Trauma of Forced Displacement in Children as a Result of Russian-Ukrainian War

This study was designed to assess whether the symptoms of posttraumatic stress mediate or moderate the relationship between political stressors and emotional and behavioral disorders in Palestinian children. It was hypothesized that (a) posttraumatic stress and worry mediate the effect of political stressors on behavioral and emotional disorders and (b) the relationship between political stressors and behavioral and emotional disorders should be attenuated for children with low levels of worry and posttraumatic stress and strengthened for children with high levels of worry and posttraumatic stress. The total sample was 1267 school age children of both sexes with a mean age of 11.97 years. Interviews were conducted with children at school. As hypothesized, the results indicated that posttraumatic stress and worry mediated and moderated the relationship between political stressors and emotional and behavioral disorders in children. Cognitive-behavioral therapy may be used to reduce the incidence of posttraumatic stress and decrease self-reported worry, somatic symptoms, general anxiety, and depression among children exposed to political trauma. Cognitive-behavioral treatment that exclusively targets excessive worry can lead to clinical change in the other interacting subsystems at the cognitive, physiological, affective and behavioral levels.

Objective: This study aims to examine the effect of labor comfort on traumatic childbirth perception, post-traumatic stress disorder (PTSD), and breastfeeding after the fourth postpartum week. Methods: This prospective longitudinal study was conducted between June 2019 and February 2020 in Turkey (n = 102). A personal information form and the Childbirth Comfort Questionnaire were administered to pregnant women with cervical dilatation of 5-8 cm in the delivery room. They were also administered the Traumatic Childbirth Perception Scale (TCPS), PTSD Scale, and Breastfeeding Self-Efficacy Scale twice, including 4 weeks and 3 months after childbirth. Additionally, the TCPS and PTSD Scale were reapplied 6 months after childbirth. Results: The prevalence of traumatic childbirth perceptions and PTSD at 4 weeks of the postpartum period was 68.6% and 59.8%, respectively. The multiple linear regression analysis revealed a significant relationship between physical labor comfort (p = 0.003), transcendence (p = 0.023), family history of labor difficulty (p = 0.027), and feelings about birth before labor begins (p = 0.005) and traumatic childbirth perceptions 4 weeks after childbirth. Additionally, there was a significant relationship between physical labor comfort (p = 0.001), psychospiritual labor comfort (p = 0.006), transcendence (p = 0.001), primiparity (p = 0.009), place of residence (p = 0.044), and traumatic childbirth perceptions (p < 0.001) and PTSD 4 weeks after childbirth. Physical labor comfort affected traumatic childbirth perceptions 3 and 6 months after childbirth (p < 0.05). Physical labor comfort affected breastfeeding self-efficacy 4 weeks and 3 months after childbirth (p < 0.05). A significant relationship was also found between high traumatic childbirth perception levels, high PTSD prevalence, and low breastfeeding self-efficacy 3 months after giving birth (p < 0.05). Conclusions: Puerperal women had high traumatic childbirth perception levels and PTSD prevalence. Low labor comfort increased traumatic childbirth perception and PTSD prevalence. There was a significant relationship between low labor comfort, high traumatic childbirth perception level, high PTSD prevalence, and low breastfeeding self-efficacy. Therefore, midwives should support pregnant women to increase labor comfort by using alternative methods. Thus, traumatic childbirth perception may decrease and breastfeeding self-efficacy may increase.

