Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis

The impact of trauma and how to intervene: a narrative review of psychotraumatology over the past 15 years

To mark 15 years of the European Journal of Psychotraumatology, editors reviewed the past 15-year years of research on trauma exposure and its consequences, as well as developments in (early) psychological, pharmacological and complementary interventions. In all sections of this paper, we provide perspectives on sex/gender aspects, life course trends, and cross-cultural/global and systemic societal contexts. Globally, the majority of people experience stressful events that may be characterized as traumatic. However, definitions of what is traumatic are not necessarily straightforward or universal. Traumatic events may have a wide range of transdiagnostic mental and physical health consequences, not limited to posttraumatic stress disorder (PTSD). Research on genetic, molecular, and neurobiological influences show promise for further understanding underlying risk and resilience for trauma-related consequences. Symptom presentation, prevalence, and course, in response to traumatic experiences, differ depending on individuals' age and developmental phase, sex/gender, sociocultural and environmental contexts, and systemic socio-political forces. Early interventions have the potential to prevent acute posttraumatic stress reactions from escalating to a PTSD diagnosis whether delivered in the golden hours or weeks after trauma. However, research on prevention is still scarce compared to treatment research where several evidence-based psychological, pharmacological and complementary/ integrative interventions exist, and novel forms of delivery have become available. Here, we focus on how best to address the range of negative health outcomes following trauma, how to serve individuals across the age spectrum, including the very young and old, and include considerations of sex/gender, ethnicity, and culture in diverse contexts, beyond Western, Educated, Industrialized, Rich, and Democratic (WEIRD) countries. We conclude with providing directions for future research aimed at improving the well-being of all people impacted by trauma around the world. The 15 years EJPT webinar provides a 90-minute summary of this paper and can be downloaded here [http://bit.ly/4jdtx6k].

Protocol MelatoSom-Kids-PTSD: sleep disturbances in children and adolescents with post-traumatic stress disorder (PTSD) - a randomized double-blind placebo-controlled trial to investigate the efficacy of paediatric prolonged-release melatonin

Introduction: Sleep disorders in the insomnia spectrum, as well as nightmares, are among the most sensitive and persistent symptoms in children with post-traumatic stress disorder (PTSD). There is currently no reference treatment or specific pharmacological treatment recommendation on the management of sleep disturbances in children and adolescents suffering from PTSD, despite the fact that they have a significant effect on daytime functioning and overall mental health of children as well as on family's health and quality of life. In this respect, paediatric prolonged-release melatonin (PedPRM) has shown significant beneficial effects on insomnia disorders in children with autism spectrum disorders and positive effects on anxiety and depressive symptomatology. Our study will be the first randomized controlled trial to examine the efficacy of PedPRM melatonin on sleep disorders in children and adolescents with PTSD, as well as on PTSD symptoms, associated daytime functioning and overall mental health in these children and their caregivers.Methods/design: The MelatoSOM-Kids-PTSD study (French national hospital-based clinical research programme) will be a multi-centre prospective double-blind placebo-controlled parallel group clinical trial investigating the efficacy of paediatric prolonged-release melatonin to alleviate sleep disturbances in children and adolescents with PTSD (120 participants recruited over a 24-month period). The experimental group will be treated with active prolonged-release melatonin over 13 weeks (PedPRM). The control group will receive a placebo. The primary endpoint will be the difference in sleep diary derived total sleep time after 13 weeks of treatment in the PedPRM group versus placebo group. Secondary endpoints will be the differences in objective sleep quality parameters and daytime functioning before and after treatment, in children with PTSD and their caregivers.Discussion: This paper describes the MelatoSOM-Kids-PTSD protocol, which will evaluate the effectiveness of melatonin, a treatment that has already demonstrated an excellent benefit-risk ratio in the paediatric population over 4 years.

Psychometric evaluation of the UCLA PTSD Reaction Index (PTSD RI-5) in a Turkish Clinical sample of trauma-exposed children

Objective: Trauma victimization is common among children, however, a significant proportion of trauma victims go unrecognized unless they are thoroughly assessed, even in child psychiatry clinics. The aim of this study was to evaluate the psychometric properties and diagnostic accuracy of the Turkish version of the UCLA PTSD Reaction Index for DSM-5 (PTSD RI-5) in a clinical sample of trauma-exposed children and adolescents.Method: A total of 208 children and adolescents admitted to the child psychiatry clinic, each of whom had a history of at least one traumatic event, were evaluated with the PTSD RI-5 to investigate trauma history and PTSD symptoms. All participants also completed the Revised Child Anxiety and Depression Scale (RCADS) and 64 participants were assessed with a semi-structured diagnostic interview for PTSD and depression.Results: Internal consistency for the total scale was high (Cronbach's α = 0.91) and the confirmatory factor analysis (CFA) supported the four-factor structure of the PTSD RI-5 (CFI =  0.915, TLI = 0.902, RMSEA =0.062). ROC analysis showed strong diagnostic accuracy (AUC = 0.94).Conclusion: The Turkish version of the PTSD RI-5 may a reliable and valid tool for diagnosing PTSD in clinical samples and may improve diagnosis and treatment outcomes by identifying unrecognized trauma-related symptoms.

Psychometric accuracy of the Dutch Child and Adolescent Trauma Screener

Objective: The aim of this study is to investigate the psychometrics of the Dutch version of the Child and Adolescent Trauma Screener (CATS-2). By this, an international recognized instrument to screen symptoms of post-traumatic stress (PTSS) in children and adolescents according to the Diagnostic and Statistical Manual for Mental Disorders, 5th edition (DSM-5) becomes available for Dutch youth.Procedure and Method: Based on the validated CATS-2 we established the Dutch version, named the KJTS. A total of 587 children and adolescent, age 7-21, and 658 caregivers referred to mental health care services in Amsterdam was included in the study to examine psychometric properties. The construct was tested by confirmatory factor analysis (CFA). Furthermore reliability, convergent-divergent patterns and diagnostic test accuracy were examined.Results: The underlying DSM-5 factor structure with four symptom clusters (re-experiencing, avoidance, negative alterations in mood and cognitions, hyperarousal) was supported by CFA showing a good fit for the selfreport (CFI = .95, TLI = .94), and an acceptable fit for the caregiver report (CFI = .90, TLI = .89). The KJTS showed excellent reliability (alpha = .92) on both selfreport and caregiver report. The convergent-discriminant validity pattern showed medium to strong correlations with measures of internalization problems, such as anxiety and affective problems (r = .44-.72) and low to medium correlations with externalizing symptoms (r = .21-.36). The ROC-curve analysis has proven a good accuracy (AUC = .81; n = 106).Discussion and conclusion: This study demonstrates the psychometric accuracy of the KJTS in a Dutch clinical population. The KJTS reflects adequately the dimensionality of PTSD as described in the DSM-5, with a good fit for selfreports, an acceptable fit for caregiver reports, excellent reliability and sufficient validity. Limitations are described. The outcomes support the use of the KJTS in research and clinical practice for screening and monitoring of PTSS.

The perceived burden of working with traumatized youth: construction and psychometric investigation of the Trauma Professionals' Burden Scale (TPBS)

Background: It is assumed that providing trauma-informed care for children and adolescents is a major challenge for professionals in child and youth welfare, psychiatric clinics and psychotherapy practices, yet studies are scarce. This is partly due to the fact that valid instruments that capture the specific stress caused by working with traumatized youths are missing. Our study aims to present the construction and results of the psychometric investigation of a scale that addresses the concerns, strains and needs of professionals, the Trauma Professionals' Burden Scale (TPBS).Methods: In our cross-sectional survey with youth psychotherapists, welfare professionals and psychiatric care staff (N = 834), the psychometric properties of the TPBS were examined using standard item and reliability analyses, exploratory factor analysis and confirmatory factor analysis (CFA). Convergent validity was assessed by testing the hypothesis that two TPBS subscales show high positive correlations with two established scales.Results: After deletion of eleven items, the remaining items of the TPBS show good discriminatory power, allowing to discriminate between participants with high or low scores, and high factor loadings. CFA results indicate fair model fit (RMSEA = .081, CFI = .81). Internal consistencies of the subscales range from ω = .76 to ω = .89. The expected correlations with the established scales are confirmed. A six-item short scale was created, showing excellent model fit (RMSEA = .047, CFI = .99) and good internal consistency (ω = .88).Conclusions: Although further validating research is required, the present study supports the psychometric validity of the TPBS enabling to assess professionals' stress associated with providing trauma-informed care for youth.

Patterns of mental health problems and resilience among immigrant and refugee adolescents: a latent profile analysis

Background: Immigrant and refugee adolescents often face traumatic experiences and are vulnerable to mental health problems, such as post-traumatic stress disorder (PTSD), anxiety and depression. Yet, they also show remarkable resilience in the face of these stressors. Research is still scarce on how both mental health problems and resilience dynamically interplay in immigrant and refugee adolescents' development.Objective: We aimed to identify latent profiles of immigrant and refugee adolescents' wellbeing, consisting of externalizing and internalizing symptoms, PTSD (intrusion and avoidance), and resilience, and analyse the demographic and contextual determinants of these profiles.Method: We employed cross-sectional survey data from the RefugeesWellSchool project for 1607 immigrant and refugee adolescents (mean age 15.3 years, SD 2.15, 42.3% girls) from six European countries: Belgium, Denmark, Finland, Norway, Sweden, and the United Kingdom. Latent profile analysis and three-step procedure with BCH weights were used to identify the wellbeing profiles and their determinants.Results: Results identified four adolescent wellbeing profiles: (1) Low symptoms (49.7%, n = 791); (2) High symptoms with intrusion (10.6%, n = 169); (3) Moderate symptoms (26.9%, n = 428); and (4) Resilient avoidant (12.8%, n = 203). Older participants, those with refugee background, shorter residence in the host country, more experiences of daily stressors or discrimination, or low family support were less likely to belong to the Low symptoms or Resilient avoidant groups (p ≤ .001).Conclusions: The profiles reflected distinct differentiation of intrusive and avoidance dimensions of the PTSD-symptoms. Intrusion clustered with high level of other mental health problems, whereas avoidance co-occurred with high resilience. Experiences related to immigration, stressors, and family support were crucial determinants of the wellbeing profile membership. Future interventions should utilize information obtained by person-centered studies to create better targeted and tailored support for immigrant and refugee adolescents.

