To describe the test construction procedure and evaluate the internal consistency, criterion-referenced validity, and diagnostic accuracy of the Child/Adolescent Self-Report Version of the UCLA PTSD ...Reaction Index for DSM-5 (RI-5) across 2 independent samples.
Study 1 examined the clarity, developmental appropriateness, acceptability of individual RI-5 items, and internal consistency and criterion-referenced validity of the full test. The study 1 sample included 486 youth recruited from 2 major US cities who completed the RI-5 and a measure of depression. Study 2 evaluated the reliability and diagnostic accuracy of the RI-5 in 41 treatment-seeking youth who completed the RI-5 and a "gold standard" structured diagnostic interview, the Clinician-Administered PTSD Scale for DSM-5-Child/Adolescent Version.
RI-5 total scale scores showed excellent internal consistency in the 2 samples. Study 1 provided evidence of criterion-referenced validity, in that total scale scores correlated positively with depressive symptoms. Study 2 provided evidence of diagnostic accuracy (including discriminant-groups validity). RI-5 total scores discriminated youth with from youth without PTSD as benchmarked against the structured diagnostic interview. Further, receiver operating characteristic analyses using a total score of 35 provided excellent diagnostic classification accuracy (area under the curve 0.94).
The developmental appropriateness and diagnostic accuracy of the RI-5 support its utility for clinical assessment, case conceptualization, and treatment planning in different child-serving systems, including schools, juvenile justice, child welfare, and mental health.
To evaluate the comparative effectiveness of a classroom-based psychoeducation and skills intervention (tier 1) and a school-based trauma- and grief-focused group treatment (tier 2) of a three-tiered ...mental health program for adolescents exposed to severe war-related trauma, traumatic bereavement, and postwar adversity.
A total of 127 war-exposed and predominantly ethnic Muslim secondary school students attending 10 schools in central Bosnia who reported severe symptoms of posttraumatic stress disorder (PTSD), depression, or maladaptive grief and significant impairment in school or relationships were randomly assigned to one of two experimental conditions. These included either an active-treatment comparison condition (tier 1), consisting of a classroom-based psychoeducation and skills intervention alone (n = 61, 66% girls, mean age 16.0 years, SD 1.13) or a treatment condition composed of both the classroom-based intervention and a 17-session manual-based group therapy intervention (tier 2), trauma and grief component therapy for adolescents (n = 66, 63% girls, mean age 15.9 years, SD 1.11). Both interventions were implemented throughout the school year. Distressed students who were excluded from the study due to acute risk for harm (n = 9) were referred for community-based mental health services (tier 3).
Program effectiveness was measured via reductions in symptoms of PTSD, depression, and maladaptive grief assessed at pretreatment, posttreatment, and 4-month follow-up. Analysis of mean-level treatment effects showed significant pre- to posttreatment and posttreatment to 4-month follow-up reductions in PTSD and depression symptoms in both the treatment and comparison conditions. Significant pre- to posttreatment reductions in maladaptive grief reactions were found only in the treatment condition. Analyzed at the individual case level, the percentages of students in the treatment condition who reported significant (p <.05) pre- to posttreatment reductions in PTSD symptoms (58% at posttreatment, 81% at 4-month follow-up) compare favorably to those reported in controlled treatment efficacy trials, whereas the percentages who reported significant reductions in depression symptoms (23% at posttreatment, 61% at follow-up) are comparable to, or higher than, those found in community treatment settings. Lower but substantial percentages of significant symptom reduction were found for PTSD (33% at posttreatment, 48% at follow-up) and depression symptoms (13% at posttreatment; 47% at follow-up) in students in the comparison condition. The odds of significant symptom reduction were higher for PTSD symptoms at both posttreatment and 4-month follow-up and for maladaptive grief at posttreatment (no follow-up was conducted on maladaptive grief). Rates of significantly worsened cases were generally rare in both the treatment and comparison conditions.
