Posttraumatic stress disorder symptom structure in injured children: functional impairment and depression symptoms in a confirmatory factor analysis.
ABSTRACT To examine the factor structure of posttraumatic stress disorder (PTSD) symptoms in children and adolescents who have experienced an acute single-incident trauma, associations between PTSD symptom clusters and functional impairment, and the specificity of PTSD symptoms in relation to depression and general distress.
Examined PTSD symptom structure in two samples of children (8 to 17 years of age) assessed an average of 6 months after unintentional injury: (1) a combined dataset of 479 children assessed with a PTSD symptom checklist, and (2) a sample of 204 children assessed via a standardized clinical interview. We evaluated the fit of six alternative models for the factor structure of PTSD symptoms, and the association of PTS symptom clusters with indicators of functional impairment. We then evaluated three models for the structure of PTSD and depression symptoms jointly, to examine specificity of PTSD versus general distress or mood symptoms.
In both samples, the DSM-IV 3-factor model fit the data reasonably well. Two alternative four-factor models fit the data very well: one that separates effortful avoidance from emotional numbing, and one that separates PTSD-specific symptoms from general emotional distress. Effortful avoidance and dysphoria symptoms were most consistently associated with impairment. The best-fitting model for PTSD and depression symptom clusters had three factors: PTSD-specific, depression-specific, and general dysphoria symptoms.
The DSM-IV model for PTSD symptom categories was a reasonable fit for these child data, but several alternative models fit equally well or better, and suggest potential improvements to the current diagnostic criteria for PTSD in children.
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ABSTRACT: Given the consistent growth of the Latino population in the United States, there is a critical need for validated Spanish measures to assess posttraumatic stress disorder (PTSD) symptoms in children. The current study examines the psychometric properties of the Child PTSD Symptom Scale (CPSS). We examined 259 children (8-17 years) who had experienced a recent traumatic event. Study measures were completed in Spanish (n = 106; boys = 58, girls = 48) or in English (n = 153; boys = 96, girls = 57). In addition to internal consistency, confirmatory factor analyses were conducted by testing four models to examine construct validity: (1) PTS single-factor, (2) DSM-IV three-factor, (3) Numbing four-factor, and (4) Dysphoria four-factor models. Findings demonstrated good internal consistency for both the English and Spanish versions of the CPSS. The English version revealed superior fit to the data for several models of PTS symptoms structure compared to the Spanish version. The current study demonstrated construct validity for the English CPSS, but not for the Spanish CPSS. Future studies will examine additional alternative models as well as convergent and discriminant validity of the Spanish CPSS.Child Psychiatry and Human Development 08/2014; · 1.93 Impact Factor
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ABSTRACT: Millions of children worldwide experience acute medical events. Children's responses to these events range from transient distress to significant posttraumatic stress disorder symptoms (PTSS). While many models suggest explanations for the development and maintenance of PTSS in adults, very few have focused on children. Current models of child PTSS are primarily restricted to the post-trauma period, thus neglecting the critical peri-trauma period when screening and preventive interventions may be most easily implemented. Research on PTSS in response to pediatric medical trauma typically examines predictors in isolation, often overlooking potentially important interactions. This paper proposes a new model utilizing the bio-psycho-social framework and focusing on peri-trauma processes of acute medical events. Understanding the relationships among bio-psycho-social factors during peri-trauma can inform early identification of at-risk children, preventive interventions and clinical care. Recommendations for future research, including the need to examine PTSS in the context of multiple influences, are discussed.Clinical Child and Family Psychology Review 09/2014; · 3.13 Impact Factor
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ABSTRACT: The inclusion of post-traumatic stress disorder (PTSD) in the Diagnostic and Statistical Manual III (DSM-III) was a considerable achievement that has vastly enriched our knowledge of reactions to traumatic events and our ability to offer appropriate care to survivors. Nevertheless, limitations created by the way in which PTSD belatedly entered the diagnostic canon continue to create problems today. One problem was created by the assumption, subsequently proven incor-rect, that PTSD was fully explained by exposure to an event outside the range of usual human experience. This resulted in the stressor criterion, Criterion A, assuming a central role in the diagnosis. The realisation that PTSD can follow more mundane traumatic events such as motor-vehicle accidents that nevertheless have the potential to create intense fear and helplessness, and the confirmation that individual vulnerability is as important in PTSD as in other psychiatric dis-orders, has led inevitably to subsequent problems in defining exactly what does and does not comprise a traumatic event. In the late 1970s there was also far less appreciation than there is today con-cerning the role of stressful life events in the onset and maintenance of many psychiatric disorders. In seeking to introduce a condition that was defined in terms of the aetiological role of extreme stress, it may therefore not have been so evident to those crafting the DSM-III definition that traumatic stressors would produce a range of psychopathological reactions, and that it would be necessary Post-traumatic Stress Disorder, First Edition. Edited by Dan Stein, Matthew Friedman, and Carlos Blanco.
June 2010 Medline Topic Alert
1. J Am Acad Child Adolesc Psychiatry. 2010 Jun;49(6):616-625.e4. Epub 2010 Apr 9.
Posttraumatic Stress Disorder Symptom Structure in Injured Children: Functional
Impairment and Depression Symptoms in a Confirmatory Factor Analysis.
Kassam-Adams N, Marsac ML, Cirilli C.
Children's Hospital of Philadelphia.
OBJECTIVE: To examine the factor structure of posttraumatic stress disorder
(PTSD) symptoms in children and adolescents who have experienced an acute
single-incident trauma, associations between PTSD symptom clusters and functional
impairment, and the specificity of PTSD symptoms in relation to depression and
general distress. METHOD: Examined PTSD symptom structure in two samples of
children (8 to 17 years of age) assessed an average of 6 months after
unintentional injury: (1) a combined dataset of 479 children assessed with a PTSD
symptom checklist, and (2) a sample of 204 children assessed via a standardized
clinical interview. We evaluated the fit of six alternative models for the factor
structure of PTSD symptoms, and the association of PTS symptom clusters with
indicators of functional impairment. We then evaluated three models for the
structure of PTSD and depression symptoms jointly, to examine specificity of PTSD
versus general distress or mood symptoms. RESULTS: In both samples, the DSM-IV
3-factor model fit the data reasonably well. Two alternative four-factor models
fit the data very well: one that separates effortful avoidance from emotional
numbing, and one that separates PTSD-specific symptoms from general emotional
distress. Effortful avoidance and dysphoria symptoms were most consistently
associated with impairment. The best-fitting model for PTSD and depression
symptom clusters had three factors: PTSD-specific, depression-specific, and
general dysphoria symptoms. CONCLUSIONS: The DSM-IV model for PTSD symptom
categories was a reasonable fit for these child data, but several alternative
models fit equally well or better, and suggest potential improvements to the
current diagnostic criteria for PTSD in children. Copyright © 2010 American
Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights
PMID: 20494271 [PubMed - as supplied by publisher]
2. Aust N Z J Psychiatry. 2010 Jun;44(6):543-50.
A study on the relationship between posttraumatic stress disorder in flood victim
parents and children in Hunan, China.
