UCLA Posttraumatic Stress Disorder Reaction Index Research Articles

Posttraumatic stress disorder in disaster-exposed youth: examining diagnostic concordance and model fit using ICD-11 and DSM-5 criteria

BackgroundCompeting definitions of posttraumatic stress disorder (PTSD) have been proposed by ICD-11 and DSM-5; it is unclear which diagnostic model works best for children and adolescents. Although other studies have predicted the impact of these models by approximating the criteria using older measures, this study advances the research by comparing measures designed to assess ICD-11 and DSM-5 criteria in hurricane-exposed youth. This study evaluates ICD-11 and DSM-5 (both the standard and preschool-age) diagnostic models by identifying diagnostic rates, evaluating diagnostic concordance, investigating the predictive value of constructs associated with PTSD (demographics, disaster threat and exposure, functional impairment), and examining model fit.MethodThe sample was exposed to Hurricane Ian (2022), a deadly Category 5 hurricane. Parents reported on disaster exposure and their child’s PTSD symptoms (n = 152; ages 7–17) using the International Trauma Questionnaire for Children and Adolescents Caregiver Version (ITQ-CG) for ICD-11 criteria and UCLA PTSD Reaction Index for DSM-5, Parent/Caregiver Report Version (RI-5) for DSM-5 criteria.ResultsICD-11 PTSD symptom criteria rates were 24% and dropped to 20% when the impairment criterion was added. PTSD symptom criteria rates were 11% (10% with impairment) for DSM-5 and 13% (12% with impairment) for DSM-5 Preschool. ICD-11 rates were higher than DSM-5 and DSM-5 Preschool rates. There was no difference between DSM-5 and DSM-5 Preschool rates of PTSD. There was moderate to substantial concordance between ICD-11 and the DSM-5 models. All diagnostic models were associated with exposure and impairment, but only ICD-11 was associated with threat. ICD-11 was the only one to evidence acceptable model fit.ConclusionsUsing the ITQ-CG and RI-5 to assess PTSD in youth, results showed higher PTSD diagnostic rates for ICD-11 than DSM-5; this contradicts prior findings (based off approximated ICD-11 criteria) and seems largely due to differences in symptom thresholds used by the two measures. The ITQ-CG exhibited excellent model fit and was associated with several constructs important to PTSD.

Endocannabinoid dysregulation and PTSD in urban adolescents: Associations with anandamide concentrations and FAAH genotype.

The endocannabinoid system, which regulates fear- and anxiety-related behaviors, is dysregulated in adults with posttraumatic stress disorder (PTSD), as indicated by higher circulating anandamide (AEA) concentrations. The C385A (rs324420) polymorphism in the fatty acid amide hydrolase (FAAH) gene, which catabolizes AEA, is linked to higher AEA concentrations and greater PTSD symptoms in adults. Given that adolescence is a critical period during which trauma and psychiatric disorders emerge, understanding this relationship in youth is essential. This study examines PTSD symptoms, AEA concentrations, and FAAH genotype in a diverse adolescent sample. This study included 102 Detroit-area adolescents (M ± SD = 13.33 ± 2.21 years, 54.9% female) and their parents/guardians. The sample consisted of 40.2% White Non-Hispanic, 34.3% Black Non-Hispanic, 6.9% White Hispanic, 4.9% Asian/Pacific Islander, and 12.7% Biracial adolescents. Trauma exposure and PTSD symptoms were assessed using the UCLA PTSD Reaction Index for DSM-5. Plasma concentrations of AEA were measured by liquid chromatography-tandem mass spectrometry, and FAAH genotype was determined from saliva samples and high-throughput screening. The majority (90%) of adolescents reported trauma exposure, and 20% met PTSD criteria. Higher AEA concentrations were associated with more severe PTSD symptoms (p = 0.009), especially hyperarousal. The FAAH A-allele (present in 52.5% of participants) was associated with higher AEA concentrations (2.11 ± 0.69 pmol/ml, p = 0.013) and greater PTSD severity (22.65 ± 15.931, p = 0.027), particularly those with the reexperiencing cluster, compared to the CC genotype (1.79 ± 0.66 pmol/ml and 15.87 ±+ 13.043, respectively). Elevated AEA concentrations and the FAAH A-allele were associated with greater PTSD symptom severity in urban adolescents. These findings suggest endocannabinoid dysregulation may play a role in adolescent PTSD, highlighting the need for further research and targeted interventions.

