Posttraumatic Stress Symptoms In Adolescents Research Articles

Emotional Dysregulation and Post-Traumatic Stress Symptoms: Which Interaction in Adolescents and Young Adults? A Systematic Review.

Emotional dysregulation (ED) has recently been conceptualized as a transnosographic entity in major mental disorders, and increasing evidence has suggested association between ED and post-traumatic stress symptoms (PTSS), though the nature of this association is unclear. The aim of the present review was to examine the possible interplay between ED and trauma exposure in the literature, as well as a possible role for the comorbidity of PTSD or PTSS in adolescents and young adults. In particular, we explored whether ED may represent a risk factor for PTSD or, conversely, a consequence of traumatic exposure. This systematic review was conducted according to PRISMA 2020 guidelines in three databases (PubMed, Scopus, and Embase). The 34 studies included showed a wide heterogeneity in terms of the populations selected and outcomes examined. Most studies used the Difficulties in Emotion Regulation Scale (DERS) and examined the relationship between ED, trauma, and psychopathological manifestations after the occurrence of trauma, with a focus on child abuse. Although current data in the literature are heterogeneous and inconclusive, this research highlights the role of ED as a mechanism that may mediate vulnerability to PTSD, but also as a predictor of severity and maintenance of typical, atypical, or associated PTSD symptoms, suggesting prevention programs for PTSD and other mental disorders should support the development of emotion regulation strategies.

Posttraumatic stress symptoms in adolescents and young adults with a chronic somatic disease: a mixed-methods study

BackgroundAdolescents and young adults (AYA) with a chronic somatic disease (CD) have a 3-fold higher risk of post-traumatic stress disorder (PTSD) than healthy controls. In addition, elevated post-traumatic stress symptoms (PTSS) have a negative impact on CD severity, treatment adherence, health problems and functional impairment. However, a more detailed understanding of this comorbidity is lacking.MethodsAYA with type 1 diabetes mellitus, juvenile idiopathic arthritis or cystic fibrosis (12–21 years of age) and elevated anxiety and/or depression symptoms, as well as their reference persons (≥ 18 years of age), completed online questionnaires in self- or observer report. The most stressful event related to the CD was reported descriptively. Questionnaires were used to assess PTSS, anxious and depressive symptoms, actual overall health, coping, personal growth and social support. Qualitative content analysis, linear regression models and correlations were used for mixed methods analysis.ResultsAccording to the reports of n = 235 AYA (mean age 15.61; 73% girls) and n = 70 reference persons, four categories were identified as the most stressful events due to CD: (1) psychological burden (40% of AYA / 50% of reference persons); (2) CD self-management (32% / 43%); (3) social burden (30% / 27%); and (4) physical impairment (23% / 16%). 37% of AYA reported clinically relevant PTSS due to CD. The best predictors of PTSS severity were anxious-depressive symptoms, emotional coping, personal growth and current overall health (F(4, 224) = 59.404, R² = 0.515, p < .001). Of all categories, psychological (β = 0.216, p = .002) and social burden (β = 0.143, p = .031) showed significant association with the severity of PTSS (F(4, 230) = 4.489, R² = 0.072, p = .002). The more categories the most stressful event addressed, the higher was the PTSS symptom severity (r = .168, p = .010).ConclusionsMany AYA showed clinically relevant PTSS and reported experiencing stressful events in several areas of life through their CD. The association between the stressful event categories and other variables could help identify AYA with CD who need psychological interventions the most.Trial registration: German Clinical Trials Register (DRKS): DRKS00016714, registered on 25/03/2019 and DRKS00017161, registered on 17/09/201.

School bullying victimization and post-traumatic stress symptoms in adolescents: the mediating roles of feelings of insecurity and self-disclosure

BackgroundPosttraumatic stress symptoms (PTSSs) is known to be a typical problem for school bullying victims. However, the underlying mechanism between school bullying victimization and PTSSs remains unknown. This study examined the mediating roles of feelings of insecurity and self-disclosure in the relationship between school bullying victimization and PTSSs in adolescents.MethodsSelf-report questionnaires were used to assess 5013 adolescents; 443 of them with school bullying experiences were selected to carry out this study.ResultsThe results found that school bullying victimization was directly related to more PTSSs, indirectly associated with more PTSSs through feelings of insecurity, and through the path from feelings of insecurity to self-disclosure. However, school bullying victimization did not exert an indirect effect on PTSSs through one step effect of self-disclosure.ConclusionsThese findings indicated that feelings of insecurity and self-disclosure mediated the relationship between school bullying victimization and PTSSs. The psychological service should reduce adolescents’ feelings of insecurity and give them more chances to disclose their bullying experiences.

