Pathways to PTSD, part I: children with burns

Boston University, Boston, Massachusetts, United States
American Journal of Psychiatry (Impact Factor: 12.3). 08/2005; 162(7):1299-304. DOI: 10.1176/appi.ajp.162.7.1299
Source: PubMed


The goal of this study was to develop a model of risk factors for posttraumatic stress disorder (PTSD) in a group of acutely burned children.
Seventy-two children between the ages of 7 and 17 who were admitted to the hospital for an acute burn were eligible for study. Members of families who consented completed the Child PTSD Reaction Index, the Multidimensional Anxiety Scale for Children, and other self-report measures of psychopathology and environmental stress both during the hospitalization and 3 months following the burn. A path analytic strategy was used to build a model of risk factors for PTSD.
Two pathways to PTSD were discerned: 1) from the size of the burn and level of pain following the burn to the child's level of acute separation anxiety, and then to PTSD, and 2) from the size of the burn to the child's level of acute dissociation following the burn, and then to PTSD. Together these pathways accounted for almost 60% of the variance in PTSD symptoms and constituted a model with excellent fit indices.
These findings support a model of complex etiology for childhood PTSD in which two independent pathways may be mediated by different biobehavioral systems.

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    • "increases in anxiety and mood disorders (Famularo, Fenton, Kinscherff, & Augustyn, 1996) and severe behavioral problems (Saigh, Yasyk, Oberfield, Halamandaris, & McHugh, 2002), but posttraumatic stress symptoms (PTSS) are the most commonly reported symptoms of psychological distress. Clinically significant PTSS levels have been reported in the aftermath of a wide variety of traumatic experiences, such as violence (Kilpatrick et al., 2003), war trauma (Ajdukovic, 1998), abuse (Ackerman, Newton, McPherson, Jones, & Dykman, 1998), chronic illness (Connolly, McClowry, Hayman, Mahony, & Artman, 2004), burns (Saxe et al., 2005), traffic accidents (Meiser-Stedman, Smith, Glucksman, Yule, & Dalgleish, 2008), child sexual abuse (Finkelhor, 1994), and natural disasters (Jensen, Dyb, & Nygaard, 2009; La Greca, Silverman, Vernberg, & Prinstein, 1996). Given the impairing effects of severe PTSS and other mental health problems that children and adolescents may develop in the aftermath of a traumatic event, effective treatments are needed. "
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    ABSTRACT: The efficacy of trauma-focused cognitive behavioral therapy (TF-CBT) has been shown in several randomized controlled trials. However, few trials have been conducted in community clinics, few have used therapy as usual (TAU) as a comparison group, and none have been conducted outside of the United States. The objective of this study was to evaluate the effectiveness of TF-CBT in regular community settings compared with TAU. One hundred fifty-six traumatized youth (M age = 15.1 years, range = 10-18; 79.5% girls) were randomly assigned to TF-CBT or TAU. Intent-to-treat analysis using mixed effects models showed that youth receiving TF-CBT reported significantly lower levels of posttraumatic stress symptoms (est. = 5.78, d = 0.51), 95% CI [2.32, 9.23]; depression (est. = 7.00, d = 0.54), 95% CI [2.04, 11.96]; and general mental health symptoms (est. = 2.54, d = 0.45), 95% CI [0.50, 4.58], compared with youth in the TAU group. Youth assigned to TF-CBT showed significantly greater improvements in functional impairment (est. = -1.05, d = -0.55), 95% CI [-1.67, -0.42]. Although the same trend was found for anxiety reduction, this difference was not statistically significant (est. = 4.34, d = 0.30), 95% CI [-1.50, 10.19]. Significantly fewer youths in the TF-CBT condition were diagnosed with posttraumatic stress disorder compared to youths in the TAU condition, χ(2)(1, N = 116) = 4.61, p = .031, Phi = .20). Findings indicate that TF-CBT is effective in treating traumatized youth in community mental health clinics and that the program may also be successfully implemented in countries outside the United States.
    Journal of Clinical Child & Adolescent Psychology 08/2013; 43(3). DOI:10.1080/15374416.2013.822307 · 1.92 Impact Factor