Cross-cultural validation of the Clinician-Administered PTSD scale for DSM-5, child and adolescent version in Japan

ABSTRACT Background: The establishment of a formal diagnosis of post-traumatic stress disorder (PTSD) for children and adolescents is the foundation for advancing pertinent clinical research and formulating proper treatment and management. However, a validated diagnostic tool for PTSD in children and adolescents is lacking in Japan. Objective: To examine the cross-cultural validity and reliability of the Japanese Clinician-Administered PTSD Scale for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), child and adolescent version (CAPS-CA-5-J). Method: Overall, 73 children who had experienced potentially traumatic events were recruited from three medical facilities. The linguistically validated CAPS-CA-5-J was conducted by trained psychiatrists and psychologists. Additionally, children and their caretakers completed questionnaires such as the UCLA PTSD reaction index for DSM-5 (PTSD-RI-5), Depression Self-Rating Scale for Children (DSRDC), and Strength and Difficulties Questionnaire (SDQ); 16 participants were randomly selected for the inter-rater reliability assessment. Results: Owing to missing values in the CAPS-CA-5-J and PTSD-RI-5, 68 children were included in the final analysis. Regarding reliability, the CAPS-CA-5-J showed excellent internal consistency (Cronbach’s alpha coefficient = 0.90) and interrater agreement (kappa coefficient = 0.88). Convergent validity was supported by a strong correlation between the total severity scale of the CAPS-CA-5-J and the PTSD-RI-5 scores (Pearson’s correlation coefficient = 0.82). Divergent validity was indicated by a moderate correlation between the CAPS-CA-5-J and DSRDC, and no correlation was found with the SDQ scores. Conclusions: This study is the first to validate a structured clinical interview for children and adolescents with PTSD in Japan. The psychometric properties of the CAPS-CA-5-J were good enough and comparable to those reported in previous validation studies. Therefore, the CAPS-CA-5-J can be considered reliable and valid for use in Japan.

Prevalence and associated factors of post-traumatic stress symptoms in hospitalised children with cancer and their parents in South China: A multicentred cross-sectional study

ObjectiveThis study aimed to examine the prevalence and risk factors of Post-Traumatic Stress Symptoms (PTSS) in hospitalised children with cancer and their parents and explore the PTSS correlation between parents and children. MethodsData were collected using the University of California at Los Angeles (UCLA) Posttraumatic Stress Disorder-Reaction Index for DSM-IV and the Chinese version of the Impact of Event Scale-Revised Questionnaire. ResultsOut of 203 families with hospitalised children with cancer, 77.3% of parents and 7.9% of children experienced PTSS. Time since diagnosis of less than 3 months (β = −0.063, P < 0.001), actively seeking financial help (β = −0.190, P = 0.031), children living in rural areas (β = 0.166, P = 0.023) and having a daughter with cancer (β = 0.135, P = 0.040) were risk factors for parental PTSS. At the early stages of diagnosis (β = 0.118, P = 0.017), recurrence (β = 0.140, P = 0.042) and low monthly household income (β = −0.283, P = 0.003) were risk factors for children's PTSS. No significant correlation between parental PTSS and children's PTSS (r = −0.06, P > 0.05). ConclusionsThe hospitalised children with cancer had a low prevalence of PTSS, but their parents' PTSS prevalence was high. No significant correlation was observed between parental and children's PTSS. Attention should be given to the mental health of families with hospitalised children with cancer. Early psychosocial support should be provided, especially to families with poor economic situations and a newly diagnosed or relapsed child.

