Parent-led stepped care for traumatised children: parental factors that predict treatment completion and response

An evaluation of trauma focused cognitive behavioral therapy for children in Zambia

Trauma-therapy in children and adolescents often involves the inclusion of their parents. A multi-informant approach was used to investigate whether trauma-focused cognitive-behavioral therapy (TF-CBT) changes dysfunctional posttraumatic cognitions (PTCs) in participating parents. This, in turn, may mediate their child's posttraumatic stress symptoms (PTSS) posttreatment. Children and adolescents (6-17 years old) were assigned to either a TF-CBT (n = 57) or a waitlist (n = 56) condition, within a multisite randomized controlled trial conducted in Germany. They were assessed using the Clinician Administered PTSD Scale for Children and Adolescents, version for DSM-IV and they completed the University of California at Los Angeles Post-Traumatic Stress Disorder Reaction Index for Children and Adolescents (UCLA). Their parents completed the UCLA, caregiver report, and the Posttraumatic Cognitions Inventory to rate their dysfunctional PTCs related to their child's trauma. The mediation hypothesis was tested using a multiple mediation model. The change in parental PTCs was stronger in the TF-CBT condition (b = 13.19, 95% confidence interval [CI] [2.89, 23.49]). It mediated the relationship between the group (TF-CBT vs. waitlist) and the caregiver report on the child's PTSS (b = -.08, 95% CI [-.15, -.01]), but not the child's PTSS, assessed using the interview (b = .01, 95% CI [-.14, .17]) and the self-report questionnaire (b = .01, 95% CI [-.08, .10]), posttreatment. TF-CBT helped participating parents to challenge their dysfunctional PTCs related to their child's trauma. The change in parental PTCs only mediated their perception of their child's PTSS but not their child's self-perception or the clinical evaluation of their child's PTSS. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The current preoccupation is with risk prediction in sexual offenders and the associated emphasis on effective models of treatment. However, a few studies have identified noncompliance with treatment and attrition rates as playing an important role in later sexual recidivism. This study—the Challenge Project—reports on attrition rates in a community treatment project for child sexual abusers in Southeast London. The researchers have attempted to identify which variables can predict attendance at and completion of treatment. The findings for the first 78 men in treatment for at least 1 year are that variables associated with psychological difficulties and childhood trauma are consistently more important in predicting treatment completion than offense-related variables. The sexual recidivism rate for the community sample was so low after an average of 3 years at risk that it was not possible to examine its relationship with compliance in treatment.

A randomized controlled trial of a bidirectional cultural adaptation of cognitive behavior therapy for children and adolescents with anxiety disorders

Anxiety disorders that are the most commonly occurring psychiatric disorders in childhood, are associated with a range of social and educational impairments and often continue into adulthood. Cognitive behaviour therapy (CBT) is an effective treatment option for the majority of cases, although up to 35–45% of children do not achieve remission. Recent research suggests that some genetic variants may be associated with a more beneficial response to psychological therapy. Epigenetic mechanisms such as DNA methylation work at the interface between genetic and environmental influences. Furthermore, epigenetic alterations at the serotonin transporter (SERT) promoter region have been associated with environmental influences such as stressful life experiences. In this study, we measured DNA methylation upstream of SERT in 116 children with an anxiety disorder, before and after receiving CBT. Change during treatment in percentage DNA methylation was significantly different in treatment responders vs nonresponders. This effect was driven by one CpG site in particular, at which responders increased in methylation, whereas nonresponders showed a decrease in DNA methylation. This is the first study to demonstrate differences in SERT methylation change in association with response to a purely psychological therapy. These findings confirm that biological changes occur alongside changes in symptomatology following a psychological therapy such as CBT.

The current nonrandomized clinical trial explored changes over time in children with an anxiety disorder during stepped care, manual-based cognitive behaviour therapy (CBT). Clinically anxious children (8-12 years, n = 133) and their parents participated in child focused CBT (10 sessions). If assessments indicated additional treatment was necessary, participants could step up to a second and possibly third treatment phase (each 5 sessions) including more parental involvement. After the first treatment phase 45% of the Intention-To-Treat sample was free of any anxiety disorder; after the second and third phase an additional 17% and 11% respectively. In total, 74% of the children no longer met criteria for any anxiety disorder following treatment. Child and parent reported anxiety and depression symptoms of children improved significantly during all treatment phases, as well as child reported anxiety sensitivity and negative affect. Children participating in more treatment showed significant improvements during additional treatment phases, indicating that late change occurred for the subgroup that had not changed during the first phase. Stepped care offers a standardized, assessment based, yet tailored treatment approach for children with anxiety disorders. A more intensive treatment is offered when initial CBT is insufficient, providing children additional opportunities to reach the desired outcome.