Li X, Huang X, Tan H, Liu A, Zhou J, Yang T.
Department of Epidemiology and Health Statistics, Central South University,
Changsha, Hunan, China. firstname.lastname@example.org <email@example.com>
OBJECTIVE: To explore the relationship between posttraumatic stress disorder
(PTSD) in flood victim parents and children in Hunan, China. METHODS: Using the
method of multistage cluster random sampling, we conducted a retrospective
investigation on 3,698 families in Hunan, China who suffered from flooding in
1998. Investigators held face-to-face interviews with the parents and children of
the families. The diagnosis of PTSD was made according to the criteria of the
Diagnostic and Statistical Manual of Mental Disorders, fourth edition. The
comparison of rate of PTSD positive in the groups of children with different
characteristics was done by chi-square test. In the evaluation of the impact of
parent PTSD on PTSD in their children, we used a multivariable logistic
regression model to re-estimate the adjusted Odds Ratio and its confidence
interval. We did this after the possible confounding variables were adjusted for.
Additionally, the Odds Ratio and its confidence interval were estimated under the
condition of a single variable. RESULTS: A total of 4,327 children and the
parents of 3,292 families were included for analysis; 203 (4.7%) of 4,327
children and 740 (11.2%) of 6,584 parents were diagnosed with PTSD. We found that
the PTSD positive rate is significantly higher in the children with
disaster-related experience. The rate of beating their children in PTSD positive
fathers (54.9%) was higher than that of PTSD negative fathers (51.2%). No
correlation was found between mothers' PTSD and beating their children. The risk
of developing PTSD is higher for children living in the families with PTSD
parents. CONCLUSION: The rate of PTSD in 7-14-year-old children is 4.7% in areas
in Hunan, China, who suffered from flooding in 1998. The possibility for children
to develop PTSD is increased in families with PTSD parents.
PMID: 20482413 [PubMed - in process]
3. J Clin Psychiatry. 2010 Apr 20. [Epub ahead of print]
Psychopharmacologic treatment of posttraumatic stress disorder in children and
adolescents: a review.
Strawn JR, Keeshin BR, Delbello MP, Geracioti TD Jr, Putnam FW.
University of Cincinnati, Dept of Psychiatry, Box 670559, Cincinnati, OH
45267-0559, USA. firstname.lastname@example.org.
OBJECTIVE: Despite the high prevalence and significant morbidity associated with
posttraumatic stress disorder (PTSD) in children and adolescents, there are
limited and conflicting data to guide psychopharmacologic interventions. With
these considerations in mind, we sought to summarize the current evidence for
psychopharmacologic interventions in youth with PTSD. DATA SOURCES/STUDY
SELECTION: We conducted a literature review of the National Library of Medicine
to identify publications of pharmacologic treatments for youth with PTSD or
posttraumatic stress symptoms. The search was limited to articles written in
English and published between 1966 and 2009. In addition, we manually searched
each citation for additional references and the following journals: Journal of
the American Academy of Child and Adolescent Psychiatry and the Journal of Child
and Adolescent Psychopharmacology. DATA EXTRACTION: All articles were manually
reviewed and evaluated. Thereafter, each agent or class of medication was
categorized by level of evidence. DATA SYNTHESIS: Three double-blind, randomized
controlled trials of selective serotonin reuptake inhibitors (SSRIs) and 1
double-blind randomized controlled trial of imipramine in children and
adolescents with PTSD or acute stress disorder were identified. Additionally,
several open-label studies and case series involving other classes of medications
(eg, antiadrenergics, other antidepressants, and second-generation
antipsychotics) were reviewed. CONCLUSIONS: The extant data do not support the
use of SSRIs as first-line treatments for PTSD in children and adolescents. There
is limited evidence that the brief use of antiadrenergic agents,
second-generation antipsychotics, and several mood stabilizers may attenuate some
PTSD symptoms in youth. However, controlled trials of these agents in children
and adolescents with PTSD are needed. © Copyright 2010 Physicians Postgraduate
PMID: 20441729 [PubMed - as supplied by publisher]
4. Pediatrics. 2010 May;125(5):e1124-34.
Prevalence and predictors of posttraumatic stress disorder in adult survivors of
Stuber ML, Meeske KA, Krull KR, Leisenring W, Stratton K, Kazak AE, Huber M,
Zebrack B, Uijtdehaage SH, Mertens AC, Robison LL, Zeltzer LK.
Department of Psychiatry, David Geffen School of Medicine, University of
California, Los Angeles, California, USA. email@example.com
OBJECTIVE: This study compared the prevalence of symptoms of posttraumatic stress
disorder (PTSD), with functional impairment and/or clinical distress, among very
long-term survivors of childhood cancer and a group of healthy siblings. METHODS:
A total of 6542 childhood cancer survivors >18 years of age who received
diagnoses between 1970 and 1986 and 368 siblings of cancer survivors completed a
comprehensive demographic and health survey. RESULTS: A total of 589 survivors
(9%) and 8 siblings (2%) reported functional impairment and/or clinical distress
in addition to the set of symptoms consistent with a full diagnosis of PTSD.
