aimed to characterize developmental patterns of poly-victimization in a normative sample of adolescents by applying longitudinal latent class analysis. Using the four most recent waves of data from the Zurich Project on the Social Development of Children and Youths (z-proso), we identified three classes, or separate groups, of youths with distinct patterns of victimization from age 11 to 17. The largest class represented young people who were least likely to be victimized in any way and at any time. The two smaller groups represented different types of poly-victimization-a non-parental and a long-term parental victimization group. Adolescents in the two groups differed both in the number as well as type of victimization that they experienced at different times. Moreover, class membership also had implications for different mental health outcomes.

Examination of polytrauma typologies: A latent class analysis approach

Potentially traumatizing events (PTE) are highly prevalent, and are associated with detrimental effects on psychological health, including increased risk of posttraumatic stress disorder (PTSD). Multiple endorsed PTEs (polytraumatization) may have even greater effects on a person's health than the impact of a single index event. To better understand patterns of polytraumatization, person-centered analytic techniques such as Latent class analysis (LCA) are recommended. The current study used LCA to explore latent subgroupings of people based on their endorsement of PTEs, thus defining patterns in PTE exposure. The sample included 850 participants who endorsed at least one PTE on a web-administered Trauma History Questionnaire (THQ). Results indicated a best-fitting 3-class solution: (1) a class with a greater probability of experiencing interpersonal PTEs and other PTEs, (2) a class with moderate PTE exposure and higher probability of mugging and accidents, and (3) a class with low PTE exposure. Differences in age, gender, and PTSD symptom severity accounted for class membership. Results suggest the experience of interpersonal PTEs may be a risk factor for additional lifetime PTE exposure, and is associated with increased PTSD severity. Additional findings underscore the heterogenity of trauma experiences, highlighting the importance of examining such patterns in future research.

Latent classes of childhood poly-victimization and associations with suicidal behavior among adult trauma victims: Moderating role of anger

The aims of the present study were first to identify discrete patterns of childhood victimization experiences including crime, child maltreatment, peer/sibling victimization, sexual violence, and witnessing violence among adult trauma victims using latent class analysis; second, to examine the association between class-membership and suicidal behavior, and third to investigate the differential role of dispositional anger on the association between class-membership and suicidal behavior. We hypothesized that those classes with accumulating exposure to different types of childhood victimization (e.g., poly-victimization) would endorse higher suicidal behavior, than the other less severe classes, and those in the most severe class with higher anger trait would have stronger association with suicidal behavior. Respondents were 346 adults (N=346; M_age=35.0years; 55.9% female) who had experienced a lifetime traumatic event. Sixty four percent had experienced poly-victimization (four or more victimization experiences) and 38.8% met the cut-off score for suicidal behavior. Three distinct classes emerged namely, the Least victimization (Class 1), the Predominantly crime and sibling/peer victimization (Class 2), and the Poly-victimization (Class 3) classes. Regression analysis controlling for age and gender indicated that only the main effect of anger was significantly associated with suicidal behavior. The interaction term suggested that those in the Poly-victimization class were higher on suicidal behavior as a result of a stronger association between anger and suicidal behavior in contrast to the association found in Class 2. Clinical implications of findings entail imparting anger management skills to facilitate wellbeing among adult with childhood poly-victimization experiences.