Individual and Social Risk and Protective Factors as Predictors of Trajectories of Post-traumatic Stress Symptoms in Adolescents.

The present study elucidates heterogeneity in post-traumatic stress symptoms (PTSS) across adolescence in a sample of youth who have experienced myriad types and combinations of potentially traumatic events (PTEs), including substantiated physical abuse, sexual abuse, neglect and/or at least one other self-reported PTE. A machine learning technique was used to assess a multivariate set of variables (e.g., PTEs, individual risk and protective factors, social risk and protective factors, and racial and ethnic minority status) as predictors of PTSS trajectory group membership. The sample included 498 maltreated (n = 275) and comparison (n = 223) 14-19-year-old female adolescents (M = 15.27, SD = 1.06 at Time 1) assessed annually until age 19. 45.7% of participants were White, 45.3% Black, 0.4% Native American, 0.8% Hispanic, and 7.7% other. Growth mixture modeling identified three distinct trajectories of PTSS: (1) recovery (56%); (2) moderate, chronic (25%); and (3) high, chronic (19%). An elastic net model was used to test predictors of membership in the recovery versus the high, chronic PTSS trajectory groups. Results demonstrated that the recovery trajectory was characterized by the absence of sexual abuse, physical abuse, and other traumas, higher self-esteem, less affective dysregulation, less risky peers, lower levels of parent depression, and being of racial/ethnic minority status. Findings help to characterize individual variation in trajectories of PTSS following PTEs by underscoring the unique trauma responses of racial and ethnic minority youth and offering possible targets of interventions to promote recovery from PTSS.

Development and pilot testing of a five item traumatic stress screener for use with adolescents in pediatric primary care

BackgroundAlmost 80% of adolescents in the US have experienced a traumatic event, and approximately 7% have post-traumatic stress disorder. However, there is a lack of validated and feasible assessments for assessing traumatic stress symptoms in pediatric primary care, and traumatic stress symptoms are routinely unidentified. This study aimed to develop, pilot test, and assess the psychometric properties of the Adolescent Primary Care Traumatic Stress Screen (APCTSS), a five-item yes/no screener for post-traumatic stress symptoms in adolescents designed for use in pediatric primary care.MethodsThe APCTSS was developed by pediatricians, psychiatrists, psychologists, and social workers who all provide care to trauma-affected adolescent patients. The providers sought to create a developmentally appropriate tool that accurately reflected DSM-5 posttraumatic stress symptoms and that was feasible and acceptable for use in pediatric primary care. To develop the APCTSS, they combined and adapted the UCLA Post-traumatic Stress Disorder (PTSD) Reaction Index for DSM-5 with the adult Primary Care PTSD Screen for DSM-5. Next, 213 adolescent medicine patients were universally approached during routine clinic visits and 178 agreed to participate and were enrolled. The 178 patients were aged 13-22 (M=18.4, SD=2.3), 64.4% female; 62.1% Black or African-American, and 20.7% Hispanic/Latinx. Patients completed APCTSS, Patient Health Questionnaire for Adolescents (PHQ-A), and the Child PTSD Symptom Scale for DSM-5 Interview (CPSS-5-I), and 61 completed the Traumatic Events Screening Inventory for Children (TESI-C).Results56.7% reported a criterion A trauma, 30.1% met criteria for DSM-5 PTSD, 7.4% met criteria for subsyndromal PTSD symptoms, and 19.0% for post-event impairing symptoms. Validity and reliability testing indicated that the APCTSS was internally consistent, had good concurrent and discriminant validity, and demonstrated good sensitivity and specificity in identifying adolescents at high risk for post-trauma symptoms. Over half of patients (56.0%) who screened positive on the APCTSS (score ≥2) would not have been identified as having a mental health concern using the PHQ-A, including 60.8% of patients who had probable PTSD, subsyndromal PTSD, or post-event impairing symptoms.ConclusionsMany youth with trauma-related mental health symptoms are unidentified in pediatric primary care, which is a missed opportunity for early identification and may contribute to a host of poor outcomes. The development of an effective and feasible traumatic stress screening tool for youth primary care may improve early intervention, and the health and well-being of trauma affected youth.