Survivors had more than fourfold greater risk of PTSD, compared with siblings
(odds ratio [OR]: 4.14 [95% confidence interval [CI]: 2.08-8.25]). With
controlling for demographic and treatment variables, increased risk of PTSD was
associated with educational level of high school or less (OR: 1.51 [95% CI:
1.16-1.98]), being unmarried (OR: 1.99 [95% CI: 1.58-2.50]), having annual income
below $20,000 (OR: 1.63 [95% CI: 1.21-2.20]), and being unemployed (OR: 2.01 [95%
CI: 1.62-2.51]). Intensive treatment also was associated with increased risk of
full PTSD (OR: 1.36 [95% CI: 1.06-1.74]). CONCLUSIONS: PTSD was reported
significantly more often by survivors of childhood cancer than by sibling control
subjects. Although most survivors apparently are faring well, a subset reported
significant impairment that may warrant targeted intervention.
PMID: 20435702 [PubMed - indexed for MEDLINE]
5. Pediatrics. 2010 May;125(5):1094-100. Epub 2010 Apr 26.
Intimate partner violence: the role of the pediatrician.
Thackeray JD, Hibbard R, Dowd MD; Committee on Child Abuse and Neglect; Committee
on Injury, Violence, and Poison Prevention.
Collaborators: Jenny C, Christian C, Crawford J, Flaherty E, Hibbard R, Kaplan R,
MacMillan H, Saul J, Thackeray JD, Hurley TP, Gardner HG, Baum CR, Dowd MD,
Durbin D, Ebel B, Lichenstein R, Limbos MA, O'Neil J, Quinlan KP, Parker K,
Scholer S, Sege RD, Turner MS, Weiss JC, Gilchrist J, Haverkos LJ, Midgett JD,
Roche L, Sinclair AS, Yanchar N, Kozial B.
The American Academy of Pediatrics and its members recognize the importance of
improving the physician's ability to recognize intimate partner violence (IPV)
and understand its effects on child health and development and its role in the
continuum of family violence. Pediatricians are in a unique position to identify
abused caregivers in pediatric settings and to evaluate and treat children raised
in homes in which IPV may occur. Children exposed to IPV are at increased risk of
being abused and neglected and are more likely to develop adverse health,
behavioral, psychological, and social disorders later in life. Identifying IPV,
therefore, may be one of the most effective means of preventing child abuse and
identifying caregivers and children who may be in need of treatment and/or
therapy. Pediatricians should be aware of the profound effects of exposure to IPV
PMID: 20421260 [PubMed - indexed for MEDLINE]
6. Seishin Shinkeigaku Zasshi. 2010;112(2):153-8.
Recovery and beyond: working with young tsunami victims in Thailand.
Pityaratstian N, Ketumarn P, Piyasilpa V, Sidthiraksa N, Ularntinon S.
Department of Psychiatry, Faculty of Medicine, Chulalongkorn University, Bangkok.
PMID: 20384200 [PubMed - indexed for MEDLINE]
7. Acta Orthop Belg. 2010 Feb;76(1):90-3.
Acute stress disorder and post-traumatic stress disorder following traumatic
Copuroglu C, Ozcan M, Yilmaz B, Gorgulu Y, Abay E, Yalniz E.
Department of Orthopaedics and Traumatology, Faculty of Medicine, Trakya
University, Edirne, Turkey. firstname.lastname@example.org
Traumatic amputations are important causes of acute stress disorder and
post-traumatic stress disorder. In this study, we aimed to find out the
occurrence rate of symptoms of acute and post-traumatic stress disorder after
traumatic amputations and according to this, to assess the psychiatric status of
the patients in the postoperative period. Twenty-two patients with traumatic limb
amputation who were treated in our institution were retrospectively evaluated.
During the early post-traumatic period, the patients were observed to determine
whether they needed any psychiatric supportive treatment. During the follow-up
period, after the sixth month from the trauma, the patients were referred to the
psychiatry department and they were evaluated to determine whether they needed
any psychiatric supportive treatment, by clinical psychiatric examination and use
of the 'post-traumatic stress disorder scale' (Clinician Administered Post
traumatic Scale, or CAPS). Twenty-one (95.5%) of 22 patients were male, one
(4.5%) female. Mean age of the patients was 40.8 years (range: 15 to 69). During
the early posttraumatic period, 8 (36.3%) of these patients consulted the
psychiatry clinic following the orthopaedists' observations. Five (22.7%) of
these patients needed psychiatric supportive treatment for acute stress disorder.
After the 6th month (6 months to 5 years), 17 (77.2%) had chronic and delayed
post-traumatic stress disorder and needed psychiatric supportive treatment.
Patients who have sustained a traumatic amputation may need psychiatric
supportive treatment in the late period after the trauma. As we orthopaedic
surgeons treat these patients surgically, we should be aware of their psychiatric
PMID: 20306971 [PubMed - indexed for MEDLINE]
8. J Am Acad Psychiatry Law. 2010;38(1):73-9.
Adolescent parricide as a clinical and legal problem.
MS, 909 Social Science Building, University of Minnesota, Minneapolis, MN
55455-0499, USA. email@example.com
Criminologists contribute to the knowledge regarding the continuing problem of
parricide by way of macrostudies, utilizing large samples that reveal patterns of
how such acts are carried out, gender differences, and other aspects. Clinicians
have the opportunity to pursue microinvestigations into the details of how
cognitive processes and emotions operate in the adolescent who engages in such
behavior. Such investigations entail pursuing specifics in the psychosocial
realm, such as earlier maltreatments and ongoing psychological conflicts, and
also being alert to the neurobiological differences between adolescents and
adults. The use of battered child syndrome as a legal defense is discussed, with
contrasts made between relying on a posttraumatic stress disorder (PTSD) approach
and a duress defense, based on explanations related to shame and humiliation.
PMID: 20305078 [PubMed - indexed for MEDLINE]
9. Psychiatry Res. 2010 Apr 30;176(2-3):229-35. Epub 2010 Mar 6.
Comparison of MMPI-2 and PAI validity indicators to detect feigned depression and
PTSD symptom reporting.
Lange RT, Sullivan KA, Scott C.
Department of Research, BC Mental Health and Addiction Services, Vancouver,
The purpose of this study was to compare the clinical utility of PAI and MMPI-2
validity indicators to detect exaggeration of psychological symptoms.
Participants were 49 (75.5% female) Australian university students who completed
the MMPI-2 and PAI under one of three conditions: Control [i.e., honest
responding (n=20)], Feign Post Traumatic Stress Disorder [PTSD (n=15)], or Feign
Depression (n=14). Participants instructed to feign depression or feign PTSD had
significantly higher scores on the majority of MMPI-2 and PAI validity indicators
compared with controls. The Meyers Validity Index, the Obvious-Subtle index, and
the Response Bias Scale were the most accurate MMPI-2 validity indicators.
