Posttraumatic Stress Disorder In Adolescents Research Articles

Results of mental health screening of children who were forced to leave Ukraine in 2022

Background. As a result of Russian aggression, many citizens of Ukraine are forced to migrate to safe countries. Since the beginning of the war, more than 17 million people have left Ukraine. During the war, the population is exposed to a constant stress factor that is not homogeneous. For some people, this is due to being in the war zone, exposure to shelling, and staying in shelters. For others, it is caused by forced migration, separation from family, and difficult adaptation to a new social environment. The most vulnerable category is children and adolescents. Among children and adolescents who are forced to seek refuge in foreign countries, the most common post-traumatic stress disorder (PTSD). Purpose – analysis of the mental state and risk of PTSD in children and adolescents who were forced to leave Ukraine during the war. Materials and Methods. We studied 50 children aged 8 to 17 years (mean age: 11.2±2.4) who had left for European countries after the outbreak of the armed conflict in Ukraine. Results. The median total score of the PTSST was 19 points [QR 15; 23]; 42.0±6.9% of respondents were at high risk of developing post-traumatic stress disorder (PTSST score ≥ 21); 44.0±7.1% of children had an average risk of developing PTSD (PTSST from 10 to 20), 14.0±4.9% had a low level of traumatic childhood stress (PTSST ≤ 10). Thus, 86% of children had significant psychological manifestations that will require specialist consultation and qualified assistance. When analysing the degree of childhood traumatic stress depending on the child’s age, it was found that children aged 7–10 years were significantly more at risk of developing PTSD, which highlights the vulnerability of this period of life. Conclusions. According to the survey, children undergo significant changes in their mental state, even when they travel abroad and stay in safe conditions. Children aged 7 to 10 were the most sensitive to the impact of stress factors and the risk of developing PTSD. The interdependence of parental influence and the state of children’s mental health, which was determined by the educational level of parents, was established.

PTSD in Children and Adolescents in the Educational Context. A Conceptual Approach

This paper explores the multifaceted aspects of Post-Traumatic Stress Disorder (PTSD) in children and adolescents within educational contexts. It investigates the complexity of diagnosing PTSD in this demographic, recognizing the role of cognitive function, expression barriers, and parental influence. Considering the diverse and unique presentations of PTSD symptoms in children, the study highlights the challenges in identifying and treating PTSD among school-age children and adolescents, especially among highly vulnerable populations such as refugees. Through an extensive review of existing literature, the paper compares and contrasts the criteria from DSM-5 and ICD-11 for PTSD diagnosis and evaluates the efficacy of treatment options such as EMDR, CBT, and school-based interventions. The impact of PTSD on academic performance and social integration is emphasized, underlining the implications for educators, mental health professionals, and policy makers. Furthermore, the study calls attention to the co-occurrence of PTSD with other mental health conditions and the significant effects beyond educational achievement, including developmental, social, and cognitive domains. Drawing on current research, it advocates for integrated intervention strategies that promote socio-emotional learning, and underscores the importance of a secure, supportive educational environment.

Depression and posttraumatic stress disorder in adolescents with nonsuicidal self-injury: comparisons of the psychological correlates and suicidal presentations across diagnostic subgroups.

