Posttraumatic symptomatology in children and adolescents after an industrial fire

Exploring the impacts of perceived locus of control on post-traumatic stress disorder among disaster survivors: A systematic review

WHAT IS KNOWN ON THE SUBJECT?: It was previously reported that perceived external locus of control may exacerbate depressive symptoms, is associated with anxiety, boosts stress and general mental distress and weakens resilience against traumatic situations or difficulties. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Those with a higher external locus of control are more prone to develop PTSD symptoms since the perceived external locus of control is among the predictors of PTSD. An internal locus of control is considered important in preventing PTSD, although an external locus of control appears to be a variable that causes/increases the prevalence of PTSD. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is known that nurses are deployed in clinical and fieldwork during disaster and assume key roles both interventional practices and psychosocial education. Thus, it is of particular importance for mental health nurses to be aware of the locus of control in themselves, their colleagues, and the community before, during and after disasters to be able to combat the risk/presence of PTSD.

ABSTRACT

AIM: The present systematic review explored the impacts of perceived locus of control on PTSD among individuals experiencing disasters.

METHOD

This is a systematic review study carried out through a search of the relevant research published in English over the period December 2021 to April 2022. Accordingly, we sought the studies to review on the Web of Science, PubMed, Scopus, Cochrane and Google Scholar databases using the keywords "Child, Children, Adolescent, Adolescence, Adult, Aged, Elderly, Post-Traumatic Stress Disorder, PTSD, Internal-External Control, Locus of Control, Disasters, Natural Disasters."

RESULTS

A total of 1.011 studies were found in the five databases using the keywords above. Following the exclusions, the remaining six studies were recruited for this systematic review. The six studies in question addressed earthquakes (2), hurricanes (1), wildfires (1), SARS (1) and fireworks explosions (1). In the study with wildfire survivors, there was a weak significant association between external locus of control and PTSD among those directly exposed to the disaster (r = .15, p < .01). The study with survivors of the SARS epidemic demonstrated that those with a high perceived chance (external) locus of control suffered PTSD (p = .001). An internal locus of control is considered important in preventing PTSD, although an external locus of control appears to be a variable that causes/increases the prevalence of PTSD.

CONCLUSION

It was concluded that perceived locus of control is related to PTSD in individuals experiencing a disaster. The additional evidence was that post-disaster PTSD among those with a high perceived external locus of control is stronger than those with a high perceived internal locus of control.

Development of the School-Aged Life Impact Burn Recovery Evaluation (SA-LIBRE5-12) Profile: A Conceptual Framework

Pediatric burn injuries can alter the trajectory of the survivor's entire life. Patient-centered outcome measures are helpful to assess unique physical and psychosocial needs and long-term recovery. This study aimed to develop a conceptual framework to measure pediatric burn outcomes in survivors aged 5 to 12 years as a part of the School-Aged Life Impact Burn Recovery Evaluation Computer Adaptive Test (SA-LIBRE5-12 CAT) development. This study conducted a systematic literature review guided by the WHO International Classification of Functioning - Child and Youth and domains in the American Burn Association/Shriners Hospitals for Children Burn Outcomes Questionnaire5-18. Interviews with eight parents and seven clinicians were conducted to identify important domains in child recovery. One clinician focus group with four clinicians was completed to identify gaps in the preliminary framework, and semi-weekly expert consensus meetings were conducted with three experts to solidify the framework. Qualitative data were analyzed by grounded theory methodology. Three major thematic outcome domains emerged: 1) Physical Functioning: fine motor and upper extremity, gross motor and lower extremity, pain, skin symptoms, sleep and fatigue, and physical resilience; 2) Psychological Functioning: cognitive, behavioral, emotional, resilience, and body image; and 3) Family and Social Functioning: family relationships, and parental satisfaction, school, peer relations and community participation. The framework will be used to develop item banks for a CAT-based assessment of school-aged children's health and developmental outcomes, which will be designed for clinical and research use to optimize interventions, personalize care, and improve long-term health outcomes for burned children.

The Role of Social Determinants in Mental Health and Resilience After Disasters: Implications for Public Health Policy and Practice

In this general literature review, we will explore the impacts and contribution of social determinants to mental health and resiliency following both natural and man-made disasters. Natural disasters, such as wildfires, earthquakes, tsunamis, and hurricanes, as well as man-made disasters, such as civil wars, have been known to inflict significant damage to the mental health of the victims. In this paper, we mainly explore some most studied vulnerability and protective social determinant factors such as gender, age, ethnicity, socials support and socioeconomic status for the mental health and resiliency in survivors of such disasters. Several other possible factors such as previous trauma, childhood abuse, family psychiatric history, and subsequent life stress that were explored by some studies were also discussed. We conducted a literature search in major scientific databases, using keywords such as: mental health, social determinants, disasters, wildfires, earthquakes, terrorist attacks, and resilience. We discuss the implications for public health policy and practice.

Prevalence of posttraumatic stress disorder among adolescents in school and its impact on their well-being: a cross-sectional study

INTRODUCTION

anyone can develop posttraumatic stress disorder (PTSD) following a traumatic event; this disorder can develop comorbid PTSD disorders such as anxiety and depression, which could seriously interfere with the daily life of the adolescent who was to be the subject of our study by evaluating the prevalence of PTSD in public schools and also evaluating the impact of this disorder.

METHODS

the survey was carried out during the period from March to June 2017. Participants were selected for a cross-sectional survey. Standardized questionnaires (life events checklist, CPTS-RI, STAIY and CDI) were used. The independent variables were investigated using binary logistic regression analyzes which were performed to investigate factors associated with PTSD.