Diagnostic-specific MMPI-2 validity indicators, such as the Infrequency-PSTD
scales and Malingered Depression scale, were not effective at detecting
participants instructed to feign those conditions. For the PAI, the most accurate
validity indicator was the MAL index; however, the detection rate using this
validity indicator was modest at best. The MMPI-2 validity indicators were
clearly superior to those on the PAI at identifying feigned versus honest
responding in this sample. Crown Copyright (c) 2010. Published by Elsevier
Ireland Ltd. All rights reserved.
PMID: 20207423 [PubMed - indexed for MEDLINE]
10. Psychol Health. 2009 Apr;24(4):457-71.
Post-traumatic growth in women after childbirth.
Sawyer A, Ayers S.
Department of Psychology, University of Sussex, Brighton, UK.
Childbirth is a complex event that leads to a variety of psychological outcomes.
This cross-sectional study examined post-traumatic growth in women following
childbirth (N = 219) using an online questionnaire, and explored associations
between growth, support and control during birth, coping after birth and symptoms
of post-traumatic stress disorder (PTSD). At least moderate degrees of growth
were reported by 50.2% of women and average levels of growth were similar to
those reported following accidents and assaults. Growth was positively related to
approach coping and the avoidant strategy of seeking alternative rewards, but was
unrelated to support and control during birth, other avoidant coping strategies
after birth, and PTSD symptoms. It is concluded that growth does occur following
childbirth. Further research is needed to clarify factors associated with growth
in women following childbirth and to determine if growth is associated with
psychological benefits in this population.
PMID: 20205005 [PubMed - indexed for MEDLINE]
11. Oncol Nurs Forum. 2010 Mar;37(2):160-7.
Post-traumatic stress disorder in Israeli survivors of childhood cancer.
DeKeyser Ganz F, Raz H, Gothelf D, Yaniv I, Buchval I.
School of Nursing, Hadassah Hebrew University, Jerusalem, Israel.
PURPOSE/OBJECTIVES: To investigate the prevalence, symptom severity, and risk
factors associated with post-traumatic stress disorder (PTSD) in childhood cancer
survivors. DESIGN: Descriptive, correlational study. SETTING: Follow-up clinic in
Petach Tikva, Israel. SAMPLE: Convenience sample of 70 adult Israeli survivors of
childhood cancer. METHODS: Questionnaires (the Post-Traumatic Diagnostic Scale
and the Multidimensional Scale of Perceived Social Support) were distributed to
participants, and demographic and clinical data were obtained from medical
records. MAIN RESEARCH VARIABLES: Post-traumatic stress, social support, and
clinical and demographic data. FINDINGS: Twenty (29%) of the participants met the
Diagnostic and Statistical Manual of Mental Disorders (4th ed.) criteria for
PTSD; 10% experienced mild, 40% moderate, and 50% moderate to severe symptoms.
Only 16% of the sample did not experience any symptoms of PTSD. A statistically
significant negative relationship was found between PTSD symptom scores and the
current age of the respondent (r(s) = -0.27, p = 0.03) and time since medical
treatment (r(s) = -0.34, p = 0.004) but not any other demographic or clinical
variables or social support. CONCLUSIONS: Higher severity of PTSD symptoms was
found, possibly because of local living conditions. Most clinical and demographic
variables were not risk factors. This population should be studied further in an
effort to prevent PTSD via early diagnosis. IMPLICATIONS FOR NURSING: Oncology
nurses should be aware of the potential risk factors (recent completion of
treatment and younger current age) and the high prevalence and severity of PTSD
among survivors of childhood cancer to identify patients at higher risk and
develop programs that prevent, limit, and treat PTSD.
PMID: 20189921 [PubMed - indexed for MEDLINE]
12. J Child Sex Abus. 2009 Sep;18(5):553-73.
Externalizing behavior among adopted boys with preadoptive histories of child
Nalavany BA, Ryan SD, Hinterlong J.
East Carolina University, Greenville, North Carolina 27858, USA.
This study examined the severity of externalizing symptomology among adopted boys
with preadoptive histories of child sexual abuse, physical abuse,
neglect/abandonment, or no abuse. The study was based on data collected across a
three-year period from parents who adopted children from Florida's child welfare
system. The sample consisted of 1,136 adopted boys aged 6 to 18 years. In
repeated cross-sectional multivariate analyses, the results revealed that adopted
boys with preadoptive child sexual abuse were prone to significantly higher
levels and clinically severe externalizing symptomotology as compared to adopted
boys without such histories. The findings highlight the need for postadoption
services and empirically validated interventions for families adopting boys with
preadoptive child sexual abuse.
PMID: 20183417 [PubMed - indexed for MEDLINE]
13. J Child Sex Abus. 2009 Sep;18(5):532-52.
The trauma outcome process assessment model: a structural equation model
examination of adjustment.
Borja SE, Callahan JL.
Oklahoma State University, Stillwater, Oklahoma 74078, USA.
This investigation sought to operationalize a comprehensive theoretical model,
the Trauma Outcome Process Assessment, and test it empirically with structural
equation modeling. The Trauma Outcome Process Assessment reflects a robust body
of research and incorporates known ecological factors (e.g., family dynamics,
social support) to explain internalizing distress (e.g., anxiety, depression),
externalizing distress (e.g., aggression), and recovery outcomes following
traumatic events. Results revealed that expected relationships among the
variables were significantly related in the expected direction, and the measures
mapped well onto the expected latent constructs. Following optimal specification
of the relationships within the Trauma Outcome Process Assessment, structural
equation modeling revealed strong support for the Trauma Outcome Process
Assessment as a comprehensive identification and treatment model to explain the
differential outcomes of those exposed to traumatic stressors.