Anxiety, Depression, and Posttraumatic Stress Disorder in Patients With Induced Laryngeal Obstruction

Patients with induced laryngeal obstruction (ILO) present with a variety of behavioral health profiles. Identifying these profiles is crucial in that behavioral health conditions may affect treatment duration and outcomes. To characterize the prevalence of anxiety, depression, posttraumatic stress disorder (PTSD), and physical somatic symptoms in adult and pediatric patients with ILO and determine the factors associated with anxiety, depression, PTSD, and physical somatic symptoms in patients with ILO? This cross-sectional study included a nonprobability sample of 83 adult and 81 pediatric patients diagnosed with ILO at outpatient adult and pediatric otolaryngology clinics between 2021 and 2023. Exclusion criteria included a comorbid respiratory diagnosis other than asthma, head or neck cancer, or neurological impairments. Recruitment took place between September 2021 and March 2023. The analyses were run in January 2024. Patients were prospectively screened for anxiety, depression, PTSD, and somatic physical symptoms. In addition, any past behavioral health diagnoses were extracted from the medical record. Comorbidities, ILO symptoms triggers, and onset details were gathered from ILO evaluations. Adult patients completed the Screen for Adult Anxiety Related Disorders (SCAARED), depression (Patient Health Questionnaire [PHQ]-9), and somatic physical symptoms portions of the Patient Health Questionnaires (PHQ-15), and the PTSD Checklist for the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (PCL-5). Pediatric patients completed the Screen for Child Anxiety Related Disorders (SCARED), depression (PHQ-9A) and somatic physical symptoms portions of the Patient Health Questionnaires for Adolescents (PHQ-15A), and the UCLA PTSD Reaction Index brief screeners. Eighty-three adult patients participated in this study (mean [SD] age, 45.8 [14.3] years; 64 female, 19 male). Eighty-one pediatric patients participated (mean [SD] age, 13.83 [2.55] years; 67 female, 14 male). Adult and pediatric patients with ILO screened positive for elevated rates of anxiety (53 adults [63%]; 49 children [60%]), depression (27 adults [32%]; 25 children [30%]), and PTSD (29 adults [34%]; 13 children [16%]). Most of the patients with anxiety and depression symptoms were formally diagnosed prior to ILO evaluation, with rates of previously diagnosed anxiety, depression, and PTSD also above published norms. Adults were twice as likely as children to present with PTSD (odds ratio, 2.1; 95% CI, 0.05-4.48). Elevated rates of physical somatic symptoms were also evident, with 38 adults (45%) and 32 children (39%) scoring in the moderate to severe range. This study found high rates of adult and pediatric patients with ILO screened positive for anxiety, depression, and PTSD symptoms. Future work should investigate how behavioral health and ILO treatments can best be coordinated to maximize treatment outcomes.

The fear that remains: Associations between trauma, related psychopathology, and fear-potentiated startle in youth resettled as refugees.

Fear-potentiated startle (FPS) can be used to measure fear and safety learning-behaviors affected by trauma that may map onto posttraumatic stress disorder (PTSD). Therefore, FPS could be a candidate biomarker of trauma-related psychopathology and a potential identifier of trauma-exposed youth in need of focused treatment. We enrolled n=71 (35 females, Mage =12.7 years) Syrian youth exposed to civilian war trauma. Eyeblink electromyogram (EMG) data from a differential conditioning FPS paradigm were obtained 2.5 years after resettlement. Youth provided self-report of trauma exposure (Harvard Trauma Questionnaire) and PTSD symptoms (UCLA PTSD Reaction Index). While FPS during conditioning was not associated with symptoms, associations with psychopathology emerged in fear extinction. Probable PTSD was associated with FPS in the last block of extinction, such that FPS to threat cue was significantly greater in the PTSD+ group compared to the PTSD- group at the end of extinction (F=6.25, p=.015). As with adults, we observed a deficit in extinction learning but not fear conditioning in youth with PTSD. These results support the use of trauma-informed cognitive behavioral therapy based on the learning principles of extinction in youth with PTSD.