Childhood trauma and posttraumatic stress symptoms in adolescents and young adults: The mediating role of mentalizing and emotion regulation strategies

ObjectivesChildhood trauma (physical, emotional, sexual abuse and/or physical and emotional neglect) represents a specific risk for developmental perturbations and long-term negative outcomes. Adolescents and young adults with childhood trauma have rarely experienced a single type of traumatic event but rather multiple traumatic experiences. However, studies on adolescent PTSD are sparse. This study examines the possible mediating role of mentalizing, cognitive and interpersonal emotion regulation strategies between multiple types of childhood trauma exposure and PTSD in adolescents and young adults. MethodsThe sample consisted of 456 adolescents and young adults aged 15 and 25, recruited from four high schools and one university. Participants completed self-report questionnaires assessing childhood trauma, mentalizing, cognitive and interpersonal strategies of emotion regulation and PTSD. ResultsStructural Equation Modeling revealed that multiple types of childhood trauma exposure have a significant indirect effect on PTSD symptoms through its association with hypomentalizing and maladaptive cognitive strategies of emotion regulation (i.e. self-blame, rumination, catastrophizing). Results also showed a significant indirect effect between multiple types of childhood trauma exposure and PTSD symptoms through its association with hypomentalizing and maladaptive interpersonal strategies of emotion regulation (i.e. emotional reactivity and tendency to avoid emotional connection). Indirect paths were also run in reverse to control for the direction of the effect. ConclusionOur findings show that exposure to multiple types of childhood trauma contributes to severe PTSD through several complex pathways including both hypomentalizing and maladaptive emotion regulation strategies in adolescence and young adulthood.

Post-traumatic Stress Symptoms in Adolescents Exposed to the Earthquake in Lombok, Indonesia: Prevalence and Association With Maladaptive Trauma-Related Cognition and Resilience.

Background: Natural disasters may physically and psychologically affect individuals and their surrounding community. This study determines the prevalence of post-traumatic stress (PTS) symptoms and its association with maladaptive trauma-related cognition and resilience among adolescents post-earthquake.Materials and Methods: Data were collected, in this cross-sectional study, during an intervention program post-earthquake held in a state high school located at Lombok, Indonesia. The study sample engaged students 14–19 years of age using the purposive sampling method. The questionnaires used to measure PTS symptoms, maladaptive trauma-related cognition, and resilience were Children's Revised Impact of Event Scale-13 (CRIES-13), Child Post-Traumatic Cognitions Inventory (CPTCI), and Child and Youth Resilience Measure-Revised (CYRM-R), respectively.Results: The prevalence of PTS symptoms was 69.9%. Among the respondents, 61.37% were female and 56.48% had mothers with lower educational levels. Using multiple linear regression, the final predictors of PTS symptoms were excessive reactions (e.g., wailing loudly, miserable shrieking) of proxy during earthquake (β = 3.283, p = 0.005), maladaptive trauma-related cognition (β = 0.224, p = 0.002), and resilience (β = 0.192, p < 0.001) with female gender (β = 7.350, p < 0.001) as a control variable. Through simple linear regression, victims who witnessed injury or death during the earthquake (p = 0.003), had a proxy died during the earthquake (p = 0.01), and trapped victims or those who had difficulty escaping (p = 0.01) were identified to potentially predict the occurrence of PTS symptoms, warranting further study.Conclusion: The presence of excessive proxy reactions during the earthquake, maladaptive trauma-related cognition, and resilience in adolescents exposed to a natural disaster are worth targeting and prioritizing in future post-disaster interventions.

