Is posttraumatic stress in youth a culture-bound phenomenon? A comparison of symptom trends in selected U.S. and Russian communities

Loneliness and posttraumatic stress in U.S. adolescents: A longitudinal study

BACKGROUND

Loneliness and posttraumatic stress (PTS) are common in adolescence. However, there has been little longitudinal research on their association. To address this deficit, this study examined the longitudinal association between these phenomena in a sample of U.S. school students while also exploring if gender was important in this context.

METHODS

Data were analysed from 2807 adolescents (52.1 % female; age at baseline 11-16 years (M = 12.79)) who were followed over a one-year period. Information was obtained on loneliness in year 1 using a single-item question, while PTS was assessed with the self-report Child Post-Traumatic Stress - Reaction Index (CPTS-RI). A full path analysis was performed to assess the across time associations.

RESULTS

Almost one-third of the students reported some degree of loneliness while most students had 'mild' PTS. In the path analysis, when controlling for baseline PTS and other covariates, loneliness in year 1 was significantly associated with PTS in year 2 (β = 0.06, 95%CI: 0.02, 0.09). Similarly, PTS in year 1 was significantly associated with loneliness in year 2 (β = 0.19, 95%CI: 0.15, 0.23). An interaction analysis further showed that loneliness was higher in girls with PTS than in their male counterparts.

LIMITATIONS

The use of a single-item measure to assess loneliness that used the word 'lonely' may have resulted in underreporting.

CONCLUSION

Loneliness and PTS are bidirectionally associated in adolescence. Efforts to reduce loneliness in adolescence may help in combatting PTS, while clinicians should intervene to address loneliness if detected in adolescents with PTS.

Mindfulness and Posttraumatic Stress Disorder Symptom Severity in Urban African-American High School Students

OBJECTIVES

The aim of the current study was to examine the relations among mindfulness, posttraumatic stress disorder (PTSD) symptom severity, and stressful life events (SLEs) in African-American urban adolescents. Another aim was to examine mindfulness as a moderator of the relation between SLEs and PTSD symptom severity in this population.

METHOD

Eighty-eight African-American high school students from a low-income urban community completed measures of demographics, PTSD symptom severity, SLEs, and mindfulness.

RESULTS

Mindfulness was significantly negatively related to PTSD symptom severity, r(86) = -.70, p < .001, 95% CI [-.58, -79], and SLEs were significantly positively related to PTSD symptom severity, r(86) = .29, p = .003, 95% CI [.09, .47]. Mindfulness was an independent predictor of PTSD symptom severity after accounting for SLEs, B = -1.16, t(84) = -9.06, p < .001, 95% CI [-1.41, -0.90], and SLEs were an independent predictor of PTSD symptom severity after accounting for mindfulness, B = 0.49, t(84) = 2.92, p = .004, 95% CI [0.16, 0.82]. Mindfulness did not moderate the relation between SLEs and PTSD symptom severity, B = -.003, t(84) = -0.15, p = .89, 95% CI [-.04, .03].

IMPLICATIONS

This study has implications for both mindfulness as a potential protective factor against PTSD symptom severity and SLEs as a potential risk factor for increased PTSD symptom severity in African-American urban adolescents.

The Role of Gender in the Associations Among Posttraumatic Stress Symptoms, Anger, and Aggression in Russian Adolescents

Symptoms of posttraumatic stress disorder (PTSD) have been linked to anger and aggressive behavior in adult and veteran populations. However, research on the associations among anger, aggression, and PTSD in adolescents is lacking, particularly regarding differences between the sexes. To address this research gap, we used self-report data from Russian adolescents (N = 2,810; age range: 13-17 years) to perform a full path analysis examining the associations between PTSD symptoms and the emotional (anger traits) and cognitive (rumination) components of anger as well as physical/verbal and social aggression, after adjusting for depressive symptoms. We also examined the interaction effects between PTSD symptoms and sex on anger and aggression. The results indicated that girls scored higher on measures of anger and PTSD symptoms, ds = 0.20-0.32, whereas boys scored higher on measures of physical and verbal aggression, d = 0.54. Clinical levels of PTSD symptoms were associated with anger rumination, β = .16, and trait anger, β = .06, and an interaction effect for PTSD symptoms and sex was found for aggression, whereby boys with clinical levels of PTSD symptoms reported more physical/verbal and social aggression, βs = .05 and .20, respectively. Our findings suggest that PTSD symptoms may have an important impact on anger, anger rumination, and aggression during adolescence. In particular, boys seem to have an increased risk for aggressive behavior in the presence of PTSD symptoms. The present results highlight the importance of taking anger and aggression into account when evaluating PTSD.