Effectiveness of a school-based, lay counselor-delivered cognitive behavioral therapy for Chinese children with posttraumatic stress symptoms: a randomized controlled trial

Improving children's access to mental health services need more innovative solutions, especially in low- and middle-income countries. School-based psychosocial interventions delivered by lay counselors may be an efficient way to improve children's access to mental health services. But few studies were conducted to examine the effectiveness of these interventions. Therefore, this study is to evaluate the effectiveness of trauma-focused cognitive behavioral therapy (TF-CBT) in a group format delivered by lay counselors to children with trauma-related symptoms in China. A total of 234 children (aged 9-12 years) with full or subthreshold posttraumatic stress disorder (PTSD) were randomly assigned to group-based TF-CBT or treatment as usual (TAU). In the intervention group, 118 children received 10-12 sessions of group-based TF-CBT delivered by lay counselors for 9 consecutive weeks. In the TAU group, 116 children received the usual school services provided by psychology teachers. The primary outcome was the reduction in PTSD severity, which was assessed with the UCLA PTSD reaction index for DSM-5 (PTSD-RI-5). The secondary outcomes included the reduction in PTSD severity and the remission of PTSD, both of which were measured with the PTSD checklist-5 (PCL-5). Secondary outcomes also included the reduction in depression severity and the reduction in generalized anxiety severity. Blinded assessments were collected at baseline, posttreatment (primary endpoint), and 3-month follow-up. This trial is registered with Chinese Clinical Trial Registry, ChiCTR1900027131. At posttreatment, the intervention group scored significantly lower than the TAU group on PTSD-RI-5 PTSD (30.98 vs. 39.22; adjusted mean difference [AMD],-7.35; 95% CI,-11.66 to-3.04), PCL-5 PTSD (28.78 vs. 38.04; AMD,-8.49; 95% CI,-13.23 to-3.75), depression (5.52 vs. 7.96; AMD,-1.63; 95% CI,-2.50 to-0.76), and generalized anxiety (7.23 vs. 8.64; AMD,-1.21; 95% CI,-2.20 to-0.23). The remission of PCL-5 PTSD was also significantly higher in the intervention group (42.86% vs. 13.54%, χ 2 =13.10, P<0.001). These two groups showed a similar level of symptoms at the 3-month follow-up. The group-based TF-CBT can significantly alleviate PTSD, depression, and generalized anxiety right after treatment in Chinese children who suffer from different types of trauma. But the long-term effects of this intervention need to be further tested. This intervention can be delivered by trained lay counselors in low- and middle-income countries. None.

Temporal Relationships between PTSD Symptoms and Social Functioning among Adolescents in Residential Care

ABSTRACT Objective Theoretical and conceptual models of posttraumatic stress disorder (PTSD) symptom progression in youth have identified social functioning as having a central influence. Yet a dearth of research has examined the bidirectional temporal associations between PTSD symptoms and social functioning. Method This study is the first to investigate these temporal dynamics in a sample of adolescents in trauma-informed residential treatment (N= 453; M age = 15.77 [range = 12.12–18.95], SD = 1.55; 57.2% female). The UCLA PTSD Reaction Index for DSM-5 was analyzed as a measure of youth-reported PTSD symptoms and the Interpersonal Problems subscale of the Children’s Depression Inventory, 2nd edition was analyzed as a measure of youth-reported social functioning issues. The Social Problems subscale from the Child Behavior Checklist was analyzed as a measure of clinician-reported social functioning difficulties. Measures were completed at baseline and then approximately every three months for the duration of treatment. Multivariate lagged analyses were used to examine the temporal, bidirectional associations between PTSD symptoms and social functioning. Results Results indicated that while controlling for length of stay, trauma exposure, age, and gender, reductions in PTSD symptoms predicted subsequent reductions in social functioning problems across both measures (prs = .12-.16), and that improvement in interpersonal relationships predicted subsequent decreases in PTSD symptoms (pr = .12). Conclusions Taken together, these findings highlight the importance of healthy social relationships for decreasing adolescent’s psychological distress. Treatments that include components that target social functioning in addition to symptom reduction may maximally benefit youth with trauma-related psychopathology.

Parental Psychological Flexibility as a Mediating Factor of Post-Traumatic Stress Disorder in Children after Hospitalization or Surgery.