Emotional Behavioral Problems and Post Traumatic Stress Symptoms in Collaborators in Children With Cancer

Objectives: The purpose of this study was to investigate the emotional, behavioral problems, and posttraumatic stress symptoms in siblings of children with cancer and a control group. Methods: This study is a causal-comparative study. The sample consisted of 30 siblings aged 11 to 18 years old in children with cancer, 30 controls, who were matched for age and sex. The data was collected through availability sampling. In this study, a self-report questionnaire of adolescents and symptom scales of post-traumatic stress disorder-self-report form was used to assess the internalization, externalization, and symptoms of post-traumatic stress disorder. Results: The results showed that there is a significant difference between internalization problems, extraversion problems, and post-traumatic stress symptoms in adolescents with cancer and the control group. Conclusion: According to the results, the siblings of children with cancer had more behavioral emotional behaviors than the control group that these findings revealed a greater vulnerability in this group and a guide for appropriate interventions.

Prevalence and determinants of posttraumatic stress in adolescents following an earthquake.

Context:The 2016 Aceh earthquake causes a significant mental health impact in adolescents. However, the prevalence and determinants have never been reported.Aims:The study aimed to estimate the prevalence rate and determinants of posttraumatic stress symptoms in adolescents following an earthquake.Settings and Design:This cross-sectional study was conducted in Pidie Jaya district approximately 6 months following the earthquake.Materials and Methods:The Trauma Screening Questionnaire (TSQ) was distributed to adolescents living around the earthquake-affected area.Statistical Analysis:The Chi-square test and binomial logistic regression were performed using GNU PSPP statistical software.Results:The prevalence of posttraumatic stress disorder (PTSD) was 47%, and the mean score of TSQ was 5.11 (standard deviation = 2.3). The presence of PTSD was associated with gender and age (P = 0.001). Logistic regression analysis confirmed that gender, being injured, witnessing someone injured, feeling stressed after the earthquake, and feeling scared of staying inside a building following the earthquake were independently and significantly associated with PTSD (P = 0.001).Conclusion:The prevalence of PTSD at 6 months following an earthquake is relatively high, and many factors are associated with the presence of PTSD.

Osobowość typu D a objawy zespołu stresu pourazowego u młodzieży – mediacyjna rola prężności

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Ogińska-Bulik N, Michalska P. Type D personality and post-traumatic stress symptoms in adolescents – the mediating role of resilience. Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii. 2019;28(4):241-256. doi:10.5114/ppn.2019.92485. APA Ogińska-Bulik, N., & Michalska, P. (2019). Type D personality and post-traumatic stress symptoms in adolescents – the mediating role of resilience. Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii, 28(4), 241-256. https://doi.org/10.5114/ppn.2019.92485 Chicago Ogińska-Bulik, Nina, and Paulina Michalska. 2019. "Type D personality and post-traumatic stress symptoms in adolescents – the mediating role of resilience". Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii 28 (4): 241-256. doi:10.5114/ppn.2019.92485. Harvard Ogińska-Bulik, N., and Michalska, P. (2019). Type D personality and post-traumatic stress symptoms in adolescents – the mediating role of resilience. Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii, 28(4), pp.241-256. https://doi.org/10.5114/ppn.2019.92485 MLA Ogińska-Bulik, Nina et al. "Type D personality and post-traumatic stress symptoms in adolescents – the mediating role of resilience." Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii, vol. 28, no. 4, 2019, pp. 241-256. doi:10.5114/ppn.2019.92485. Vancouver Ogińska-Bulik N, Michalska P. Type D personality and post-traumatic stress symptoms in adolescents – the mediating role of resilience. Advances in Psychiatry and Neurology/Postępy Psychiatrii i Neurologii. 2019;28(4):241-256. doi:10.5114/ppn.2019.92485.

Investigating the Connection Between Traumatic Brain Injury and Posttraumatic Stress Symptoms in Adolescents.