A three-tiered, integrative mental health program composed of schoolwide dissemination of psychoeducation and coping skills (tier 1), specialized trauma- and grief-focused intervention for severely traumatized and traumatically bereaved youths (tier 2), and referral of youths at acute risk for community-based mental health services (tier 3) constitutes an effective and efficient method for promoting adolescent recovery in postwar settings.
Most mental health services for trauma‐exposed children and adolescents were not originally developed for refugees. Information is needed to help clinicians design services to address the ...consequences of trauma in refugee populations. We compared trauma exposure, psychological distress, and mental health service utilization among children and adolescents of refugee‐origin, immigrant‐origin, and U.S.‐origin referred for assessment and treatment by U.S. providers in the National Child Traumatic Stress Network (NCTSN). We used propensity score matching to compare trauma profiles, mental health needs, and service use across three groups. Our sample comprised refugee‐origin youth (n = 60, 48.3% female, mean age = 13.07 years) and propensity‐matched samples of immigrant‐origin youth (n = 143, 60.8% female, mean age = 13.26 years), and U.S.‐origin youth (n = 140, 56.1% female, mean age = 12.11 years). On average, there were significantly more types of trauma exposure among refugee youth than either U.S.‐origin youth (p < .001) or immigrant youth (p ≤ .001). Compared with U.S.‐origin youth, refugee youth had higher rates of community violence exposure, dissociative symptoms, traumatic grief, somatization, and phobic disorder. In contrast, the refugee group had comparably lower rates of substance abuse and oppositional defiant disorder (ps ranging from .030 to < .001).This clinic‐referred sample of refugee‐origin youth presented with distinct patterns of trauma exposure, distress symptoms, and service needs that merit consideration in services planning.
Resumen
Spanish s by the Asociación Chilena de Estrés Traumático (ACET)
La mayoría de los servicios mentales para niños y adolescentes expuestos a trauma no fueron originalmente desarrollados para refugiados. Se necesita información para ayudar a los clínicos a diseñar servicios que aborden las consecuencias del trauma en poblaciones de refugiados. Comparamos la exposición al trauma, la angustia psicológica y la utilización de servicios mentales entre niños y adolescentes de grupos refugiados, inmigrantes y de origen americano para la evaluación y tratamiento por los proveedores americanos en la Red Nacional de Estrés Traumático infantil (RNETI). Usamos la puntuación de pares de propensión para comparar los perfiles de trauma, necesidades de salud mental y uso de servicios en los tres grupos. La muestra comprendió jóvenes refugiados (n = 60, 48,3% femenino, edad promedio = 13.7 años) ymuestras de pares de propensión de jóvenes inmigrantes (n = 143, 60,8%, femenino, edad promedio = 13.26 años) y jóvenes de origen americano (n = 140 56,1%, femenino, edad promedio = 12.11 años). En promedio, hubo significativamente más tipos de exposición a traumas entre los jóvenes refugiados que en los jóvenes de origen americano (p<.001) o jóvenes inmigrantes (p<.001). Comparados con los jóvenes de origen americano, los jóvenes refugiados tuvieron mayores tasas de exposición a violencia comunitaria, síntomas disociativos, duelo traumático, somatización y trastorno fóbico. En contraste, el grupo de refugiados tuvo en comparación tasas más bajas de abuso de sustancias y trastorno oposicionista desafiante (ps que van desde .030 a < .001). Esta muestra clínica referida de jóvenes refugiados presentados con patrones distintivos de exposición a trauma, síntomas de angustia y necesidades de servicio, merecen una consideración en la planificación de los servicios.
