Posttraumatic Stress Disorder Symptom Structure in Chinese Adolescents Exposed to a Deadly Earthquake

This present study examined the structure of posttraumatic stress disorder (PTSD) symptoms in a large sample of Chinese adolescents exposed to a deadly earthquake. A total of 2,800 middle school students aged 12 to 18 years participated in the study 6 months after the “Wenchuan Earthquake”. Results of confirmatory factor analysis indicated that a five-factor intercorrelated model composed of intrusion, avoidance, numbing, dysphoric arousal, and anxious arousal, fit data significantly better than both the four-factor numbing model King et al. (Psychological Assessment 10:90–96, 1998) and the four-factor dysphoria model Simms et al. (Journal of Abnormal Psychology 111:637–647, 2002). Further examination of the external convergent and discriminant validity revealed that except for the dysphoric arousal factor, the remaining four PTSD factors yielded significantly different correlations with external measures of anxiety vs. depression. The findings add to the limited literature on the factor structure of PTSD in youths and on the five-factor PTSD model. In addition, they provide more detail into the latent psychopathological processes of PTSD, and inform the forthcoming DSM-5.     

Posttraumatic Stress Symptoms of Chinese Rural Children and Adolescents Surviving the 2008 Wenchuan Earthquake Assessed Using CRIES

Posttraumatic stress symptoms in Chinese rural children and adolescents were examined after the May 2008 Wenchuan earthquake. Analysis showed that three factors were identified, namely, avoidance, intrusion, and arousal, resembling those in the studies with Western samples. Gender differences in posttraumatic stress symptoms were not significant. Moderate negative correlation coefficients between posttraumatic stress symptom scores and mental health scores were found, indicating that the more severe the posttraumatic stress symptoms, the worse the person's mental health.     

Behavioral Inhibition and Risk for Posttraumatic Stress Symptoms in Latino Children Exposed to Violence

Latino children in urban contexts marked by poverty are at high risk of being exposed to violence and developing posttraumatic stress disorder (PTSD). Nonetheless, there is great variability in individual responses to violence exposure. This study examines risk for developing re-experiencing, avoidance, and arousal symptoms of PTSD as a function of individual differences in behavioral inhibition and exposure to community violence. Participants were 148 Latino students (M age =11.43 years, SD?=?0.69; 55 % girls) living in an area marked by poverty and crime. Children completed self-report measures of behavioral inhibition and posttraumatic stress symptoms during a baseline assessment. During a follow-up interview 6 months later, children completed self-report measures of exposure to community violence since the baseline assessment and posttraumatic stress symptoms. Structural equation models revealed that behavioral inhibition at baseline was positively associated with PTSD avoidance and arousal symptoms at follow-up, after controlling for symptoms at baseline. Furthermore, behavioral inhibition moderated the association between violence exposure and symptoms such that violence was more strongly associated with the development of PTSD avoidance symptoms as behavioral inhibition increased. Results suggest that individual differences in behavioral inhibition contribute to risk for specific PTSD symptoms and are important for understanding variation in responses to trauma exposure. By examining diathesis-­stress models within a disorder, we may be better able to elucidate the etiology of a disorder and translate this improved understanding into personalized intervention approaches that maximize effectiveness.     

Experiential Avoidance and Rumination in Parents of Children on Cancer Treatment: Relationships with Posttraumatic Stress Symptoms and Symptoms of Depression

We conducted a cross-sectional survey study to investigate whether there is a relationship between experiential avoidance (EA), rumination, post-traumatic stress symptoms (PTSS), and symptoms of depression, in parents of children on cancer treatment. Data from 79 parents (55 mothers) of 79 children with a median of three months since their cancer diagnosis were included in cross-sectional analyses. EA and rumination were positively correlated with PTSS and symptoms of depression. EA and rumination did not provide incremental explained variance in PTSS over and above that explained by symptoms of depression, while controlling for symptoms of anxiety and demographic characteristics. However, EA and rumination provided incremental explained variance in symptoms of depression over and above that explained by PTSS, while controlling for symptoms of anxiety and demographic characteristics. Rumination and EA are important constructs in the understanding of PTSS and symptoms of depression in parents of children on cancer treatment. Future research should delineate the temporal relationships between these constructs.     