Background: Understanding the course of post-traumatic stress disorder (PTSD) and the factors that impact this is essential to inform decisions about when and for whom screening and intervention are likely to be beneficial. Objective: To provide meta-analytic evidence of the course of recovery from PTSD in the first year following trauma, and the factors that influence that recovery. Method: We conducted a meta-analysis of observational studies of adult PTSD prevalence which included at least two assessments within the first 12 months following trauma exposure, examining prevalence statistics through to 2 years post-trauma. We examined trauma intentionality (intentional or non-intentional), PTSD assessment method (clinician or self-report), sample sex distribution, and age as moderators of PTSD prevalence over time. Results: We identified 78 eligible studies including 16,484 participants. Pooled prevalence statistics indicated that over a quarter of individuals presented with PTSD at 1 month post-trauma, with this proportion reducing by a third between 1 and 3 months. Beyond 3 months, any prevalence changes were detected over longer intervals and were small in magnitude. Intentional trauma, younger age, and female sex were associated with higher PTSD prevalence at 1 month. In addition, higher proportions of females, intentional trauma exposure, and higher baseline PTSD prevalence were each associated with larger reductions in prevalence over time. Conclusions: Recovery from PTSD following acute trauma exposure primarily occurs in the first 3 months post-trauma. Screening measures and intervention approaches offered at 3 months may better target persistent symptoms than those conducted prior to this point. HIGHLIGHTS PTSD rates in the immediate aftermath of trauma exposure decline from 27% at 1 month to 18% at 3 months post-trauma, showing significant spontaneous recovery. Problems appear to stabilize after 3 months. Screening/intervention for PTSD at 3 months post-trauma is indicated.

Posttraumatic Stress Disorder Among Military Returnees From Afghanistan and Iraq

Post-Traumatic Stress Disorder in Patients with Rheumatic Diseases During the COVID-19 Outbreak​

ObjectiveThe COVID-19 pandemic is not only a traumatic event, but a collective stressor unfolding over time, causing devastating implications for the mental health. This study aimed to shed light on...

Introduction: The current study investigated the prevalence and characteristics of behavioural and emotional disorders in children with mild intellectual disability, as well as the predictive potential of personal and socio-demographic factors. Objective: The main objective of this research was to determine the impact of socio-demographic and personal factors on the prevalence and types of emotional and behavioural disorders in children with mild intellectual disability. Methods: Non-experimental research was conducted on 311 children with mild intellectual disability, aged 9-18 years, who attended 8 special primary schools in central and south-west Serbia. For the assessment of psychopathology, we used the Child Behaviour Checklist - Teacher Report Form (CBCL-TRF), a checklist of problem behaviours in children aged 6-18 years. To collect data on socio-demographic status, we created a questionnaire about socio-economic factors and demographic indicators. The informants were classroom teachers. Results: An increased incidence of behavioural and emotional disorders was found in children with mild intellectual disability, compared to children of average intelligence. Both dimensions of psychopathology were significantly influenced by personal and socio-demographic variables, including child's age, gender, academic achievement, placement type, parental educational level and employment, as well as the structure and socio-economic status of the families. Conclusion: Children with intellectual disability are at increased risk of developing psychopathology, mostly within the dimension of adjustment and behavioural disorders. Risk factors include specific developmental and psychological characteristics and social learning difficulties, as well as a number of adverse socio-demographic factors.

Introduction: The current study investigated the prevalence and characteristics of behavioural and emotional disorders in children with mild intellectual disability, as well as the predictive potential of personal and socio-demographic factors. Objective: The main objective of this research was to determine the impact of socio-demographic and personal factors on the prevalence and types of emotional and behavioural disorders in children with mild intellectual disability. Methods: Non-experimental research was conducted on 311 children with mild intellectual disability, aged 9-18 years, who attended 8 special primary schools in central and south-west Serbia. For the assessment of psychopathology, we used the Child Behaviour Checklist - Teacher Report Form (CBCL-TRF), a checklist of problem behaviours in children aged 6-18 years. To collect data on socio-demographic status, we created a questionnaire about socio-economic factors and demographic indicators. The informants were classroom teachers. Results: An increased incidence of behavioural and emotional disorders was found in children with mild intellectual disability, compared to children of average intelligence. Both dimensions of psychopathology were significantly influenced by personal and socio-demographic variables, including child's age, gender, academic achievement, placement type, parental educational level and employment, as well as the structure and socio-economic status of the families. Conclusion: Children with intellectual disability are at increased risk of developing psychopathology, mostly within the dimension of adjustment and behavioural disorders. Risk factors include specific developmental and psychological characteristics and social learning difficulties, as well as a number of adverse socio-demographic factors.