Maladaptive appraisals and posttraumatic stress reactions in young terror survivors across 8 years: a random intercepts cross-lagged analysis

Background: Though there is substantial support for the importance of maladaptive appraisals for the development of posttraumatic stress reactions (PTSR), little is known about the long-term temporal relationship between maladaptive appraisals and PTSR beyond the first year after a traumatic event.Objective: We aimed to investigate three research questions: (1) Does the level of maladaptive appraisals change over time? (2) Are maladaptive appraisals and PTSR concurrently related to each other in the long term? (3) What is the direction of the temporal relationship between maladaptive appraisals and PTSR?Method: The participants were young survivors after the terror attack at Utøya island in Norway in 2011. We included data measured at 14-15 months, 30-32 months, and 102-108 months post trauma. The participants (N = 315) were all younger than 25 years at the time of the attack (mean age was 18.4, SD = 2.3), and 48.3% were female. The aims were investigated using correlations, paired t-tests, random intercept cross-lagged panel models (RI-CLPM), and cross-lagged panel models (CLPM).Results: We found a significant decrease in PTSR severity from 14-15 months to 30-32 months, and there was a significant increase in the mean level of maladaptive appraisals from 30-32 months to 102-108 months post trauma. Maladaptive appraisals and PTSR were highly associated across the three time points. Stable individual differences seem to account for most of the longitudinal relationship between maladaptive appraisals and PTSR, and we did not find clear indications of a direction of the temporal relationship between the variables.Conclusions: Our results indicate that the level of maladaptive appraisals can be quite stable once established, that they remain associated with PTSR, and that the long-term relationship between maladaptive appraisals and PTSR in the years following a trauma may best be explained by stable individual differences.

Preliminary efficacy of eye movement desensitization and reprocessing for children aged 1.5-8 years with PTSD: a multiple baseline experimental design (N = 19)

Background: Trauma exposure is common in (pre) school-aged children and around one-fifth of exposed children meet the criteria for post-traumatic stress disorder (PTSD). These symptoms can cause severe impairment to a child's functioning and, if left untreated, have negative long-term consequences. Therefore, there is an urgent need for effective treatment to reduce the acute and long-term effects of trauma. However, currently, there are no established empirically validated treatments for PTSD in young children.Objective: To assess the efficacy of eye movement desensitization and reprocessing (EMDR) therapy for improving PTSD symptoms, behavioural and emotional problems in young children aged 1.5-8 years, and parenting stress in their parents.Method: A non-concurrent, multiple baseline experimental design was combined with standardized measures across 19 mostly chronically trauma-exposed children fulfilling DSM-5 PTSD diagnosis. Primary outcomes included effects on the severity of PTSD symptoms and the rate of diagnostic remission from PTSD. Secondary outcomes included emotional and behavioural problems and parenting stress at each assessment point (baseline, pre-treatment, post-treatment, and three-month follow-up). Participants received six 1-hour EMDR sessions.Results: At post-treatment 79% of the children no longer met the diagnostic criteria for PTSD. Further, a significant decline in the severity of PTSD symptoms, emotional and behavioural problems in children was found post-treatment (all effect sizes > 1.20), as well as a significant reduction of parenting stress in their parents (Cohen's d effect size 0.45). All gains were maintained at the three-month follow-up, including a 79% loss of PTSD diagnosis. There was no dropout (0%) and no adverse events were reported.Conclusions: The findings provide preliminary evidence of the safety, feasibility, and efficacy of six sessions of EMDR therapy for reducing paediatric PTSD and comorbidity in young children aged 1.5-8 years and, at the same time, decreasing parenting stress. Further trials are warranted.Trial Registration: International Clinical Trial Registry Platform (before National Trial Register, trial search/who/int: identifier: NL8426, EMDR for young children with PTSD).

Mediator role of cognitive distortions in the relationship between posttraumatic stress disorder symptoms and peritraumatic stress levels

BACKGROUND

There are many studies showing the relationships between posttraumatic stress disorder (PTSD), peritraumatic stress, and cognitive distortions. However, there is a very limited number of studies focusing on the relationship between PTSD and cognitive distortions in children and adolescents. This study aimed to investigate the relationship between PTSD symptoms and peritraumatic stress levels in adolescents who experienced the 6 February Turkey earthquakes and the mediator role of cognitive distortions in this relationship.

METHODS

The study sample consisted of 261 adolescents with a mean age of 15.51 ± 1.07. The Child Posttraumatic Stress Disorder Reaction Index (CPTSD-RI), the Peritraumatic Distress Inventory (PDI), and the Cognitive Distortion Scale (CDS) were administered to the participants.

RESULTS

It was determined that there was a positive relationship between the peritraumatic stress levels and PTSD symptoms of the participants, and their peritraumatic stress levels significantly and positively predicted their PTSD symptoms and cognitive distortions. According to the results of the regression analyses, the self-perception, self-blame, helplessness, hopelessness, and perceiving life as dangerous dimensions of cognitive distortions and total CDS scores of the participants had partial mediator roles in the relationship between their peritraumatic stress levels and PTSD symptoms.

LIMITATIONS

Participants' PTSD symptoms were assessed using self-report scales. Pre-traumatic factors were not questioned.

CONCLUSION

Our results showed that the peritraumatic stress levels of adolescents who survived the 6 February Turkey earthquakes predicted their PTSD symptom levels, and their cognitive distortions played a mediator role in the relationship between their peritraumatic stress levels and PTSD symptoms.

IMPLICATIONS AND CONTRIBUTION

In psychological and psychiatric assessments of adolescents living in earthquake zones, peritraumatic stress levels should be kept in mind as a significant factor that can pose a risk in terms of PTSD. Furthermore, it is believed that cognitive distortions that can be causally related to PTSD should be taken into account in the treatment of PTSD.

Psychological therapies for post-traumatic stress disorder in children and adolescents

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects (i.e. benefits and harms) of psychological therapies for post-traumatic stress disorder and complex post-traumatic stress disorder in children and adolescents.

Short- and Long-Term Effectiveness of Brief Intensive Trauma Treatment for Adolescents With Posttraumatic Stress Disorder and Their Caregivers: Protocol for a Multicenter Randomized Controlled Trial

BACKGROUND

Childhood trauma is pervasive, with approximately 50% of adolescents experiencing at least one potentially traumatic event before adulthood. Eight percent to 33% of potentially traumatic event-exposed adolescents develop posttraumatic stress disorder (PTSD), which can cause extreme suffering and coincides with numerous comorbid illnesses and high-risk behaviors. PTSD can be effectively treated in adolescents through weekly sessions of eye movement desensitization and reprocessing or trauma-focused cognitive behavioral therapy. Despite the availability of these treatments, numerous severely traumatized adolescents do not receive available treatment options due to high treatment avoidance. In adolescents who receive care, a large group of youth does not experience a sufficient symptom decrease after regular treatment. In addition, dropout rates during prolonged treatment are substantial, varying between 10% and 30%. This underscores the need for innovative and brief trauma treatment. Pilot studies indicate that Brief Intensive Trauma Treatment (BITT) can be a safe and effective treatment for adolescents with PTSD. However, randomized controlled trials on its effectiveness are crucial and urgently needed.

OBJECTIVE

This is the first study to test the effectiveness of a 1-week BITT in adolescents with PTSD and comorbid symptoms and their caregivers.

METHODS

This multicenter, single-blinded randomized controlled trial will be conducted in 4 youth care centers in the European and Caribbean Netherlands: Levvel, Karakter, Fornhese-GGz Centraal, and Mental Health Caribbean (Bonaire). We will randomize adolescents (12-18 years old) with PTSD to a BITT (n=50) or waitlist control group (WLCG; n=50). BITT comprises 1-week (ie, 5 consecutive workdays) intensive trauma treatment, encompassing daily 90-minute manualized sessions of trauma-focused cognitive behavioral therapy and eye movement desensitization and reprocessing. The day begins and ends with psychomotor therapy. Caregivers receive daily parental counseling sessions consisting of psychoeducation and social support skill training. We will conduct measurements at similar intervals for both groups: at baseline; directly after BITT or WLCG; and at 3, 6, and 9 months' follow-up. The WLCG will receive BITT after the 3-month follow-up assessment. We will assess all study parameters using digital or face-to-face questionnaires and semistructured interviews. We will assess the primary outcome PTSD symptoms using the Child and Adolescent Trauma Screen 2 (CATS-2) and the Clinician-Administered PTSD Scale for DSM-5 (Diagnostic and Statistical Manual of Mental Disorders [Fifth Edition])-Child/Adolescent Version (CAPS-CA-5).

RESULTS

As of September 2022, we enrolled 104 participants. Data will be collected until December 2025. Results are expected to be published in the summer of 2026.

CONCLUSIONS

This first, innovative study on BITT's effectiveness may enhance treatment outcomes for PTSD by preventing dropout, reducing avoidance, shortening therapy duration, and empowering therapists by working together intensively. This research will provide valuable insights across cultures for treating severely traumatized adolescents who do not benefit sufficiently from regular treatment.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06143982, http://clinicaltrials.gov/ct2/show/NCT06143982.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/66115.

Shadows of trauma: an umbrella review of the prevalence and risk factors of post-traumatic stress disorder in children and adolescents

INTRODUCTION

Post-Traumatic Stress Disorder (PTSD) is a significant mental health concern affecting children and adolescents, often resulting from exposure to traumatic events such as violence, natural disasters, or abuse. A substantial number of children and adolescents experience these traumatic events; however, the reported prevalence of PTSD in this population varies widely across systematic reviews and meta-analyses. This umbrella review aims to synthesize findings from multiple systematic reviews and meta-analyses to provide a comprehensive estimate of PTSD prevalence and identify key risk factors associated with the disorder.

METHODS

A comprehensive literature search was conducted across several databases, including PubMed, Scopus, EMBASE, and others, using the COCOPOP framework. Systematic reviews and meta-analyses published between January 1, 2014, and December 1, 2024, were included. Data were extracted by two reviewers independently and analyzed using Stata 17 with a random-effects meta-analysis model.

RESULTS

A total of twelve studies were included, with a combined sample size of 121,333 participants. The pooled prevalence estimate for PTSD among children and adolescents was found to be 25% (95% CI: 20-30%), with substantial heterogeneity (I² = 99.9%). Subgroup analyses indicated variations in prevalence based on publication year and the number of primary studies included in the systematic reviews. Key risk factors identified included older age, female gender, low social support, feelings of entrapment, and experiencing bereavement.