PMID: 20183416 [PubMed - indexed for MEDLINE]
14. Epidemiol Psichiatr Soc. 2009 Oct-Dec;18(4):294-8.
A cognitive behavioural perspective on the relationship between childhood trauma
This editorial reviews the relationship between childhood trauma and the
development of psychosis in adulthood. There are numerous studies, including
large, prospective studies, which clearly support a link between childhood
adversity and experience of psychosis later in life. There is also evidence that
there is a dose response relationship, and that childhood trauma is particularly
associated with the experience of hallucinations and delusional ideas. It is
possible that psychosis is a relatively understandable response to the experience
of severe trauma, and recent cognitive models of psychosis can help to explain
the underlying mechanisms in such a causal relationship. There are obvious
treatment implications, which include the need to assess histories of childhood
trauma in people with psychosis, the incorporation of trauma in shared
understandings of psychosis with service users, the incorporation of change
strategies in cognitive behaviour therapy for psychosis that are derived from
evidence-based approaches to the treatment of trauma and PTSD, and the prevention
of traumatisation by mental health services.
PMID: 20170042 [PubMed - indexed for MEDLINE]
15. Epidemiol Psichiatr Soc. 2009 Oct-Dec;18(4):284-93.
Childhood sexual abuse and psychosis: aetiology and mechanism.
The aim of this Editorial is to describe the association between child sexual
abuse and psychosis, and to consider potential mechanisms for the association.
The association is strongly supported by the literature. Evidence from a variety
of sources is triangulated in order to create a plausible model of the link,
which can then be used to direct future research. The mechanisms are certainly
complex, and there is evidence of interacting contributions at genetic,
neurophysiological, behavioural, cognitive and emotional levels. Child sexual
abuse is an important antecedent in psychosis, both theoretically and clinically.
At the theoretical level, it potentially illuminates mechanisms by which
psychotic symptoms are generated, at the clinical level it opens possibilities
for improving cognitive-behavioural approaches to treatment.
PMID: 20170041 [PubMed - indexed for MEDLINE]
16. Epidemiol Psichiatr Soc. 2009 Oct-Dec;18(4):277-83.
Childhood trauma and psychotic disorders: evidence, theoretical perspectives, and
implication for interventions.
[Article in English, Italian]
Lasalvia A, Tansella M.
PMID: 20170040 [PubMed - indexed for MEDLINE]
17. J Child Adolesc Psychopharmacol. 2010 Feb;20(1):39-47.
Predictors of placebo response in randomized controlled trials of psychotropic
drugs for children and adolescents with internalizing disorders.
Cohen D, Consoli A, Bodeau N, Purper-Ouakil D, Deniau E, Guile JM, Donnelly C.
Department of Child and Adolescent Psychiatry, Université Pierre et Marie Curie,
GH Pitié-Salpétrière, AP-HP, Paris, France.
OBJECTIVE: The aim of this study was to assess predictors of placebo response in
all available short-term, placebo-controlled trials of psychotropic drugs for
children and adolescents with internalizing disorders, major depressive disorder
(MDD), obsessive compulsive disorder (OCD,) and anxiety disorders (ANX) exclusive
of OCD and posttraumatic stress disorder (PTSD). METHOD: We reviewed the
literature relevant to the use of psychotropic medication in children and
adolescents with internalizing disorders, restricting our review to double-blind
studies including a placebo arm. Placebo response, defined according to each
trial's primary response outcome variable and Clinical Global
Impressions-Improvement, when available, and potential predictive variables were
extracted from 40 studies. RESULTS: From 1972 to 2007, we found 23 trials that
evaluated the efficacy of psychotropic medication involving youth with MDD, 7
pertaining to youths with OCD, and 10 pertaining to youths with ANX (N = 2,533
patients in placebo arms). For all internalizing disorders combined, predictors
of nonresponse to placebo were the percentage of Caucasian patients included in
the study and the duration of the disorder: Both variables were negatively
correlated with the percent of placebo responders. The type of disorder was found
to predict the robustness of placebo response: (OCD < ANX < MDD). For a subset of
MDD studies, we found that baseline illness severity tended to be negatively
correlated with placebo response. Finally, trial "success" was significantly
associated with lower placebo response rate. CONCLUSION: Predictors of placebo
response in internalizing disorders of youths parallel those in adult studies,
with the exception of race. These predictors should be considered when designing
placebo-controlled trials in youths to enhance findings of true drug-placebo differences.
PMID: 20166795 [PubMed - indexed for MEDLINE]
18. J Psychosom Obstet Gynaecol. 2010 Mar;31(1):40-9.
Measuring posttraumatic stress following childbirth: a critical evaluation of
Stramrood CA, Huis In 't Veld EM, Van Pampus MG, Berger LW, Vingerhoets AJ,
Schultz WC, Van den Berg PP, Van Sonderen EL, Paarlberg KM.
Department of Obstetrics and Gynecology, University Medical Center Groningen,
Groningen, The Netherlands. firstname.lastname@example.org
OBJECTIVES: To evaluate instruments used to assess posttraumatic stress disorder
(PTSD) following childbirth with both quantitative (reliability analysis and
factor analysis) and qualitative (comparison of operationalization) techniques.
METHODS: An unselected population of 428 women completed the Traumatic Event
Scale-B (TES-B) and the PTSD Symptom Scale-Self Report (PSS-SR) 2-6 months after
delivery. RESULTS: Assessment of internal consistency yielded similar results for
the TES-B and PSS-SR (Cronbach's alpha = 0.87 and 0.82, respectively). Factor
analysis revealed two rather than three DSM-IV symptom categories for both
instruments: childbirth-related factors (re-experiencing/ avoidance) and symptoms
of depression and anxiety (numbing/hyperarousal). Although the TES-B and the
PSS-SR sum-scores show a strong relationship (Spearmans rho = 0.78), agreement
between the instruments on the identification of PTSD cases is low (kappa =
0.24); discrepancy between TES-B and PSS-SR is largely due to differences in
instruction to respondents, formulation of items, answer categories, and cut-off
values. CONCLUSIONS: Large operationalization differences between TES-B and
PSS-SR have been identified, i.e., in the formulation of questions, answer
categories, cut-off values and instructions to respondents. Comparison between
studies using different instruments for measuring PTSD following childbirth
should be done with utmost caution.
PMID: 20146642 [PubMed - indexed for MEDLINE]
19. J Trauma Stress. 2010 Feb;23(1):161-8.
Factors associated with trauma and posttraumatic stress disorder among homeless
youth in three U.S. cities: the importance of transience.
Bender K, Ferguson K, Thompson S, Komlo C, Pollio D.
Graduate School of Social Work, University of Denver, Denver, CO 80208, USA.