Childhood trauma encompassing abuse, neglect, and household dysfunction is known to have enduring consequences on mental health, increasing susceptibility to depression, anxiety, and PTSD (post-traumatic stress disorder) across the lifespan. Despite the rising focus on mental health in higher education, research on the prevalence and impact of childhood trauma within Indian undergraduate populations remains limited. This study examines the prevalence of childhood trauma and its association with mental health outcomes in undergraduates, framed within a lifespan developmental perspective. We conducted a cross-sectional study involving 410 undergraduate students (74.6% female; mean age = 20.57 years). Participants completed validated instruments: The Childhood Trauma Questionnaire (CTQ), Beck Depression Inventory (BDI-21), PTSD Checklist for DSM-5 (PCL-5), and the Generalized Anxiety Disorder 7-Item Scale (GAD-7). Descriptive statistics, Pearson's correlations, and multiple linear regression analyses were employed to assess the relationships between childhood trauma subtypes and mental health outcomes. Emotional abuse (r = 0.507, p < .01) and physical abuse (r = 0.517, p < .05) demonstrated the strongest associations with depression, anxiety, and PTSD symptoms. Emotional neglect significantly predicted depressive symptoms (β = 0.231, p = .002). Female students reported substantially higher PTSD scores compared to males (p < .05), reflecting gendered differences in trauma responses. Although minimization/denial of trauma showed negative correlations with mental health symptoms, these associations were not statistically significant, suggesting a possible role of avoidance-based coping. This study reveals a robust relationship between childhood trauma and mental health challenges among undergraduates, with emotional abuse, physical abuse, and emotional neglect emerging as key predictors of psychological distress. The findings highlight the urgent need for trauma-informed, gender-sensitive mental health interventions within academic institutions. Early screening and culturally tailored support services could play a pivotal role in mitigating the long-term impacts of adverse childhood experiences during the critical life phase of emerging adulthood.

Background: Different classification models have been proposed to explain the heterogeneity of alcohol-related problems in general populations. Such models suggest quantitatively or qualitatively different symptom endorsement characteristics between subgroups of alcohol drinkers. Objectives: The present study aimed to identify homogenous subgroups of drinkers in a general population sample in addition to examining the relationship between the subgroups and psychopathological symptoms. Method: Data of past-year alcohol users (n = 1,520) were analyzed from the nationally representative sample of the National Survey on Addiction Problems in Hungary 2015. Latent class analysis (LCA) was conducted to identify subgroups of drinkers based on the dichotomous indicator items of the Alcohol Use Disorders Identification Test questionnaire. Multinomial logistic regression and multiple comparisons were performed to explore the relationship between latent classes and socio-demographical variables and psychopathological symptoms. Results: LCA suggested a 3-class model: “Light alcohol drinkers” (71.6%), “Alcohol drinkers with low risk of dependence” (19.3%), and “Alcohol drinkers with severe dependence symptoms” (9.1%). More severe subgroups showed significantly higher level of anxiety, depression, hostility, obsessive-compulsivity, interpersonal sensitivity, and psychiatric or alcohol use disorder-related treatment involvement. Male gender, younger age, lower level of educational achievement, and earlier onset of the first alcoholic drink were associated with membership of more severe subgroups. Conclusions: The present results indicated that severity-based subgroups of drinkers can be discriminated. Approximately 9% of the alcohol users showed severe symptoms of alcohol dependence. The present data also supported the association between more severe forms of alcohol consumption, and internalizing and externalizing characteristics. Although the 2 at-risk classes of alcohol drinkers did not differ in terms of alcohol consumption-related measures, they were distinguished by the level of harmful consequences due to alcohol use, psychopathological symptoms and psychiatric treatment history.

It is known that the negative impact of childhood traumas on the mental health of the individual is significant and leads to the emergence of many psychiatric conditions. The aim of this study was to determine the relationship between childhood trauma, violence tendency, and crime among male prisoners and inmates in prison. The study group consisted of 313 male prisoners who have been convicted of drug crimes, sexual crimes, deliberate manslaughter, and theft crimes in Mersin Anamur T type closed-open prison. Sociodemographic forms prepared by researchers, Childhood Trauma Questionnaire (CTQ), and the Violence Tendency Scale (VTS) were used for measuring variables. It was observed that there is a relationship between childhood traumas and criminal behavior in prisoners and detainees and that criminal behavior is affected by sociodemographic variables. In addition, there is a relationship between childhood traumas and violent tendencies. As the scores of individuals on emotional abuse, physical abuse, physical neglect, sexual abuse, and childhood trauma scales increased, the scores of individuals on VTS increased as well. CTQ predicts 11% of the variance of violence tendency. If psychiatric conditions and violence tendency of individuals with childhood trauma are detected, it will be possible for preventive actions to be taken before these people become prisoners or detainees.