CONCLUSIONS

The prevalence of PTSD among children and adolescents exposed to trauma is notably high. Key contributing factors include older age, female gender, low social support, feelings of entrapment, and experiencing bereavement. Targeted interventions focusing on these risk factors, such as enhancing social support systems and providing early mental health interventions, are essential to improve outcomes for this vulnerable population. Further research is needed to refine these strategies and ensure they effectively meet the needs of children and adolescents affected by trauma.

Type of trauma exposure and subsequent mental health Symptoms: Examining the role of social needs in TX-YDSRN youth

Many youth experience potentially traumatic events and may go on to develop post-traumatic stress disorder (PTSD). For youth who develop PTSD, little research has examined the role of health-related social needs, like housing instability or food insecurity, on its development. The present study aimed to explore the types of traumatic experiences reported at baseline by youth and sought to explore the relationship between post-traumatic stress symptoms and reported health-related social needs. Specifically, it aimed to determine if the effects of health-related social needs differed across demographic variables (e.g., sex assigned at birth, gender, race, ethnicity) and trauma types (i.e., interpersonal and other trauma). Findings demonstrated interpersonal trauma was a significant predictor of PTSD symptoms. While lower interpersonal safety was associated with a greater likelihood of participants reporting interpersonal trauma, it was not related to PTSD symptoms. Our findings highlight the need for clinicians to utilize interventions that specifically target the psychological effects of interpersonal trauma. Furthermore, interventions should consider the wider social context to address factors like interpersonal safety which may play a part in the increased risk of trauma exposure among youth.

Posttraumatic stress in infancy: The roles of cumulative trauma and caregiving context

Infants are exposed to traumatic events at higher rates than older children, potentially leading to posttraumatic stress symptoms. Despite this higher prevalence, posttraumatic stress responses in infancy have not been well researched due to conceptual, developmental, and methodological challenges. This study conducted in the United States investigated the responses of infants aged 3-18 months after exposure to a range of traumatic events. Caregivers reported on their infants' trauma exposure and posttraumatic stress symptoms using the UCLA PTSD Reaction Index for DSM-5 for Children Age 6 and Younger and reported on their own posttraumatic symptoms on the PTSD Diagnostic Scale for DSM-5 (PDS-5). Of 116 racially and ethnically diverse infants, 96 (82.8%) were exposed to at least one traumatic event (M = 1.6; SD = 1.2; range = 0-7). Infant trauma exposure and caregiver symptoms were significant predictors of the number and severity of caregiver-endorsed infant symptoms. These findings indicate that infants as young as 3 months of age may manifest posttraumatic stress symptoms after trauma exposure. Developmental context and caregiver functioning should be considered when assessing for posttraumatic stress symptoms in infants.

Trajectory of Post-Traumatic Stress During the First Year after Pediatric Traumatic Brain or Orthopedic Injury

Up to 50% of children sustaining physical injury develop post-traumatic stress symptoms (PTSS). Most studies of PTSS have not included patients with traumatic brain injury (TBI); consequently, the influence of injury type and severity on the longitudinal course of PTSS is unclear. To address this gap, we completed a longitudinal prospective cohort study examining the trajectory of self-reported PTSS severity during the first year after TBI or orthopedic injury (OI). Within a biopsychosocial framework, we examined PTSS in relation to injury variables, demographic characteristics, and pre-injury child and family functioning. Patients ages 9-15 years with TBI or OI were recruited from two level I pediatric trauma centers. Online surveys were completed as soon as possible following injury (mdn = 8 days). Caregivers rated pre-injury family, sociodemographic, and child characteristics. Follow-up surveys assessing children's self-reported PTSS using the Children's PTSD Symptom Scale (CPSS) were scheduled 3,6, and 12 months after injury. English-speaking families completed surveys either online or by telephone interview; Spanish-speaking families were interviewed. Baseline surveys were completed by 303 families; 265 (87%) completed at least 1 follow-up and comprised the cohort. General linear mixed models examined the influence of injury group and severity, age, sex, and time of assessment on CPSS scores. Pre-injury estimates of child and family functioning were examined as predictors in supplemental models. Participants (72% boys, mean [SD] age 12.7 [1.9] years) included 204 with TBI (76 mild, 82 complicated-mild/moderate, 46 severe) and 61 with OI. Relative to OI, patients with TBI had significantly elevated mean CPSS scores at 3 (3.7 points, 95% confidence intervals [CI]: 1.1, 6.3); 6 (3.2, 95% CI: 0.7, 5.7) and 12 months (2.3, 95% CI: 0.1, 4.5). The primary model indicated that TBI severity had a nonlinear relation with CPSS. Mild TBI (mTBI) had the highest mean scores; with significant differences relative to OI at 3 (4.6 points, 95% CI: 1.6, 7.6); 6 (5.7, 95% CI: 2.7, 8.6) and 12 months (3.2, 95% CI: 0.6, 5.8). This model also revealed that adolescent females had higher CPSS scores than children or adolescent males. Differences relative to younger males at 6 and 12 months were 4.9 (95% CI: 1.6, 8.3) and 5.0 points (95% CI: 2.1, 8.0). In supplemental models, higher symptom burden was associated with poorer baseline family functioning and with higher levels of children's pre-injury anxiety, affective problems, and conduct problems. PTSS persisted for a significant minority of patients with TBI across the first year of recovery, particularly those with mTBI. Screening should emphasize risk factors to target patients with the greatest need for trauma-focused intervention. Cost-effective, scalable, evidence-based trauma-focused interventions are essential to meet American College of Surgeons standards to provide psychological screening and treatment to children sustaining PTSS.

Polyvictimization Profiles and Variations in Youth Mental Health Symptoms: A Person-Centered Approach

Polyvictimization, exposure to multiple potentially traumatic events (PTEs), is prevalent and has profound mental health implications. Investigating the patterns and impact of co-occurring PTEs during childhood is essential to design and deliver tailored clinical services. This study included a diverse community sample of 326 youth (ages 7-16). Latent class analysis (LCA) of DSM-5 posttraumatic stress disorder (PTSD) criterion A events was conducted to identify PTE classes. Classes were further characterized using race-related, peer, and dating victimization, and psychopathology symptoms (PTSD, anxiety, depression). Three classes emerged: (1) low trauma, (2) interpersonal and community violence (IPV/CV), and (3) emotional abuse, neglect, and interpersonal violence in familial relationships (EA/N/IPVFam). Demographics, total PTEs, age at first exposure, race-related events, PTSD, anxiety, and depression symptoms varied across classes, indicating functional significance of identified profiles. Results underscore the importance of considering PTE profiles and person-centered approaches to understand and address trauma-related sequelae in youth.

Cognitive therapy for PTSD following multiple-trauma exposure in children and adolescents: a case series

BACKGROUND

Cognitive therapy for PTSD (CT-PTSD) is an efficacious treatment for children and adolescents with post-traumatic stress disorder (PTSD) following single incident trauma, but there is a lack of evidence relating to this approach for youth with PTSD following exposure to multiple traumatic experiences.

AIMS

To assess the safety, acceptability and feasibility of CT-PTSD for youth following multiple trauma, and obtain a preliminary estimate of its pre-post effect size.

METHOD

Nine children and adolescents (aged 8-17 years) with multiple-trauma PTSD were recruited to a case series of CT-PTSD. Participants completed a structured interview and mental health questionnaires at baseline, post-treatment and 6-month follow-up, and measures of treatment credibility, therapeutic alliance, and mechanisms proposed to underpin treatment response. A developmentally adjusted algorithm for diagnosing PTSD was used.

RESULTS

No safety concerns or adverse effects were recorded. Suicidal ideation reduced following treatment. No participants withdrew from treatment or from the study. CT-PTSD was rated as highly credible. Participants reported strong working alliances with their therapists. Data completion was good at post-treatment (n=8), but modest at 6-month follow-up (n=6). Only two participants met criteria for PTSD (developmentally adjusted algorithm) at post-treatment. A large within-subjects treatment effect was observed post-treatment and at follow up for PTSD severity (using self-report questionnaire measures; ds>1.65) and general functioning (CGAS; ds<1.23). Participants showed reduced anxiety and depression symptoms at post-treatment and follow-up (RCADS-C; ds>.57).

CONCLUSIONS

These findings suggest that CT-PTSD is a safe, acceptable and feasible treatment for children with multiple-trauma PTSD, which warrants further evaluation.

Evaluation of New Mental Health Diagnoses After Pediatric Traumatic Injuries at a Level 1 Pediatric Trauma Center

BackgroundTraumatic injury is associated with significant mental health morbidity. To evaluate the need for implementation of active-post injury mental health screening at a Level 1 Pediatric Trauma center, we aimed to characterize all new mental health diagnoses after injury and evaluated for patient or injury factors that may aid in targeting of future screening.MethodsA single-center retrospective analysis of trauma patients aged 6-18 years presenting in 2022 was performed. Our primary outcome was a new DSM-5 mental health diagnosis documented after traumatic injury. Patients with and without a new mental health diagnosis were compared by age, sex, race, ethnicity, injury type/mechanism, injury severity score (ISS), intensive care unit (ICU) admission, and length of stay (LOS).Results492 patients were included. Their median (IQR) age was 13.5 (10.4, 15.4) years. The median (IQR) follow-up interval was 157 (9, 429) days. There were 24 (4.9%) children with a new mental health diagnosis: 12 (50%) with trauma-related stress disorders, with the remaining having diagnoses such as depressive or anxiety disorders. Patients with a new mental health diagnosis had longer LOS (3.0 [1.8, 7.5] vs 2.0 [1.0, 3.3] days, P = 0.02) and were more likely to have sustained penetrating injury (P = 0.01). There were no differences in demographics, rates of preexisting mental health diagnosis or area deprivation index (P > 0.05).DiscussionThere were fewer new mental health diagnoses in our cohort than expected, likely underestimating the acute need. Comprehensive post-injury screening is imperative to sufficiently identify and intervene upon mental health morbidity after pediatric trauma.

A structural equation model of parenting and child's resilience after the earthquake in Türkiye

This study investigated the relationship between parental psychological wellbeing, parenting, children's psychological difficulties, and prosocial behavior in Kahramanmaraş earthquake-affected families living in Türkiye in 2023. To this end, a mediation model was proposed for parental psychological distress that was hypothesized to exert an indirect effect on a child's psychological difficulties and prosocial behavior through parenting. Participants were 358 preschoolers between 4 and 6 years old and their one parent (father or mother) who completed a set of validated self-report surveys in a cross-sectional design study. Results showed positive associations between parental psychological distress and child's psychological difficulties but negative association with child's prosocial behavior. Furthermore, quality of parenting mediated the association between parental psychological distress and child's psychological difficulties and prosocial behavior. Our findings suggest that positive parenting may serve as a protective mechanism that mediates the association between parental psychological distress and a child's psychological difficulties and prosocial behaviors among families displaced by a natural disaster like an earthquake. These findings point to the need for supporting positive parent-child relationships in addition to decreasing the psychological distress of parents when exposed to potentially traumatizing events like this.