To identify potentially modifiable individual and social-environmental correlates of posttraumatic stress symptoms (PTSS) among adolescents hospitalized for traumatic brain injury (TBI). Four pediatric hospitals and 1 general hospital in the United States. Children ages 11 to 18 years, hospitalized for moderate-severe TBI within the past 18 months. Retrospective cross-sectional analysis. The University of California at Los Angeles (UCLA) Post-traumatic Stress Disorder (PTSD) Reaction Index and the Youth Self-Report (YSR) PTSD subscale. Of 147 adolescents enrolled, 65 (44%) had severe TBI, with an average time since injury of 5.8 ± 4 months. Of the 104 who completed the UCLA-PTSD Reaction Index, 22 (21%) reported PTSS and 9 (8%) met clinical criteria for PTSD. Of the 143 who completed the YSR-PTSD subscale, 23 (16%) reported PTSS and 6 (4%) met clinical criteria for PTSD. In multivariable analyses, having a negative approach to problem solving and depressive symptoms were both associated (P < .001) with higher levels of PTSS based on the UCLA-PTSD Reaction Index (β = 0.41 and β = 0.33, respectively) and the YSR-PTSD subscale (β = 0.33 and β = 0.40, respectively). Targeting negative aspects of problem solving in youths after brain injury may mitigate PTSS.

Factors associated with post-traumatic stress symptoms among adolescents exposed to the Sewol ferry disaster in Korea

This study evaluated the factors associated with post-traumatic stress symptoms in Korean adolescents who lived in a disaster-affected community. A total of 1101 students attending secondary and high schools in Jindo, the location of the Sewol ferry disaster, were enrolled in a cross-sectional survey. The Child Report of Post-traumatic Symptoms (CROPS), the Center for Epidemiological Studies Depression Scale (CES-D), and the State Anxiety Inventory for Children (SAIC) were administered. Female gender, older children, poor academic achievement, and directly witnessing the rescue scene were associated with post-traumatic stress symptoms. The CES-D and SAIC scores of subjects with witness of the rescue were significantly higher than those of respondents without such experiences. The regression analysis revealed that directly witnessing the rescue scene was significantly associated with post-traumatic stress symptoms after adjusting for other variables. The results of this study suggest that witnessing the rescue scene following a disaster might be a risk factor for post-traumatic stress symptoms in adolescents in disaster-affected communities.

Psychological Distress and Posttraumatic Stress Symptoms in Adolescents and Young Adults with Cancer and Their Parents.

To investigate the prevalence and predictors of psychological distress in adolescent and young adult (AYA) cancer patients and their parent caregivers. In a cross-sectional study design, AYA participants (n = 196) and parent caregivers (n = 204) were recruited from 18 sites across Australia. AYAs were aged 15-25 years at cancer onset and within 6-24 months of diagnosis. AYAs and parents completed a survey that includes validated measures of psychological distress (anxiety, depression, and posttraumatic stress symptoms [PTSS]). Additional measures included validated and study-specific questionnaires related to sociodemographic and medical information, social supports, cancer impacts, and life stressors. Nearly half the sample (48% AYAs and 42% parents) scored above a clinical cutoff score for PTSS, indicating further assessment was warranted. Nearly one third of AYAs and parents (31% AYAs and 28% parents) reported moderate to severely elevated symptoms of anxiety and depression. Factors associated with elevated AYA distress included female gender, less social support, and self-image and identity issues. For parents, living outside the metropolitan area, other life stressors, and impact on plans for the future and broader family were factors associated with increased distress. Despite numerous studies of AYA cancer survivors, very few studies have examined the psychosocial and psychological impacts of cancer when onset occurs during adolescence and young adulthood. Almost no studies have examined the impacts on their parent caregivers. The findings of this study support the need for early identification of psychological distress, appropriate developmental perspectives to understand AYA distress, and the need for family-based psychological assessment and interventions.

Negative Trauma Appraisals and PTSD Symptoms in Sri Lankan Adolescents.

The cognitive model posits that negative appraisals play an important role in posttraumatic stress disorder, in children as well as in adults. This study examined correlates of negative appraisals in relation to trauma exposure and their relationship to posttraumatic stress symptoms (PTSS) in 414 Sri Lankan adolescents, aged 12 to 16, living in areas impacted in varying degrees by the 2004 tsunami. In 2008, participants completed measures of negative appraisals, lifetime traumatic events, posttraumatic stress symptoms, internalizing symptoms, ongoing adversity, and social support. The majority (70 %) of the participants reported multiple traumatic events; 25 % met DSM-IV criteria for full or partial PTSD. Adolescents who had experienced more severe events, abusive events, greater cumulative trauma, or greater current adversity reported more negative appraisals. In regression analyses controlling for known risk factors such as female gender, cumulative trauma, ongoing adversity, and low social support, negative appraisals were the best predictor of PTSS, explaining 22 % of the variance. This relationship appeared specific to PTSS, as negative appraisals did not predict internalizing symptoms. Findings confirm the link between negative cognitions concerning traumatic events and persistent PTSS in adolescents, but longitudinal studies are needed to determine whether appraisals contribute to symptom maintenance over time.