Childhood trauma, depression and negative symptoms are independently associated with impaired quality of life in schizophrenia. Results from the national FACE-SZ cohort

Child and family traumatic stress intervention (CFTSI) reduces parental posttraumatic stress symptoms: A multi-site meta-analysis (MSMA).

Prevalence and types of childhood trauma in first episode psychosis patients. Relation with clinical onset variables

A type of treatment intervention that is widely regarded in terms of treating adolescents with issues of substance use is the therapeutic community (TC). Despite their effectiveness, empirical studies of drug treatment are mostly atheoretical, even though treatment programming is based on theory. In this study, an attempt was made to apply concepts related to a Gottfredson and Hirschi’s General Theory of Crime to predict treatment completion. Using data collected as part of the Drug Abuse Treatment Outcomes Studies Adolescents (DATOS-A), a multisite prospective study of adolescent drug abuse treatment effectiveness, this study examined whether characteristics associated with low self-control predicted treatment completion. The primary finding was that motivation for treatment was significantly related to treatment completion. Although the characteristics associated with low self-control did not predict treatment completion in the hierarchical linear modeling (HLM) models that included the demographics and risk and protective factors, there were several significant bivariate relationships between pretreatment behaviors and the characteristics associated with low self-control. Because of these relationships, it is important that TC practitioners are aware of how these characteristics might interplay with treatment completion and how TC strategies may help the adolescent to overcome them.

IntroductionAlthough a plethora of studies have delineated the relationship between childhood trauma and onset, symptom severity, and course of depression and anxiety disorders, there has been little evidence that childhood trauma may lead to interpersonal problems among adult patients with depression and anxiety disorders. Given the lack of prior research in this area, we aimed to investigate characteristics of interpersonal problems in adult patients who had suffered various types of abuse and neglect in childhood.MethodsA total of 325 outpatients diagnosed with depression and anxiety disorders completed questionnaires on socio-demographic variables, different forms of childhood trauma, and current interpersonal problems. The Childhood Trauma Questionnaire (CTQ) was used to measure five different forms of childhood trauma (emotional abuse, emotional neglect, physical abuse, physical neglect, and sexual abuse) and the short form of the Korean-Inventory of Interpersonal Problems Circumplex Scale (KIIP-SC) was used to assess current interpersonal problems. We dichotomized patients into two groups (abused and non-abused groups) based on CTQ score and investigated the relationship of five different types of childhood trauma and interpersonal problems in adult patients with depression and anxiety disorders using multiple regression analysis.ResultDifferent types of childhood abuse and neglect appeared to have a significant influence on distinct symptom dimensions such as depression, state-trait anxiety, and anxiety sensitivity. In the final regression model, emotional abuse, emotional neglect, and sexual abuse during childhood were significantly associated with general interpersonal distress and several specific areas of interpersonal problems in adulthood. No association was found between childhood physical neglect and current general interpersonal distress.ConclusionChildhood emotional trauma has more influence on interpersonal problems in adult patients with depression and anxiety disorders than childhood physical trauma. A history of childhood physical abuse is related to dominant interpersonal patterns rather than submissive interpersonal patterns in adulthood. These findings provide preliminary evidence that childhood trauma might substantially contribute to interpersonal problems in adulthood.

STUDY BACKGROUND AND OBJECTIVES: The Philippines is one of the 22 countries with high TB burden. DOTS was adopted not only by purely public providers (PP) but also by public-private mix (PPM) facilities. This study aims to identify the patient and facility factors that promote completion of TB treatment in DOTS facilities in an urban setting. The study also explores the difference between the PP and PPM DOTS facilities in terms of case management and treatment outcomes. [Methods] A case control study was done by interviewing 394 patients sampled from TB cohort report between 2003 and 2005 of 14 DOTS facilities in Metro Manila. Statistical analyses used include chi-square test and logistic regression analysis. Being female and aged 30-44 (OR = 7.04; 95% CI 1.12-44.35), unemployed (OR = 2.73; 95% CI 1.18-6.33), being above per capita poverty threshold (OR = 2.03; 95% CI 1.03-3.99), having experienced at least one of the signs and symptoms of TB (OR = 4.64; 95% CI 1.29-16.67), taking the medication at health facility (OR = 3.87; 95% CI 1.48-10.16) and patient's understanding of DOT (OR = 2.67; 95% CI 1.37-5.23) predict TB treatment completion. Public-private mix type of DOTS facility was also significantly associated with completing treatment (chi 2 (1) = 54.76, p = 0.000). Patient factors like middle-aged female compared to female aged more than 60, being above per capita poverty threshold, unemployment and having experienced at least one signs and symptoms of TB and facility factors like providing treatment at the facility and explaining the DOT to patient increase the likelihood of completing treatment. Thus, encouraging patients to take their medication at the facility and helping the patients understand the importance of DOT can increase TB treatment completion. The seemingly better DOTS implementation and treatment outcomes by the PPM must be evaluated further through cost effectiveness and efficiency studies.