UCLA PTSD reaction index for DSM-5 (PTSD-RI-5): a psychometric study of adolescents sampled from communities in eleven countries

Background: Children and adolescents are often exposed to traumatic events, which may lead to the development of posttraumatic stress disorder (PTSD). It is therefore important for clinicians to screen for potential symptoms that can be signs of PTSD onset. PTSD in youth is a worldwide problem, thus congruent screening tools in various languages are needed. Objective: The aim of this study was to test the general psychometric properties of the Traumatic Stress Disorder Reaction Index for children and adolescents (UCLA PTSD) Reaction Index for DSM-5 (PTSD-RI-5) in adolescents, a self-report instrument intended to screen for trauma exposure and assess PTSD symptoms. Method: Data was collected from 4201 adolescents in communities within eleven countries worldwide (i.e. Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestine-Gaza, Philippines, Portugal, Romania, and Serbia). Internal consistency, discriminant validity, and a confirmatory factor analysis of a four-factor model representing the main DSM-5 symptoms of the PTSD-RI-5 were evaluated. Results: The PTSD-RI-5 total score for the entire sample shows very good reliability (α = .92) as well as across all countries included (α ranged from .90 to .94). The correlations between anxiety/depressive symptoms and the PTSD-RI-5 scores were below .70 indicating on good discriminant validity. The four-factor structure of the scale was confirmed for the total sample and data from six countries. The standardized regression weights for all items varied markedly across the countries. The lack of a common acceptable model across all countries prevented us from direct testing of cross-cultural measurement invariance. Conclusions: The four-factor structure of the PTSD-RI-5 likely represents the core PTSD symptoms as proposed by the DSM-5 criteria, but there could be items interpreted in a conceptually different manner by adolescents from different cultural/regional backgrounds and future cross-cultural evaluations need to consider this finding.

Psychometric properties of the UCLA PTSD reaction index: part I

This article presents psychometric characteristics of the UCLA PTSD Reaction Index for DSM IV (PTSD-RI) derived from a large sample of children and adolescents (N = 6,291) evaluated at National Child Traumatic Stress Network centers. Overall mean total PTSD-RI score for girls was significantly higher as compared with boys. Age-related differences were found in that overall mean total PTSD-RI scores and within sex groups were higher among those aged 7-9 years and 16-18 years. There were no significant differences in mean total PTSD-RI scores across racial/ethnic groups. The PTSD-RI total scale displayed good to excellent internal consistency reliability across age ranges, sex, and racial/ethnic groups (α = .88-.91). Correlations of PTSD-RI scores with PTS subscale scores on the TSCC-A for the entire sample and within sex, age, and ethnic/racial groups provided evidence of convergent validity, although not discriminant validity. In contradistinction to previously reported 4-factor models, an exploratory factor analysis revealed 3 factors that mostly reflected the underlying dimensions of PTSD in DSM IV. PTSD-RI scores were associated with increased odds ratios for functional/behavior problems (odds ratio [OR] = 1-1.80). These findings are striking in light of the wide range of trauma exposures, age, and race/ethnicity among subjects.

Considering PTSD for DSM-5

This is a review of the relevant empirical literature concerning the DSM-IV-TR diagnostic criteria for PTSD. Most of this work has focused on Criteria A1 and A2, the two components of the A (Stressor) Criterion. With regard to A1, the review considers: (a) whether A1 is etiologically or temporally related to the PTSD symptoms; (b) whether it is possible to distinguish "traumatic" from "non-traumatic" stressors; and (c) whether A1 should be eliminated from DSM-5. Empirical literature regarding the utility of the A2 criterion indicates that there is little support for keeping the A2 criterion in DSM-5. The B (reexperiencing), C (avoidance/numbing) and D (hyperarousal) criteria are also reviewed. Confirmatory factor analyses suggest that the latent structure of PTSD appears to consist of four distinct symptom clusters rather than the three-cluster structure found in DSM-IV. It has also been shown that in addition to the fear-based symptoms emphasized in DSM-IV, traumatic exposure is also followed by dysphoric, anhedonic symptoms, aggressive/externalizing symptoms, guilt/shame symptoms, dissociative symptoms, and negative appraisals about oneself and the world. A new set of diagnostic criteria is proposed for DSM-5 that: (a) attempts to sharpen the A1 criterion; (b) eliminates the A2 criterion; (c) proposes four rather than three symptom clusters; and (d) expands the scope of the B-E criteria beyond a fear-based context. The final sections of this review consider: (a) partial/subsyndromal PTSD; (b) disorders of extreme stress not otherwise specified (DESNOS)/complex PTSD; (c) cross- cultural factors; (d) developmental factors; and (e) subtypes of PTSD.

The role of family phenomena in posttraumatic stress in youth

TOPIC

Youth face trauma that can cause posttraumatic stress (PTS).

PURPOSE

(1) To identify the family phenomena used in youth PTS research; and(2) to critically examine the research findings regarding the relationship between family phenomena and youth PTS.