Attachment as a mediator between community violence and posttraumatic stress symptoms among adolescents with a history of maltreatment

Experiences that are detrimental to the attachment relationship, such as childhood maltreatment, may reduce feelings of safety among survivors and exacerbate the effects of exposure to subsequent violence, such as witnessing community violence. Though attachment style has been examined in regard to posttraumatic stress in adults who have a history of exposure to violence in childhood, less is known about the influence of attachment on the relationship between exposure to violence and posttraumatic stress symptoms in children and adolescents. The current study aimed to explore the role of attachment in the link between exposure to community violence and posttraumatic stress symptoms in adolescents with a history of childhood abuse. Participants included adolescents (aged 15–18 years) who had a history of maltreatment (N=75) and a matched sample without a childhood abuse history (N=78) from the National Data Archive on Child Abuse and Neglect (Salzinger, Feldman, & Ng-Mak, 2008). A conditional process model using bootstrapping to estimate indirect effects showed a significant indirect effect of insecure attachment on the relationship between exposure to community violence and posttraumatic stress symptoms for adolescents with a history of childhood physical abuse, but not for adolescents without this history. Implications for a cumulative risk model for post-trauma pathology starting in adolescence are discussed.

Post-traumatic stress symptoms in adolescents exposed to an earthquake: Association with self-efficacy, perceived magnitude, and fear

The objective of this study was to evaluate th×e relationship between the magnitude of an earthquake, the fear experienced, the self-efficacy beliefs, and post-traumatic stress symptoms in adolescents. We expected self-efficacy beliefs to predict post-traumatic stress symptoms, and this relation to be mediated by fear. We used data from a longitudinal project on adolescent normative development that was under way at the time of the 2010 earthquake in Chile. Six months before the earthquake, 218 adolescents responded to a self-efficacy beliefs scale; three months after the earthquake they reported the perceived magnitude of the event, the fear they experienced, and their post-traumatic stress symptoms. Results showed that perceived magnitude was not associated with fear or post-traumatic stress symptoms, but self-efficacy beliefs and fear were associated with post-traumatic stress symptoms. The hypothesized role of fear as a mediator in the relation between self-efficacy beliefs and post-traumatic stress symptoms was supported by the data. The results of the study, suggest that preventive interventions aimed to increase awareness of how to face a disaster may not only contribute to save lives but may also increase adolescentś sense of personal efficacy, reducing subsequent emotional reactivity associated with the event.

Posttraumatic stress symptoms and mental health services utilization in adolescents with social anxiety disorder and experiences of victimization

Recent findings from studies on adults show similarities between social anxiety disorder (SAD) and posttraumatic stress in the form of recurrent memories and intrusive and distressing images of earlier aversive events. Further, treatment models for SAD in adults have been successfully developed by using transdiagnostic knowledge on posttraumatic stress symptoms (PTSS). Studies on adolescents are though missing. The present study aimed at exploring the association between PTSS and SAD in Swedish adolescents. A second aim was to study mental health services utilization in relation to these conditions. A total of 5,960 high-school students participated and reported on SAD, life time victimization, PTSS and mental health service utilization. Socially anxious adolescents reported significantly higher levels of PTSS than adolescents not reporting SAD and this difference was seen in victimized as well as non-victimized subjects. Contact with a school counselor was the most common mental health service utilization in subjects with SAD and those with elevated PTSS. In the prediction of contact with a CAP-clinic, significant odds ratios were found for a condition of SAD and elevated PTSS (OR = 4.88, 95 % CI = 3.53–6.73) but not for SAD only. Screening of PTSS in adolescents with SAD is recommended. The service of school counselors is important in detecting and helping young people with SAD and elevated PTSS. Clinical studies on SAD and PTSS in adolescents could aid in modifying treatment models for SAD.