Background: Illness, surgery, and surgical hospitalization are significant stressors for children. Children exposed to such medical events may develop post-traumatic medical syndrome (PMTS, pediatric medical traumatic stress) that could slow their physical and emotional recovery. Objective: This study examined the relationship between the level of parental psychological resilience and the development of PMTS in young children. Method: We surveyed 152 parents of children aged 1–6 who were admitted to the pediatric surgery department. Parents completed questionnaires in two phases. In the first phase, one of the parents completed the Acceptance and Action Questionnaire (AAQ-ll) and the Parental Psychological Flexibility (PPF) Questionnaire. In the second phase, about three months after discharge, the same parent completed the Young Child PTSD (Post Traumatic Stress Disorder) Checklist (YCPC) and the UCLA (Los Angeles, CA, USA) PTSD Reaction Index for DSM-5 Parent/Caregiver Version for Children Age 6 Years and Younger Evaluating Post-traumatic Disorder. In addition, the parent completed a Posttraumatic Stress Diagnostic Scale (PDS) questionnaire to assess the existence of post-traumatic symptoms in the parents. Results: The findings indicate that (1) a parent’s psychological flexibility is significantly associated with the level of personal distress (r = −0.45, p < 0.001), (2) a parents’ level of distress is significantly correlated with the child’s level of PTMS, and (3) a parent’s level of psychological flexibility is a significant mediating factor between the level of parental post-traumatic distress and the child’s level of PTMS. Conclusions: A parent’s psychological flexibility may act as a protective factor against the development of the child’s mental distress after hospitalization or surgery.

Parental Internalizing Psychopathology and PTSD in Offspring after the 2012 Earthquake in Italy.

Post-traumatic stress disorder (PTSD) is common in youths after earthquakes, with parental psychopathology among the most significant predictors. This study investigated the contribution and the interactional effects of parental internalizing psychopathology, the severity of exposure to the earthquake, and past traumatic events to predict PTSD in offspring, also testing the reverse pattern. Two years after the 2012 earthquake in Italy, 843 children and adolescents (9–15 years) living in two differently affected areas were administered a questionnaire on traumatic exposure and the UCLA PTSD Reaction Index. Anxiety, depression, and somatization were assessed in 1162 parents through the SCL-90-R. General linear model showed that, for offspring in the high-impact area, predictors of PTSD were earthquake exposure, past trauma, and parental internalizing symptoms, taken individually. An interaction between earthquake exposure and parental depression or anxiety (not somatization) was also found. In the low-impact area, youth PTSD was only predicted by earthquake exposure. The reverse pattern was significant, with parental psychopathology explained by offspring PTSD. Overall, findings support the association between parental and offspring psychopathology after natural disasters, emphasizing the importance of environmental factors in this relationship. Although further research is needed, these results should be carefully considered when developing mental health interventions.

Psychometric Properties of the Parent-Report Version of the UCLA PTSD Reaction Index for DSM-5.

The UCLA PTSD Reaction Index for DSM-5 (RI-5) is a developmentally appropriate and well recognized screening tool for the assessment of Post-Traumatic Stress Disorder (PTSD) in children and adolescents. The children/adolescent self-report version of the RI-5 has been thoroughly studied in very recent years, showing adequate psychometric properties. Despite such results, the utility of the parent/caregiver-report version, which also integrates the RI-5 system, remains to be explored. As such, the present study aimed to test the general psychometric properties of the parent/caregiver-report version of RI-5, based on a sample of 457 children and adolescents, aged between 7 and 17years, exposed to at least one potentially traumatic experience, and their respective primary caregivers. The RI-5 total score and categories revealed good internal consistency reliability. The total number of traumas reported emerged as a significant predictor of the RI-5 total score. The RI-5 total score proved to be significantly correlated with more internalizing and externalizing problems, but correlation coefficients were below .70, serving as an indicator of discriminant validity. The four-factor structure of the RI-5 was supported through confirmatory factor analysis. In conclusion, the present study provided preliminary evidence supporting the utility of the parent/caregiver-report version of the RI-5 for research purposes and for clinical assessment and treatment, anchored on a multiple informant perspective of child psychopathology.

A Conversion Crosswalk for the UCLA PTSD Reaction Index: Translating DSM-IV to DSM-5.