RESULTS

the number of students was 982 adolescents with an age of 12 to 17 years (14.98 ± 1.49) and the participation rate was 88.69% (n = 871). A high prevalence of PTSD was found with 19.3% (n = 168). The factors independently associated with PTSD included being a girl (adjusted odds ratio (AOR) =2.113, 95% C.I =1.015-4.399, p=0.046), having a middle school level (AOR =5.765, 95% C.I =2.262-14.692, p<0.0001), sleep interrupted (AOR =0.142, 95% C.I =0.027-0.745, p=0.021), guilt (AOR =27.378, 95% C.I =6.835-109.663, p<0.0001), difficulties of memory (AOR =0.157, 95% C.I = 0.071-0.346, p<0.0001), and difficulties of concentration (AOR =0.041, 95% C.I = 0.004-0.392, p=0.006). Among adolescents in school with PTSD, anxiety had 79.1% (n = 133) and depression had 51.1% (n = 86).

CONCLUSION

the prevalence of PTSD and comorbid anxiety and depression was high among educated students. Factors associated with PTSD included being in college, being a girl, and having guilt. It is necessary to adapt suitable treatments immediately after a traumatic event or during the disease.

External locus-of-control partially mediates the association between cumulative trauma exposure and posttraumatic stress symptoms among adolescents from diverse background

Locus of control (LOC) is a modifiable mediator of symptoms of posttraumatic stress disorder (PTSD) among traumatized individuals and a potential target of intervention. Compared with studies involving adults, the potential mediation effect of LOC on PTSD symptoms among trauma-exposed children and adolescents is relatively under-explored. This study, therefore, assessed the mediation effects of LOC on the association between lifetime cumulative trauma and PTSD symptoms among a large cohort of adolescents from different cultural background.

Cross-sectional study.

LOC was determined using the Multi-Dimension Locus of Control Scale; Posttraumatic stress symptoms using the UCLA PTSD Reaction Index; and other significant negative life events using the Life Events Checklist.

Among 3826 adolescents who completed the study, external LOC explained 24% of variance (R² = .24; F_2,3823 = 619.01; p < .01) in PTSD symptoms and had significant indirect effect on the relationship between self-reported cumulative traumatic event exposure and PTSD symptoms (ß = .14; 95% BC CI [.10, .20]). Moderated mediation results showed significant potentiation of the moderation effects among older adolescents; boys; and those from more affluent families.

The study further strengthened the hitherto limited evidence that external LOC partially mediate the relationship between cumulative trauma exposure and PTSD symptoms among adolescents.

Immediate and Long-Term Mental Health Outcomes in Adolescent Female Rape Survivors

Rape is considered a stressful trauma and often has long-lasting health consequences. Compared with adult females, limited data exist on the psychological impact of rape in adolescents. The aim of this study was to assess the prevalence and associated factors of emotional distress in a cohort of adolescent rape survivors in Cape Town. Participants in this prospective longitudinal study were 31 adolescent female rape survivors recruited from a rape clinic in Cape Town and assessed within 2 weeks of the assault. Assessment measures included a sociodemographic questionnaire and initial screening with the Child and Adolescent Trauma Survey (CATS), the patient-rated Children's Depression Inventory (CDI), and the Multidimensional Anxiety Scale for Children (MASC). The CATS, CDI, and MASC were repeated at 1, 3, 6, 9, and 12 months post enrollment. Psychiatric diagnoses were made with the clinician-administered Mini International Neuropsychiatric Interview-Child and Adolescent version (MINI-Kid). At baseline, on the MINI-Kid, a definitive diagnosis of major depressive episode was endorsed in 22.6% of the participants. Stress-related disorders were found in 12.9%, whereas 16.1% had anxiety disorders. There was no diminution of symptoms on self-reported psychopathology measures at follow-up assessment over the five follow-up time points, suggesting persistent psychopathology over a 1-year period despite repeated clinical assessments and supportive counseling. Symptoms of anxiety, depression, and posttraumatic stress disorder in this sample of adolescent female rape survivors were high at enrollment and found to be persistent, underlining the need for long-term support, screening, and evidence-based follow-up care.

Psychosocial Difficulties in Adolescents nine Months after a Railway Accident

A railway accident which occurred in Lac-Megantic in Quebec, Canada, caused disruption for an entire community. This study examines the psychosocial difficulties in a group of exposed adolescents aged between 11 to 17, nine months after the tragedy. The analyses were conducted on a sample of 515 adolescents, attending high school, and living near the impact area. Post-traumatic stress disorder (PTSD), mental health problems (depression, anxiety), and problem use of alcohol or drugs prevalence were estimated. Multiple logistic regression was used to identify risk factors for PTSD clinical threshold. Almost half (43.4%) of adolescents reported being severely exposed to the railway accident and one third (31.3%) have reported a PTSD. Serious injuries, depression and anxiety (p < .05) were associated with greater risks for adolescents with a PTSD. However, sex, victimization, and emerging problems or problem use of alcohol or drugs are not associated with the PTSD. The results of the study highlight the relationship between a traumatic event such as the railway accident and the presence of PTSD nine months after, as well as risk factors for PTSD in adolescents. Paying close attention to mental health problems in adolescents when a traumatic event occurs and provide adequate aid is essential.

Brief Practical Screeners in English and Spanish for Acute Posttraumatic Stress Symptoms in Children

With millions of children experiencing acute traumatic events, validated screening tools are needed in both research and service contexts. We aimed to identify and evaluate short forms of the Acute Stress Checklist for Children in English (ASC-Kids) and Spanish (Cuestionario de Estrés Agudo-Niños [CEA-N]), using data from 4 samples (Ns of 254, 225, 176, and 80) of children with recent acute trauma. Confirmatory factor analyses of the full checklist in the largest sample guided item selection for 6-item and 3-item short forms. Across samples, both short forms (ASC-6/ASC-3 in English; CEA-6/CEA-3 in Spanish) were correlated with acute stress disorder (ASD) symptom severity on the full checklist (r = .79 to .92), and on an interview measure (r = .52 to .62). Receiver operating curve analyses for each short form detecting current ASD status showed high areas under the curve (.76 to .95). Cutoff scores identified based on Sample 1 provided acceptable sensitivity (.59 to 1.00) and specificity (.57 to .86) across samples. Children scoring above the cutoff on each screener reported greater concurrent impairment from ASD symptoms and more severe posttraumatic stress 3 months later. These very brief measures could expand clinicians' and researchers' ability to screen for acute posttraumatic stress in children.