Screening for Traumatic Exposure and Posttraumatic Stress Symptoms in Adolescents in the War-Affected Eastern Democratic Republic of Congo

To explore adolescent mental health in the eastern Democratic Republic of Congo, scene of a complex emergency since 1996. Community cross-sectional data obtained using a cluster sample approach. From November 5, 2007, through February 5, 2008, we assessed 13 secondary schools in 4 selected health zones in the Ituri district. One thousand forty-six adolescents and young adults aged 13 to 21 years completed a self-report questionnaire. War-related traumatic events, posttraumatic stress symptoms, and sociodemographic variables. The Adolescent Complex Emergency Exposure Scale, specifically designed for this region, screened for exposure to potentially traumatic events, and the Impact of Event Scale-Revised measured symptoms of posttraumatic stress consistent with Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria. Among the 477 girls (45.6%) and 569 boys (54.4%) in the study, 95.0% reported at least 1 traumatic event. On average, adolescents were exposed to 4.71 traumatic events, with higher exposure rates reported in boys, older groups, rural and urban areas, and respondents whose mother or father was dead. Of 990 respondents, 52.2% met symptom criteria for posttraumatic stress disorder. Symptom scores were strongly related to cumulative trauma exposure; however, the strength of this relationship differed slightly across living area groups for girls. Adolescents in the eastern Democratic Republic of Congo are highly exposed to political violence, putting them at a considerable risk--mediated by living area and sex--to develop posttraumatic stress symptoms.

Emotional Distress and Posttraumatic Stress in Children: The Impact of Direct Versus Indirect Exposure

This study examined whether familiarity with the physical environment and verbal/pictorial exposure to a tsunami also inducted posttraumatic stress symptoms in adolescents. The Impact of Event Scale (IES) and Pediatric Emotional Distress Scale (PEDS) were administered to 231 subjects (130 directly exposed and 101 indirectly exposed). The directly exposed group scored high on the IES and PEDS. A significant sex difference was observed on all three dimensions of the IES, and fearful and traumatic event-related dimensions of PEDS, with females at a higher risk compared to males. In the indirectly exposed group, no sex difference was observed for the IES (avoidance and total impact score) or the fearful, acting out, or traumatic experience related dimensions of the PEDS. Significant sex differences were observed in this group on the IES intrusion and PEDS withdrawal scores, with males higher on intrusion and females higher on withdrawal.

Post-Traumatic Stress Symptoms in Adolescents after Two Murders in a School: A Controlled Follow-up Study

Two students were murdered by gunshot by another student. Among the classmates and the students in another school, we aimed to investigate the factors on the fifth day of trauma to be predictive of higher post-traumatic stress symptoms (PTSS) scores five months later. The adolescents attending the school (School A: acute phase n:41; second phase n:57; follow-up group n:35) where the event had occurred, and the adolescents attending a school (School B: acute phase n:98; second phase n:57) of similar statue were included. They had completed "Trauma Questionnaire" (TQ), "Childhood Post Traumatic Stress Disorder-Reaction Index" (CPTSD-RI), "Beck Depression Inventory" (BDI), and "State-Trait Anxiety Inventory" (STAI) both 5 days and 5 months after the event. Both 5 days and 5 months after the trauma, students in school A, and the girls in both schools had significantly higher CPTSD-RI scores. Nine students (25.7%) in the follow-up group were found to have CPTSD-RI scores higher than 39, indicating severe PTSD symptoms. The CPTSD-RI scores of this group 5 months after the trauma were significantly correlated with the several scores of the acute term (CPTSD-RI [r: .76,p < .001]; BDI [r: .56, p: .001]; STAI-state [r:. 49, p: .004]). Results reveal that a murder of a peer triggers post-traumatic stress symptoms in a vast majority of the 16-year-old adolescents even without directly witnessing the event. The severity of PTSS significantly increases as the adolescent is in closer relationship with the victim. The concomitant depression and/or anxiety with acute stress symptoms 5 days after the trauma, female gender, and worse school performance were found to be significantly related to the development of more severe PTSS 5 months later.