1
|
Lofthouse K, Beeson E, Dalgleish T, Danese A, Hodgekins J, Mahoney-Davies G, Smith P, Stallard P, Wilson J, Meiser-Stedman R. Characteristics of complex posttraumatic stress disorder (PTSD) in young people with PTSD following multiple trauma exposure. J Child Psychol Psychiatry 2024; 65:822-831. [PMID: 37994207 DOI: 10.1111/jcpp.13918] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Complex PTSD (CPTSD) is a relatively new diagnosis. The objective of the present study was to investigate how trauma characteristics, comorbid psychopathology and cognitive and social factors experienced by children and adolescents with a posttraumatic stress disorder (PTSD) diagnosis following exposure to multiple traumatic events differs between those who meet the criteria for CPTSD and those who do not. METHOD The present research used baseline data from the DECRYPT trial (BMJ Open, 2021, 11, e047600). Participants (n = 120) were aged 8-17 years and had exposure to multiple traumas and a PTSD diagnosis. The data collected comprised self-report and parent/caregiver-report questionnaires and interviews. Three primary analyses were conducted, comparing number of trauma types, prevalence of sexual trauma and prevalence of intrafamilial abuse between the CPTSD and PTSD-only groups. A range of comorbid psychopathology and cognitive and social factors were compared between the groups in an exploratory secondary analysis. All analyses were preregistered. RESULTS The CPTSD group (n = 72, 60%) had a significantly higher frequency of sexual trauma than the PTSD-only group (n = 48, 40%). The groups did not significantly differ on number of trauma types or prevalence of intrafamilial abuse. From the secondary analysis, the CPTSD group were found to have significantly higher scores on measures of negative post-traumatic cognitions, depression and panic. These results were replicated in correlation analyses using a continuous measure of CPTSD symptoms. CONCLUSIONS A large proportion of youth exposed to multiple traumatic events met criteria for CPTSD. Sexual trauma appears to be related to CPTSD symptoms. Youth with CPTSD appear to have greater severity of comorbid depression and panic symptoms, as well as more negative post-traumatic cognitions. Further investigation could focus on the directionality and mechanisms for these associations.
Collapse
Affiliation(s)
- Katie Lofthouse
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Ella Beeson
- Hertfordshire Partnership University NHS Foundation Trust, St Albans, UK
| | - Tim Dalgleish
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Andrea Danese
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Social, Genetic and Developmental Psychiatry Centre, King's College London, London, UK
| | - Joanne Hodgekins
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | | | - Patrick Smith
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - Jon Wilson
- Norfolk and Suffolk NHS Foundation Trust, Norwich, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
2
|
Minnis H. Abuse, neglect and neurodevelopment across the life course: what can paediatricians and child psychiatrists do about this together? The Illingworth-Rees keynote lecture 2023. Arch Dis Child 2023:archdischild-2023-325942. [PMID: 37788885 DOI: 10.1136/archdischild-2023-325942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 10/05/2023]
Abstract
Paediatricians and child psychiatrists share complex cases, often associated with abuse, neglect and other 'Adverse Childhood Experiences (ACEs)'. ACEs are associated in a dose-response relationship with both mental and physical health problems across the life span. We found that 9-year-old children who had been abused and neglected were much more likely to also have symptoms of heritable neurodevelopmental conditions (NDCs) such as ADHD, autism and intellectual disabilities. To our surprise, these were not caused by the abuse and neglect. Instead, both the NDCs and the abuse and neglect were being caused by additional genetic factors. We also found that children who have experienced abuse and neglect, and who also have NDCs, are at twice the risk of developing symptoms of severe mental illness in adolescence. This has caused us to develop our 'Double Jeopardy' hypothesis-that experiencing both abuse and neglect and NDCs in childhood might double the risk of a range of physical and mental health problems across the life span.Both paediatricians and child psychiatrists will be faced with children who have complex problems, and they will sometimes need to work together to solve these-whether or not abuse or neglect is in the mix.Dr Corinne Rees's words were prescient: 'The truth that psychological issues and behaviour are integral to all illness indicates the necessity for every doctor to feel competent in considering their relevance'. As paediatricians and child psychiatrists, let's move forward together to overcome the mind-body dichotomy for the benefit of our patients.