Longitudinal Linkages Between Posttraumatic Stress Disorder Symptoms and Violent Behaviors Among Chinese Adolescents Following the Wenchuan Earthquake

This study was conducted to examine the longitudinal relations between posttraumatic stress disorder (PTSD) symptoms and violent behaviors. In this study, 415 adolescent survivors of the Wenchuan earthquake in China (May 12, 2008) were assessed by using self-report questionnaires 1 year (T1), 1.5 years (T2), and 2 years (T3) after the earthquake. The findings suggested that from 1 to 1.5 years after the earthquake, only intrusive symptoms of PTSD were a risk factor for violent behaviors, whereas violent behaviors were a risk factor for all 3 PTSD symptom clusters. Furthermore, 1.5 to 2 years after the earthquake, avoidance symptoms of PTSD were a risk factor for violent behaviors and hyperarousal symptoms of PTSD had no significant relation with violent behaviors.     

Examining the Prospective Relationship between Pre-Disaster Respiratory Sinus Arrhythmia and Post-Disaster Posttraumatic Stress Disorder Symptoms in Children

Previous studies have examined the concurrent relationship between posttraumatic stress disorder (PTSD) and a range of psychophysiological variables, including respiratory sinus arrhythmia (RSA). However, there is a lack of research examining the prospective development of trauma symptomatology, and the directionality of the association between RSA level and PTSD has yet to be determined. The current study is the first prospective study to examine whether RSA level and RSA reactivity are risk factors for PTSD symptoms in children. Assessments were conducted both prior to (Time 1) and following (Time 2) a natural disaster (i.e., Hurricane Katrina). Participants were 36 children who were 3–6 years-old during the Time 1 assessment. Structured diagnostic interviews were used to assess PTSD symptoms at both Time 1 and Time 2. RSA level during a neutral stimulus, RSA reactivity to emotional video stimuli (distress, joy, and trauma videos) and RSA reactivity to memory stimuli (remote happy memory, trauma memory, mother’s recall of the trauma memory) were also collected at both time points. Time 1 RSA level during a neutral stimulus was a significant predictor of Time 2 PTSD symptoms (controlling for age, Time 1 PTSD symptoms, Time 2 neutral RSA level), such that lower RSA during a neutral condition was related to higher PTSD symptoms. Also, Time 1 RSA reactivity in response to memory (but not video) stimuli, in the form of relatively less vagal withdrawal, was a significant predictor of more Time 2 PTSD symptoms (controlling for age, Time 1 PTSD symptoms, Time 2 RSA reactivity). This unique prospective study provides evidence for level of RSA and RSA reactivity as pre-existing clinical markers of stress sensitivity that predict psychopathology following a trauma.     

Posttraumatic Response and Children Exposed to Parental Violence

Summary

In this article some of the literature on children's responses to natural and person-created trauma are discussed. In addition, data relevant to children's posttraumatic response as a result of exposure to interparental violence are presented. Using a factor analytic procedure, the study attempted to examine how the DSM-IV symptom clusters for Posttraumatic Stress Disorder come together for this sample of children. General suggestions are made regarding possible intervention with exposed children experiencing posttraumatic symptoms.     

Posttraumatic Stress Disorder in Children and Adolescents: A Review and Analysis

Only recently has the mental health community recognized the applicability of diagnostic criteria for posttraumatic stress disorder (PTSD) in children and adolescents, including a consideration of specific age-related features. This paper provides a current review of the literature on PTSD pertaining to children and adolescents. Following a discussion of issues on diagnostic criteria and assessment of this affective disorder in this population, there is an overview of the existing literature on prevalence, comorbidity, risk factors, parental and family factors, and issues of gender and age of onset. The remainder of the paper focuses on the range of traumatic stressors in children and adolescents that can result in PTSD, including natural or human disasters, war and violence, chronic or life-threatening medical conditions, community violence and the witnessing of traumatic events, and physical and/or sexual abuse and other forms of interpersonal violence. Throughout the paper, there is an emphasis on the importance of considering developmental factors. Finally, implications of the existing literature for future areas of research are addressed.     