Homeless youth experience disproportionately high rates of trauma and
posttraumatic stress disorder (PTSD). This study examined correlates of trauma
and PTSD among homeless youth with a focus on the impact of homeless culture,
substance addiction, and mental health challenges. Homeless youth (N = 146) from
Los Angeles, California, Denver, Colorado, and St. Louis, Missouri, were
recruited from organizations providing services to homeless youth using
comparable methods. Results indicate that 57% of respondents had experienced a
traumatic event and 24% met criteria for PTSD. A multinomial logistic regression
model revealed greater transience, alcohol addiction, mania, and lower
self-efficacy predicted PTSD whereas trauma exposure was associated with alcohol
addiction only. Findings have implications for screening and intervening with
traumatized homeless youth across service settings.
PMID: 20146399 [PubMed - indexed for MEDLINE]
20. J Trauma Stress. 2010 Feb;23(1):5-16.
VA mental health services utilization in Iraq and Afghanistan veterans in the
first year of receiving new mental health diagnoses.
Seal KH, Maguen S, Cohen B, Gima KS, Metzler TJ, Ren L, Bertenthal D, Marmar CR.
Health Services Research and Development Research Enhancement Award Program, San
Francisco VA Medical Center and the Department of Medicine, University of
California, San Francisco, CA 94121, USA. Karen.Seal@va.gov
Little is known about mental health services utilization among Iraq and
Afghanistan veterans receiving care at Department of Veterans Affairs (VA)
facilities. Of 49,425 veterans with newly diagnosed posttraumatic stress disorder
(PTSD), only 9.5% attended 9 or more VA mental health sessions in 15 weeks or
less in the first year of diagnosis. In addition, engagement in 9 or more VA
treatment sessions for PTSD within 15 weeks varied by predisposing variables (age
and gender), enabling variables (clinic of first mental health diagnosis and
distance from VA facility), and need (type and complexity of mental health
diagnoses). Thus, only a minority of Iraq and Afghanistan veterans with new PTSD
diagnoses received a recommended number and intensity of VA mental health
treatment sessions within the first year of diagnosis.
PMID: 20146392 [PubMed - indexed for MEDLINE]
21. J Trauma Stress. 2010 Feb;23(1):151-60.
Social and trauma-related pathways leading to psychological distress and
functional limitations four years after the humanitarian emergency in
Silove D, Brooks R, Bateman CS, Steel Z, Amaral ZF, Rodger J, Soosay I.
Centre for Population Mental Health Research, Sydney South West Area Health
Service and School of Psychiatry, University of New South Wales, New South Wales,
There is growing acknowledgment that research in the postconflict field needs to
include a focus on social conditions. The authors applied structural equation
modeling to epidemiologic data obtained from postconflict Timor-Leste, to examine
for links involving potentially traumatic events and sociodemographic factors
(age, gender, educational levels, and unemployment) with psychological symptoms
and functioning. Exposure to trauma and lack of education emerged as most
relevant with psychological distress impacting on education in the urban area.
Age and gender exerted influences at different points in the model consistent
with the known history of Timor. Although based on cross-sectional data, the
model supports the relevance of past trauma, posttraumatic distress, and
postconflict social conditions to functioning in societies such as Timor-Leste.
PMID: 20146257 [PubMed - indexed for MEDLINE]
22. Issues Ment Health Nurs. 2010 Mar;31(3):216-22.
Trauma informed care on an inpatient pediatric psychiatric unit and the emergence
of ethical dilemmas as nurses evolved their practice.
Cambridge Health Alliance, Cambridge, Massachusetts 02193, USA.
Two case studies are presented reflecting the ethical dilemmas experienced by
nurses who were striving to improve their practice in the provision of patient
care. The cases are described in the context of finding alternatives to cohesive
interventions such as chemical restraints and physical restraints. A summary of
the literature on ethical dilemmas that was relevant to the issues arising in
these cases is included. Discussion of the use of the American Nursing
Association's (ANA, 2001 ) Nursing Code of Ethics with Interpretive Statements is
highlighted for its relevance and support of the nurses experiencing the ethical
PMID: 20144033 [PubMed - indexed for MEDLINE]
23. J Trauma Stress. 2010 Feb;23(1):141-50.
Subjective sleep quality in women experiencing intimate partner violence:
contributions of situational, psychological, and physiological factors.
Woods SJ, Kozachik SL, Hall RJ.
The University of Akron College of Nursing, Akron, OH 44325-3701, USA.
This study, guided by an adaptation of the theory of unpleasant symptoms,
examined the complex relationships of childhood maltreatment, intimate partner
violence (IPV), posttraumatic stress disorder (PTSD), depression, and physical
health symptoms with global sleep quality and disruptive nighttime behaviors.
Data were analyzed using covariance structure analysis. A convenience sample of
157 women currently experiencing IPV was recruited from crisis shelters and
community agencies. Findings provide empirical support that women concurrently
experiencing PTSD, depression, and stress-related physical health symptoms
demonstrated poor global sleep quality and frequent disruptive nighttime
behaviors. Posttraumatic stress disorder and stress health symptoms functioned as
mediators of childhood maltreatment and IPV effects on both global sleep quality
and disruptive nighttime behaviors, but depression did not.
PMID: 20143342 [PubMed - indexed for MEDLINE]
24. J Trauma Stress. 2010 Feb;23(1):169-72.
Adult separation anxiety disorder among war-affected Bosnian refugees:
comorbidity with PTSD and associations with dimensions of trauma.
Silove D, Momartin S, Marnane C, Steel Z, Manicavasagar V.
School of Psychiatry, University of New South Wales and Centre for Population
Mental Health Research, Sydney South West Area Health Service, Liverpool,
Although separation anxiety disorder appears to be common among children exposed
to disasters, there are no data focusing on the impact of trauma on adult
separation anxiety disorder. The present exploratory study examined the
relationship of adult separation anxiety disorder with other psychological
reactions (posttraumatic stress disorder [PTSD], complicated grief, depression)
and dimensions of trauma among 126 war-affected Bosnian refugees resettled in
Australia. Adult separation anxiety disorder was associated with PTSD, but not
with complicated grief or depression. Although adult separation anxiety disorder
was weakly linked with traumatic losses, this association was nonspecific.