Collapse
Affiliation(s)
- Helen Minnis
- School of Health and Wellbeing, University of Glasgow, Glasgow G12 8TB, UK
| |
Collapse
|
3
|
McGuire R, Halligan SL, Schweizer S, Leung JT, Hiller RM. Cognitive and affective control for adolescents in care versus their peers: implications for mental health. Child Adolesc Psychiatry Ment Health 2023; 17:128. [PMID: 37946284 PMCID: PMC10636895 DOI: 10.1186/s13034-023-00668-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 10/04/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Many adolescents who have been removed from the care of their biological parent(s) and placed in State or Local Authority care have experienced significant adversity, including high rates of maltreatment and other trauma(s). As a group, these young people experience far higher rates of mental health difficulties compared to their peers. While their mental health outcomes are well-documented, little is known about mechanisms that may drive this. One potential mechanism, linked to both trauma and adversity exposure and mental health, is affective control (the application of cognitive control in affective contexts). METHODS We compared cognitive and affective control in 71 adolescents (65% girls) in care aged 11-18 (M = 14.82, SD = 2.10) and 71 age and gender-matched peers aged 11-19 years (M = 14.75, SD = 1.95). We measured cognitive and affective control using standard experimental tasks, and for those in care, we also examined associations with self-reported emotion regulation, mental health, and school well-being. RESULTS After controlling for IQ, there was a significant group difference in affective control performance, with those in care on average performing worse across all tasks. However, further analyses showed this was driven by deficits in overall cognitive control ability, and was not specific to, or worsened by, affective stimuli. Further, we found no evidence that either cognitive or affective control was associated with emotion regulation abilities or the mental health and well-being of young people in care. CONCLUSIONS Results suggest that cognitive and affective control may not underlie mental health for young people in care, though limitations should be considered. We discuss implications for theory and intervention development, and avenues for further research. TRIAL REGISTRATION https://doi.org/10.17605/OSF.IO/QJVDA.
Collapse
Affiliation(s)
- Rosie McGuire
- Department of Psychology, University of Bath, Bath, United Kingdom
- Division of Psychology and Language Sciences, University College London, 26 Bedford Way, London, WC1H 0AP, United Kingdom
| | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, United Kingdom.
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa.
| | - Susanne Schweizer
- School of Psychology, University of New South Wales, Sydney, Australia
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Jovita T Leung
- Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Rachel M Hiller
- Division of Psychology and Language Sciences, University College London, 26 Bedford Way, London, WC1H 0AP, United Kingdom
- Anna Freud National Centre for Children and Families, London, United Kingdom
| |
Collapse
|
4
|
Kangaslampi S, Zijlmans J. MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations. Eur Child Adolesc Psychiatry 2023:10.1007/s00787-023-02310-9. [PMID: 37814082 DOI: 10.1007/s00787-023-02310-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023]
Abstract
3,4-Methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement. We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms. Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on (1) reinforcing motivation, (2) the development of a strong therapeutic alliance, (3) additional emotion and behavior management techniques, (4) more directive exposure-based methods during MDMA sessions, (5) more support for concomitant challenges and integrating treatment benefits, and (6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues. We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents.
Collapse
Affiliation(s)
- Samuli Kangaslampi
- Faculty of Social Sciences/Psychology, Tampere University, Tampere, Finland.
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, The Netherlands.
| | - Josjan Zijlmans
- Department of Child and Adolescent Psychiatry & Psychosocial Care, Amsterdam University Medical Center, Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health, Amsterdam University Medical Center, Mental Health, Amsterdam, The Netherlands
| |
Collapse
|
5
|
Davis RS, Halligan SL, Meiser-Stedman R, Elliott E, Ward G, Hiller RM. A Longitudinal Investigation of the Relationship Between Trauma-Related Cognitive Processes and Internalising and Externalising Psychopathology in Young People in Out-of-Home Care. Res Child Adolesc Psychopathol 2023; 51:485-496. [PMID: 36525227 PMCID: PMC10017561 DOI: 10.1007/s10802-022-01005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2022] [Indexed: 12/23/2022]
Abstract
Young people in out-of-home care are at increased risk of developing a range of posttrauma mental health difficulties, including PTSD, but more commonly anxiety, depression and externalising symptoms. Cognitive models of PTSD indicate that trauma-related maladaptive appraisals, coping strategies and trauma memory qualities are key processes in the development and maintenance of PTSD, yet there has been limited investigation of the potential role of these processes in broader posttrauma psychopathology, particularly in young people who have been exposed to complex, rather than acute, trauma. We recruited 120 10-18 years olds in out-of-home care, and their caregivers, who completed assessments at two time points: baseline and 12-month follow-up. Young people completed self-report measures of trauma-related maladaptive appraisals, coping strategies and trauma-memory qualities, as well as reporting on PTSD, anxiety, depression and externalising symptoms. Carers also reported on internalising and externalising symptoms. We found that all three cognitive processes were associated with baseline self-reported internalising symptoms, with maladaptive appraisals most robustly associated with both anxiety and depression. Changes in all three processes over 12-months predicted a change in self-reported internalising and externalising symptoms, with maladaptive appraisals and coping predicting anxiety symptoms, and coping uniquely predicting depression and externalising symptoms. Effects remained after controlling for co-occurring PTSD symptoms. Findings were not replicated when using carer-reported symptoms. These findings suggest that existing cognitive models of PTSD may also usefully explain broader posttrauma depression, anxiety and externalising symptoms in young people who have experienced maltreatment and live in out-of-home care. Clinical implications are discussed.