To describe the prevalence and correlates of post-traumatic stress disorder (PTSD), depressive and anxiety disorders, or any other mental disorder among adult victims treated in a hospital at different points in time after the 11 March 2004 terrorist attacks in Madrid. A random sample of 56 individuals injured in the attacks was interviewed in person at one, six, and twelve months after the attacks. Current DSM-IV mental disorders: depressive disorders and anxiety disorders (PTSD, generalised anxiety, agoraphobia, social phobia, and panic disorder) were assessed with the Spanish version of the MINI (Mini International Neuropsychiatric Interview), a structured, lay-administered psychiatric interview. PTSD was the most prevalent psychiatric disorder (35.7% at month 1, 34.1% at month 6, and 28.6% at month 12), followed by major depression (28.6%, 22.7%, and 28.6%, respectively). Others relevant conditions were suicide risk, generalised anxiety disorder (GAD), agoraphobia, and panic disorder. No significant differences in the prevalence of the disorders were found between the different assessment times. Patients with a psychiatric history prior to 11 March had a higher prevalence of PTSD, major depression, GAD, and panic disorder at month 1. Females had higher prevalence of PTSD, agoraphobia, and panic disorder at month 1. The only predictive factor for PTSD at month 12 was PTSD at month 6 (OR = 14.007). The only predictive factor for major depression at month 12 was major depression at month 6 (OR = 15.847). The prevalence of PTSD and major depression was high and remained stable between month 1, month 6, and month 12. The only predictive factor for PTSD at month 12 was PTSD at month 6.

Effects of earthquake and related environmental factors on relationship of posttraumatic stress disorder with LDLR rs5925

Exposure to maltreatment in childhood is associated with lifelong risk of mental and behavioral disorders. Whether the effects extend to the next generation remains unclear. We examined whether maternal exposure to childhood abuse and neglect in her own childhood were associated with mental and behavioral disorders and psychiatric symptoms in her children, and whether maternal lifetime mental and behavioral disorders or lower education level mediated or added to the effects. Mothers (n = 2252) of the Prediction and Prevention of Preeclampsia and Intrauterine Growth Restriction cohort study completed the Childhood Trauma Questionnaire and reported on their education and their 7.0–12.1-year-old children’s psychiatric symptoms using the Strengths and Difficulties Questionnaire. We identified lifetime mental and behavioral disorder diagnoses for the mothers and diagnoses for their children from birth (2006–2010) until 8.4–12.8 years (12/31/2018) from Care Register for Health Care. We found that maternal exposure to childhood abuse, but not neglect, was associated with higher hazards of mental and behavioral disorders (hazard ratio 1.20, 95% confidence interval 1.06–1.37) in children. These associations were partially mediated by maternal mental and behavioral disorders and education (proportion of effect size mediated: 23.8% and 15.1%, respectively), which together with maternal exposure to childhood abuse added to the hazard of mental and behavioral disorders in children. Similar associations were found for maternal exposure to childhood abuse and neglect with psychiatric symptoms in children. To conclude, maternal exposure to childhood maltreatment is associated with mental and behavioral disorders and psychiatric symptoms in children. Our findings call for interventions to prevent intergenerational transmission.