Person-centred integrated primary care for refugees: a mixed-methods, stepped wedge design study to assess the impact

AIM

To assess the impact of a person-centred culturally sensitive approach in primary care on the recognition and discussion of mental distress in refugee youth.

BACKGROUND

Refugee minors are at risk for mental health problems. Timely recognition and treatment prevent deterioration. Primary care is the first point of contact where these problems could be discussed. However, primary care staff struggle to discuss mental health with refugees.Guided by the needs of refugees and professionals we developed and implemented the Empowerment intervention, consisting of a training, guidance and interprofessional collaboration in four general practices in the Netherlands.

METHODS

This mixed-method study consisted of a quantitative cohort study and semi-structured interviews. The intervention was implemented in a stepped wedge design. Patient records of refugee youth and controls were analysed descriptively regarding number of contacts, mental health conversations, and diagnosis, before and after the start of the intervention.Semi-structured interviews on experiences were held with refugee parents, general practitioners, primary care mental health nurses, and other participants in the local collaboration groups.Findings:A total of 152 refugees were included. Discussions about mental health were significantly less often held with refugees than with controls (16 versus 38 discussions/1000 patient-years) but increased substantially, and relatively more than in the control group, to 47 discussions/1000 patient-years (compared to 71 in the controls) after the implementation of the programme.The intervention was much appreciated by all involved, and professionals in GP felt more able to provide person-centred culturally sensitive care.

CONCLUSION

Person-centred culturally sensitive care in general practice, including an introductory meeting with refugees, in combination with interprofessional collaboration, indeed results in more discussions of mental health problems with refugee minors in general practice. Such an approach is assessed positively by all involved and is therefore recommended for broader implementation and assessment.

One in six children and adolescents in south Ethiopia had childhood trauma

BACKGROUND

Childhood trauma is a serious experience that can have a profound impact on the physical, psychological, and social development of children and adolescents, with long-term effects on both the individual and society. Unfortunately, this condition is often overlooked by parents, teachers, medical professionals, mental health practitioners, and researchers. Therefore, this study aimed at assessing childhood trauma and associated factors among children and adolescents aged 5-14 years old at Wolaita Sodo University Comprehensive Specialized Hospital in South Ethiopia in 2022.

METHOD

From 22 September to 22 November, 2022, a hospital-based cross-sectional study was conducted, at Wolaita Sodo University Comprehensive Specialized Hospital. A total of 423 hospital based samples were selected using a systematic random sampling technique. Data was collected using a structured interviewer administered questionnaire. Childhood trauma was screened using the internationally validated the child trauma screening questionnaire after determining for its reliability in the study area. The data was analysed using descriptive and logistic regression analysis methods. The strength as well as presence of association was presented using odds ratio and 95% CI with a corresponding p-value < 0.05.

RESULT

The magnitude of childhood trauma among children and adolescents aged 5-14 was 18%. Living in a family size of four and above (AOR = 1.8; 95% CI: 1.07, 3.13), lower level of parental education (AOR = 4.4; 95% CI: 2.18, 9.00) and children and adolescent with emotional problems (AOR = 1.9; 95% CI: 1.09, 3.20) were found to be independent predictors of childhood trauma.

CONCLUSION AND RECOMMENDATION

Approximately one in six children and adolescents have experienced childhood trauma. Factors such as living in a larger family, having parents with a low educational level, and experiencing emotional problems were found to be independently associated with childhood trauma. A holistic preventive approach, along with early detection and management of childhood trauma, is essential in order to prevent both the short-term and long-term impacts of such experiences.

Therapeutic Potential of MDMA- and Psychedelic-Assisted Psychotherapy for Adolescent Depression and Trauma

PURPOSE OF REVIEW

There is a mental health crisis affecting youth, and the utility of existing treatments is often limited by lack of effectiveness and tolerability. The aim of this review is to report on outcomes of clinical trials for psilocybin-assisted psychotherapy for adults with depression and MDMA-assisted psychotherapy for adults with post-traumatic stress disorder (PTSD) and discuss recommendations for exploring these treatments in adolescent populations.

RECENT FINDINGS

There have been encouraging data supporting the use of psilocybin-assisted psychotherapy for depression, including previously treatment-resistant symptoms. MDMA-assisted psychotherapy is showing similar promise in treating PTSD, with excellent response and remission rates that appear durable. However, no studies have looked at the use of these treatments in younger patients. The safety and efficacy of psychedelic- and MDMA-assisted psychotherapies should be investigated in adolescents, especially considering the burden of untreated and undertreated psychiatric illness in youth, and the benefits of a potentially earlier, more effective, and more tolerable recovery process. Research and implementation should be tailored to the needs of this population, and equity and access should be considered at every stage. In this novel and rapidly evolving landscape, the psychiatric community is encouraged to advocate for safe, appropriate, and inclusive inquiry into, and application and scaling of these treatment models in adolescent patients.

Scoping Review: Digital Mental Health Interventions for Children and Adolescents Affected by War

OBJECTIVE

More than 200 million children and adolescents live in countries affected by violent conflict, are likely to have complex mental health needs, and struggle to access traditional mental health services. Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support. We performed a scoping review to map existing digital mental health interventions relevant for children and adolescents affected by war, to examine the strength of the evidence base, and to inform the development of future interventions.

METHOD

Based on a pre-registered strategy, we systematically searched MEDLINE, Embase, Global Health, APA PsychInfo, and Google Scholar from the creation of each database to September 30, 2022, identifying k = 6,843 studies. Our systematic search was complemented by extensive consultation with experts from the GROW Network.

RESULTS

The systematic search identified 6 relevant studies: 1 study evaluating digital mental health interventions for children and adolescents affected by war, and 5 studies for those affected by disasters. Experts identified 35 interventions of possible relevance. The interventions spanned from universal prevention to specialist-guided treatment. Most interventions directly targeted young people and parents or carers/caregivers and were self-guided. A quarter of the interventions were tested through randomized controlled trials. Because most interventions were not culturally or linguistically adapted to relevant contexts, their implementation potential was unclear.

CONCLUSION

There is very limited evidence for the use of digital mental health interventions for children and adolescents affected by war at present. The review provides a framework to inform the development of new interventions.

PLAIN LANGUAGE SUMMARY

Digital mental health interventions have the potential to overcome some of the barriers in accessing mental health support for children and adolescents living in war affected regions. In this scoping review, the authors identified 1 study evaluating digital mental health interventions for children and adolescents affected by war and 5 for those affected by disasters. In addition, 35 interventions were identified through expert consultation as of possible relevance. The authors found very limited evidence for the use of digital mental health interventions for children and adolescents affected by war, and given this provide a framework to inform the development of new interventions.

DIVERSITY & INCLUSION STATEMENT

We actively worked to promote sex and gender balance in our author group.

STUDY PREREGISTRATION INFORMATION

Digital mental health interventions for children and young people affected by war: a scoping review; https://osf.io/; hrny9.

Psychological Interventions for Pediatric Posttraumatic Stress Disorder: A Systematic Review and Network Meta-Analysis

Importance

Pediatric posttraumatic stress disorder (PTSD) is a common and debilitating mental disorder, yet a comprehensive network meta-analysis examining psychological interventions is lacking.

Objective

To synthesize all available evidence on psychological interventions for pediatric PTSD in a comprehensive systematic review and network meta-analysis.

Data Sources

PsycINFO, MEDLINE, Web of Science, and PTSDpubs were searched from inception to January 2, 2024, and 74 related systematic reviews were screened.

Study Selection

Two independent raters screened publications for eligibility. Inclusion criteria were randomized clinical trial (RCT) with at least 10 patients per arm examining a psychological intervention for pediatric PTSD compared to a control group in children and adolescents (19 years and younger) with full or subthreshold PTSD.

Data Extraction and Synthesis

PRISMA guidelines were followed to synthesize and present evidence. Two independent raters extracted data and assessed risk of bias with Cochrane criteria. Random-effects network meta-analyses were run.

Main Outcome and Measures

Standardized mean differences (Hedges g) in PTSD severity.

Results

In total, 70 RCTs (N = 5528 patients) were included. Most RCTs (n = 52 [74%]) examined trauma-focused cognitive behavior therapies (TF-CBTs). At treatment end point, TF-CBTs (g, 1.06; 95% CI, 0.86-1.26; P < .001), eye movement desensitization and reprocessing (EMDR; g, 0.86; 95% CI, 0.54-1.18; P < .001), multidisciplinary treatments (MDTs) (g, 0.88; 95% CI, 0.53-1.23; P < .001), and non-trauma-focused interventions (g, 0.95; 95% CI, 0.62-1.28; P < .001) were all associated with significantly larger reductions in pediatric PTSD than passive control conditions. TF-CBTs were associated with the largest short-term reductions in pediatric PTSD relative to both passive and active control conditions and across all sensitivity analyses. In a sensitivity analysis including only trials with parent involvement, TF-CBTs were associated with significantly larger reductions in pediatric PTSD than non-trauma-focused interventions (g, 0.35; 95% CI, 0.04-0.66; P = .03). Results for midterm (up to 5 months posttreatment) and long-term data (6-24 months posttreatment) were similar.

Conclusions and Relevance

Results from this systematic review and network meta-analysis indicate that TF-CBTs were associated with significant reductions in pediatric PTSD in the short, mid, and long term. More long-term data are needed for EMDR, MDTs, and non-trauma-focused interventions. Results of TF-CBTs are encouraging, and disseminating these results may help reduce common treatment barriers by counteracting common misconceptions, such as the notion that TF-CBTs are harmful rather than helpful.

Early maladaptive schemas as mediators between childhood maltreatment and adult psychopathology in psychiatric inpatients

BACKGROUND

Early maladaptive schemas are well-established mechanisms between childhood maltreatment (i.e., abuse and neglect) and psychopathology in adulthood. However, research has not yet examined the unique contribution of childhood maltreatment, while controlling for the family dysfunction-related experiences, in shaping specific EMS domains and their associations with distinct psychopathological outcomes.