Collapse
Affiliation(s)
| | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK.,Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | | | - Georgina Ward
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Rachel M Hiller
- Department of Psychology, University of Bath, Bath, UK. .,Division of Psychology and Language Sciences, University College London, London, UK. .,Anna Freud National Centre for Children and Families, London, UK.
| |
Collapse
|
6
|
Redican E, Murphy J, McBride O, Bunting L, Shevlin M. The Prevalence, Patterns and Correlates of Childhood Trauma Exposure in a Nationally Representative Sample of Young People in Northern Ireland. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:963-976. [PMID: 35571535 PMCID: PMC9077031 DOI: 10.1007/s40653-022-00449-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/28/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Childhood trauma (CT) exposure is common, with many young people affected by multiple co-occurring traumas. METHODS Participants were a representative sample of 11-19-year-olds (n = 1293), who participated in the largest ever representative survey of youth mental health in Northern Ireland (NI) - the NI Youth Wellbeing Prevalence Survey 2020. This study used latent class analysis (LCA) to identify typologies that were most representative of trauma experience and co-occurrence among young people living in NI. Demographic, parental and deprivation variables were then used within a multinomial logistic regression analysis to describe trauma class membership. RESULTS Over 35% (n = 478) of participants reported exposure to at least one CT, with over 50% (n = 259) of trauma-exposed young people reporting multiple trauma exposure. LCA results provided support for a three-class model; 'low-exposure', 'moderate-exposure: community-victimization' and 'high-exposure: sexual-trauma'. While none of the child, parental or familial covariates differentiated members of the 'moderate-exposure: community-victimization' from 'low-exposure', those in 'high-exposure: sexual-trauma' were over four and a half times more likely to belong to a family in receipt of income benefits and over ten times more likely to have experienced some form of out-of-home care. CONCLUSIONS This study highlights the presence of three distinct trauma classes in the NI adolescent population. In particular, this study identifies a small minority of young people who have experienced multiple CT's, including sexually based traumas, with these traumas most likely to have occurred in the context of out-of-home care and familial poverty.
Collapse
Affiliation(s)
- Enya Redican
- School of Psychology, Ulster University, Coleraine, UK
| | - Jamie Murphy
- School of Psychology, Ulster University, Coleraine, UK
| | - Orla McBride
- School of Psychology, Ulster University, Coleraine, UK
| | | | - Mark Shevlin
- School of Psychology, Ulster University, Coleraine, UK
| |
Collapse
|
7
|
McGuire R, Halligan SL, Meiser‐Stedman R, Durbin L, Hiller RM. Differences in the diagnosis and treatment decisions for children in care compared to their peers: An experimental study on post-traumatic stress disorder. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:1075-1088. [PMID: 35702815 PMCID: PMC9796033 DOI: 10.1111/bjc.12379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/17/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES Despite evidence of high rates of diagnosable mental health difficulties in children in care, there remains ongoing debate around the appropriateness of traditional diagnoses and treatments. The aim of this study was to quantitatively explore whether mental health diagnosis and treatment decision-making differed when a young person was identified as being in care, specifically focused on post-traumatic stress disorder (PTSD). PTSD is a trauma-specific mental health disorder with rates substantially higher in children in care versus their peers. METHODS Participants were 270 UK mental health professionals who completed an online survey. Participants were randomized to receive one of two vignettes, which were identical in their description of a teenage boy experiencing PTSD symptoms, except in one he was in foster care and in the other he lived with his mother. Participants were asked to select a primary diagnosis, treatment approach, and potential secondary diagnosis. RESULTS Professionals were twice as likely to choose a primary diagnosis of PTSD and a National Institute for Clinical Excellence (NICE)-recommended PTSD treatment when randomized to the mother vignette versus the foster carer vignette. Selecting PTSD as the primary diagnosis made clinicians three times more likely to select a NICE-recommended treatment for PTSD. Developmental trauma was the most common 'diagnosis' for both groups, although this led to different treatment decisions. CONCLUSIONS In the context of PTSD, we found children in care face diagnosis and treatment decision-making biases. Practice implications are discussed.