Studies have shown that children and adolescents exposed to natural disasters could be at high risk of mental health problems. Post-traumatic stress disorder (PTSD) is now well established as the most common psychopathological outcome of trauma. Studies have shown that PTSD often co-occurs with depression. The comorbidity of PTSD and depression adversely affects the hospitalization of patients. The high prevalence of PTSD and depression poses challenges for accurate diagnosis and treatment. Therefore, the potential mechanism of the comorbidity of PTSD and depression deserves attention. Researchers have proposed several models of comorbidity, such as the “demoralization model,” which indicates that the initial PTSD symptoms may cause subsequent depression. Conversely, the “depressogenic effect model” suggests that the initial depression may cause the subsequent PTSD. However, the “synchronous change model” posits that PTSD and depression occur at the same time and are independent of each other. Clearly, a consistent conclusion has not been reached. Therefore, the relationship between PTSD and depression should be further explored. Moreover, there are some limitations in previous studies. For example, the majority of these studies have focused on PTSD symptoms as a whole, without distinguishing PTSD symptom clusters (such as re-experiencing, avoidance, and hyperarousal) with depression over time. In addition, the most recent studies focused on adults. Children and adolescents are in the developmental stage of cognitive nervous system and emotional regulation and lack the coping mechanism for adaptation and recovery from a disaster. Therefore, they may be vulnerable to environmental changes and negative life events. In view of this, the comorbidity of PTSD and depression needs to be explored in children. The present study investigates the relationship between depressive symptoms and PTSD and differences between the relationships of PTSD clusters and depression among children who survived the Zhouqu debris flow. PTSD was measured with the University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index for DSM-IV, and depressive symptoms were measured with the Children’s Depression Inventory. Participants were assessed at 3, 15, and 27 months after the Zhouqu debris flow. The sample consisted of 1070 adolescents (aged 13.90±1.33), among which 452 (42%) were male and 618 (58%) were female. A cross-lagged analysis revealed bidirectional associations between PTSD and depressive symptoms from T1 to T2, and only depressive symptoms predicted PTSD significantly from T2 to T3. The relationships between depressive symptoms and three PTSD clusters were also different. From T1 to T3, depressive symptoms predicted three PTSD clusters continuously. However, avoidance had no predictive effect on depression from T1 to T3, re-experiencing predicted depressive symptoms from T1 to T2, and hyperarousal demonstrated a continuous predictive effect on depression from T1 to T3. Our study suggested that the relationship between depressive symptoms and PTSD may change over time and the relationships between the three clusters of PTSD and depression may be different. Psychological therapy should focus on different symptoms based on the trauma stage. Future studies should compare the relationships between depressive symptoms and PTSD across different courses after trauma, trauma types, genders, and age stages.

To examine factors that account for women veterans' higher prevalence of past-year DSM-5 posttraumatic stress disorder (PTSD) compared to women civilians and men veterans. Cross-sectional analyses of the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Face-to-face interviews with 379 women veterans, 20,007 women civilians, and 2740 men veterans were conducted. Trauma type (child abuse, interpersonal violence, combat or war zone, and other), number of trauma types, past-year stressful life events, current social support, and DSM-5 PTSD were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Generalized linear models were used that accounted for the complex survey design. Women veterans had a higher unadjusted prevalence of past-year PTSD (11.40%) compared to their civilian (5.96%) and male (5.19%) counterparts. Individual predictor models indicated that the difference between women veterans' and civilians' prevalence of PTSD was attenuated when adjusting for number of trauma types, whereas the difference between men and women veterans was attenuated when adjusting for child abuse, interpersonal violence, and stressful life events. Nonetheless, while full adjustment in a multiple predictor model accounted for the difference in PTSD between women veterans and civilians, gender differences between men and women veterans remained. Number of trauma types, type of trauma, and social factors may together help explain women veterans' higher PTSD prevalence compared to women civilians, but do not fully account for differences between men and women veterans. Results highlight a need to explore additional explanatory factors and evaluate associations with longitudinal data.