Psychological Treatments for Symptoms of Posttraumatic Stress Disorder in Children,Adolescents, and Young Adults: A Meta-Analysis

Meta-analyses of the treatment of posttraumatic stress disorder (PTSD) in childhood and adolescence are restricted to specific trauma, selected interventions, and methodologically rigorous studies. This large meta-analysis quantifies the effects of psychological treatments for PTSD symptoms in children and adolescents. An extensive literature search yielded a total of 13,040 articles; 135 studies with 150 treatment conditions (N = 9562 participants) met the inclusion criteria (psychological interventions with children and/or adolescents with PTSD symptoms that report quantitative measures of symptom change). The mean effect sizes (ESs) for PTSD symptoms ranged from large to small, depending on the control condition. Cognitive behavioral therapy (CBT) yielded the highest ESs. Age and caretaker involvement were identified as moderators. CBT, especially when conducted in individual treatment with the inclusion of parents, is a highly effective treatment for trauma symptoms. Psychological treatments need to be modified to address younger patients’ specific needs.     

Rorschach Protocols From Children and Adolescents Diagnosed With Posttraumatic Stress Disorder

Rorschach protocols from 35 children and adolescents with posttraumatic stress disorder (PTSD) and 35 with oppositional defiant disorder (ODD) were compared. Both groups revealed significant differences from the normative tables on the same 12 variables: SCZI, DEPI, CDI, X+%, EgoC, Afr, T, EA, P, WSumC, RawSumSS, and WgtSumSS. However, as predicted, 4 of those variables, the Schizophrenic Index (SCZI) and 3 of the criterion tests that comprise it (X+%, RawSumSS, and WgtSumSS) were significantly different between the PTSD and ODD groups, with the PTSD group responding with more extreme scores. These findings contradict Exner's (1993) statement that only people with schizophrenia can be "defined or conceptualized as having both the problems of disordered thinking and inaccurate perception" (p. 356). Children and adolescents with PTSD also display these problems when trauma interrupts the child's naive belief that the world has predictable rules, the people in it are trustworthy and fair, and punishment and pain are consequences of bad behavior. When young victims cannot comprehend or make sense of what has happened to them, life becomes irrational, illogical, and confusing. Exner's SCZI does what it was designed to do: identify individuals with disordered thinking and inaccurate perception. Therefore, SCZI should be renamed the Perception and Thinking Index (PATI) to reflect its function rather than a diagnostic category.     

Posttraumatic Growth, Posttraumatic Stress Symptoms and Mental Health Among Coronary Heart Disease Survivors

The present study aimed to estimate posttraumatic stress symptoms (PTSS) and posttraumatic growth (PTG) among heart disease survivors and examine whether PTG moderates the association between PTSS and mental health. Data from 82 myocardial infarction and acute coronary artery bypass graft survivors (aged 46–82) was obtained at admission to a cardiac rehabilitation unit. Mental status was assessed by the PTSD Inventory, Posttraumatic Growth Inventory (PTGI), Mental Health Inventory and Health Related Quality of Life (HRQOL). 17.1 % of the participants suffered significantly from PTSS and most of the study sample (71.2 %) reported PTG. PTSS were positively associated with PTG and psychological distress and negatively with well-being and HRQOL. PTG moderated the association between PTSS and most mental health outcomes. We conclude that posttraumatic growth may attenuate the negative effect of posttraumatic stress symptoms on mental health.     

The Relationship between Anger Rumination and Aggression in Typically Developing Children and High-Risk Adolescents

This paper examines anger rumination as a risk factor of aggression in typically developing children and high-risk adolescents. Study 1 developed and evaluated the psychometric properties of a self-report measure of children’s anger rumination (Children’s Anger Rumination Scale; CARS) and its association with teacher- and peer-rated overt and relational aggression in school-aged children (n = 254, M age = 10.62). Findings offered support for the reliability and validity of the CARS as well as support for the hypothesis that children who ruminate to anger exhibit elevated levels of overt and relational aggression. Study 2 examined concurrent and prospective relationships between anger rumination and aggression and the moderating effects of trait anger in a sample of male juvenile offenders (n = 119, M age = 16.74). Latent growth curve analyses revealed that the interaction between trait anger and anger rumination predicted initial levels of aggression (i.e., intercept) and changes in aggression over time (i.e., slope). Juvenile offenders who were high in trait anger and ruminated in response to anger exhibited the highest initial levels of aggression. Contrary to our hypothesis, this group did not exhibit greater increases in aggression over time relative to others, but instead they had stably high levels of aggression at each time point. These findings suggest that cognitive-behavioral treatment strategies for aggression may be improved by educating youths about the contributory role of anger rumination in the development of aggression and providing them with adaptive alternatives to coping with feelings of anger.     