The use of patient-reported measures in assessing mental health symptoms is common in both the research and clinical fields. With regard to assessing posttraumatic stress symptoms, there are specific versions of measures designed for child and adolescent populations in accordance with the fourth and fifth editions of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV and DSM-5, respectively). Different clinical thresholds, numbers of items, and score ranges may present obstacles for clinicians and researchers attempting to compare self-report ratings across different versions of a measure. The current study aimed to produce a score conversion crosswalk between two child/adolescent self-report measures of posttraumatic stress disorder (PTSD): the UCLA PTSD Reaction Index for DSM-IV (RI-IV) and DSM-5 (RI-5). Using item response theory (IRT), we calibrated both measures separately to derive scaled scores. The discrimination parameters ranged from 0.57 to 2.08 (SE = 0.09-0.17) for RI-IV and from 0.73 to 2.11 for RI-5 (SE = 0.07-0.13). The scaled scores were connected with equipercentile linking. Total scores based on common items between the two measures were used as anchors to enhance the linking results. A total of 1,486 children and adolescents completed the measure: 571 respondents filled out the RI-IV and 915 respondents filled out the RI-5. The results allow linked scores to be compared to establish recommended clinical cutoffs and help elucidate the implications of changes in the diagnostic criteria for the measurement of self-reported PTSD symptoms in children and adolescents.

Posttraumatic stress disorder symptoms among trauma-exposed adolescents from low- and middle-income countries

BackgroundExposure to traumatic events in childhood is associated with the development and maintenance of various psychiatric disorders, but most frequently with posttraumatic stress disorder (PTSD). The aim of this study was to evaluate the types of traumatic events experienced and the presence and predictors of PTSD symptoms among adolescents from the general population from ten low- and middle-income countries (LMICs).MethodsData were simultaneously collected from 3370 trauma-exposed adolescents (mean age = 15.41 [SD = 1.65] years, range 12–18; 1465 (43.5%) males and 1905 (56.5%) females) in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Romania, and Serbia, with Portugal, a high-income country, as a reference point. The UCLA PTSD Reaction Index for the DSM-5 (PTSD-RI-5) was used for the assessment of traumatic events and PTSD symptoms.ResultsThe most frequently reported traumatic events were death of a close person (69.7%), witnessing violence other than domestic (40.5%), being in a natural disaster (34.4%) and witnessing violent death or serious injury of a close person (33.9%). In total, 28.5% adolescents endorsed two to three DSM-5 PTSD criteria symptoms. The rates of adolescents with symptoms from all four DSM-5 criteria for PTSD were 6.2–8.1% in Indonesia, Serbia, Bulgaria, and Montenegro, and 9.2–10.5% in Philippines, Croatia and Brazil. From Portugal, 10.7% adolescents fall into this category, while 13.2% and 15.3% for the Palestinian Territories and Nigeria, respectively. A logistic regression model showed that younger age, experiencing war, being forced to have sex, and greater severity of symptoms (persistent avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity) were significant predictors of fulfilling full PTSD criteria.ConclusionsNearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event, while nearly one in ten might have sufficient symptoms for full DSM-5 PTSD diagnosis. The findings can inform the generation of PTSD burden estimates, allocation of health resources, and designing and implementing psychosocial interventions for PTSD in LMICs.

Validating the Child Trauma Screen Among a Cross-Sectional Sample of Youth and Caregivers in Pediatric Primary Care.

Pediatric primary care providers have an important role in addressing the health effects of trauma, yet routine screening is rare. This study evaluated whether the 10-item Child Trauma Screen (CTS) could identify youth experiencing posttraumatic stress disorder (PTSD) symptoms. Participants were 107 caregiver-youth pairs aged 7 to 17 years old, 55.8% male, and 76.4% Hispanic who were recruited at an urban pediatric primary care clinic. Youth and caregivers separately completed the CTS and the UCLA PTSD Reaction Index for DSM-5 (RI-5) prior to their medical visit. Half of youth experienced at least one type of trauma, and one sixth reported elevated PTSD symptoms. The CTS was highly correlated with the RI-5 on PTSD symptom severity, and correctly classified 85% of youth based on likely PTSD diagnosis. The brief CTS can accurately identify youth suffering from PTSD symptoms, and may be particularly feasible to implement in busy primary care practices.