Variations in the influence of parental socialization of anxiety among clinic referred children

This study examined the relations between parental socialization of child anxious behaviors (i.e., reinforcement, punishment, modeling, transmission of information) and child anxiety and related problems at varying child sensitivity levels. Data corresponding to 70 clinic-referred children (M age = 9.86 years; 50% girls; 49% Hispanic/Latino, 51% Caucasian) showed that for children with low (but not high) anxiety sensitivity, anxiety-related parental socialization behaviors were associated with more child anxiety and depression symptoms. Findings also indicated that parental socialization of anxious behaviors and anxiety sensitivity functioned similarly in the prediction of anxiety and depression across Caucasian and Hispanic/Latino children. There were no significant mean level variations across child sociodemographic characteristics in general, but anxiety-promoting parenting behaviors were twice as high in Hispanic/Latino compared to Caucasian families.

Disasters and Depressive Symptoms in Children: A Review

BACKGROUND

Disasters are destructive, potentially traumatic events that affect millions of youth each year.

OBJECTIVE

The purpose of this paper was to review the literature on depressive symptoms among youth after disasters. Specifically, we examined the prevalence of depression, risk factors associated with depressive symptoms, and theories utilized in this research area.

METHODS

We searched MEDLINE, PsycInfo, and PubMed electronic databases for English language articles published up to May 1, 2013. Reference lists from included studies were reviewed to capture additional studies. Only quantitative, peer reviewed studies, conducted with youth under the age of 18 years, that examined postdisaster depressive symptoms were included. Seventy-two studies met inclusion criteria. Prevalence of depressive symptoms, disaster type, correlates of depressive symptoms, and theories of depressive symptoms were reviewed.

RESULTS

Only 27 studies (38%) reported on prevalence rates among youth in their sample. Prevalence rates of depression among youth postdisaster ranged from 2% to 69%. Potential risk factors were identified (e.g., female gender, exposure stressors, posttraumatic stress symptoms). Theories were examined in less than one-third of studies (k = 21).

CONCLUSIONS

Given the variability in prevalence rates, difficulty identifying a single profile of youth at risk for developing depressive symptoms, and lack of a unifying theory emerging from the studies, recommendations for future research are discussed. Use of established batteries of assessments could enable comparisons across studies. Merging existing theories from children's postdisaster and depression literatures could aid in the identification of risk factors and causal pathways.

The 39-item Child Exposure to Community Violence (CECV) scale: exploratory factor analysis and relationship to PTSD symptomatology in trauma-exposed children and adolescents

BACKGROUND

Exposure to multiple forms of community violence in youth is associated with a wide range of negative health outcomes. A number of scales measuring community violence exposure have been developed, including the Child Exposure to Community Violence Checklist (CECV).

PURPOSE

This study examined the psychometric properties of an adapted version of the CECV in a South African sample of trauma-exposed youths. In addition, the study assessed the relationship between exposure to community violence and posttraumatic stress disorder (PTSD) symptomatology.

METHODS

Trauma-exposed youth completed two self-report instruments, namely, the CECV and the Child PTSD Checklist (CPC), on a single occasion. Exploratory factor analysis (EFA) was used to investigate the factor structure of the CECV, and the association between CECV and CPC scores was also explored.

RESULTS

EFA of the CECV revealed three factors that accounted for 38.66 % of variance in the model and consisted of 29 of the original 39 items. Reliability of the three factors ranged from moderate to excellent (α = 0.682 to α = 0.892). Exposure to community violence was positively correlated with posttraumatic stress symptomatology (r = 0.464, p < 0.001). Adolescents attending high school reported significantly higher levels of exposure to community violence than did children in primary school.

CONCLUSION

Findings provide support for the conceptualization of exposure to community violence as comprising distinct, multiple factors. Levels of exposure to community violence and family violence were high. We found a highly significant, positive association between exposure to community violence and PTSD symptomatology, providing evidence for the convergent validity of the CECV.

A longitudinal study of posttraumatic stress disorder symptoms and its relationship with coping skill and locus of control in adolescents after an earthquake in China

Background/Objectives

Post-traumatic stress disorder is a common psychological maladaptation among adolescents after undergoing an earthquake. Knowledge about the prevalence and maintenance of post-traumatic stress disorder symptoms and the changes of its predictors over time can help medical providers assist adolescent survivors with mitigating long-term impacts. This study examined the changes in posttraumatic stress disorder symptoms and its relationship with coping skill and locus of control among adolescent earthquake survivors in China.

Methodology/Findings

The study used an observational longitudinal design. A total of 1420 adolescents were evaluated twice after the earthquake by using the Post-traumatic stress disorder Checklist-Civilian Version, The Internality, Powerful others and Chance scale and the Coping Styles Scale. The results indicated that the mean scores of posttraumatic stress disorder symptoms were decreased significantly and the positive rates of posttraumatic stress disorder symptoms also declined remarkably at 17 months compared to the 3 months post-earthquake. Internality locus of control and problem solving coping skill were effective resilient factors for the development and maintenance of posttraumatic stress disorder symptoms, while chance locus of control was a powerful risk factor of posttraumatic stress disorder symptoms as well as being female, being injured and property loss.

Conclusions/Significance

Continuous screening is recommended to identify adolescent earthquake survivors with posttraumatic stress disorder symptoms. More attention should be paid to adolescent survivors who are prone to adopt passive coping strategies responding to trauma events and who own external causal attribution.