Nonsuicidal self-injury (NSSI) combined with suicide ideation increases the risk of suicidal behaviors. Depression and posttraumatic stress disorder (PTSD) are comorbidities of NSSI compounding this relationship. The present study compared diagnostic subgroups of NSSI based on current depression and PTSD on psychological correlates (i.e., vulnerabilities and impairment) and suicidal presentations (i.e., suicidal cognitions and behaviors) in a psychiatric sample of adolescents. Eighty-seven adolescents meeting DSM-5 criteria for NSSI and 104 age-range-matched nonclinical controls (NC) participated. Participants completed self-report measures on psychological vulnerabilities and impairment (e.g., emotion regulation difficulties, negative cognitions). Adolescents with NSSI also completed clinical interviews on psychiatric diagnoses and a recent self-injurious behavior (SIB). Scores on the psychological correlates of NSSI were compared between adolescents with NSSI and NC, and across three diagnostic subgroups of NSSI (A: NSSI+/depression-/PTSD-, n = 14; B: NSSI+/depression+/PTSD-, n = 57; C: NSSI+/depression+/PTSD+, n = 14). Differences between NSSI diagnostic subgroups were tested on the motives for SIB and accompanying suicidal presentations (e.g., desire, intent, motive, lethality). Common comorbidities of NSSI included depression, panic disorder, generalized anxiety disorder, and PTSD. The NSSI subgroup classification was significantly associated with panic disorder, which was controlled for in the subsequent group comparisons. Overall, adolescents who engage in NSSI with vs. without depression reported more psychological vulnerabilities and impairment and a greater degree of suicidal thoughts/desire in SIB (i.e., groups B, C >A), which remained significant after controlling for panic disorder. An increased odds of the suicidal motive for SIB was found in adolescents with all three conditions (i.e., group C: NSSI+/depression+/PTSD+) compared to those with NSSI but neither depression nor PTSD (i.e., group A: NSSI+/depression-/PTSD-); however, this was not significant after controlling for panic disorder. Psychological underpinnings of adolescent NSSI in clinical contexts may be largely associated with concurrent depression. Suicidal motives in adolescents who engage in NSSI in the presence of depression and PTSD may be confounded by the co-occurrence of panic disorder. This study warrants the importance of attending to the comorbid depression with NSSI in adolescents as it is related to an increase in suicidal desire accompanying SIB.

Traumatic events and posttraumatic stress symptoms in a treatment-seeking sample of Ukrainian children during the war

BackgroundThe Russian invasion of Ukraine resulted in a dramatic increase of children and adolescents being confronted with war and other traumatic experiences, which could result in an increase of trauma-related mental health disorders such as posttraumatic stress disorder (PTSD) in an entire generation. This study aims at reporting the prevalence of traumatic events, PTSD, and Complex PTSD (CPTSD) in children and adolescents seeking for mental health treatment since the Russian invasion. Additionally, the consistency of child and caregiver reported trauma, PTSD and CPTSD will be examined.MethodsThis study is part of the “TF-CBT Ukraine” project in which Ukrainian therapists were trained in assessing their patients via the “Child and Adolescent Trauma Screen” (CATS-2) before initiating trauma-focused treatment, if indicated. Altogether N = 200 Ukrainian children and adolescents (Mage = 12.01, range 4–21; 62.0% female) were included in the study between October 2022 and August 2023. Data were analysed descriptively, via t-tests and bivariate correlations.ResultsThe children and adolescents reported on average four different traumatic events, most frequently war (n = 123; 68.7%), bullying threats (n = 71; 39.7%) and domestic violence (n = 68; 38.0%). Almost 70% (n = 123) of the participants fulfilled the DSM-5 PTSD criteria, 31% (n = 56) fulfilled the ICD-11 PTSD criteria and 21% (n = 38) the ICD-11 CPTSD criteria. Rates of PTSD were even higher in preschool children (95%). The comparisons of self-and caregiver reports on traumatic events and PTSD/CPTSD severity scores indicated moderate to high correlations between the patients and their caregivers (r = 0.710–0.767).ConclusionsThis study shows that Ukrainian children and adolescents starting treatment report a high number of traumatic events and trauma-related symptoms, which could have a long-lasting negative impact on their social-emotional development and quality of life. The implementation of evidence-based trauma-focused interventions for these children is therefore crucial.

Predictors of Post-Traumatic Stress Disorder in Adolescents: Loneliness and Self-Compassion

Predictors of Post-Traumatic Stress Disorder in Adolescents: Loneliness and Self-Compassion

A latent class analysis of dissociative PTSD subtype among Chinese adolescents following the COVID-19 pandemic and lockdown

BackgroundThe COVID-19 pandemic and related policies have amplified the vulnerability of adolescents to the development of posttraumatic stress disorder (PTSD) and dissociation symptoms. This study sought to explore the profile patterns and psychopathological characteristics of co-occurring PTSD and dissociation symptoms in Chinese adolescents. MethodsA total of 57,984 junior and senior high school students in Deyang City, China were recruited between July 13 and July 19, 2020. PTSD and dissociation symptoms, risk factors, and functional impairment variables were assessed using the Global Psychotrauma Screen for Teenagers (GPS-T) instrument. Latent class analysis (LCA) was employed to examine the phenomenology and risk factors of co-occurring PTSD and dissociation symptoms. Analysis of Variance (ANOVA) was utilized to investigate differences in COVID-19 pandemic-related exposure and functional impairment across distinct symptom profiles. ResultsA 4-class model was selected as the optimal solution, comprising subgroups of low symptom, predominant PTSD symptom, predominant dissociation symptom, and PTSD-dissociation symptom. Class membership could be significantly predicted by other stressful experiences, social support, childhood maltreatment and psychiatric histories. The PTSD-dissociation symptom class exhibited the most severe COVID-19 pandemic-related exposure and functional impairment among all classes. LimitationsThe cross-sectional design, Chinese cultural background, online survey method and oversimple measurements were the limitations. ConclusionsOur findings extend existing knowledge about the coexisting patterns of PTSD and dissociation symptoms in adolescents, which could assist in identifying high-risk youths. Furthermore, our findings offer recommendations for shaping public health policies and formulating effective clinical interventions for adolescents following the COVID-19 pandemic and lockdown.