To screen types of behavioral problems among children with hemophilia and their relation to the disease parameters. Fifty boys, 6-18 years old, with moderate and sever hemophilia were subjected to: history taking, joint evaluation using the Hemophilia Joint Health Score, and behavioral assessment using the Child Behavioral Check List. Patients experienced different patterns of behavior disorder. Patients' age significantly correlated with anxious/depressed behavior, somatic complaints, social problems, aggressive behavior, internalizing behavior, and total behavior problems. Hemophilia severity significantly correlated with social problems, thought problems, aggressive behavior, internalizing behavior, externalizing behavior, and total behavior disorders. Affected joint number significantly correlated with withdrawn/depressed behavior, social problems, thought problems, aggressive behavior, internalizing behavior, and total behavior disorders. A high Hemophilia Joint Health Score of the target joints was significantly correlated with social problems, rule-breaking behavior, aggressive behavior, externalizing behavior, and total behavior disorders. Hemophilic arthropathy duration significantly correlated with somatic complaints, social problems, thought problems, attention problems, aggressive behavior, internalizing behavior, externalizing behavior, and total behavior problems. Children with hemophilia had behavioral disorders. The most affected scale was aggressive behavior. The least affected scale was attention problems. Behavioral disorders in children with hemophilia are influenced by the age of the patient, the severity of the disease, the number of joints affected, the duration of hemophilic arthropathy, and the score of joint affected by Hemophilia Joint Health Score.

Evidence-based treatments for posttraumatic stress disorder (PTSD) have not been established for adolescents despite high prevalence of PTSD in this population. To examine the effects of counselor-delivered prolonged exposure therapy compared with supportive counseling for adolescents with PTSD. A single-blind, randomized clinical trial of 61 adolescent girls with PTSD using a permuted block design. Counselors previously naive to prolonged exposure therapy provided the treatments in a community mental health clinic. Data collection lasted from February 2006 through March 2012. Participants received fourteen 60- to 90-minute sessions of prolonged exposure therapy (n = 31) or supportive counseling (n = 30). All outcomes were assessed before treatment, at mid-treatment, and after treatment and at 3-, 6-, and 12-month follow-up. The primary outcome, PTSD symptom severity, was assessed by the Child PTSD Symptom Scale-Interview (range, 0-51; higher scores indicate greater severity). Secondary outcomes were presence or absence of PTSD diagnosis assessed by the DSM-IV Schedule for Affective Disorders and Schizophrenia for School-Age Children and functioning assessed by the Children's Global Assessment Scale (range, 1-100; higher scores indicate better functioning). Additional secondary measures, PTSD severity assessed by the Child PTSD Symptom Scale-Self-Report (range, 0-51; higher scores indicate greater severity) and depression severity assessed by the Children's Depression Inventory (range, 0-54; higher scores indicate greater severity), were also assessed weekly during treatment. Data were analyzed as intent to treat. During treatment, participants receiving prolonged exposure demonstrated greater improvement on the PTSD symptom severity scale (difference between treatments in improvement, 7.5; 95% CI, 2.5-12.5; P < .001) and on all secondary outcomes (loss of PTSD diagnosis: difference, 29.3%, 95% CI, 20.2%-41.2%; P = .01; self-reported PTSD severity: difference, 6.2; 95% CI, 1.2-11.2; P = .02; depression: difference, 4.9; 95% CI, 1.6-8.2; P = .008; global functioning: difference, 10.1; 95% CI, 3.4-16.8; P = .008). These treatment differences were maintained through the 12-month follow-up: for interviewer-assessed PTSD (difference, 6.0; 95% CI, 1.6-10.4; P = .02), loss of PTSD diagnosis (difference, 31.1; 95% CI, 14.7-34.8; P = .01), self-reported PTSD (difference, 9.3; 95% CI, 1.2-16.5; P = .02), depression (difference, 7.2; 95% CI, 1.4-13.0; P = .02), and global functioning (difference, 11.2; 95% CI, 4.5-17.9; P = .01). Adolescents girls with sexual abuse-related PTSD experienced greater benefit from prolonged exposure therapy than from supportive counseling even when delivered by counselors who typically provide supportive counseling. clinicaltrials.gov Identifier: NCT00417300.