Prevalence and trajectory of psychopathology among child and adolescent survivors of disasters: a systematic review of epidemiological studies across 1987-2011

AIMS

The goal of this paper was to systematically review evidence on (1) the potential magnitude of the psychopathological impacts of community-wide disasters on child and adolescent survivors, and (2) the long-term course or trajectory of disaster-induced psychopathology among children and adolescents.

METHODS

The PubMed/MEDLINE and PsycINFO databases were searched from their respective inception through December 2011. All of the resulting epidemiological studies of child and adolescent survivors following community-wide disasters were examined.

RESULTS

Sixty cross-sectional studies and 25 longitudinal or long-term follow-up studies were identified. The estimated rates of posttraumatic stress disorder (PTSD) and depression among child and adolescent survivors varied greatly across the included studies, ranging from 1.0 to 95 % and 1.6 to 81 %, respectively, while the reported rates of diagnosable PTSD according to the DSM-IV criteria and diagnosable depression ranged from 1.0 to 60 % and 1.6 to 33 %, respectively. The long-term courses of psychopathology among youthful survivors were summarized. Methodological issues with those studies were discussed.

CONCLUSIONS

The empirical findings summarized in this review highlight the importance of psychosocial intervention at early postdisaster stages for child and adolescent survivors. The methodological flaws revealed by this review indicate the need for continued attempts to better understand the epidemiology and trajectory of psychopathological problems among youthful survivors.

Distinguishing primary and secondary variants of callous-unemotional traits among adolescents in a clinic-referred sample

The current study used model-based cluster analyses to determine if there are 2 distinct variants of adolescents (ages 11-18) high on callous-unemotional (CU) traits that differ on their level of anxiety and history of trauma. The sample (n = 272) consisted of clinic-referred youths who were primarily African American (90%) and who came from low-income families. Consistent with hypotheses, 3 clusters emerged, including a group low on CU traits, as well as 2 groups high on CU traits that differed in their level of anxiety and past trauma. Consistent with past research on incarcerated adults and adolescents, the group high on anxiety (i.e., secondary variant) was more likely to have histories of abuse and had higher levels of impulsivity, externalizing behaviors, aggression, and behavioral activation. In contrast, the group low on anxiety (i.e., primary variant) scored lower on a measure of behavioral inhibition. On measures of impulsivity and externalizing behavior, the higher scores for the secondary cluster were found only for self-report measures, not on parent-report measures. Youths in the primary cluster also were perceived as less credible reporters than youths in the secondary cluster (i.e., secondary variant) or cluster low on CU traits. These reporter and credibility differences suggest that adolescents within the primary variant may underreport their level of behavioral disturbance, which has important assessment implications.

Gender patterns in the contribution of different types of violence to posttraumatic stress symptoms among South African urban youth

OBJECTIVE

Identifying the comparative contributions of different forms of violence exposure to trauma sequelae can help to prioritize interventions for polyvictimized youth living in contexts of limited mental health resources. This study aimed to establish gender patterns in the independent and comparative contributions of five types of violence exposure to the severity of posttraumatic stress symptoms among Xhosa-speaking South African adolescents.

METHOD

Xhosa-speaking adolescents (n=230) attending a high school in a low-income urban community in South Africa completed measures of violence exposure and posttraumatic stress symptoms.

RESULTS

While witnessing of community violence was by far the most common form of violence exposure, for the sample as a whole only sexual victimization and being a direct victim of community violence, together with gender, contributed independently to the severity of posttraumatic stress symptoms. When the contribution of different forms of violence was examined separately for each gender, only increased exposure to community and sexual victimization were associated with symptom severity among girls, while increased exposure to direct victimization in both the community and domestic settings were associated with greater symptom severity in boys.

CONCLUSIONS

The findings provide some preliminary motivation for focusing trauma intervention initiatives in this community on girls who have experienced sexual abuse compounded by victimization in the community, and boys who have been direct victims of either domestic or community violence. Further research is required to establish whether the risk factors for posttraumatic stress symptoms identified among adolescents in this study are consistent across different communities in South Africa, as well as across other resource-constrained contexts.

Parents' retrospective reports of youth psychological responses to the sniper attacks in the Washington, DC, area

A random-digit-dial telephone survey was conducted in May 2003, with 355 parents of children ages 2-17 years old, living in Washington, DC, or in the two surrounding counties during the October 2002 sniper shootings, to examine parent retrospective reports of child event-related psychological distress. An estimated 32% of parents reported that children experienced at least one psychological distress symptom related to sniper shootings. Older children, females, children with a history of trauma exposure prior to sniper attacks, children whose parents reported routine disruption as the result of attacks, children whose parents perceived them as at great risk for harm from sniper attacks, and those children whose parents reported more traumatic stress symptoms in response to attacks were at greatest risk for reported psychological distress.

Attack-related life disruption and child psychopathology in New York City public schoolchildren 6-months post-9/11

In the aftermath of disasters, understanding relationships between disaster-related life disruption and children's functioning is key to informing future postdisaster intervention efforts. The present study examined attack-related life disruptions and psychopathology in a representative sample (N = 8,236) of New York City public schoolchildren (Grades 4-12) surveyed 6 months after September 11, 2001. One in 5 youth reported a family member lost their job because of the attacks, and 1 in 3 reported their parents restricted their postattack travel. These forms of disruption were, in turn, associated with elevated rates of probable posttraumatic stress disorder and other anxiety disorders (and major depressive disorder in the case of restricted travel). Results indicate that adverse disaster-related experiences extend beyond traumatic exposure and include the prolonged ripple of postdisaster life disruption and economic hardship. Future postdisaster efforts must, in addition to ensuring the availability of mental health services for proximally exposed youth, maintain a focus on youth burdened by disaster-related life disruption.