Post-traumatic stress disorder in adolescents during the COVID-19 pandemic: a cross-sectional Tunisian study

ObjectivesEvaluate the prevalence of post-traumatic stress disorder (PTSD) on Tunisian adolescents enrolled in secondary schools during the COVID-19 pandemic and to identify associated factors.MethodsWe conducted a cross-sectional, descriptive, and analytic study on a sample of Tunisian adolescents. Participants were randomly selected from two schools in the region of Hamma (southern of Tunisia). This survey took place during the period extending from 5 March to 26 May 2021. Students were asked to complete a pre-established information sheet which contains questions about socio-demographic features, medical history, knowledge about the pandemic of COVID-19, and personal or family history of being infected with this virus. The Child PTSD Symptom Scale (CPSS) was used to screen for PTSD among students.ResultsThe sample was composed of 326 students (92 boys and 234 girls; mean age 16.65 years). The prevalence of PTSD was 37.4% according to the CPSS. Adolescents had more PTSD symptoms when they lived in a conflictual family atmosphere (AOR = 3.1 [1.4–6.9]). Moreover, adolescents who were infected by the virus, or whose relatives were contaminated or dead because of the COVID-19 infection, were more likely to develop PTSD symptoms. We stated that students who estimated that their knowledge about the COVID-19 pandemic were insufficient had a significant  higher risk for PTSD (AOR = 2.5 [1.4–4.6]).ConclusionStudents seemed to have high frequency of PTSD symptoms during the COVID-19 pandemic. The identification of risk and protective factors are interesting to guide screening and prevention actions.Key points• Adolescents were vulnerable to psychological distress during COVID-19 pandemic, they were more exposed to develop post-traumatic stress disorder.• A total of 37.4% was the prevalence of PTSD among Tunisian adolescents. Sufficient information about the pandemic was protective. Conflictual family atmosphere constitutes a risk factor.• Family and social efforts should be directed toward supporting teenagers to cope with the pandemics’ mental health burden.

Polytraumatization, defense mechanisms, PTSD and complex PTSD in Indian adolescents: a mediation model

BackgroundAdolescence is recognized as a particularly susceptible developmental period for experiencing multiple types of Adverse Childhood Experiences (ACE), increasing the vulnerability to higher levels of Post-Traumatic Stress Disorder (PTSD) and Complex PTSD symptoms. Some studies found that defense mechanisms play an important role on the association between ACE and psychological symptoms.MethodsWe analyzed the associations between direct and indirect exposure to ACE and PTSD and Complex PTSD (affective dysregulation, negative self-concept and disturbances in relationships) through the mediation role of mature defense mechanisms: mature, neurotic, and immature defense mechanisms in Indian adolescents. A sample of 411 Indian adolescents (M = 14.2 years old; S.D. = 0.5) completed validated self-report questionnaires. Serial multiple mediation models were tested by conducting a structural equation modelling employing Preacher and Hayes’ procedures (2008).ResultsImmature and neurotic defense mechanisms mediated the association between direct exposure to ACE with PTSD symptoms. Immature defense mechanisms were mediators of the relationship between direct exposure to ACE and Complex PTSD symptoms clusters.ConclusionsMaladaptive defense mechanisms can disturb the process of self-regulation and emotion regulation capabilities in coping with traumatic experiences, leading to higher PTSD and Complex PTSD symptoms severity.

Neuroimaging in Adolescents: Post-Traumatic Stress Disorder and Risk for Substance Use Disorders.