Further research is needed to clarify the pathogenic pathways leading to the
comorbid PTSD-adult separation anxiety disorder pattern and its clinical
PMID: 20135680 [PubMed - indexed for MEDLINE]
25. J Trauma Stress. 2010 Feb;23(1):69-77.
Correlates of posttraumatic stress disorder symptoms in Marines back from war.
Booth-Kewley S, Larson GE, Highfill-McRoy RM, Garland CF, Gaskin TA.
Behavioral Science and Epidemiology Department, Naval Health Research Center, San
Diego, CA 92106-3521, USA. email@example.com
The effect of combat and operational stress on the mental health of military
personnel is a major concern. The objective of this study was to identify factors
associated with possible posttraumatic stress disorder (PTSD). A questionnaire
was completed by 1,569 Marines who deployed in support of conflicts in Iraq and
Afghanistan (2002-2007). Using the PTSD Checklist with a cutoff score of 44,
17.1% of the sample screened positive for possible PTSD. Of 9 demographic and
psychosocial factors examined in relation to PTSD, 4 were significant in a
multivariate analysis: deployment-related stressors, combat exposure, marital
status, and education. Deployment-related stressors had a stronger association
with PTSD than any other variable. This is an important finding because
deployment-related stressors are potentially modifiable.
PMID: 20104587 [PubMed - indexed for MEDLINE]
26. Int J Psychophysiol. 2010 Mar;75(3):326-31. Epub 2010 Jan 15.
PTSD, but not childhood maltreatment, modifies responses to unpleasant odors.
Croy I, Schellong J, Joraschky P, Hummel T.
Department of Psychosomatic Medicine, University of Dresden Medical School,
Fetscherstr. 74, D-01307 Dresden, Germany. Ilona.Croy@mailbox.tu-dresden.de
Childhood maltreatment (CM) as well as posttraumatic stress disorder (PTSD) is
said to result in functional changes to amygdalae and orbitofrontal cortex. Thus,
it might be expected to change olfactory function in adults with a CM-history and
current PTSD symptomatology as amygdalae and orbitofrontal cortex are of major
importance for olfactory information processing. To explore this we investigated
olfactory function in 31 women with current psychopathology and a history of CM,
28 without CM, and 27 healthy women. We used the "Sniffin' Sticks" threshold and
identification test and analyzed chemosensory event-related potentials.
Participants were also asked to complete a questionnaire to access current
symptoms of posttraumatic stress disorder (PTSD). We found no significant
difference between the CM-Group and the two control groups, but PTSD severity
correlated significantly with odor identification scores and with parameters of
event-related potentials in response to unpleasant stimuli. The results indicate
preferential processing of unpleasant stimuli in PTSD patients irrespective of
the childhood history. Copyright 2010 Elsevier B.V. All rights reserved.
PMID: 20079770 [PubMed - indexed for MEDLINE]
27. J Burn Care Res. 2010 Jan-Feb;31(1):13-25.
Posttraumatic stress disorder and pain impact functioning and disability after
major burn injury.
Corry NH, Klick B, Fauerbach JA.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School
of Medicine, Baltimore, Maryland 21224, USA.
This study sought to clarify the prospective and concurrent associations of
posttraumatic stress disorder (PTSD) and pain with functioning and disability
after burn injury. The sample was composed of consecutive patients admitted to a
regional burn center with major burn injuries (N = 171) who were followed at 1,
6, 12, and 24 months postdischarge. The predictor measures were the McGill Pain
Questionnaire and Davidson Trauma Scale, and the outcome measures were Short
Form-36 Health Survey subscales administered at 6, 12, and 24 months after
discharge. Linear mixed-effects analyses were conducted to evaluate pain and PTSD
as predictors of functional outcomes. Higher PTSD symptom severity soon after
hospital discharge was prospectively related to poorer physical and social
functioning and greater psychosocial disability (P < .001). However, significant
PTSD-by-time interactions also predicted future physical functioning and
disability, indicating that the deleterious effects of early PTSD were
ameliorated by time. In addition, at each follow-up, PTSD symptoms were
concurrently related to greater physical and psychosocial disability, poorer
social functioning, and less vitality (P < .001). More severe pain at each
follow-up, but not PTSD, was correlated with poorer concurrent physical
functioning (P < .002). Significant interaction terms indicated that the
concurrent effect of PTSD on psychosocial disability, social functioning, and
vitality attenuated during the 24-month recovery period. These findings suggest
that assessing PTSD and pain following burn injury may aid in predicting future
functioning. Future work should confirm this and evaluate whether aggressively
treating both PTSD and pain helps improve functioning after major burn injury.
PMID: 20061832 [PubMed - indexed for MEDLINE]
28. Drug Alcohol Depend. 2010 Apr 1;108(1-2):115-21. Epub 2010 Jan 8.
Relationship of combat experiences to alcohol misuse among U.S. soldiers
returning from the Iraq war.
Wilk JE, Bliese PD, Kim PY, Thomas JL, McGurk D, Hoge CW.
Division of Psychiatry and Neuroscience, Walter Reed Army Institute of Research,
U.S. Army Medical Research and Materiel Command, Silver Spring, MD 20910, United
OBJECTIVE: Studies have shown a relationship between combat experiences and
alcohol misuse in military personnel; it is not known if there are specific
combat experiences that confer a greater risk. The current study examined the
association of specific types of combat experiences with a positive screen for
alcohol misuse. METHODS: 1120 U.S. soldiers who were members of brigade combat
infantry teams were surveyed anonymously 3-4 months after returning from
deployment to Iraq regarding their experiences in combat and their physical and
mental health. Combat items were independently rated and placed into the
following categories: (1) Fighting; (2) Killing; (3) Threat to oneself; (4)
Death/injury of others; (5) Atrocities; and, (6) Positive experiences. Alcohol
misuse was measured using a 2-item alcohol screen combined with alcohol-related
behavioral items. RESULTS: Of the soldiers sampled, 25% (N=275) screened positive
for alcohol misuse 3-4 months post-deployment; 12% (N=125) screened positive and
exhibited alcohol-related behavioral problems. Most combat exposure factors were
significantly related to alcohol misuse individually. When factors were analyzed
simultaneously, soldiers who had higher rates of exposure to the threat of
death/injury were significantly more likely to screen positive for alcohol
misuse; exposure to atrocities predicted misuse of alcohol with alcohol-related
behavioral problems. CONCLUSIONS: High exposure to threatening situations and
atrocities was associated with a positive screen for alcohol misuse. Clinicians
treating combat veterans should be aware of the potential association of alcohol
misuse with specific types of experiences and closely follow those soldiers upon
their return home. Published by Elsevier Ireland Ltd.