Prevalence of mental health problems in adolescent schoolchildren in Galle District, Sri Lanka: eight months after tsunami

The present study was conducted to assess the prevalence and associations of mental health problems (MHPs) among adolescent schoolchildren in Sri Lanka 8 months after the tsunami disaster. A descriptive cross-sectional study was carried out in the Galle Municipality area, Sri Lanka. The study instrument consisted of a self-administered questionnaire and the validated Sinhalese version of the Strengths and Difficulties Questionnaire. The prevalence of MHPs in the study population was 32.2% (confidence interval [CI] = 28.44% to 35.96%). Direct experience of the tidal wave (odds ratio [OR] = 2.93, P = .013), perception of being affected by tsunami (OR = 1.79, P = .0014), and impact of rumors (OR = 1.85, P < .001) were significantly associated with MHPs. Not having a close friend (OR = 1.79, P = .04), being criticized by teachers (OR = 1.66, P = .008), and adolescents being not satisfied with their academic achievements (OR = 2.42, P = .02) were also significantly associated with MHPs. Even 8 months after the tsunami, MHPs among adolescent schoolchildren in the affected areas are still very high.

Posttraumatic stress disorder symptoms in adolescents: risk factors versus resilience moderation

BACKGROUND

Exposure to community violence and trauma, stress, and childhood abuse and neglect have been identified as risk factors for the development of posttraumatic stress disorder (PTSD) symptoms among adolescents. Although evidence suggests that resilience may moderate the relationship between some of these risk factors and PTSD symptoms, no studies to date have examined these risk factors collectively.

AIMS

Our first aim was to examine the relationship between exposure to community violence, childhood abuse and neglect, perceived stress, and PTSD symptoms. Our second aim was to examine the extent to which resilience moderated the relationship between risk factors and PTSD symptoms.

METHOD

A convenience sample of 787 participants was drawn from 5 public secondary schools in the Cape Town metropole of South Africa. The participants were invited to complete a battery of questionnaires on a single occasion.

RESULTS

Of the participants, 48.3% were Black, 58.6% were female, and 31.6% were in grade 8. After controlling for covariates, we found that exposure to community violence, perceived stress, and childhood abuse and neglect together accounted for 33.4% of the variance in PTSD symptoms (F(8,778) = 71.06, P < .001). Nevertheless, resilience moderated the relationship between childhood abuse and symptoms of PTSD (beta = .09, t(786) = 2.88, P < .001), where the independent effect of childhood abuse and neglect on PTSD symptoms was significantly reduced with increasing resilience. Resilience did not, however, interact with exposure to community violence or perceived levels of stress to influence PTSD symptoms.

CONCLUSION

High levels of exposure to community violence, perceived stress, and childhood abuse and neglect may contribute to the development of PTSD symptoms in South African adolescents. However, high levels of resilience may buffer the negative effects of childhood abuse and neglect.

Examining the Psychometric Properties of the Family Accommodation Scale-Parent-Report (FAS-PR)

Growing research has examined parental accommodation among the families of children with obsessive-compulsive disorder (OCD). However, these studies have utilized a parent-report (PR) version of a measure, the Family Accommodation Scale (FAS) that has never received proper psychometric validation. In turn, previously derived subscales have been developed via clinical rather than empirical evidence. This study aims to conduct a comprehensive psychometric analysis of the FAS-PR utilizing data collected from 96 youths with OCD. Exploratory factors analysis was conducted and revealed a 12-item scale yielding two separate, yet related subscales, Avoidance of Triggers (AT) and Involvement in Compulsions (IC). Subsequent analyses revealed good internal consistency and convergent and discriminant validity. These findings suggest that future research should seek to examine factors that may impact various facets to accommodation as well as the role these facets plays in predicting treatment outcome. Limitations are discussed.

Cumulative effect of multiple trauma on symptoms of posttraumatic stress disorder, anxiety, and depression in adolescents

BACKGROUND

Recent literature has indicated that exposure to multiple traumatic events in adults is associated with high levels of posttraumatic stress disorder (PTSD), anxiety, and depression. Against the backdrop of stressful life events and childhood abuse and neglect, we investigated the cumulative effect of multiple trauma exposure on PTSD, anxiety, and depression in an adolescent sample.

METHOD

One thousand one hundred forty 10th-grade learners from 9 Cape Town (South Africa) schools completed questionnaires on stressful life experiences; trauma exposure; and symptoms of anxiety, depression, and PTSD. Our population of interest for this study was adolescents between the ages of 14 and 18 years who had been exposed to serious, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, qualifying traumatic events. The final sample size was thus 922.

RESULTS

Rates of trauma exposure, PTSD, depression, and anxiety were high. Controlling for sex, stressful life experiences in the past year, and childhood adversity, we found an effect of cumulative trauma exposure effect on PTSD and depression, with an increase in the number of traumas linearly associated with an increase in symptoms of PTSD (F((4,912)) = 7.60, P < .001) and depression (F((4,912)) = 2.77, P < .05). We did not find a cumulative effect on anxiety.

CONCLUSION

Our findings indicate that adolescents exposed to multiple traumas are more likely to experience more severe symptoms of PTSD and depression than those who experience a single event, with this effect independent of childhood adversity and everyday stressful life experiences. Exposure to multiple trauma, however, does not seem to be associated with more severe anxiety symptoms.

Social support, discrimination, and coping as predictors of posttraumatic stress reactions in youth survivors of Hurricane Katrina

This study examined the influence of aspects of the post-Hurricane Katrina recovery environment (i.e., discrimination, social support) and coping behaviors on children's posttraumatic stress reactions (symptoms of posttraumatic stress disorder [PTSD], anxiety, and depression). Data corresponding to 46 youth (M = 11.43 years; 39% girls; 33% African American, 67% European American) revealed that greater helpfulness from extrafamilial sources of social support predicted lower levels of child-rated symptoms of PTSD, anxiety, and depression. A positive predictive relation was found between helpfulness from professional support sources and PTSD, perhaps suggesting that parents whose children were experiencing higher PTSD symptom levels sought professional support and reported it to be helpful. Youths' avoidant coping behaviors predicted both PTSD and anxiety symptoms. Discrimination, active coping, and familial support did not predict any of the posttraumatic stress reactions assessed in this study.