OBJECTIVE

Our aim was to examine the unique role of childhood maltreatment, while controlling for the effects of family dysfunction on early maladaptive schemas and subsequently on personality disorders and psychological distress using structural equation modelling and network analysis.

METHODS

A total of 2,011 unique inpatients aged 18 to 80 years (M = 39.7, SD = 14.18; 53.4% women) admitted to the Alexianen Zorggroep Tienen Psychiatric Hospital between 2011 and 2021 were included in this study. Self-report questionnaires were completed as part of the hospital admission process. Data were analyzed using structural equation modeling and network analysis.

RESULTS

The results showed positive associations between childhood maltreatment, family dysfunction, early maladaptive schema domains, symptoms of personality disorders, and psychological distress. Accounting for the effects of family dysfunction-related experiences, early maladaptive schema played a significant mediating role in the association between childhood maltreatment and psychopathological outcomes. The results highlighted the central role of the domains disconnection/rejection and impaired autonomy/performance for personality disorders and psychological distress. There were no significant gender-specific differences in the network of relationships between the variables.

CONCLUSIONS

These results demonstrate the key role of EMS in the domains of disconnection/rejection and impaired autonomy/performance in the association between childhood maltreatment and personality pathology and psychological distress in psychiatric inpatients. Clinical implications, study limitations, and recommendations for future research are discussed.

Exploring Intersections Between Trauma and Discrimination in Youth of Color Seeking Mental Health Services

OBJECTIVE

The purpose of this study is to explore the intersection between trauma and discrimination among Black and Latino/a/x youth seeking treatment. Specifically, we examine the following: (1) the frequency of various everyday discrimination experiences, averaged across the sample and disaggregated by demographic characteristics; (2) unique associations between exposure to potentially traumatic events (PTEs) and everyday discrimination experiences; and (3) unique associations between everyday discrimination experiences and specific posttraumatic stress symptoms while accounting for demographic characteristics and PTEs.

METHOD

Participants were 573 Black (54.8%) and non-Black Latino/a/x youth (10-18 years of age, 55.8% female, 25.7% first- or second-generation immigrant) who were treatment-seeking and had exposure at least one traumatic event.

RESULTS

Two-thirds of trauma-exposed youth reported having experienced discrimination, with the most common experience being treated as not smart (46%), followed by being treated with less courtesy or respect (40%). Rates of discrimination varied by intersecting demographic characteristics in nuanced ways. Among 11 PTEs, exposure to a natural disaster, experiencing community violence, and witnessing community violence were each positively associated with overall everyday discrimination scores and specific discriminatory encounters. Everyday discrimination experiences were positively associated with posttraumatic stress symptoms after accounting for demographic characteristics and exposure to PTEs.

CONCLUSION

Findings provide important context for understanding experiences of everyday discrimination in Black and Latino/a/x youth seeking mental health services for trauma. Findings further highlight variability in the types of discrimination youth with different intersecting identities experience, the high rates of co-occurrence between discrimination and other traumatic events, and unique associations between specific discrimination experiences and posttraumatic stress reactions.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper received support from a program designed to increase minority representation in science.

Posttraumatic stress disorder in disaster-exposed youth: examining diagnostic concordance and model fit using ICD-11 and DSM-5 criteria

BACKGROUND

Competing definitions of posttraumatic stress disorder (PTSD) have been proposed by ICD-11 and DSM-5; it is unclear which diagnostic model works best for children and adolescents. Although other studies have predicted the impact of these models by approximating the criteria using older measures, this study advances the research by comparing measures designed to assess ICD-11 and DSM-5 criteria in hurricane-exposed youth. This study evaluates ICD-11 and DSM-5 (both the standard and preschool-age) diagnostic models by identifying diagnostic rates, evaluating diagnostic concordance, investigating the predictive value of constructs associated with PTSD (demographics, disaster threat and exposure, functional impairment), and examining model fit.

METHOD

The sample was exposed to Hurricane Ian (2022), a deadly Category 5 hurricane. Parents reported on disaster exposure and their child's PTSD symptoms (n = 152; ages 7-17) using the International Trauma Questionnaire for Children and Adolescents Caregiver Version (ITQ-CG) for ICD-11 criteria and UCLA PTSD Reaction Index for DSM-5, Parent/Caregiver Report Version (RI-5) for DSM-5 criteria.

RESULTS

ICD-11 PTSD symptom criteria rates were 24% and dropped to 20% when the impairment criterion was added. PTSD symptom criteria rates were 11% (10% with impairment) for DSM-5 and 13% (12% with impairment) for DSM-5 Preschool. ICD-11 rates were higher than DSM-5 and DSM-5 Preschool rates. There was no difference between DSM-5 and DSM-5 Preschool rates of PTSD. There was moderate to substantial concordance between ICD-11 and the DSM-5 models. All diagnostic models were associated with exposure and impairment, but only ICD-11 was associated with threat. ICD-11 was the only one to evidence acceptable model fit.

CONCLUSIONS

Using the ITQ-CG and RI-5 to assess PTSD in youth, results showed higher PTSD diagnostic rates for ICD-11 than DSM-5; this contradicts prior findings (based off approximated ICD-11 criteria) and seems largely due to differences in symptom thresholds used by the two measures. The ITQ-CG exhibited excellent model fit and was associated with several constructs important to PTSD.

Attention-Deficit/Hyperactivity Disorder and Subsequent Trauma Exposure: The Mediating Role of Deviant Peer Affiliation

Individuals with ADHD symptoms are at an increased risk of lifetime trauma exposure. However, research has yet to fully examine whether symptoms of ADHD function as a temporal risk factor for experiencing trauma and specific mechanisms that may explain the association between symptoms of ADHD and trauma exposure. Two constructs that may account for the relation between ADHD symptoms and trauma are deviant peer association and neighborhood disadvantage. The present study sought to 1) elucidate the temporal nature of ADHD symptoms and exposure to trauma and 2) examine whether peer deviancy and/or neighborhood disadvantage mediate the relation between childhood ADHD symptoms and subsequent trauma exposure across a 20-year longitudinal cohort study. Participants (N = 616) were predominantly Black/African American (86%; Male n = 389) from an urban school district. Using structural equation modeling, total trauma exposures during young adulthood (Years 17-20) were regressed on parent- and teacher-rated ADHD symptoms in Grade 1 (Year 1). A significant indirect path from ADHD symptoms to trauma exposure through deviant peer affiliation (Year 16) indicated that having childhood ADHD symptoms predicted deviant peer affiliation 16 years later, which in turn predicted greater exposures to traumatic events during young adulthood, controlling for neighborhood disadvantage. Neighborhood disadvantage was not a significant mediator when accounting for peer deviancy. Taken together, findings contribute to a limited body of research that utilizes a prospective design to examine the association between childhood ADHD symptoms and trauma exposure in young adulthood among Black/African American youth. Potential targets for intervention are proposed.

Trauma, Justice, and Equity: Using Critical Theories and Concepts to Address Systemic Harm Among Youth Punishment System-Involved Black Girls

This review critically evaluates the existing literature on youth punishment system (YPS)-involved Black girls and their intersections of with trauma and post-traumatic stress disorder (PTSD). It synthesizes findings from previous studies, identifying key research trends, gaps, and controversies, while also highlighting areas in need of further investigation. Black girls, particularly those involved in systems such as juvenile justice, child welfare, and education, often face disproportionate exposure to violence, abuse and neglect, trauma, and systemic racism. For Black girls with histories of trauma and PTSD, these intersecting challenges are compounded by the added vulnerabilities of race, gender, and YPS involvement. This article argues that addressing the complex needs of this population requires recognition that Black girls' harm is criminalized and, therefore, inextricably linked to their YPS-involvement, so a comprehensive, culturally responsive approach that includes trauma-informed care, healing-centered engagement, and holistic support systems are needed. Equitable access to tailored mental health services, educational resources, and culturally relevant interventions is essential to mitigate the long-term effects of trauma, promote resilience, and foster healing. Additionally, advocacy efforts to dismantle systemic harm and address racial and gender disparities are critical for creating inclusive environments that empower and support Black girls in these systems. By centering their lived experiences, this review emphasizes the importance of fostering environments of healing, justice, and equity for this vulnerable population.

Long-term psychopathology rates of children and adolescents and associated factors in the worst-sticken area of 2023 Kahramanmaras earthquake

INTRODUCTION

Earthquakes are natural disasters that can have significant psychological impacts on individuals, particularly children. While physical injuries are often the immediate focus following an earthquake, the psychological effects can be long-lasting and profound. Understanding the psychiatric effects of traumatic experiences in children following earthquakes is crucial for developing effective interventions and support systems.

METHOD

One hundred fifty three children and adolescents who experienced the earthquake were evaluated in the first year of the earthquake. Depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms were measured using standardized assessment tools. Factors that may be related to psychopathology, such as sleep disturbance, the extent of trauma, and where one lived after the earthquake, were also evaluated. The anxiety, depression and stress levels of the mother and father separately and their relationship with the child's psychopathology were evaluated.

RESULTS

The frequency of depression risk among participants was found to be 24.8%, while the frequency of anxiety risk was 62.8%. The frequency of PTSD risk was 97.4%. Children who migrated to another province after the earthquake had higher scale scores. Parental depression anxiety stress level was positively correlated with children's scale scores. Disruption in sleep patterns increased the risk of depression by 2.38 times. Experiencing the loss of friends in the earthquake increased PTSD score by 6.27.

DISCUSSION

The findings of this study highlight the importance of addressing the psychiatric needs of children following earthquakes. Psychosocial support and access to appropriate treatment should be prioritized to mitigate the long-term psychological effects of traumatic experiences in children.

Supporting Children's Mental Health Needs in Disasters

Public health emergencies, including climate-related and manmade disasters such as active shooter incidents, occur regularly in the United States. A comprehensive approach is needed to ensure that children's mental health needs are adequately addressed following disasters. This article summarizes the latest evidence on how health systems can effectively address children's unique developmental, social, emotional, and behavioral needs in the context of disasters. To do so requires the integration of mental health considerations throughout all disaster phases, including preparedness, response, and recovery. We discuss the role of traditional emergency response systems and emerging models for responding to mental health crises. These include the national children's disaster mental health concept of operations and specific resources such as crisis lines, mobile crisis units, and telemental health. To achieve a broader reach in addressing children's mental health needs during disasters, health systems can foster a "pediatric disaster system of care" by partnering with community touch points such as schools, faith-based organizations, public health, and law enforcement. Unique considerations during disasters are required to maintain access to care for children with preexisting behavioral health conditions. During disasters, attention is needed to promote equitable identification of mental health needs and linkage to services, particularly for minoritized groups and children living in rural, frontier, and high-poverty areas. Strategies to address children's mental health needs during disasters include the provision of psychological first aid, screening for and triaging mental health needs, and stepped care approaches that progressively allocate higher-intensity evidence-based treatments to children with greater and enduring needs.