Collapse
Affiliation(s)
| | - Sarah L. Halligan
- Department of PsychologyUniversity of BathBathUK,Department of PsychiatryUniversity of Cape TownCape TownSouth Africa
| | - Richard Meiser‐Stedman
- Department of Clinical Psychology & Psychological Therapies, Norwich Medical SchoolUniversity of East AngliaNorwichUK
| | - Lucy Durbin
- Department of PsychologyUniversity of BathBathUK
| | - Rachel M. Hiller
- Department of PsychologyUniversity of BathBathUK,Division of Psychology and Language SciencesUniversity College LondonLondonUK,Anna Freud National Centre for Children and FamiliesLondonUK
| |
Collapse
|
8
|
Zilberstein K. Trauma in Context: an Integrative Treatment Model. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:487-500. [PMID: 35600523 PMCID: PMC9120280 DOI: 10.1007/s40653-021-00416-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/17/2021] [Indexed: 06/03/2023]
Abstract
Evidenced based trauma treatments benefit children, but they rarely suffice for youth with multiple and complex comorbidities. After the completion of standard treatments, many children continue to show residual social, behavioral, and emotional difficulties. Part of the difficulty is that while the literature on trauma describes numerous facets that contribute to the severity, expression, and outcomes of trauma exposure, clinical assessments and interventions do not sufficiently reflect that literature. Clinicians thus have little guidance on how to integrate the intricacies of client's circumstances into a trauma-informed framework. To expand the scope and efficacy of treatments and guide clinicians in selecting appropriate interventions, this paper explores factors associated with pretreatment traumatic responses and proposes an integrative treatment model that includes the trauma experience, itself, combined with pre- and post-trauma factors that are both internal and external to the child and family. Pre-trauma experiences influence the severity of traumatic responses, while post-trauma factors impact a person's ability to cope and recover. Both are important targets for direct intervention.
Collapse
|
9
|
Hiller RM, Davis RS, Devaney J, Halligan SL, Meiser-Stedman R, Smith P, Stallard P, Kandiyali R, MacNeill S. Protocol for the RELATE trial: a feasibility and pilot randomised controlled trial of a low-intensity group intervention for young people in care with elevated posttraumatic stress symptoms. Pilot Feasibility Stud 2021; 7:204. [PMID: 34774093 PMCID: PMC8590138 DOI: 10.1186/s40814-021-00936-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 10/22/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Young people in out-of-home care have often experienced trauma, such as direct maltreatment or witnessing violence. There is good evidence that rates of mental health difficulties are high in this group, including posttraumatic stress disorder (PTSD), a trauma-specific mental health outcome. There remains less evidence to guide how to effectively address elevated PTSD symptoms (PTSS) in these young people, particularly in ways that are feasible and scalable for stretched social-care and mental health services. Methods and analysis This protocol describes a feasibility study comprising a pilot two-arm randomised controlled trial (RCT). Participants (N = 50) will be randomised to either (a) a group-based trauma-focused programme (Teaching Recovery Techniques), delivered by mental health practitioners both online and in-person, or (b) care-as-usual. Primarily, the trial aims to explore the key feasibility and protocol acceptability questions, including rates of recruitment and retention, as well as the acceptability of the intervention (particularly the online delivery format) to participants and services. In addition, outcomes including PTSS (primary clinical outcome), depression and functioning will be assessed at baseline (pre-randomisation), post-intervention and at a 3-month follow-up. Ethics and dissemination Ethical approval has been received from the Health Research Authority (Wales REC1 Ref 20/WA/0100) and University, with further approval from the host trust and social care site. The results will inform the design of a definitive RCT. Dissemination will include peer-reviewed journal articles reporting the qualitative and quantitative results, as well as presentations at conferences and lay summaries. Trial registration ClinicalTrials.gov, NCT04467320. Registered on 13 July 2020.