PMID: 20060237 [PubMed - indexed for MEDLINE]
29. AIDS Care. 2009 Dec;21(12):1508-16.
Positive future orientation as a mediator between traumatic events and mental
health among children affected by HIV/AIDS in rural China.
Zhang J, Zhao G, Li X, Hong Y, Fang X, Barnett D, Lin X, Zhao J, Zhang L.
State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal
OBJECTIVE: The current study was designed to explore the effect of future
orientation in mediating the relationship between traumatic events and mental
health in children affected by HIV/AIDS in rural China. METHODS: Cross-sectional
data were collected from 1221 children affected by HIV/AIDS (755 AIDS orphans and
466 vulnerable children). Future orientation among children was measured using
three indicators (future expectation, hopefulness toward the future, and
perceived control over the future). Measures of mental health consisted of
depression, loneliness, and self-esteem. Children's experience of any traumatic
events was measured using a modified version of the Life Incidence of Traumatic
Events-Student Form. Mediation analysis was conducted using structural equation
modeling (SEM) methods. RESULTS: Among the children surveyed, most of the
traumatic indicators were negatively associated with future expectation,
hopefulness, perceived control, and self-esteem, and positively associated with
depression and loneliness. The SEM of mediation analysis demonstrated an adequate
fit. Future orientation fully mediated the relationship between traumatic events
and mental health and accounted for 67.9% of the total effect of traumatic events
on mental health. CONCLUSIONS: Results of this study support the positive effect
of future expectation in mediating the relationship between traumatic events and
mental health among children affected by HIV/AIDS in China. Future mental health
promotion and intervention efforts targeting children affected by HIV/AIDS should
include components that can mitigate the negative impact of traumatic events on
their lives. These components may aim to develop children's positive future
expectations, increase their hopefulness toward the future, and improve their
perceived control over the future.
PMID: 20024730 [PubMed - indexed for MEDLINE]
30. AIDS Care. 2009 Dec;21(12):1481-9.
Stressful or traumatic life events, post-traumatic stress disorder (PTSD)
symptoms, and HIV sexual risk taking among men who have sex with men.
Reisner SL, Mimiaga MJ, Safren SA, Mayer KH.
The Fenway Institute, Fenway Community Health, Boston, MA, USA.
The present study assessed the presence of post-traumatic stress disorder (PTSD)
symptoms in response to stressful or traumatic life events and their impact on
HIV risk behaviors and associated psychosocial variables among men who have sex
with men (MSM). Participants (n=189; 60% HIV-infected) who were recruited by
notices posted in a community health clinic and via a modified respondent-driven
sampling technique completed a behavioral assessment survey. Sixty percentage of
participants screened positive for having PTSD symptoms using the startle,
physiological arousal, anger, and numbness screening instrument. After
controlling for race, sexual self-identification, and HIV status, multivariable
logistic regression analyses revealed that screening in for having PTSD symptoms
was significantly associated with having engaged in unprotected anal (insertive
or receptive) sex in the past 12 months, over and above any effects of whether or
not a traumatic/stressful event occurred during the year (adjusted odds ratio
[OR] = 2.72; p<0.02; 95% confidence interval [CI] = 1.19-6.20). In addition, MSM
with PTSD symptoms were more likely to have clinically significant depressive
symptoms (adjusted OR = 3.50; p<0.001) and/or symptoms of social anxiety
(adjusted OR = 2.87; p<0.01; 95% CI = 1.48-5.62). The current study, in the
context of other research documenting the high rates of co-occurring psychosocial
issues facing MSM, points to the importance of incorporating coping with these
issues in HIV and sexually transmitted disease prevention and care interventions.
PMID: 20024727 [PubMed - indexed for MEDLINE]
31. Neuroscience. 2010 Mar 10;166(1):168-77. Epub 2009 Dec 16.
Oxytocin response to an experimental psychosocial challenge in adults exposed to
traumatic experiences during childhood or adolescence.
Pierrehumbert B, Torrisi R, Laufer D, Halfon O, Ansermet F, Beck Popovic M.
Service Universitaire de Psychiatrie de l'enfant et de l'adolescent, Lausanne,
Long-term implications of the exposure to traumatizing experiences during
childhood or adolescence, such as sexual abuse, or cancer, have been documented,
namely the subjects' response to an acute stress in adulthood. Several indicators
of the stress response have been considered (e.g. cortisol, heart rate). Oxytocin
(OT) response to an acute stress of individuals exposed to trauma has not been
documented. Eighty subjects (n=26 women who had experienced episodes of child
abuse, n=25 men and women healthy survivors of cancer in childhood or
adolescence, and 29 controls) have been submitted to a laboratory session
involving an experimental stress challenge, the Trier social stress test.
Overall, there was a clear OT response to the psychosocial challenge. Subjects
having experienced a childhood/adolescence life-threatening illness had higher
mean levels of OT than both abused and control subjects. There was a moderate
negative relationship between OT and salivary cortisol. It is suggested that an
acute stress stimulates OT secretion, and that the exposure to enduring
life-threatening experiences in childhood/adolescence has long-lasting
consequences regarding the stress system and connected functions, namely the
activation of OT secretion. Better knowledge of such long-term implications is
important so that to prevent dysregulations of the stress responses, which have
been shown to be associated to the individual's mental health. Copyright 2010
IBRO. Published by Elsevier Ltd. All rights reserved.
PMID: 20018229 [PubMed - indexed for MEDLINE]
32. Clin Child Fam Psychol Rev. 2010 Mar;13(1):46-76.
Posttraumatic stress disorder in maltreated youth: a review of contemporary
research and thought.
Kearney CA, Wechsler A, Kaur H, Lemos-Miller A.
Department of Psychology, University of Nevada, Las Vegas, 4505 Maryland Parkway,
Las Vegas, NV 89154-5030, USA. firstname.lastname@example.org
Youths who have been maltreated often experience symptoms of posttraumatic stress