Early biological and psychosocial factors associated with PTSD onset and persistence in youth

Background: Posttraumatic stress disorder (PTSD) is a debilitating mental health condition that can develop after experiencing or witnessing a traumatic event. While considerable research has investigated PTSD in adults, little is known about the biological, psychological, and social factors that contribute to its onset, development, and persistence in youth.Methods: This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify longitudinal studies examining factors associated with PTSD status and symptom severity in children and adolescents. Literature searches were conducted in PubMed, Scopus, and Web of Science, yielding 24 eligible studies after screening.Results: The included studies identified various biological factors associated with paediatric PTSD, including dysregulation of the hypothalamic-pituitary-adrenal axis, brain structural alterations, and physiological markers such as heart rate. Psychological factors, including depression, trauma appraisals, coping styles, and cognitive deficits predicted PTSD symptom development. Social factors included parental PTSD, family environment, and cultural influences. Many studies highlighted the importance of the interplay between these biological, psychological, and social factors in the manifestation of PTSD in youth.Conclusion: This review synthesises evidence that PTSD development in youth is influenced by a complex array of neurobiological vulnerabilities, psychological processes, and environmental factors. Longitudinal, multi-dimensional studies are needed to further elucidate personalised risk profiles and trajectories, which can inform targeted prevention and intervention strategies for PTSD in youth.

Victimization, immigration status, and psychosocial well-being: A representative study among finnish adolescents

BACKGROUND

Immigrant adolescents seem to be at risk for victimization and being victimized in adolescence is related to risk factors regarding mental health.

OBJECTIVE

This study compared the frequency and type of victimization experiences among immigrant and native Finnish adolescents and tested whether these experiences mediate the relationship between immigration status and psychosocial well-being. Additionally, willingness to disclose victimization experiences in anonymous questionnaires was compared between the groups.

PARTICIPANTS AND SETTING

In this computer-based study a population-based sample of 5607 Finnish adolescents was used (Mage = 15.23, SDage = 0.42, Range 15 to 16 years; 49.8 % girls, 48.5 % boys), of which 11.7 % were immigrants. Twelve lifetime victimization experiences were assessed, and psychosocial well-being was measured with Strengths and Difficulties Questionnaire.

METHODS

Descriptive statistics, crosstabulation and t-tests were used to report victimization experiences and participants' willingness to share them in an anonymous questionnaire. The relationship between immigration status and psychosocial well-being was investigated with mediation analysis, victimization experiences as mediator.

RESULTS

Findings revealed that immigrant adolescents experienced more victimization, particularly in the form of property crimes, hate crimes, and physical and sexual abuse, than native adolescents. Victimization experiences were found to mediate the impact of immigration status on psychosocial well-being. Moreover, immigrant adolescents were less likely to disclose victimization experiences.

CONCLUSIONS

The results suggest a potential underestimation of the prevalence of victimization experiences in immigrant adolescents, which warrants further investigation. As these experiences play an important role in the relationship between immigrant status and psychosocial well-being, the findings endorse assessing adverse experiences, as well as safe disclosure when planning psychosocial support and treatment for immigrant adolescents.

Self-harm, Suicide, and ICD-11 Complex Posttraumatic Stress Disorder in Treatment-Seeking Adolescents with Major Depression

Posttraumatic stress disorder (PTSD) is linked with self-harm and suicide, but few studies have examined these severe outcomes in relation to complex trauma. This study examined the associations between self-harm and suicide-related phenomena with ICD-11 complex PTSD (CPTSD) among treatment-seeking youths. A convenience sample of 109 adolescents with major depression (69.7% female; mean age = 15.24) were recruited from an outpatient psychiatric clinic. Participants completed measures for ICD-11 CPTSD, adverse childhood experiences (ACEs), self-harm behaviors, and past-year history of four suicide-related phenomena. Relationships between each self-harm and suicide-related variable with CPTSD were assessed at the symptom and diagnostic levels. Participants reported an average of three ACEs; 33.9% met diagnostic requirements for ICD-11 CPTSD. Past-year suicidal thought and attempt, but not self-harm, significantly associated with CPTSD status. At the symptom level, self-harm associated with CPTSD total symptom and all symptom clusters scores, with strongest associations found with symptoms of negative self-concept. CPTSD total symptom scores also associated strongly with past-year history of suicidal thought, plan, and attempt; the three core PTSD symptom clusters scores consistently and strongly linked with these suicide-related phenomena. For symptoms of complex trauma, relationship disturbances associated with having a suicide attempt, and negative self-concept associated with both having a plan and an attempt. Assessing and targeting ICD-11 CPTSD symptoms have potential to reduce self-harm and suicidality in young people experiencing mental distress, particularly for those with a trauma history and regardless of whether they meet criteria for a diagnosable trauma response.

Endocannabinoid dysregulation and PTSD in urban adolescents: Associations with anandamide concentrations and FAAH genotype

BACKGROUND

The endocannabinoid system, which regulates fear- and anxiety-related behaviors, is dysregulated in adults with posttraumatic stress disorder (PTSD), as indicated by higher circulating anandamide (AEA) concentrations. The C385A (rs324420) polymorphism in the fatty acid amide hydrolase (FAAH) gene, which catabolizes AEA, is linked to higher AEA concentrations and greater PTSD symptoms in adults. Given that adolescence is a critical period during which trauma and psychiatric disorders emerge, understanding this relationship in youth is essential. This study examines PTSD symptoms, AEA concentrations, and FAAH genotype in a diverse adolescent sample.

METHODS

This study included 102 Detroit-area adolescents (M ± SD = 13.33 ± 2.21 years, 54.9% female) and their parents/guardians. The sample consisted of 40.2% White Non-Hispanic, 34.3% Black Non-Hispanic, 6.9% White Hispanic, 4.9% Asian/Pacific Islander, and 12.7% Biracial adolescents. Trauma exposure and PTSD symptoms were assessed using the UCLA PTSD Reaction Index for DSM-5. Plasma concentrations of AEA were measured by liquid chromatography-tandem mass spectrometry, and FAAH genotype was determined from saliva samples and high-throughput screening.

RESULTS

The majority (90%) of adolescents reported trauma exposure, and 20% met PTSD criteria. Higher AEA concentrations were associated with more severe PTSD symptoms (p = 0.009), especially hyperarousal. The FAAH A-allele (present in 52.5% of participants) was associated with higher AEA concentrations (2.11 ± 0.69 pmol/ml, p = 0.013) and greater PTSD severity (22.65 ± 15.931, p = 0.027), particularly those with the reexperiencing cluster, compared to the CC genotype (1.79 ± 0.66 pmol/ml and 15.87 ±+ 13.043, respectively).

CONCLUSION

Elevated AEA concentrations and the FAAH A-allele were associated with greater PTSD symptom severity in urban adolescents. These findings suggest endocannabinoid dysregulation may play a role in adolescent PTSD, highlighting the need for further research and targeted interventions.

Cross-cultural validation of the Clinician-Administered PTSD scale for DSM-5, child and adolescent version in Japan

Background: The establishment of a formal diagnosis of post-traumatic stress disorder (PTSD) for children and adolescents is the foundation for advancing pertinent clinical research and formulating proper treatment and management. However, a validated diagnostic tool for PTSD in children and adolescents is lacking in Japan.Objective: To examine the cross-cultural validity and reliability of the Japanese Clinician-Administered PTSD Scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), child and adolescent version (CAPS-CA-5-J).Method: Overall, 73 children who had experienced potentially traumatic events were recruited from three medical facilities. The linguistically validated CAPS-CA-5-J was conducted by trained psychiatrists and psychologists. Additionally, children and their caretakers completed questionnaires such as the UCLA PTSD reaction index for DSM-5 (PTSD-RI-5), Depression Self-Rating Scale for Children (DSRDC), and Strength and Difficulties Questionnaire (SDQ); 16 participants were randomly selected for the inter-rater reliability assessment.Results: Owing to missing values in the CAPS-CA-5-J and PTSD-RI-5, 68 children were included in the final analysis. Regarding reliability, the CAPS-CA-5-J showed excellent internal consistency (Cronbach's alpha coefficient = 0.90) and interrater agreement (kappa coefficient = 0.88). Convergent validity was supported by a strong correlation between the total severity scale of the CAPS-CA-5-J and the PTSD-RI-5 scores (Pearson's correlation coefficient = 0.82). Divergent validity was indicated by a moderate correlation between the CAPS-CA-5-J and DSRDC, and no correlation was found with the SDQ scores.Conclusions: This study is the first to validate a structured clinical interview for children and adolescents with PTSD in Japan. The psychometric properties of the CAPS-CA-5-J were good enough and comparable to those reported in previous validation studies. Therefore, the CAPS-CA-5-J can be considered reliable and valid for use in Japan.

Meta-Analysis: Prevalence of Youth Mental Disorders in Sub-Saharan Africa

Youth in sub-Saharan Africa (SSA) face limited access to professional mental health resources. A comprehensive assessment of the prevalence of mental disorders would build an understanding of the scope of the need. We conducted systematic searches in PsycInfo, Pubmed, AfriBib and Africa Journals Online to identify prevalence rates for five disorders (anxiety, depression, conduct disorder, attention problems and post-traumatic stress) among SSA youth with a mean age of less than 19 years. We calculated a random-effects pooled prevalence for each disorder and assessed possible moderators. The meta-analysis included 63 studies with 55,071 participants. We found the following pooled prevalence rates: 12.53% post-traumatic stress disorder (PTSD), 15.27% depression, 6.55% attention-deficit hyperactivity disorder, 11.78% anxiety and 9.76% conduct disorder. We found high heterogeneity across the studies, which may have resulted from differences in samples or measurement tools. Reported prevalence rates were not explained by the sample (i.e., special or general population), but whether the psychometric tool was validated for SSA youth affected the reported prevalence of PTSD and anxiety. In a meta-regression, prevalence rates were associated with the disorder type, with a higher prevalence of depression and PTSD. We found the mean age significantly moderated the prevalence in univariate meta-regression, with increased age correlated with greater prevalence. Our findings suggest there is a need to explore reasons for varying prevalence rates further and to develop interventions that support youth mental health in SSA, particularly interventions for depression and PTSD. Limitations included a lack of standardization in psychometric tools and limited reporting on research methods, which influenced quality rating. Importantly, the search only considered studies published in English and was conducted 2 years ago. Although recent estimates reported slightly higher than our prevalence estimates, these reviews together highlight the prevalence and importance of youth mental health difficulties in SSA.