摘要
Traditional and Simplified Chinese s by AsianSTSS
Traditional Chinese
標題: 透過難民、移民及美國藉的兒童臨床樣本, 比較創傷經歷、心理需要和
心理治療服務使用模式
撮要: 大部分現有為受創兒童及青少年提供的心理治療服務都不是專為難民而設。臨床治療師需要更多數據為難民設計治療, 治理創傷對他們的影響。本研究樣本為獲美國醫療單位轉介去國家兒童創傷壓力網絡(NCTSN), 接受評估和治療的兒童及青少年。我們比較難民、移民及美國藉的兒童及青少年的創傷經歷、心理悲痛和心理治療服務的使用模式。我們利用傾向評分匹配法, 比較三組樣本的創傷剖象、心理需要和治療服務使用。樣本包括難民青少年 (n = 60, 48.3% 女性, 平均年齡 = 13.07 歲), 及採用了傾向評分匹配法的青少年移民樣本 (n = 143, 60.8% 女性, 平均年齡 = 13.26 歲), 及美國藉青少年樣本 (n = 140, 56.1% 女性, 平均年齡 = 12.11 歲)。平均來說, 相比美國藉青少年(p < .001)和青少年移民(p < .001), 難民青少年顯著地反映更多種創傷經歷。與美國藉青少年相比, 難民青少年有較高水平的社群暴力經歷、離解症狀、創傷後悲傷、軀體化和恐懼症, 但有較低水平的濫用藥物狀況和對抗性蔑視失常 (ps 值域為 .030 至 < .001)。本研究的難民青少年樣本展現明顯的創傷經歷、悲痛症狀和心理治療服務需要的模式, 醫療單位日後設計治療時值得考慮這些數據。
Simplified Chinese
标题: 透过难民、移民及美国藉的儿童临床样本, 比较创伤经历、心理需要和心理治疗服务使用模式
撮要: 大部分现有为受创儿童及青少年提供的心理治疗服务都不是专为难民而设。临床治疗师需要更多数据为难民设计治疗, 治理创伤对他们的影响。本研究样本为获美国医疗单位转介去国家儿童创伤压力网络(NCTSN), 接受评估和治疗的儿童及青少年。我们比较难民、移民及美国藉的儿童及青少年的创伤经历、心理悲痛和心理治疗服务的使用模式。我们利用倾向评分匹配法, 比较三组样本的创伤剖象、心理需要和治疗服务使用。样本包括难民青少年 (n = 60, 48.3% 女性, 平均年龄 = 13.07 岁), 及采用了倾向评分匹配法的青少年移民样本 (n = 143, 60.8% 女性, 平均年龄 = 13.26 岁), 及美国藉青少年样本 (n = 140, 56.1% 女性, 平均年龄 = 12.11 岁)。平均来说, 相比美国藉青少年(p < .001)和青少年移民(p < .001), 难民青少年显著地反映更多种创伤经历。与美国藉青少年相比, 难民青少年有较高水平的社群暴力经历、离解症状、创伤后悲伤、躯体化和恐惧症, 但有较低水平的滥用药物状况和对抗性蔑视失常 (ps 值域为 .030 至 < .001)。本研究的难民青少年样本展现明显的创伤经历、悲痛症状和心理治疗服务需要的模式, 医疗单位日后设计治疗时值得考虑这些数据。
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
We examined the underlying factor structure of the UCLA PTSD Reaction Index (PTSD‐RI) using data from 6,591 children/adolescents exposed to trauma, presenting for treatment at any of 54 National ...Child Traumatic Stress Network (NCTSN) centers. Using confirmatory factor analysis, we tested the 3‐factor DSM‐IV PTSD model, 2 separate 4‐factor models (Dysphoria vs. Emotional Numbing) and a recently conceptualized 5‐factor Dysphoric Arousal model. We found a slight, but significant advantage for the Dysphoria model over the Emotional Numbing model on the PTSD‐RI, with a difference in Bayesian information criterion (BIC) values of 81 points. As with several recent studies of adult trauma victims, we found a slight advantage for the Dysphoric Arousal model over the other models on the PTSD‐RI, with BIC differences exceeding 300 points. Retaining the Dysphoric Arousal model, we tested the convergent validity of the PTSD‐RI factors against subscales of the Trauma Symptom Checklist for Children. Supporting the convergent validity of the PTSD‐RI, in the Dysphoric Arousal model, the dysphoric arousal factor related most strongly to anger, whereas the emotional numbing factor related most strongly to depression, and anxious arousal factor related most strongly to anxiety. Results support the use of the PTSD‐RI for evaluating PTSD among youth.