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    • "In contrast, other studies have found that burn-injured children and adolescents experience significant problems with quality of life particularly appearance [3], overanxious disorders and phobias, depressive symptoms and the presence of PTSD [2] [14] which may be in the context of parental separation and/or dissociative responses during burn treatment [1] which can be painful and traumatic [15] [16]. Overall, these studies suggest that the long-term effects of scarring and an altered appearance can impact greatly on quality of life and socialisation of this population as it is a reminder of the traumatic incident. "
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    ABSTRACT: Background: Burns leave patients with long-term physical scarring. Children with scarring are required to face challenges of reintegration into their community, including acceptance of an altered appearance and acceptance by others. This can be difficult given society's preoccupation with physical appearance. Limited research exists investigating validity of cosmetic camouflage as a psychosocial intervention for children with scarring. This study investigated whether using cosmetic camouflage (Microskin™) had a positive impact on health-related quality of life, self-concept and psychopathology for children and adolescents (8-17 years) with burn scarring. Method: A prospective multi-centre randomised controlled trial was conducted across Australian and New Zealand paediatric hospitals. 63 participants (49 females, mean age 12.7 ± 2.1 years) were enrolled. Data points were baseline (Time 1) and at 8 weeks (Time 2) using reliable and valid psychometric measures. Results: Findings indicate there were significant improvements in socialisation, school and appearance scales on the Paediatric Quality of Life Inventory and psychopathology scores particularly peer problems decreased. However self-concept remained stable from baseline throughout intervention use. Conclusion: Cosmetic camouflage appears to have a positive impact on quality of life particularly socialisation. Cosmetic camouflage is a valid tool to assist children with scarring to actively participate socially within their communities.
    Burns: journal of the International Society for Burn Injuries 06/2013; 40(1). DOI:10.1016/j.burns.2013.04.025 · 1.88 Impact Factor
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    • "Paediatric medical traumatic stress refers to the psychological and physical responses experienced by children and their families as a result of encountering pain, injury, serious illness and invasive medical procedures [5]. Symptoms of posttraumatic stress disorder (PTSD) are identified in children who experience a traumatic accident such as a burn [6] [7] [8] and limited studies have addressed the psychological impact on parents of a child who sustains a burn. Parents need to help their child cope as an inpatient in hospital and often experience stress as they make complex treatment decisions whilst watching their child in pain, in the frequent context of self recrimination and concern for their child's future. "
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    ABSTRACT: In order to identify parents at risk of developing ongoing psychological distress after their child has sustained a burn a greater understanding of paediatric medical trauma is required. AIM: To investigate the impact of exposure to paediatric trauma on parents of children with a burn and to identify risk factors and relationships between psychological distress and resilience. METHODS: Sixty-three parents were recruited. Parents completed standardised assessments measuring symptoms of posttraumatic stress disorder (PTSD), depression, anxiety, stress, and resilience within one week of the burn occurring. Statistical analysis included t-tests, Kruskal-Wallis one way ANOVA and Spearman's Roe. RESULTS: Parents experienced significantly more symptoms of PTSD (p=0.001) than a comparative community population. Factors including having a daughter, witnessing the event, feeling helpless or having past traumatic experiences significantly influenced symptoms of psychological distress and resilience (p=0.05). CONCLUSION: Parents of burn survivors experience significant psychological distress with low levels of resilience. As part of standard routine care health professionals should screen parents to identify those at greatest risk and provide effective evidence based interventions aimed at improving resilience and reducing stress.
    Burns: journal of the International Society for Burn Injuries 03/2013; 39(6). DOI:10.1016/j.burns.2013.01.009 · 1.88 Impact Factor
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