Risikofaktoren der Posttraumatischen Belastungsstörung nach Trauma-Typ-I bei Kindern und Jugendlichen

Es wird ein Überblick zu Risikofaktoren einer Posttraumatischen Belastungsstörung (PTB) nach einem einmaligen traumatischen Ereignis in Kindheit und Jugend gegeben. Dazu wurde eine umfangreiche Literaturrecherche durchgeführt, als deren Ergebnis 55 Einzelstudien identifiziert werden konnten. Die berücksichtigten Studien sollten sowohl eine quantitative Erfassung der posttraumatischen Symptomatik als auch der Prädiktoren beinhalten. Prädiktoren wurden in prä-, peri- und posttraumatische Faktoren eingeteilt, wobei sich die folgenden als besonders vielversprechend herausstellten: Prätraumatische psychische Morbidität, Stressorschwere, Lebensgefahr, Ressourcenverlust und peritraumatische emotionale Reaktion, sowie eine Akute Belastungsstörung bzw. PTB nach dem Ereignis, Komorbidität, weitere kritische Lebensereignisse und mangelnde soziale Unterstützung.

Psychometric properties of the Multidimensional Scale of Perceived Social Support in youth

INTRODUCTION

There is increasing awareness of the contribution of perceived social support (PSS) to emotional and physical well-being. Numerous scales measuring PSS have been developed, including the Multidimensional Scale of Perceived Social Support (MSPSS). The psychometric properties of the MSPSS have been demonstrated in diverse samples, although its reproducibility in the South African youth has not yet been investigated.

METHODS

This study aimed to investigate the psychometric properties of the MSPSS in the South African youth using confirmatory factor analysis. The relationship of PSS to depressive and anxiety symptoms, as well as the effects of sex and ethnicity, was investigated. Participants completed a battery of self-report measures, including the MSPSS, Beck Depression Inventory, and the Child Posttraumatic Stress Disorder Checklist on a single occasion. Confirmatory factor analysis was performed to validate the a priori factor structure of the MSPSS. In addition, Cronbach alpha coefficients and intercorrelations (for clinical variables) were calculated. A missing value analysis was performed to assess the influence of missing data on our findings.

RESULTS

Data are reported for 502 youth (11.3-23.5 years). The 3-factor structure of the MSPSS (significant other, family, and friends) fitted the data well. The MSPSS showed good internal consistency. Perceived social support was also positively correlated with resilience and negatively correlated with depression, exposure to community violence, and other potentially life-threatening traumas. Females and youth of white or mixed race reported significantly higher levels of PSS than males and black youth, respectively.

CONCLUSIONS

The MSPSS is a psychometrically sound instrument that can be applied to South African youth.

School performance and social-emotional behavior of primary school children before and after a disaster

OBJECTIVES

The purpose of this work was to evaluate the cognitive and social-emotional consequences in a general population of primary school children affected by the firework disaster in Enschede, The Netherlands, on May 13, 2000. The explosions caused tremendous damage in the surrounding neighborhood. Twenty-two people immediately died and >1000 were injured.

METHODS

This retrospective study assessed school performance and social-emotional behavior before and up to 3 years after the disaster. Objectively measured school test results in spelling and arithmetic/mathematics and multi-informant social-emotional behavioral assessments were compared between exposed and nonexposed primary school children. Multivariate logistic-regression was used to assess the relationship between exposure and cognitive and social emotional functioning.

RESULTS

On school performances, the children exposed to the disaster performed over a period of 3 years after the disaster as good as or better than classmates, controls, and a national reference population. Shortly after the disaster, exposed children even seemed to have better school test results than nonexposed children. Two to 3 years after the disaster, a significant effect of disaster exposure was found on social-emotional behavior. Problematic behavior was reported by teachers, parents, and the school doctor.

CONCLUSIONS

This study demonstrates a limited influence of disaster exposure on school performance in primary school children. This study also shows that teachers and youth health care practitioners especially should be aware of children starting school several years after a disaster. Although very young at the time of a disaster (1-4 years of age), they may experience disaster-related problems.

Cerebellar volumes in pediatric maltreatment-related posttraumatic stress disorder

BACKGROUND

The results of previous studies suggest structural brain differences in pediatric maltreatment-related posttraumatic stress disorder (PTSD) However, posterior fossa volumes were not examined, despite the consensus that the cerebellum is important in emotional and cognitive development. We investigated the relationship between structural volumes of the cerebellum hemispheres, vermis, brainstem, and clinical variables in pediatric maltreatment-related PTSD.

METHODS

Fifty-eight psychotropic-naïve maltreated children and adolescents with DSM-IV PTSD were compared with two groups of pediatric subjects who had no DSM-IV criteria A trauma histories: 1) 13 with pediatric generalized anxiety disorder, and 2) 98 healthy non-abused children and adolescents. Subjects underwent a comprehensive psychiatric assessment and an anatomical magnetic resonance image brain scan.

RESULTS

Unadjusted means of the left, right, and total cerebellum were smaller in the PTSD group. The group differences remained significant in the left cerebellum, right cerebellum, and total cerebellum in the analyses adjusted for cerebral volume, sociodemographic, and IQ variables. Cerebellar volumes positively correlated with age of onset of the trauma that lead to PTSD and negatively correlated with the duration of the trauma that lead to PTSD. Cerebellar volumes were larger in boys versus girls, but there was no group x gender interaction. There were significant positive correlations between IQ measures and volumetric variables.

CONCLUSIONS

The results support cerebellar volume differences in maltreated children and adolescents with PTSD. Further studies are warranted.