Traditional and Simplified Chinese s by AsianSTSS
標題：UCLA PTSD反應指數的心理測量特徵的第二部份：全國診所轉介青少年樣本因子結構的調查結果。
撮要：從54個全國兒童創傷壓力網絡中心(NCTSN)中的一個中心內，6591位求診受創兒童中測試UCLA PTSD反應指數(PTSD‐RI)的因子結構。使用驗証因子分析，我們測試3―因子DSM‐IV PTSD模型，2個不同的4―因子模型(煩燥VS.情感麻木)，和最近構想的5―因子煩燥激發模型。煩燥模型輕微但統計上有效地勝過情感麻木模型(在PTSD―RI)，而貝葉斯信息准則(BIC)值差為81點。本研究與近年多個成人受創者研究一致地顯示煩燥激發模型比其他PTSD‐RI的模型有輕微優勝處而BIC值差是多於300點子。保留煩燥激發模型來測定PTSD‐RI因子對比兒童創傷症狀清單副量表的滙聚效力，支援PTSD‐RI的滙聚效力，「煩燥激發」因子與憤怒有強大關係，情感麻木因子則與抑鬱有最強關連，而焦慮激發因子和焦慮有最強關係。結果支持在少年中使用PTSD‐RI來評估PTSD。
标题：UCLA PTSD反应指数的心理测量特征的第二部份：全国诊所转介青少年样本因子结构的调查结果。
撮要：从54个全国儿童创伤压力网络中心(NCTSN)中的一个中心内，6591位求诊受创儿童中测试UCLA PTSD反应指数(PTSD‐RI)的因子结构。使用验证因子分析，我们测试3―因子DSM‐IV PTSD模型，2个不同的4―因子模型(烦燥VS.情感麻木)，和最近构想的5―因子烦燥激发模型。烦燥模型轻微但统计上有效地胜过情感麻木模型(在PTSD―RI)，而贝叶斯信息准则(BIC)值差为81点。本研究与近年多个成人受创者研究一致地显示烦燥激发模型比其他PTSD‐RI的模型有轻微优胜处而BIC值差是多于300点子。保留烦燥激发模型来测定PTSD‐RI因子对比儿童创伤症状清单副量表的汇聚效力，支持PTSD‐RI的汇聚效力，「烦燥激发」因子与愤怒有强大关系，情感麻木因子则与抑郁有最强关连，而焦虑激发因子和焦虑有最强关系。结果支持在少年人中使用PTSD‐RI来评估PTSD。
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
There is an increasing need to deliver effective mental health services to refugee children and adolescents across the United States; however, the evidence base needed to guide the design and ...delivery of services is nascent. We investigated the trauma history profiles, psychopathology, and associated behavioral and functional indicators among war‐affected refugee children presenting for psychological treatment. From the National Child Traumatic Stress Network's Core Data Set, 60 war‐affected refugee children were identified (51.7% males, mean age = 13.1 years, SD = 4.13). Clinical assessments indicated high rates of probable posttraumatic stress disorder (30.4%), generalized anxiety (26.8%), somatization (26.8%), traumatic grief (21.4%), and general behavioral problems (21.4%). Exposure to war or political violence frequently co‐occurred with forced displacement; traumatic loss; bereavement or separation; exposure to community violence; and exposure to domestic violence. Academic problems and behavioral difficulties were prevalent (53.6% and 44.6%, respectively); however, criminal activity, alcohol/drug use, and self‐harm were rare (all < 5.45%). These findings highlight the complex trauma profiles, comorbid conditions, and functional problems that are important to consider in providing mental health interventions for refugee children and adolescents. Given the difficulties associated with access to mental health services for refugees, both preventive and community‐based interventions within family, school, and peer systems hold particular promise.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Building upon prior research documenting differential effects of psychological maltreatment, physical, and sexual abuse on youth mental health outcomes (Spinazzola et al., 2014), the present study ...sought to clarify the relative predictive contributions of type of maltreatment compared to salient exposure characteristics. The sample included 5058 clinic-referred youth from the Core Dataset (CDS) of the National Child Traumatic Stress Network (NCTSN) with lifetime histories of exposure to one or more of three specific types of maltreatment: psychological maltreatment (PM), physical abuse (PA), and sexual abuse (SA). First, we examined variations in salient trauma characteristics (age of onset, duration of exposure, number of co-occurring trauma types, and perpetrator type and number) by maltreatment group. Second, we examined whether type of