External locus-of-control partially mediates the association between cumulative trauma exposure and posttraumatic stress symptoms among adolescents from diverse background

ABSTRACT Background and Objectives Locus of control (LOC) is a modifiable mediator of symptoms of posttraumatic stress disorder (PTSD) among traumatized individuals and a potential target of intervention. Compared with studies involving adults, the potential mediation effect of LOC on PTSD symptoms among trauma-exposed children and adolescents is relatively under-explored. This study, therefore, assessed the mediation effects of LOC on the association between lifetime cumulative trauma and PTSD symptoms among a large cohort of adolescents from different cultural background. Design Cross-sectional study. Methods LOC was determined using the Multi-Dimension Locus of Control Scale; Posttraumatic stress symptoms using the UCLA PTSD Reaction Index; and other significant negative life events using the Life Events Checklist. Results Among 3826 adolescents who completed the study, external LOC explained 24% of variance (R 2 = .24; F2,3823 = 619.01; p < .01) in PTSD symptoms and had significant indirect effect on the relationship between self-reported cumulative traumatic event exposure and PTSD symptoms (ß = .14; 95% BC CI [.10, .20]). Moderated mediation results showed significant potentiation of the moderation effects among older adolescents; boys; and those from more affluent families. Conclusions The study further strengthened the hitherto limited evidence that external LOC partially mediate the relationship between cumulative trauma exposure and PTSD symptoms among adolescents.

Epigenome-Wide Study of Posttraumatic Stress Disorder Symptom Severity in a Treatment-Seeking Adolescent Sample.

Emerging research has demonstrated that psychosocial trauma exposure may elicit epigenetic changes, with downstream effects on the transcriptional regulation of genes. Epigenome-wide association studies (EWAS) offer an agnostic approach to examine DNA methylation (DNAm) associations and are a valuable tool to aid in the identification of biological pathways involved in posttraumatic stress disorder (PTSD). This study represents the first EWAS of PTSD in an adolescent sample, an important group given the significance of this developmental period regarding both DNAm changes and PTSD risk. The sample (n = 39, M age = 15.41 years, SD = 1.27, 84.6% female) comprised adolescents who experienced interpersonal trauma and were enrolled in a treatment study. Participants were assessed using the UCLA PTSD Reaction Index for DSM-IV-Adolescent Version and provided a blood sample at baseline. Genomic DNA was isolated from whole blood and assayed using the Illumina Infinium MethylationEPIC BeadChip. The primary analysis estimated the associations among individual CpG sites and PTSD symptom scores. Of the 793,575 screened probes tested, two were significant at a false discovery rate (FDR) < 10%. Hypomethylation of both sites was associated with increased PTSD symptom scores. Analysis of differentially methylated regions (DMR) identified a DMR associated with PTSD symptom scores at an FDR < 10%. Results from follow-up models are also discussed. Findings from this preliminary investigation suggest the importance of further research conducted in adolescent samples. The analytic pipeline and results are documented for use in future meta-analytic work as more such samples become available.

Unseen Costs: The Direct and Indirect Impact of U.S. Immigration Policies on Child and Adolescent Health and Well-Being.

Shifts in migration and border control policies may increase the likelihood of trauma exposure related to child–parent separation and result in costs to the health system and society. In the present study, we estimated direct and indirect costs per child as well as overall cohort costs of border control policies on migrant children and adolescents who were separated from their parents, detained, and placed in the custody of the United States following the implementation of the 2018 Zero Tolerance Policy. Economic modeling techniques, including a Markov process and Monte Carlo simulation, based on data from the National Child Traumatic Stress Network's Core Data Set (N = 458 migrant youth) and published studies were used to estimate economic costs associated with three immigration policies: No Detention, Family Detention, and Zero Tolerance. Clinical evaluation data on mental health symptoms and disorders were used to estimate the initial health state and risks associated with additional trauma exposure for each scenario. The total direct and indirect costs per child were conservatively estimated at $33,008, $33,790, and $34,544 after 5 years for No Detention, Family Detention, and Zero Tolerance, respectively. From a health system perspective, annual estimated spending increases ranged from $1.5 million to $14.9 million for Family Detention and $2.8 million to $29.3 million for Zero Tolerance compared to baseline spending under the No Detention scenario. Border control policies that increase the likelihood of child and adolescent trauma exposure are not only morally troubling but may also create additional economic concerns in the form of direct health care costs and indirect societal costs.

Post-traumatic stress disorder and related factors in students whose school burned down: Cohort study.