Trauma in childhood and adolescence has long-term negative consequences in brain development and behavior and increases the risk for psychiatric disorders. Among them, post-traumatic stress disorder (PTSD) during adolescence illustrates the connection between trauma and substance misuse, as adolescents may utilize substances to cope with PTSD. Drug misuse may in turn lead to neuroadaptations in learning processes that facilitate the consolidation of traumatic memories that perpetuate PTSD. This reflects, apart from common genetic and epigenetic modifications, overlapping neurocircuitry engagement triggered by stress and drug misuse that includes structural and functional changes in limbic brain regions and the salience, default-mode, and frontoparietal networks. Effective strategies to prevent PTSD are needed to limit the negative consequences associated with the later development of a substance use disorder (SUD). In this review, we will examine the link between PTSD and SUDs, along with the resulting effects on memory, focusing on the connection between the development of an SUD in individuals who struggled with PTSD in adolescence. Neuroimaging has emerged as a powerful tool to provide insight into the brain mechanisms underlying the connection of PTSD in adolescence and the development of SUDs.

Effect of Audio-Visual-Based Art and Music Therapy in Reducing Adolescents Post Traumatic Stress Disorder

PurposePost-traumatic stress disorder (PTSD) is a severe anxiety disorder that can develop due to exposure to any event that may result in psychological trauma. This study compared the effect of interactive audio-visual-based art and music therapy in reducing post-traumatic stress disorder in adolescents who survived abduction in Nigeria. MethodsA quasiexperiment was carried out in two selected secondary schools in Northern Nigeria. The study sample comprised 470 students randomly divided into a control group of 235 and an experiment group of 235. The treatment group was further divided into art 118 and music 117 therapy groups, respectively. ResultsResults suggest that interactive audio-visual art therapy and music therapy is an effective intervention strategy for reducing the PTSD of school adolescents that have experienced kidnapping in Nigeria. However, art therapy is more effective in reducing PTSD than music therapy. DiscussionWe recommend the introduction of audio-visual-based music and art therapy to reduce the PTSD of adolescents that survived kidnapping in Nigeria. More focus should be made on art therapy, which is more effective in curtailing adolescents PTSD.

MDMA-assisted psychotherapy for PTSD in adolescents: rationale, potential, risks, and considerations.

3,4-Methylenedioxymetamphetamine(MDMA)-assisted psychotherapy (MDMA-AP) is a proposed treatment for posttraumatic stress disorder (PTSD) that may be approved for adults soon. PTSD is also common among trauma-exposed adolescents, and current treatments leave much room for improvement. We present a rationale for considering MDMA-AP for treating PTSD among adolescents. Evidence suggests that as an adjunct to therapy, MDMA may reduce avoidance and enable trauma processing, strengthen therapeutic alliance, enhance extinction learning and trauma-related reappraisal, and hold potential beyond PTSD symptoms. Drawing on existing trauma-focused treatments, we suggest possible adaptations to MDMA-AP for use with adolescents, focusing on (1) reinforcing motivation, (2) the development of a strong therapeutic alliance, (3) additional emotion and behavior management techniques, (4) more directive exposure-based methods during MDMA sessions, (5) more support for concomitant challenges and integrating treatment benefits, and (6) involving family in treatment. We then discuss potential risks particular to adolescents, including physical and psychological side effects, toxicity, misuse potential, and ethical issues. We argue that MDMA-AP holds potential for adolescents suffering from PTSD. Instead of off-label use or extrapolating from adult studies, clinical trials should be carried out to determine whether MDMA-AP is safe and effective for PTSD among adolescents.

Treatment of multiple traumatized adolescents by enhancing regulation skills and reducing trauma related symptoms: rationale, study design, and methods of randomized controlled trial (the Mars-study)