maltreatment remained associated with mental health measures after adjusting for demographic variables and trauma characteristics. Profiles for youth with PM were more severe than youth who experienced either PA or SA only. Co-occurring PM and PA was associated with the most severe trauma exposure profile and with severity of PTSD symptoms, even after adjusting for demographic and trauma characteristics. Youth exposed to SA only had a distinct trauma profile and greater PTSD symptom severity after adjusting for demographic and trauma characteristic variables. Study findings hold important implications for trauma screening, assessment, and intervention, as well as for traumatic stress research methods that extend beyond abuse-specific or cumulative-risk approaches.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK, ZRSKP
Objective
Childhood bereavement is linked to suicide‐related behaviors in adolescence and adulthood, but candidate mechanisms through which bereavement may lead to suicide‐related behaviors have not ...been explored. One candidate pathway is that grief reaction arising from bereavement lead to increased perceived burdensomeness and/or thwarted belongingness, resulting in increased suicide ideation. This cross‐sectional study of bereaved adolescents explored indirect effects between grief reactions as distal predictors, perceived burdensomeness and thwarted belongingness as proximal predictors, and suicide ideation.
Method
Participants were 58 bereaved youth, 12–17 years of age (mean = 14.21, SD = 1.65; 81.0% female; 51.7% Hispanic, 17.2% African American, and 22.4% Caucasian), and their parents/guardians seeking services at a trauma and grief specialty outpatient clinic.
Results
The indirect effect of grief reactions on suicide ideation via thwarted belongingness, but not perceived burdensomeness, was statistically significant.
Conclusions
Clinicians may wish to consider signs of thwarted belongingness as possible indicators of suicide risk among bereaved youth.
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, SIK, UILJ, UKNU, UL, UM, UPUK
We examined bereaved children's and surviving caregivers’ psychological responses following the death of the other caregiver as a function of the stated cause of death. Participants included 63 ...parentally bereaved children and 38 surviving caregivers who were assessed using self‐report instruments and in‐person interviews. Surviving caregivers reported the causes of death as resulting from sudden natural death (34.9%), illness (33.3%), accident (17.5%), and suicide (14.3%). Results revealed differences between caregiver‐reported versus child‐reported cause of death, particularly in cases of suicide. Children who lost a caregiver due to a prolonged illness exhibited higher levels of both maladaptive grief (d = 3.13) and posttraumatic stress symptoms (PTSS; d = 3.33) when compared to children who lost a caregiver due to sudden natural death (e.g., heart attack). In contrast, surviving caregivers did not differ in their levels of maladaptive grief and PTSS as a function of the cause of death; however, caregivers bereaved by sudden natural death reported higher levels of depression than those bereaved by prolonged illness (d = 1.36). Limited sample size prevented analysis of outcomes among those bereaved by suicide or accident. These findings suggest that anticipated deaths may contain etiologic risk factors for maladaptive grief and PTSS in children.