The Relationship Between Peer Status and Depressive Symptoms in Children and Adolescents

The purpose of this study was to examine the relationship between specific symptoms of depression and particular styles of peer difficulties. Participants were 1687 students in fourth, sixth, seventh, eighth, ninth, and eleventh grades from a midsized Midwestern city. Based on previous studies, it was hypothesized that rejected and neglected youths would report greater depressive symptomatology than other peers. In addition, aggressive-rejected youth were predicted to report more Interpersonal Problems while submissive-rejected youths were expected to report more Anhedonia. There were no sociometric group differences on global scores of depression as measured by the Children's Depression Inventory; however, the aggressive- and submissive-rejected youths did report specific differences. Aggressive-rejected youths reported more Interpersonal Problems and feelings of Ineffectiveness, while the neglected and submissive-rejected youths reported more Anhedonia. Taken together, such differences provide support for differentiating among types of rejected students and suggest that different interventions may be necessary to address the needs of these youths.     

Psychological Distress and Symptoms of Posttraumatic Stress Disorder in Jewish Adolescents Following a Brief Exposure to Concentration Camps

We investigated the psychological impact of an organized visit to Polish concentration camps on Jewish-American adolescents. Eighty-seven adolescents who participated in a B'nai B'rith memorial visit to concentration camps in Poland completed measures of general psychological adjustment and posttraumatic stress disorder (PTSD) at four time-points: pretest, posttest, 6-month follow-up and 12-month follow-up. Measures included the SCL-90-R, the Mississippi Scale for PTSD, and the Impact of Events Scale (IES) for PTSD. On the SCL-90-R, changes in somatization, interpersonal sensitivity, obsessive-compulsive tendencies, depression, anxiety, and phobic anxiety were observed over time, with peak symptom scores at posttest and 6-month follow-up. Scores on the Mississippi Scale for PTSD and the IES Intrusion subscale also increased at 6-months. Predictors of PTSD symptoms on the Mississippi Scale included previous psychiatric treatment and SCL-90-R symptoms of paranoia, depression, and psychosis. Elevated psychotic symptoms on the SCL-90-R predicted PTSD symptoms on the IES. Jewish adolescents with preexisting symptoms of generalized distress or psychoticism appeared at increased risk for PTSD symptoms following exposure to Holocaust stimuli. This study contributes a prospective, multi-measure assessment of trauma reactions in adolescents.     

The Role of Family and Teacher Support in Post-traumatic Stress Symptoms Among Palestinian Adolescents Exposed to Community Violence

Extensive research has been conducted in recent decades on the mental health consequences of Palestinians’ exposure to military and political violence. Despite the alarming rates of Palestinian youth exposure to community violence (ECV), there is a serious dearth of research on the effects of this pattern of exposure. The current study focused on the development of post-traumatic stress disorder (PTSD) symptoms among Palestinian adolescents as a result of their ECV. The study also examines the ability of perceived support from family and teachers to moderate the relationship between ECV and PTSD symptoms, and the involvement of demographic and socioeconomic variables in explaining this development. A sample of 1930 Palestinian secondary school students, aged 12–19, from the West Bank and East Jerusalem, answered questionnaires. Data analysis used univariate, bivariate, and multivariate methods, including SEM. The prevalence of PTSD symptoms was predicted by past year ECV, family support, teacher support, residential density, parents’ education, age, and gender. SEM analysis validated additional relationship paths between variables. Results are discussed, suggesting future research with theoretical and practical implications.     

Emotional Functioning in Children and Adolescents with Elevated Depressive Symptoms

Difficulties with emotion and its regulation are of central importance to the etiology and course of depression. The current study investigated these constructs in relation to childhood and adolescence by comparing the emotional functioning of 170 9- to 15-year-olds reporting high levels of depressive symptoms (HD) to a matched sample of 170 children and adolescents reporting low levels of depressive symptoms (LD). Compared to LD, HD participants reported significantly greater shame proneness, poorer functioning on emotion regulation competencies (emotional control, self-awareness and situational responsiveness), less healthy emotion regulation strategy use (less reappraisal and greater suppression), and lower levels of guilt proneness. Empathic concern did not differ between the two groups. The findings enhance current knowledge by providing a more comprehensive profile of the emotional difficulties experienced by children and adolescents with elevated depressive symptoms.     