This research examines the prevalence of post-traumatic stress disorder (PTSD) and its related factors in students whose school burned down, one month and six months after the incident. A total of 56 students from grades one through six were invited to participate in this study with permission from their parents. Subjects were screened for PTSD by using UCLA PTSD Reaction Index (DSM-5 Version) during three periods: 1, 6, and 12 months after the incident. Children diagnosed with PTSD were interviewed by a child and adolescent psychiatrist to confirm their diagnosis and obtain related factors. Percentage and logistic regression were used for statistical evaluation. 5 out of the 56 students (8.9 %) had PTSD one month after the incident, 2 of them recovered after six months. 6 out of 56 students (10.7 %) had PTSD at six months and 2 of 40 (5%) had PTSD at one year after the incident. Students who lived in the school's dorms had significantly more PTSD than those who lived elsewhere, p < 0.01, RR = 5.16 (4.04-6.6). After one year, age was the only factor related to PTSD (p = 0.01, odds ratio = 0.452). Post-traumatic stress disorder is a common disorder in children after a disaster. Although some can recover shortly after an incident, others develop symptoms one month after the incident. Age is a risk factor that can lead to the development of PTSD.

Effects of Psycho-educational Intervention on Post-traumatic Stress Disorder Symptoms among Secondary School Students Exposed to Conflict in Kano Metropolis, Nigeria

&lt;p style="text-align:justify"&gt;Insurgency and armed conflict in Northern Nigeria especially Kano metropolis have exposed many secondary school students to trauma related experiences and post-traumatic stress disorder (PTSD). It is estimated that about 13,000 persons have been killed and about 981,416 internally displaced persons (IDPs) are living in the various camps in Northern Nigeria (NEMA, 2015). The profound impact of the trauma experienced by these students on their mental health informed the need for the psycho-education intervention. The objective of this study was to determine the effects of psycho-educational intervention on PTSD symptoms among secondary school students exposed to conflict in Kano metropolis and to examine the effects of psycho-education intervention in reduction of re-experiencing, hyper-arousal and avoidance symptoms. A pre-test and post-test control group design was adopted for this study. A sample of 40 research participants (male=19, female=21) were selected for the study. These research participants were drawn from secondary schools clustered within the community where conflicts have taken place. The instrument for data collection was the adapted version of the University of California at Los Angeles post-traumatic stress Disorder Reaction Index (UCLA PTSD Reaction Index). The UCLA PTSD Reaction Index measured PTSD symptoms. Result obtained after testing the hypotheses showed that there was a significant difference in the PTSD mean scores of students exposed to psychoeducational intervention (Mean= 22.40, Standard deviation = 4.47, Standard error = .998) and those not exposed to the intervention (Mean = 38.90, Standard deviation = 14.835, Standard error = 3.317), t (38) = -4.763, p &lt; .0001 (two-tailed), Effect size is r = .61. It is important to provide professional and psychosocial support to students who developed mental health problems due to exposure to conflict.&lt;/p&gt;

Posttraumatic Stress Disorder and executive dysfunction among children and adolescents: A Latent Profile Analysis

Background/ObjectiveThe current study aimed to examine the relationship between Posttraumatic Stress Disorder (PTSD) symptoms and executive dysfunction in children and adolescents after psychological trauma. MethodParticipants were 13,438 of children and adolescents aged 6 to 18 years exposed to the 2008 Wenchuan earthquake. PTSD and dysexecutive symptoms were assessed using the UCLA PTSD Reaction Index for Children and the Self-Report Dysexecutive Questionnaire. Latent Profile Analysis (LPA) was conducted using Mplus version 7.4. Subgroup differences in trauma exposure and quality of life were calculated using ANCOVA. ResultsA 4-class parallel model was found to best describe latent PTSD symptom profiles and executive dysfunction. Individuals in higher symptom groups showed more trauma exposure and lower quality of life. ConclusionsThis LPA study shed light on the relationship between PTSD and executive dysfunction symptoms in children and adolescents. The correlation between PTSD and executive dysfunction was maintained after individual differences were taken into consideration. Our findings provide a new view on how PTSD relates to executive dysfunction and several suggestions for treating child and adolescent PTSD patients.