抽象
Traditional and Simplified Chinese s by AsianSTSS
標題：死亡情況重要嗎? 辨別喪親少年與哀傷有關的精神病理學中社會環境的風險。
撮要：我們檢視述說死因與經歷照顧者死亡的兒童及倖存的另一照顧者的心理反應的關係。樣本是63名喪親兒童及38名倖存照顧者，而他們會由自我報告工具和個別面見來評估。倖存照顧者敍述親人死因為：突然自然死亡(34.9%)，疾病(33.3%)，意外(17.5%)和自殺(14.3%)。結果顯示照顧者與兒童述說親人死因有出入，特別在自殺方面。對比親人突然自然死亡(如心臟病)的兒童，親人死於長期病患的兒童有更嚴重的適應不良哀傷(d=3.13)和創傷後壓力症狀(PTSS; d=3.33)。但倖存照顧者則在適應不良哀傷和PTSS方面未有此分別。親人突然自然死亡比長期疾病死亡更令倖存照顧者增加抑鬱(d=1.36)。有限的樣本數量限制關於自殺或意外死亡方面的分析。本文指出預期死亡可能是兒童適應不良哀傷和PTSS的風險因由。
标题：死亡情况重要吗? 辨别丧亲少年与哀伤有关的精神病理学中社会环境的风险。
撮要：我们检视述说死因与经历照顾者死亡的儿童及幸存的另一照顾者的心理反应的关系。样本是63名丧亲儿童及38名幸存照顾者，而他们会由自我报告工具和个别面见来评估。幸存照顾者叙述亲人死因为：突然自然死亡(34.9%)，疾病(33.3%)，意外(17.5%)和自杀(14.3%)。结果显示照顾者与儿童报告亲人死因有出入，特别在自杀方面。对比亲人突然自然死亡(如心脏病)的儿童，亲人死于长期病患的儿童有更严重的适应不良哀伤(d=3.13)和创伤后压力症状(PTSS; d=3.33)。但幸存照顾者则在适应不良哀伤和PTSS方面未有此分别。亲人突然自然死亡比长期疾病死亡更令幸存照顾者增加抑郁(d=1.36)。有限的样本数量限制关于自杀或意外死亡方面的分析。本文指出预期死亡可能是儿童适应不良哀伤和PTSS的风险因由。
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BFBNIB, DOBA, FZAB, GIS, IJS, IZUM, KILJ, NLZOH, NUK, OILJ, PILJ, PNG, SAZU, SBCE, SBMB, UILJ, UKNU, UL, UM, UPUK
Children and adolescents who experience potentially traumatic events are at risk for developing posttraumatic stress disorder (PTSD). Although psychometrically sound measures are now available to ...assess these youths, brief tools are currently needed for screening purposes. Two studies were conducted to develop and validate the UCLA PTSD Reaction Index for DSM-5-Brief Form (RI-5-BF).
Study 1 used item response theory models to derive the RI-5-BF from the UCLA PTSD Reaction Index for DSM-5 and assess its internal consistency using a sample of 486 trauma-exposed youths (mean age = 13.32 years, SD = 2.90) recruited through a practice research network. Study 2 used receiver operating characteristic analyses and diagnostic efficiency statistics to assess the discriminant-groups validity and clinical utility of the RI-5-BF in identifying children at different levels of PTSD risk using a sample of 41 treatment-seeking youths (mean age = 12.44 years, SD = 2.99).
In study 1, item response theory models identified the 11 most informative items across their respective subscales. The RI-5-BF exhibited excellent internal consistency in both studies (α > .93). In study 2, receiver operating characteristic analyses indicated that an RI-5-BF score of 21 maximized sensitivity and specificity. Moreover, diagnostic likelihood ratios across multiple levels of scores provided support for the measure's clinical utility in identifying different levels of PTSD risk.
These findings provide support for both the psychometric properties of the RI-5-BF as a brief screening measure for PTSD in children and adolescents and its utility for identifying youths meriting further assessment and consideration for treatment.
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