SOURCES

Systematic literature review in PsycInfo, PILOTS, CINAHL, and MEDLINE. Twenty-six empirical articles met inclusion criteria.

CONCLUSION

Measurement of family phenomena included family functioning,support, environment, expressiveness, relationships, cohesion, communication, satisfaction, life events related to family, parental style of influence, and parental bonding. Few studies gave clear conceptualization of family or family phenomena. Empirical findings from the 26 studies indicate inconsistent empirical relationships between family phenomena and youth PTS, although a majority of the prospective studies support a relationship between family phenomena and youth PTS. Future directions for leadership by psychiatric nurses in this area of research and practice are recommended.

Avoidance symptoms and assessment of posttraumatic stress disorder in Arab immigrant women

This study investigates whether the avoidance symptom criterion required for a Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV; American Psychiatric Association, 1994) diagnosis of posttraumatic stress disorder (PTSD) is overly conservative. Arab immigrant women (N = 453), many of whom reported experiencing multiple traumatic events, completed the Posttraumatic Diagnostic Scale in Arabic as part of a face to face interview. Analyses indicated all but one avoidance symptom was reported less frequently than reexperiencing and arousal symptoms. However, those who fully met reexperiencing, avoidance, and arousal symptom criteria had worse symptom severity and functioning than those who fully met reexperiencing and arousal symptom criteria, but only partially met avoidance symptom criterion. Study findings support importance of the PTSD avoidance symptom criterion.

Biology of post-traumatic stress disorder in childhood and adolescence

Diverse patterns of cortisol secretion with consistently high circulating catecholamines have been reported in post-traumatic stress disorder (PTSD), an anxiety state that develops after exposure to traumatic life events. Indeed, peripheral cortisol levels have been reported to be low or normal in the majority of adult chronic PTSD studies, whereas, in most paediatric studies, high cortisol values have been documented. Longitudinal studies on PTSD biology, including the transition from childhood to adulthood, may shed light on these discrepancies. In children, elevated evening salivary cortisol in the aftermath of the trauma was predictive of PTSD development 6 months later, whereas plasma interleukin-6 correlated positively with evening cortisol and was equally predictive of later PTSD. Longitudinal assessment of PTSD children 1 and 6 months later revealed progressive normalisation of cortisol levels, whereas noradrenaline concentrations became gradually higher. We hypothesise that, in adults with chronic PTSD, low cortisol levels, together with high catecholamines, may reflect a late event in the natural history of the disorder, months or years after the trauma. The progressive divergence of cortisol and noradrenaline concentrations over time may be responsible for PTSD maintenance in children and explain the differences between the child and adult PTSD endophenotypes. In adults studied immediately after the trauma, and by contrast to children, low cortisol levels are predictive of later PTSD development. Our hypothesis that low cortisol levels may reflect a previous trauma, earlier in development, is supported by the well established observation that prior trauma is a risk factor for a new PTSD diagnosis. The developmental stage of an individual in relation to previous exposure to trauma and PTSD vulnerability are crucial variables that may determine clinical and biological PTSD phenotypes and explain the discrepancies between adults and children in reported cortisol levels.

Validation of a Tibetan translation of the Hopkins Symptom Checklist 25 and the Harvard Trauma Questionnaire

This study sought to translate and validate the Hopkins Symptom Checklist-25 (HSCL) and the Harvard Trauma Questionnaire (HTQ) in a Tibetan population. Translated questionnaires were administered to 57 Tibetan survivors of torture/human rights abuses living in the United States and receiving services in a torture treatment program. Participants were evaluated to determine if they met criteria for major depressive episode, generalized anxiety disorder, or posttraumatic stress disorder (PTSD). Coefficient alpha for the HSCL Anxiety subscale (.89), Depression subscale (.92), and the HTQ (.89) were high. Diagnostic accuracy using receiver operating characteristic curve analysis generated good classification accuracy for anxiety (.89), depression (.92), and PTSD (.83). However, although sensitivity and specificity for HSCL subscales were quite high, the HTQ generated low sensitivity (.33), partly because of a low rate of PTSD. Results support the reliability and validity of the HSCL but suggest further study of the HTQ with this population is required.

Evidence-based and values-based policy, management and practice in child and adolescent mental health services

Values-based practice is a new approach to working with complex and conflicting values. It is based, primarily, on learnable skills and is being applied across a range of policy, training and service development initiatives in mental health and social care. This article outlines some of the key features of values-based practice including its complementary relationships to both regulatory ethics and evidence-based practice. We describe the systemic links between values-based approaches at the three key levels of policy, service development, prioritization and commissioning, and clinical practice and managing delivery of services, particularly as they are being developed in child and adolescent mental health services. Our article concludes by indicating some of the areas for further development of values-based practice.