Collapse
Affiliation(s)
| | | | - John Devaney
- School of Social and Political Science, University of Edinburgh, Edinburgh, UK
| | | | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, University of East Anglia, Norwich, UK
| | - Patrick Smith
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Rebecca Kandiyali
- Centre for Health Economics, Warwick Medical School, University of Warwick, Coventry, UK.,Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| | - Stephanie MacNeill
- Bristol Randomised Trials Collaboration, Bristol Trials Centre, University of Bristol, Bristol, UK
| |
Collapse
|
10
|
Hitchcock C, Goodall B, Sharples O, Meiser-Stedman R, Watson P, Ford T, Dalgleish T. Population Prevalence of the Posttraumatic Stress Disorder Subtype for Young Children in Nationwide Surveys of the British General Population and of Children in Care. J Am Acad Child Adolesc Psychiatry 2021; 60:1278-1287.e3. [PMID: 33667605 PMCID: PMC7614479 DOI: 10.1016/j.jaac.2020.12.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/12/2020] [Accepted: 02/24/2021] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Posttraumatic stress disorder (PTSD) is a debilitating condition that when left untreated can have severe lifelong consequences for psychological, social, and occupational functioning. Initial conceptualizations of PTSD were centered on adult presentations. However, the instantiation of developmentally appropriate PTSD in young children (PTSD-YC) criteria, tailored to preschool (6 years old and younger) children, represents an important step toward identifying more young children experiencing distress. This study explored population-level prevalence of PTSD-YC indexed via an alternative algorithm for DSM-IV PTSD (AA-PTSD). METHOD Representative population data were used to test whether application of AA-PTSD criteria, relative to the DSM-IV PTSD algorithm, increased identification of 5- to 6-year-old children with clinical needs in both the general population (n = 3,202) and among looked after children (ie, in Britain, foster children are called looked after children [more commonly referred to as children in care].) (n = 137), in whom the risk of mental health issues is greater. RESULTS Notably, no 5- to 6-year-old children in the general population sample were diagnosed with PTSD using adult-based DSM-IV criteria. In contrast, AA-PTSD prevalence was 0.4% overall, rising to 5.4% in trauma-exposed children. In looked after children, overall PTSD prevalence rose from 1.2% when applying adult-based DSM-IV criteria to 14% when using AA-PTSD criteria. Of trauma-exposed looked after children, 2.7% met criteria for DSM-IV PTSD compared with 57.0% when applying AA-PTSD criteria. In both samples, use of the alternative algorithm to index PTSD-YC criteria markedly increased identification of children experiencing functional impairment owing to symptoms. CONCLUSION Results demonstrate the utility of the PTSD-YC diagnosis beyond at-risk and treatment-seeking samples. Use of PTSD-YC criteria substantially improves identification of 5- to 6-year-old children burdened by PTSD at the population level.
Collapse
Affiliation(s)
- Caitlin Hitchcock
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | - Benjamin Goodall
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom
| | | | | | - Peter Watson
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom
| | | | - Tim Dalgleish
- Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, United Kingdom; Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, United Kingdom.
| |
Collapse
|
11
|
Hiller RM, Halligan SL, Meiser-Stedman R, Elliott E, Rutter-Eley E, Hutt T. Coping and support-seeking in out-of-home care: a qualitative study of the views of young people in care in England. BMJ Open 2021; 11:e038461. [PMID: 33589445 PMCID: PMC7887338 DOI: 10.1136/bmjopen-2020-038461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES Young people who have been removed from their family home and placed in out-of-home care have commonly experienced abuse, neglect and/or other forms of early adversity. High rates of mental health difficulties have been well documented in this group. The aim of this research was to explore the experiences of these young people within the care system, particularly in relation to support-seeking and coping with emotional needs, to better understand feasible and acceptable ways to improve outcomes for these young people. DESIGN AND STUDY SETTING This study used 1:1 semistructured qualitative interviews with young people in out-of-home care in England, to provide an in-depth understanding of their views of coping and support for their emotional needs, both in terms of support networks and experiences with mental health services. Participants were 25 young people aged 10-16 years old (56% female), and included young people living with non-biological foster carers, kinship carers and in residential group homes. RESULTS Participants described positive (eg, feeling safe) and negative (eg, feeling judged) aspects to being in care. Carers were identified as the primary source of support, with a supportive adult central to coping. Views on support and coping differed for young people who were experiencing more significant mental health difficulties, with this group largely reporting feeling unsupported and many engaging in self-harm. The minority of participants had accessed formal mental health support, and opinions on usefulness were mixed. CONCLUSIONS Results provide insight, from the perspective of care-experienced young people, about both barriers and facilitators to help-seeking, as well as avenues for improving support.
Collapse
Affiliation(s)
| | - Sarah L Halligan
- Department of Psychology, University of Bath, Bath, UK
- Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Richard Meiser-Stedman
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Elizabeth Elliott
- Department of Psychology, University of Bath, Bath, UK
- School of Psychology and Clinical Language Science, University of Reading, Reading, UK
| | - Emily Rutter-Eley
- School of Psychology and Clinical Language Science, University of Reading, Reading, UK
| | - Tilly Hutt
- Department of Psychology, University of Bath, Bath, UK
| |
Collapse
|