BackgroundThere is ongoing debate regarding the treatment of severe and multiple traumatized children and adolescents with post-traumatic stress disorder (PTSD). Many clinicians favor a phase-based treatment approach (i.e., a stabilization phase prior to trauma-focused therapy) over immediate trauma-focused psychological treatment, despite the lack of scientific evidence. Research on the effects of different treatment approaches is needed for children and adolescents with (symptoms of complex) PTSD resulting from repeated sexual and/or physical abuse during childhood.ObjectiveThis paper describes the rationale, study design, and methods of the MARS-study, a two-arm randomized controlled trial (RCT) that aims to compare the results of phase-based treatment with those of immediate trauma-focused treatment and determine whether immediate trauma-focused treatment is not worse than phase-based treatment in reducing PTSD symptoms.MethodsParticipants are individuals between 12 and 18 years who meet the diagnostic criteria for PTSD due to repeated sexual abuse, physical abuse, or domestic violence during childhood. Participants will be blindly allocated to either the phase-based or immediate trauma-focused treatment condition. In the phase-based treatment condition, participants receive 12 sessions of the Dutch version of Skill Training in Affective and Interpersonal Regulation (STAIR-A), followed by 12 sessions of EMDR therapy. In the immediate trauma-focused condition, the participants receive 12 sessions of EMDR therapy. The two groups are compared for several outcome variables before treatment, mid-treatment (only in the phase-based treatment condition), after 12 trauma-focused treatment sessions (post-treatment), and six months post-treatment (follow-up). The main parameter is the presence and severity of PTSD symptoms (Clinician-Administered PTSD Scale for Children and Adolescents, CAPS-CA). The secondary outcome variables are the severity of complex PTSD symptoms (Interpersonal Problems as measured by the Experiences in Close Relationship-Revised, ECR-RC; Emotion Regulation as measured by the Difficulties in Emotion Regulation Scale, DERS; Self Esteem as measured by the Rosenberg Self Esteem Scale, RSES), changes in anxiety and mood symptoms (Revised Anxiety and Depression Scale; RCADS), changes in posttraumatic cognitions (Child Posttraumatic Cognitions Inventory, CPTCI), changes in general psychopathology symptoms (Child Behavior Checklist, CBCL), and Quality of Life (Youth Outcome Questionnaire, Y-OQ-30). Furthermore, parental stress (Opvoedingsvragenlijst, OBVL) and patient-therapist relationship (Feedback Informed Treatment, FIT) will be measured, whereas PTSD symptoms will be monitored in each session during both treatment conditions (Children’s Revised Impact of Event Scale, CRIES-13).DiscussionTreating (symptoms of complex) PTSD in children and adolescents with a history of repeated sexual and/or physical abuse during childhood is of great importance. However, there is a lack of consensus among trauma experts regarding the optimal treatment approach. The results of the current study may have important implications for selecting effective treatment options for clinicians working with children and adolescents who experience the effects of exposure to multiple interpersonal traumatic events during childhood.Trial registrationsThe study was registered on the “National Trial Register (NTR)” with the number NTR7024. This registry was obtained from the International Clinical Trial Registry Platform (ICTRP) and can be accessed through the ICTRP Search Portal (https://trialsearch.who.int/).

Perceived parental depression and PTSD in adolescents: mediating roles of attachment insecurity and coping style

ABSTRACT Background: Earthquakes can cause negative psychological states in adolescents and their parents, such as post-traumatic stress disorder (PTSD) and depression. Previous cross-sectional studies have shown that adolescents who perceive parental depression after an earthquake are more likely to experience PTSD. However, the mechanism underlying this process remains unclear and previous studies have not examined the association between these factors. Objective: The current study explored the mediating roles of attachment insecurity and coping style in the association between perceived parental depression and PTSD in adolescents after the Jiuzhaigou earthquake. Method: In total, 391 participants completed follow-up questionnaires at 12, 21, and 27 months (T1–T3, respectively) after the Jiuzhaigou earthquake. Results: T1 perceived parental depression was not a direct predictor of T3 PTSD in adolescents. In the full mediation model, T1 perceived parental depression predicted T3 PTSD in adolescents indirectly via T2 attachment insecurities through T2 emotion-focused coping. Conclusion: The findings highlight that attachment insecurity and emotion-focused coping mediated the relationship between perceived parental depression and PTSD in adolescents following an earthquake. To alleviate PTSD in adolescents, efforts should be directed toward reducing perceived parental depressive symptoms and emotion-focused coping, and promoting the formation of secure attachment styles.