Ecological predictors of traumatic stress symptoms in caucasian and ethnic minority children exposed to intimate partner violence

Traumatic stress symptoms were assessed for 218 children ages 5 to 13 following exposure to intimate partner violence: 33% of Caucasian and 17% of minority children were diagnosed with posttraumatic stress disorder. A risk and protective factors model was used to predict traumatic stress symptoms. For Caucasian children, the best predictors were mothers' mental health and low self-esteem. For minority children, the amount of violence, mothers' low self-esteem, and low income predicted traumatic stress. Social support to the mother, inclusive of friends, relatives, and religion, was a protective element. Implications for assessment and intervention are discussed in light of each group's experiences.

The Acute Stress Checklist for Children (ASC-Kids): development of a child self-report measure

This project aimed to develop and validate a brief, practical self-report measure of acute stress disorder (ASD) reactions (including ASD diagnostic criteria) in children and adolescents. A draft measure was reviewed for content validity by an expert panel, piloted with youth, and revised for clarity and coverage of key constructs. The new 29-item Acute Stress Checklist for Children (ASC-Kids) was administered to 176 youth age 8 to 17 who had a recent injury or intensive care unit admission. The ASC-Kids demonstrated strong test-retest reliability and internal consistency, as well as concurrent and predictive validity with other traumatic stress measures. Results of exploratory factor analyses were consistent with current conceptualizations of acute traumatic stress reactions. The ASC-Kids is a promising measure of child acute stress reactions.

Health problems in children and adolescents before and after a man-made disaster

OBJECTIVE

The aims of this study were to examine health problems of children (4-12 years old at the time of the disaster) and adolescents (13-18 years old at the time of the disaster) before and after exposure to a fireworks disaster in the Netherlands (May 2000), to compare these health problems with a control group, and to identify risk factors for postdisaster psychological problems.

METHOD

Because the electronic medical records of family practitioners were used, longitudinal monitoring of health problems from 1 year predisaster until 2 years postdisaster for both victims (N=1,628) and controls (N=2,856) was possible. Health problems were classified according to the International Classification of Primary Care.

RESULTS

Postdisaster increases were significantly larger in victims than in controls for psychological problems, musculoskeletal problems, stress reactions, and symptoms of the extremities. Children 4-12 years old presented larger increases in sleep problems compared with controls, whereas children 13-18 years old showed larger increases in anxiety problems than their controls. Significant predictors for postdisaster psychological problems included being relocated, presenting predisaster psychological problems, and a low to medium socioeconomic status.

CONCLUSIONS

Children and adolescents exposed to a disaster are at risk of long-lasting increases in both psychological and physical health problems. Postdisaster interventions should focus on those who were relocated and presented predisaster psychological problems.

Adolescent depression: challenges and opportunities: a review and current recommendations for clinical practice

Many aspects of the treatment for adolescent depression are still uncertain. However, our body of knowledge continues to accumulate, and our approaches continue to be refined. When we remember that 40 years ago the field was still arguing about the existence of depression in youth, it is clear that significant progress has been made. Recent controversies have provided another opportunity to step back and re-evaluate. Given the chronicity, morbidity, and mortality associated with adolescent depression, the risks of doing nothing are too great. Evidence-based research has provided us with some direction during this unsettling time. After careful reviews, the major professional organizations representing pediatric medicine and psychiatry all support the continued use of SSRI antidepressant medications but emphasize close monitoring. The debates also have heightened interest in effective psychotherapy approaches, particularly CBT and IPT. Given the risk for suicidality in depressed adolescents, assessment and management of safety concerns remain critical, regardless of medication usage. Above all, it is most important that we remain hopeful about our ability to guide adolescents and families through the struggles with depression toward recovery.

Stressors and child and adolescent psychopathology: evidence of moderating and mediating effects

This paper reviews studies that have tested for moderators or mediators of the relation between stressors and child and adolescent psychopathology. Many studies have tested for moderation, but results of research studying moderators have been inconclusive. There have been few theory-based studies and there have been few consistent findings. Far fewer studies have tested for mediation effects, but these studies have generally been theory-driven, have more often built upon one another in an incremental fashion, and have yielded consistent results. In particular, there is substantial evidence for the mediating role of family relationship in the relation between stressors and child and adolescent psychological symptoms. Future studies should integrate moderator and mediator research by testing for specific mediators in relation to particular moderating contexts, so that we can better understand the complex ways in which stressful life experiences affect the well-being of children and adolescents.

Childhood post-traumatic stress disorder: an overview

This article presents an overview of post-traumatic stress disorder (PTSD) as it relates to children and adolescents. The authors provide a critical review of the pediatric PTSD literature regarding the definition, epidemiology, clinical presentation, assessment, neurobiologic foundation, and treatment of PTSD. The importance of developmental and neurobiologic factors and the uniqueness of these factors to children are emphasized.

Childhood traumatic grief: an exploration of the construct in children bereaved on September 11

This study is an exploration of the measurement and correlates of childhood traumatic grief (CTG). Eighty-three children of uniformed service personnel who died during the World Trade Center attack on September 11, 2001, were assessed using measures of demographic characteristics, trauma exposure (physical proximity, emotional proximity, and secondary adversities), use of coping strategies, psychiatric symptoms (posttraumatic stress disorder [PTSD], general anxiety, depression), self-esteem, and traumatic grief. An exploratory factor analysis of the Extended Grief Inventory (EGI; Layne, Savjak, Saltzman, & Pynoos, 2001) indicated distinct constructs of normal versus traumatic grief. CTG factor scores were correlated with secondary adversities from the traumatic event, symptoms of PTSD, anxiety, depression, and coping responses, underscoring the theoretical and clinical utility of the content of the measure. Study limitations and future research recommendations are discussed.

Community violence and urban families: experiences, effects, and directions for intervention

The purpose of this study was to understand the impact of community-level stressors (particularly violence), coping strategies, and resources to prevent exposure to violence or to mitigate its effects in an inner-city community. Parents and children participated in focus groups, and children also completed standardized instruments. In the focus groups, parents and children identified several areas of concern related to "helpers," schools, community safety, and emotional distress. They identified protective resources including intensive monitoring and social supports. Fifty percent of the children met criteria for Posttraumatic Stress Disorder (PTSD), and another 21% met criteria for partial PTSD. The mental health issues in children living with ongoing community violence necessitate that researchers use a qualitative approach to inform future interventions.