Post-traumatic stress disorder in youth exposed to the Syrian conflict: A systematic review and meta-analysis of prevalence and determinants

A decade of ongoing armed conflict in Syria has damaged the physical and mental health of millions of adults and children. This study aimed to systematically review the prevalence of post-traumatic stress disorder among youth exposed to the Syrian conflict, and understand its individual and contextual determinants. The screening procedure resulted in 26 studies, with a total of 11,400 Syrian children and adolescents. The prevalence was 36% (95% CI (0.29-0.43), p < 0.001). Loss of family members or acquaintances, witnessing violence, and social withdrawal increased the risk of post-traumatic stress disorder, while social trust and social support were protective factors.

Parenting and mental health in protracted refugee situations: a systematic review

BACKGROUND

Refugees' parenting behaviour is profoundly influenced by their mental health, which is, in turn, influenced by their situation of displacement. Our research presents the first systematic review on parenting and mental health in protracted refugee situations, where 78% of all refugees reside.

METHODS

We pre-registered our protocol and screened documents in 22 languages from 10 electronic databases, reports by 16 international humanitarian organisations and region-specific content from the top 100 websites for each of the 72 countries that 'host' protracted refugees. Our criteria were empirical papers reporting parenting and parental mental health data on refugees who are in a protracted refugee situation. Studies including only internally displaced or stateless persons were excluded.

RESULTS

A total of 18,125 documents were screened and 30 studies were included. We identified a universal pathway linking macro-level stressors in protracted refugee situations, such as movement restrictions and documentation issues, to symptoms of depression and anxiety, which, in turn, led to negative parenting practices. Addtionally, culture-specific pathways were observed in the way parental mental health and parenting were expressed. Situational (e.g., overcrowding) and relational factors (e.g., spousal dynamics) modulated both of these pathways. Biases in the research included the over-representation of specific protracted refugee situations, overreliance on self-reported data, and a heavy focus on mothers while neglecting fathers and other caregivers. Longitudinal research is needed to clarify the directionality and causality between specific macro-level stressors in a given protracted refugee situation and parental mental health and practices. Refugees were rarely consulted or involved in the design of research about their parenting and parental mental health.

CONCLUSION

In recognising the existing links between protracted refugee situations, parental mental health, and parenting, our systematic review calls for a shift in thinking: from focusing solely on the micro aspects that affect 'refugee parenting' to understanding and tackling the broader macro-level stressors that drive them. We urge for larger and long-term research efforts that consider diverse protracted refugee situations, greater investment in science communication and diplomacy with governments, and stronger implementation of durable solutions by states to alleviate the roots of refugee parents' distress and negative parenting practices.

MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations

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.

Differences and similarities between children and adolescent exposed to interpersonal traumas with and without Intellectual Disability: An explorative study

BACKGROUND

Individuals with intellectual disability (ID) are more vulnerable to traumatic and stressful events, increasing their risk of developing post-traumatic stress disorder (PTSD).

AIMS

This study aimed to investigate differences in psychopathology, post-traumatic symptoms, and adaptive functioning in a sample of Italian children and adolescents with and without ID. It also sought to determine whether the type of interpersonal trauma was associated with distinct psychopathological outcomes.

METHODS AND PROCEDURES

Sixty-six children and adolescents exposed to interpersonal trauma (physical/sexual abuse, domestic violence, and neglect), were selected and divided into two groups based on the presence or absence of ID. Assessment consisted of structured parent interviews and parent-reported questionnaires. For each scale, comparisons between subtests were performed.

OUTCOMES AND RESULTS

Children and adolescents with ID were more likely to exhibit more severe post-traumatic symptoms, anxiety issues, social problems, and poorer adaptive functioning, with the exception of the practical domain, which appeared to be equally impaired in both groups. In terms of interpersonal trauma typology, exposure to physical/sexual abuse and domestic violence led to greater post-traumatic symptoms compared to neglect.

CONCLUSION AND IMPLICATIONS

Interpersonal trauma significantly affects children and adolescents, with or without ID, highlighting the need for tailored treatments for both groups.

Determinants of Posttraumatic Stress Disorder (PTSD) among children and adolescents in the subacute stage of Kahramanmaras earthquake, Turkey

BACKGROUND

Earthquakes are potentially traumatic natural disasters due to their destructive nature, and huge impacts, producing scenes of horror, undesirable and uncontrollable results. Children are affected mainly by earthquakes not only physically but also psychologically. We aimed to evaluate the rates of probable PTSD and related factors in children and adolescents after the February 6 Kahramanmaras earthquake.

METHODS

In this cross-sectional study, 246 children and adolescents were included. The research was conducted in Hatay, one of the most affected provinces, between 06/07/2023-06/08/2023. Sociodemographic form, Children's Depression Inventory, Children's Posttraumatic Response Reaction Index, Screen for Child Anxiety Related Emotional Disorders, Child and Youth Resilience Measure and Social Support Appraisals Scale for Children were applied by face-to-face survey method.

RESULTS

The median age of the participants was 12 (8-18). 133 (54%) of the participants were girls. Probable depression rate was 98%, and probable anxiety disorder rate was 63%. Probable mild, moderate, severe and very severe PTSD rates were 18%, 29%, 43% and 8%, respectively. The probable severe PTSD rate was higher in children who were injured in the earthquake (p = 0.032), who received outpatient treatment (p = 0.016), and who saw people trapped under the collapse (p = 0.012). Also, the children whose sleep routines have changed post-earthquake were found to have more probable severe PTSD (p < 0.001). Access time to the potable water supply (p = 0.045), toilet facilities (p = 0.045), shelter facilities (p = 0.004), heating facilities (p = 0.001), clothing supply (p < 0.001) and healthcare services (p = 0.009) were found to be associated with probable severe PTSD right after the earthquake. In the fifth month of the earthquake, inadequate meeting of clothing needs (p = 0.018), educational services (p = 0.028) and social activity opportunities (p < 0.001) were significantly associated with probable severe PTSD. In the multivariate analysis, the risk of probable severe PTSD was increased 2.9 times in those with post-earthquake sleep changes (p = 0.001) and 11.1 times in those with probable anxiety disorders (p < 0.001). Also, it has been shown that each unit increase in the APP-family score reduces probable severe PTSD risk by 2% (p = 0.002).

CONCLUSION

In the current study, the rates of probable PTSD, depression and anxiety disorders were considerably high. Probable anxiety disorder and sleep disturbance were significant predictors of probable severe PTSD. On the other hand, social support from family was found to be a significant protective factor for severe PTSD risk. We conclude that the lack of meeting needs that increase the risk of probable severe PTSD differs in the acute and subacute phases.

Prevalence and risk of psychiatric disorders in young people: prospective cohort study exploring the role of childhood trauma (the HUNT study)

BACKGROUND

Better knowledge about childhood trauma as a risk factor for psychiatric disorders in young people could help strengthen the timeliness and effectiveness of prevention and treatment efforts.

AIMS

To estimate the prevalence and risk of psychiatric disorders in young people following exposure to childhood trauma, including interpersonal violence.

METHOD

This prospective cohort study followed 8199 adolescents (age range 12-20 years) over 13-15 years, into young adulthood (age range 25-35 years). Data about childhood trauma exposure from adolescents participating in the Trøndelag Health Study (HUNT, 2006-2008) were linked to data about subsequent development of psychiatric disorders from the Norwegian Patient Registry (2008-2021).

RESULTS

One in four (24.3%) adolescents were diagnosed with a psychiatric disorder by young adulthood. Regression analyses showed consistent and significant relationships between childhood exposure to both interpersonal violence and other potentially traumatic events, and subsequent psychiatric disorders and psychiatric comorbidity. The highest estimates were observed for childhood exposure to two or more types of interpersonal violence (polyvictimisation), and development of psychotic disorders (odds ratio 3.41, 95% CI 1.93-5.72), stress and adjustment disorders (odds ratio 4.20, 95% CI 3.05-5.71), personality disorders (odds ratio 3.98, 95% CI 2.70-5.76), alcohol-related disorders (odds ratio 3.28, 95% CI 2.06-5.04) and drug-related disorders (odds ratio 4.67, 95% CI 2.87-7.33).

CONCLUSIONS

These findings emphasise the importance of integrating knowledge about childhood trauma as a potent risk factor for psychopathology into the planning and implementation of services for children, adolescents and young adults.

Systematic review and meta-analysis: do best-evidenced trauma-focused interventions for children and young people with PTSD lead to changes in social and interpersonal domains?

Objective: Young people with post-traumatic stress disorder experience difficulties in social and interpersonal domains. We examined whether the best-evidenced treatments of PTSD for children and young people (Trauma-focussed Cognitive Behavioural Therapy or Eye Movement Desensitisation and Reprocessing; aged 5-25) improve social or interpersonal factors in randomised controlled trials, compared to a comparator condition.Method: The review was preregistered on PROSPERO (CRD42023455615; 18th August 2023). Web of Science Core Collection, EMBASE, CINAHL, Pubmed, PsycINFO, Cochrane Central Register of Controlled Trials and PTSDPubs were searched, and data were extracted for social and interpersonal outcomes post treatment. A random effect meta-analysis was conducted to obtain between-group pooled effect size estimates.Results: The search resulted in 792 studies, of which 17 met our inclusion criteria (N = 2498). Our meta-analysis included 13 studies which investigated social skills and functioning, revealing a small but non-significant effect favouring the evidence-based treatment versus comparison (g = .20, 95% CI [-0.03, 0.44], p = .09). We narratively synthesised six studies which reported other social-related outcomes (e.g. perceptions of social support), and four out of six reported improved social domain outcomes for the evidence-based PTSD treatment condition. There was a large amount of heterogeneity, with no evidence that this could be explained by moderators.Conclusion: Few trials report on social and interpersonal outcomes, and where they are reported the evidence is mixed. It may be that trauma-focused therapies for PTSD need to be adapted in some circumstances, so that they address social and interpersonal deficits often seen in children and young people with PTSD.