The longitudinal associations between PTSD symptoms, depressive symptoms, and academic burnout in adolescence and early adulthood in the postdisaster context

The current study examined the longitudinal associations among posttraumatic stress disorder (PTSD) symptoms, depressive symptoms, and academic burnout in a sample of survivors aged 12 to 20 years following the Wenchuan earthquake. The present study had a longitudinal design. A total of 788 participants (Mage = 15.03 years, SD = 1.64; 54.8 % female) completed measures of PTSD symptoms, depressive symptoms, and academic burnout at 12, 18, and 24 months after the 2008 Wenchuan earthquake in China. The results showed that the only cross-lagged effects from PTSD to depressive symptoms, from academic burnout to depressive symptoms or from PTSD symptoms to academic burnout at the first interval and the second interval were significant. Furthermore, the longitudinal associations among PTSD symptoms, depressive symptoms, and academic burnout remained consistent between the different age groups but varied across genders. That is, in male adolescents, only the cross-lagged effects from PTSD symptoms to depressive symptoms and from PTSD symptoms to academic burnout at the first and second intervals were significant. In female adolescents, only the cross-lagged effects from academic burnout to depressive symptoms and from academic burnout to PTSD symptoms at the first and second intervals were significant. Finally, these findings highlight that academic burnout is a useful target for psychological service providers to alleviate PTSD and depressive symptoms in adolescents in a post-disaster context. In addition, PTSD symptoms may also negatively affect adolescents' performance at school.

Bullying Victimization and Comorbid Patterns of PTSD and Depressive Symptoms in Adolescents: Random Intercept Latent Transition Analysis.

Many studies have examined post-traumatic stress disorder (PTSD) or depressive symptoms in adolescents under the background of school bullying, but not their comorbidities and changes over time. This study used random intercept latent transition analysis (RI-LTA) to examine the transitions in comorbid patterns of PTSD and depressive symptoms among 815 adolescents (45.0% boys; Mage-baseline = 13.69, SD = 1.60), who reported their symptoms in a 3-year longitudinal study. Three comorbid patterns were found: low symptoms, predominantly PTSD symptoms, and symptoms of comorbidity. Among these patterns, five trends were found through 3 years: stable low symptoms, stable PTSD symptoms, improving symptoms, worsening symptoms, and an inverted-U pattern. Age, time that parents spend with their child, being an only child, family income and experiencing relational bullying were predictors of these transitions. These suggest that patterns of PTSD and depressive symptoms are heterogeneous and may change over time since trauma events. Developing targeted interventions based on underlying factors through distinct patterns and transitions may help us better optimize and utilize intervention resources to alleviate symptoms from bullying victims.

Complex posttraumatic stress disorder in adolescence: A two-year follow-up study.

Complex posttraumatic stress disorder is a new diagnosis in the 11th edition of the International Classification of Diseases (ICD-11). There is a need for a better understanding of complex PTSD in children and adolescents. The study aimed to estimate the factors associated with chronic complex PTSD versus recovery of complex PTSD in adolescents in a 2-year follow-up study. In total, 66 adolescents, mean age 14.5, 73% female, identified as having complex PTSD using self-report at baseline recruited from a general population sample, were included in the study. The International Trauma Questionnaire - Child and Adolescent Version (ITQ-CA) was used for the assessment of complex PTSD. Overall, 36% of the study sample has been identified as having chronic complex PTSD over 2years, 10% met the criteria for PTSD at a 2-year follow-up, and 54% recovered. A higher risk for chronic complex PTSD was associated with exposure to more traumatic events and more life-stressors over the 2years, low social network, low positive social support, bullying at school, and loneliness. The study found that around one-third of the traumatized youth had a prolonged trajectory of complex PTSD symptoms, which were associated with negative life experiences and social difficulties.

Effect of therapeutic competence, adherence, and alliance on treatment outcome in youth with PTSD treated with developmentally adapted cognitive processing therapy

BackgroundDevelopmentally adapted cognitive processing therapy (D-CPT) is an effective treatment for posttraumatic stress disorder (PTSD) in adolescents and young adults. It is unclear if therapeutic adherence and competence in D-CPT are associated with higher PTSD treatment gains. ObjectiveTo assess if higher therapeutic adherence and competence in D-CPT are associated with higher symptom reduction of PTSD in adolescents and young adults, while controlling for therapeutic alliance. Participants and settingParticipants were 38 patients (aged 14–21 years; M = 17.61 years, SD = 2.42 years) of a multicenter randomized controlled trial in which the efficacy of D-CPT was compared to a waitlist with treatment advice. MethodsVideotaped therapy sessions were rated using validated ratings scales to assess adherence and competence. Therapeutic alliance was assessed via weekly patient ratings. We used hierarchical linear modelling to assess the relationship of adherence and competence on PTSD symptoms being measured by both clinician and patient while controlling for alliance. ResultsNeither adherence nor competence were related to treatment outcomes in clinician or patient rated PTSD symptom severity. Higher alliance was associated with a lower symptom severity at 12 months posttreatment in both clinician and patient rated PTSD symptoms. ConclusionsIn this study of young adults with PTSD, who were treated with D-CPT by well-trained therapists, therapeutic adherence and competence were not related to treatment outcome. This might be explained by a lack of range in therapist adherence and competence. Therapeutic alliance had a positive effect on PTSD symptom severity.