Symptoms of Post-Traumatic Stress Disorder in Bereaved Children and Adolescents: Factor Structure and Correlates

This study investigated the factor structure and correlates of posttraumatic stress-disorder (PTSD) symptoms among children and adolescents confronted with the death of a loved one. Three hundred thirty-two bereaved children and adolescents (aged 8–18; 56.9 % girls) who all received some form of psychosocial support after their loss, completed self-report measures of PTSD, together with measures tapping demographic and loss-related variables, depression, prolonged grief, and functional impairment. Parent-rated indices of impairment were also collected. We first evaluated the fit of six alternative models of the factor structure of PTSD symptoms, using confirmatory factor analyses. Outcomes showed that the 4-factor numbing model from King et al. (Psychological Assessment 10, 90–96, 1998), with distinct factors of reexperiencing, avoidance, emotional numbing, and hyperarousal fit the data best. Of all participants, 51.5 % met DSM-IV criteria for PTSD. PTSD-status and scores on the PTSD factors varied as a function of age and gender, but were unrelated to other demographic and loss-related variables. PTSD-status and scores on the PTSD factors were significantly associated symptom-levels of depression, prolonged grief, and functional impairment. Findings complement prior evidence that the DSM-IV model of the factor structure of PTSD symptoms may not represent the best conceptualization of these symptoms and highlight the importance of addressing PTSD symptoms in children and adolescents seeking help after bereavement.     

Symptoms of PTSD Among Adolescents and Young Adult Survivors Six Years after the 2010 Haiti Earthquake

This study investigates the long-term consequences for adolescents and young adults who experienced the January 12, 2010, earthquake that struck Haiti. It aims to evaluate the consequences of the earthquake in adolescents and young adults six years after the disaster. During May and June 2016, in Port-au-Prince, 723 adolescents and young adults (364 girls and young women) aged 14 to 24 were assessed by means the Impact of Event Scale–Revised (IES-R) in addition to social demographic characteristics. In our sample, 35.82% reported clinically significant symptoms of PTSD, with a higher prevalence for girls and young women. They also had consistently higher scores than boys and young men on every subscale. Participants with working parents had consistently higher scores across all the subscales than participants whose parents did not work. This study showed that, more than six years after the earthquake, more than one third of the participants assessed had severe PTSD symptoms. Our results may prove useful for setting up mental health programs and devising tools appropriate for the youth population in Haiti.     

Understanding Children with War-Zone Traumatic Stress Exposed to the World's Violent Environments

This article discusses the common and unique configurations of stress responses of children to traumatizing experience in the world's warzones like Bosnia-Herzegovina, Croatia, Rwanda, Liberia, Mozambique, El Salvador, the Middle East, and other nations caught up in the throes of declared and undeclared wars. Children are the most vulnerable, and suffer the greatest. The new concepts of warzone traumatic stress (WZTrS) and warzone traumatherapy (WZTrT) are presented to expand the discussion of the treatment of warzone children beyond today's exclusive focus either on intrapsychic factors alone or on material-resource replenishing alone. These terms are an alternative to current approaches to treatment in which a discrete stressor has been identified as the responsible toxic agent that produced the child's symptoms. Most warzone children have experienced a multiplicity of stressors—a virtual matrix of violent war stressors. The WZTrT model recognizes that the mental, social, and cultural needs of traumatized children change over time—from the time they are exposed to raging toxic war stressors to the time when war hostilities end. Thus warzone traumatherapy attempts to address the child's needs on a continuum based upon a time-referenced intervention model. The model presented here acknowledges the child's adaptational strengths, and the multitheoretical employing of psychodynamic, cognitive, and behavioral techniques grounded in cultural/racial sensitivity and indigenous folk medicine as indispensable tools in warzone therapy for children. Additionally, the model takes into account the special features of relevant international policies of the United Nations (UN) and Non-Governmental Organizations (NGOs) geared to assist in the recovery and integration of warzone traumatized children. WZTrT embraces Western models of interventions integratively and flexibly employed with the personal, cultural, social, spiritual, and economic factors existing in the world of the traumatized child. Hopefully, the article will contribute to creating innovative ways of conceptualizing the mental, physical, social, cultural, and economic needs of warzone children in order to advance conceptual, technical, scientific, and practical aspects of child-relevant warzone interventions.