Pathways to PTSD, part II: Sexually abused children

OBJECTIVE

The goal of this research was to develop and test a prospective model of posttraumatic stress symptoms in sexually abused children that includes pretrauma, trauma, and disclosure-related pathways.

METHOD

At time 1, several measures were used to assess pretrauma variables, trauma variables, and stress reactions upon disclosure for 156 sexually abused children ages 8 to 13 years. At the time 2 follow-up (7 to 36 months following the initial interview), the children were assessed for posttraumatic stress disorder (PTSD) symptoms.

RESULTS

A path analysis involving a series of hierarchically nested ordinary least squares multiple regression analyses indicated three direct paths to PTSD symptoms: avoidant coping, anxiety/arousal, and dissociation, all measured during or immediately after disclosure of sexual abuse. Additionally, age and gender predicted avoidant coping, while life stress and age at abuse onset predicted symptoms of anxiety/arousal. Taken together, these pathways accounted for approximately 57% of the variance in PTSD symptoms.

CONCLUSIONS

Symptoms measured at the time of disclosure constitute direct, independent pathways by which sexually abused children are likely to develop later PTSD symptoms. These findings speak to the importance of assessing children during the disclosure of abuse in order to identify those at greatest risk for later PTSD symptoms.

Behavior problems in New York City's children after the September 11, 2001, terrorist attacks

Children's behavior was assessed with 3 cross-sectional random-digit-dial telephone surveys conducted 11 months before, 4 months after, and 6 months after September 11, 2001. Parents reported fewer behavior problems in children 4 months after the attacks compared with the pre-September 11 baseline. However, 6 months after the attacks, parents' reporting of behavior problems was comparable to pre-September 11 levels. In the 1st few months after a disaster, the identification of children who need mental health treatment may be complicated by a dampened behavioral response or by a decreased sensitivity of parental assessment to behavioral problems.

Managing a Combined Burn Trauma Disaster in the Post-9/11 World: Lessons Learned from the 2003 West Pharmaceutical Plant Explosion

At 1:37 pm on January 29, 2003, an explosion occurred at the West Pharmaceutical chemical plant in Kinston, North Carolina. The explosion killed three people at the scene and resulted in more than 30 admissions to area hospitals. The disaster resulted in 10 critically ill burn patients, who were all intubated with inhalation injuries, many with combined burn and trauma injuries. All 10 critically injured patients were admitted to a tertiary care facility 100 miles away with both a Level I trauma center and a verified burn center. Ultimately, 7 of 10 patients survived (a mortality rate of 30%), and none were transferred to another trauma or burn center. This article analyzes the unique challenges that combined burn and trauma patients present during a disaster, critically examines the response to this disaster, describes lessons learned, and presents recommendations that may improve the response to such disasters in the future.

Assessing post-traumatic stress disorder in South African adolescents: using the child and adolescent trauma survey (CATS) as a screening tool

BACKGROUND: Several studies have demonstrated that South African children and adolescents are exposed to high levels of violent trauma with a significant proportion developing PTSD, however, limited resources make it difficult to accurately identify traumatized children. METHODS: A clinical interview (K-SADS-PL, selected modules) and self-report scale (CATS) were compared to determine if these different methods of assessment elicit similar information with regards to trauma exposure and post-traumatic stress disorder (PTSD) in adolescents. Youth (n = 58) from 2 schools in Cape Town, South Africa participated. RESULTS: 91% of youth reported having been exposed to a traumatic event on self-report (CATS) and 38% reported symptoms severe enough to be classified as PTSD. On interview (K-SADS-PL), 86% reported exposure to a traumatic event and 19% were found to have PTSD. While there were significant differences in the rates of trauma exposure and PTSD on the K-SADS and CATS, a cut-off value of 15 on the CATS maximized both the number of true positives and true negatives with PTSD. The CATS also differentiated well between adolescents meeting DSM-IV PTSD symptom criteria from adolescents not meeting criteria. CONCLUSIONS: Our results indicate that trauma exposure and PTSD are prevalent in South African youth and if appropriate cut-offs are used, self-report scales may be useful screening tools for PTSD.

Aspects of exposure in childhood trauma: the stressor criterion

Attention to posttraumatic stress disorder (PTSD) in children has lagged behind the understanding of this disorder in adults. This article provides a brief review related to the stressor criterion of PTSD in children. The stressor criterion for PTSD includes three elements--an event, exposure, and a subjective reaction--each of which is described in the diagnostic criteria for the disorder. A host of stressors, both natural and human-caused, have the potential to evoke symptoms. Exposure can be direct--through, for example, physical presence, direct victimization, and witnessing, or indirect--through, for example, an interpersonal relationship with a direct victim. Exposure to media coverage of an event as a stressor for PTSD has also been examined. The requirement of a subjective reaction to the event is supported by research. A number of factors limit the ability to investigate issues associated with the stressor criterion including difficulty obtaining reliable and valid measures. Future studies should focus on specific aspects of exposure and outcomes, indirect forms of exposure, the clinical significance of findings, and the various factors that influence a child's reaction to trauma.

School Entry After a Community-Wide Trauma: Challenges and Lessons Learned from September 11th, 2001

The purpose of this paper is to describe the implementation of a school-based trauma-specific mental health program in New York City following the terrorist attacks on September 11, 2001. This program aimed to serve children most at risk for developing mental health problems as a result of physical proximity (e.g., evacuation from schools surrounding the World Trade Center) to the trauma. As we present the components of the program, we will review the literature that guided our decision making. The ongoing struggle between searching for answers from established science and immediate needs in a crisis is highlighted. Lastly, a discussion of the lessons learned and recommended next steps is presented.