Interaction of Val66Met Brain-Derived Neurotrophic Factor and 5-HTTLPR Serotonin Transporter Gene Polymorphisms with Lifetime Prevalence of Post-Traumatic Stress Disorder in Primary Care Patients

Background/Objectives: Post-traumatic stress disorder (PTSD) is a complex condition influenced by both genetic and environmental factors. This longitudinal study aimed to explore the connection between two specific genetic polymorphisms, Val66Met and 5-HTTLPR, and the lifetime prevalence of PTSD in patients from primary care settings. We also examined the role of sociodemographic and psychosocial factors to provide a more comprehensive view of PTSD risk. Methods: We recruited a cohort of primary care patients and diagnosed PTSD using a standardized diagnostic interview. Genetic analyses focused on Val66Met and 5-HTTLPR polymorphisms. We applied logistic regression to assess the association between these genetic markers and PTSD, considering factors such as gender, family history of depression, and experiences of childhood maltreatment. Results: Our findings show that women, individuals with a family history of depression, and those exposed to childhood maltreatment have a higher risk of developing PTSD. While the Val66Met polymorphism was not significantly associated with PTSD, the 5-HTTLPR polymorphism showed a marginal relationship. No significant interaction was found between the two polymorphisms in relation to PTSD. Conclusions: This study underscores the multifactorial nature of PTSD, influenced by both genetic and environmental factors. The findings point to the importance of further research on genetic predispositions and highlight the value of early interventions for high-risk populations in primary care settings.

The dissemination and implementation of trauma-focused cognitive behavioural therapy for children and adolescents in seven European countries

BACKGROUND

There is broad scientific evidence for the effectiveness of individual trauma-focused evidence-based treatments (EBTs) such as "trauma-focused cognitive behavioural therapy" (TF-CBT) for children and adolescents with posttraumatic stress symptoms. However, there is a significant research-to-practice gap resulting in traumatized children in high-income countries in Europe having only very limited access to these treatments. The aim of this study was, therefore, to identify common barriers and successful dissemination and implementation (D&I) strategies of evidence-based trauma-focused treatments (in particular TF-CBT) in seven European countries.

METHODS

For this study, we chose a mixed-method approach: an online survey among certified European TF-CBT trainers (N = 22) and the collection of country-based narratives from TF-CBT experts in different European countries (Finland, Germany, Italy, Netherlands, Norway, Sweden).

RESULTS

Common modifiable barriers to the implementation of TF-CBT were identified on different levels (e.g. government or treatment level), and successful D&I strategies were highlighted across all countries, such as translations of materials. Additionally, the experts from the country narratives put together a broad overview of TF-CBT research in Europe.

CONCLUSIONS

The results of this study revealed that especially learning collaborations and the development of joint European efforts in funding and researching D&I strategies are crucial for future implementation of trauma-focused EBTs in Europe.

Predictive models of post-traumatic stress disorder, complex post-traumatic stress disorder, depression, and anxiety in children and adolescents following a single-event trauma

BACKGROUND

This study examined the power of theory-derived models to account for the development of PTSD, Complex PTSD (CPTSD), depression, and anxiety in children and adolescents who had experienced a single-event trauma.

METHODS

Children (n = 234, aged 8-17 years) recruited from local Emergency Departments were assessed at two and nine weeks post-trauma. Data obtained from self-report questionnaires completed by the child, telephone interviews with parents, and hospital data were used to develop four predictive models of risk factors for PTSD, CPTSD, depression, and Generalized Anxiety Disorder (GAD). ICD-11 proposed diagnostic criteria were used to generate measures for CPTSD and PTSD to assess for risk factors and identify the sample prevalence of these disorders.

RESULTS

At nine weeks post-trauma, 64% did not meet criteria for any disorder, 23.5% met criteria for PTSD, and 5.2% met criteria for CPTSD. 23.9% and 10.7% had developed clinically significant symptoms of depression and GAD, respectively. A cognitive model was the most powerful predictive model, a psychosocial model was weak, and subjective markers of event severity were more powerful than objective measures.

CONCLUSIONS

Youth exposed to single-incident trauma may develop different forms of psychopathology, and PTSD and CPTSD are frequently experienced alongside other conditions. The cognitive model of PTSD shows utility in identifying predictors of PTSD, CPTSD, depression, and GAD, particularly the role of trauma-related negative appraisals. This supports the application of cognitive interventions which focus upon re-appraising trauma-related beliefs in youth.

EMDR-Teens-cPTSD: Efficacy of Eye Movement Desensitization and Reprocessing in Adolescents with Complex PTSD Secondary to Childhood Abuse: A Case Series

Background: Mental healthcare for children and adolescents with a history of childhood abuse constitutes a major public health issue. Indeed, abuse exposes children to severe and complex post-traumatic stress disorder (cPTSD) but also to neurodevelopmental and psychological repercussions impacting the developmental trajectory. Trauma-focused care is essential to avoid the chronicization of symptoms and disorders. Objective: The aim of this prospective case series study was to investigate the efficacy of eye movement desensitization and reprocessing (EMDR) on complex post-traumatic symptoms and associated psychiatric disorders in adolescents with a history of abuse. Method: Twenty-two adolescents, aged 12 to 17, who had been abused during childhood were included. All adolescents met ICD-11 criteria for complex PTSD. Subjective measures of PTSD and associated psychiatric disorders were taken before (T0) and after 3 months of EMDR therapy (T1). Results: The average PTSD symptom score on the CPTS-RI significantly decreased from 40.2 to 34.4 after EMDR, indicating improvement in post-traumatic symptoms. A significant decrease in the average depression score (CDI from 18.2 at T0 to 10.6 at T1), anxiety score (R-CMAS from 21.3 at T0 to 13.3 at T1), emotional regulation score (ALS from 29 at T0 to 10.8 at T1), insomnia score (ISI from 18.5 at T0 to T1 of 9.2 at T1), and harmful use of alcohol and drugs score (ADOSPA from 2.3 at T0 to 0.3 at T1) was observed after EMDR therapy, as well as an increase in quality of life (CBCL 4-16 score from 57.9 at T0 to 77.4 at T1). Conclusions: The results of this study are encouraging and suggest that EMDR may be effective in the symptom management reducing post-traumatic symptoms and certain comorbid disorders frequently seen in adolescents who have experienced childhood abuse. Further research is needed on adolescent populations suffering from cPTSD (e.g., randomized controlled trials with control groups and other therapies or evaluating the action of the different phases of the study).

Developmental Differences in a Hippocampal-Cingulate Pathway Involved in Learned Safety Following Interpersonal Trauma Exposure

OBJECTIVE

Nearly 65% of youth experience trauma, and up to one-third of youth with trauma exposure face profound mental health sequelae. There remains a need to elucidate factors that contribute to psychopathology following trauma exposure, and to optimize interventions for youth who do not benefit sufficiently from existing treatments. Here, we probe safety signal learning (SSL), which is a mechanism of fear reduction that leverages learned safety to inhibit fear in the presence of threat-associated stimuli and has been shown to attenuate fear via a hippocampal-cingulate--specifically, a dorsal anterior cingulate cortex (dACC)--pathway.

METHOD

The present study used behavioral and task-based functional magnetic resonance imaging data to examine age-related associations between interpersonal trauma exposure and the behavioral and neural correlates (ie, activation and functional connectivity) of SSL in a group of 102 youth (aged 9-19 years; 46 female, 56 male) with (n = 52) and without (n = 50) interpersonal trauma exposure. Primary analyses examined anterior hippocampal activation and anterior hippocampus-dACC functional connectivity. Exploratory analyses examined centromedial amygdala (CMA) and laterobasal amygdala (LBA) activation and anterior hippocampal, CMA, and LBA functional connectivity with additional anterior cingulate subregions (ie, subgenual anterior cingulate cortex [sgACC] and rostral anterior cingulate cortex [rosACC]).

RESULTS

Both youth with and without interpersonal trauma exposure successfully learned conditioned safety, which was determined by using self-report of contingency awareness. Youth with interpersonal trauma exposure (relative to youth in the comparison group) exhibited age-specific patterns of lower hippocampal activation (F2,96 = 3.75, pFDR = .049, ηp2 = 0.072), and, in exploratory analyses, showed heightened centromedial amygdala activation (F1,96 = 5.37, pFDR = .046, ηp2 = 0.053) and an age-related decrease in hippocampal-sgACC functional connectivity during SSL (F1,94 = 10.68, pFDR = .015, ηp2 = 0.102). We also show that hippocampal-sgACC functional connectivity mediated the association between interpersonal trauma exposure and post-traumatic stress disorder symptoms in an age-specific manner in the overall sample.

CONCLUSION

Together, these findings suggest that although age- and trauma-specific differences in the neural correlates of SSL may relate to the development of psychopathology, youth with interpersonal trauma exposure demonstrate successful learning of conditioned safety over time.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science.

A parallel investigation of trauma exposure, maladaptive appraisals and posttraumatic stress reactions in two groups of trauma-exposed adolescents

Background: Maladaptive appraisals, such as thoughts about experiencing a permanent and disturbing change and about being a fragile person in a scary world, are associated with posttraumatic stress reactions (PTSR) for trauma-exposed children and adolescents. Less is known about what puts young people at risk for developing such appraisals, and the differential relationship between the types of appraisals and PTSR.Objective: The primary aim was to examine the role of age, gender and exposure to potentially traumatizing events (PTEs) for the levels of maladaptive appraisals. The secondary aim was to investigate the association between the levels of maladaptive appraisals (appraisals of a permanent change and appraisals about a scary world) and PTSR.Methods: We investigated these aims in two samples: survivors after the terror attack at Utøya island in Norway in 2011 (N = 165, mean age 17.65, SD = 1.19) and adolescents referred to treatment after mainly interpersonal trauma (N = 152, mean age 15.08, SD = 2.18). The aims were investigated using linear regression and partial correlation.Results: In the terror-exposed sample, female gender was significantly associated with higher levels of scary-world appraisals, witnessing or learning that someone close were exposed to physical violence was significantly associated with more permanent-change appraisals, and a higher number of PTEs was significantly associated with higher levels of both types of appraisals. For the clinical sample, we found no significant associations between exposure to PTEs, gender, age, and the level of maladaptive appraisals. Both types of maladaptive appraisals were highly associated with PTSR in both samples, and there was no significant difference in the strength of the associations between the types of appraisals and PTSR.Conclusions: The results have implications for identifying adolescents at risk for developing harmful maladaptive appraisals. Both scary-world appraisals and permanent-change appraisals were strongly associated with PTSR in both groups of trauma-exposed adolescents.