Attenuated psychotic symptoms, substance use and self-reported PTSD in adolescence

ABSTRACT Background: The occurrence of attenuated psychotic symptoms (APS) is a major concern in populations with substance use disorders (SUDs). However, APS also frequently develop in the course of Post-Traumatic Stress Disorder (PTSD). This study explores how the prevalence of APS differs between adolescent patients with only SUD, SUD with a history of traumatic experiences (TEs), and with SUD and self-reported PTSD. Methods: We recruited n = 120 treatment-seeking adolescents at a German outpatient clinic for adolescents with SUD. All participants filled out questionnaires assessing APS (PQ-16, YSR schizoid scale), trauma history, PTSD symptoms (both UCLA PTSD Index), and SUD severity (DUDIT) next to an extensive substance use interview. We performed a multivariate analysis of co-variance with the four PQ-16 scales and the YSR scale as outcomes and PTSD status as predictor. Additionally, we performed five linear regressions predicting each PQ-16 score and YSR score based on tobacco, alcohol, cannabis, ecstasy, amphetamine, and methamphetamine use. Results: Participants with co-occurring SUD and self-reported PTSD showed significantly higher APS prevalence rates (PQ-16 score, p = .00002), more disturbed thought content (p = .000004), more perceptual disturbances (p = .002), more negative symptoms (p = .004) and more thought problems (p = .001) compared to adolescents with SUD and a history of trauma and adolescents with only SUD. Past-year substance use was not predictive for APS prevalence (F(75) = 0.42; p = .86; R 2  = .04). Conclusion: Our data suggests that the occurrence of APS in adolescents with SUD is better explained by co-occurring self-reported PTSD than by substance use frequency or substance class. This finding might indicate that APS might be reduced through treating PTSD or focusing on TEs in SUD therapy.

Resilience as Mediator in Relation to Parental Attachment and Posttraumatic Stress Disorder in Adolescents Following the Yancheng Tornado.

Resilience and secure parental attachment have been proven as important factors to alleviate the posttraumatic stress disorder (PTSD). However, the effects of the two factors on PTSD and the mechanisms of its effect at different time points in the aftermath of trauma are still unclear. This study explores the relationship among parental attachment, resilience, and development of PTSD symptoms in adolescents from a longitudinal perspective following the Yancheng Tornado. Using cluster sampling method, a total of 351 Chinese adolescents, survivors of a severe tornado, were tested on their PTSD, parental attachment and resilience at 12-months and 18-months after experiencing the natural disaster. The results showed that our proposed model fit the data well: χ2/df = 3.197, CFI = 0.967, TLI = 0.950, RMSEA = 0.079. It revealed that the resilience at 18-months partially mediated the relationship between parental attachment at 12-months and PTSD at 18-months. Research results showed that parental attachment and resilience are key resources for coping with trauma.

Adolescent Post-traumatic Stress Disorder as a Mediator Between Childhood Negative Life Event Types and Depression

The aim of the current research was to understand how subtypes of childhood negative life events (NLEs) contribute to adolescent post-traumatic stress disorder (PTSD) symptoms and depression, as well as the mediating effects of PTSD symptoms in the relationship of stress of NLEs and depression. The sample included 447 Chinese young people from 12 to 24. The participants were asked to report subtypes of their experienced childhood NLEs as well as past and current stress intensity of the NLEs. Then their current PTSD and depression symptoms were measured. Results found that among the past stress of NLEs, such as family violence or abuse had a significant impact on depression symptoms. Among the current stress of NLEs, such as death of family member or friend and serious illness or injuries had significant impacts on depression. Moreover, PTSD symptoms had partial mediating effect in the relationship between the past stress of NLEs and adolescent depression, and full mediating effect in the relationship between the current stress of NLEs and adolescent depression. These results suggested that the impacts of childhood NLEs on adolescent PTSD and depression are multi-dimentional. Future intervention of adolescent PTSD and depression should take the expousre experieces of specific types of NLEs into consideration.