Using clinical expertise and empirical data in constructing networks of trauma symptoms in refugee youth

Background: In recent years, many adolescents have fled their home countries due to war and human rights violations, consequently experiencing various traumatic events and putting them at risk of developing mental health problems. The symptomatology of refugee youth was shown to be multifaceted and often falling outside of traditional diagnoses. Objective: The present study aimed to investigate the symptomatology of this patient group by assessing the network structure of a wide range of symptoms. Further, we assessed clinicians’ perceptions of symptoms relations in order to evaluate the clinical validity of the empirical network. Methods: Empirical data on Post-Traumatic Stress Disorder (PTSD), depression and other trauma symptoms from N = 366 refugee youth were collected during the routine diagnostic process of an outpatient centre for refugee youth in Germany. Additionally, four clinicians of this outpatient centre were asked how they perceive symptom relations in their patients using a newly developed tool. Separate networks were constructed based on 1) empirical symptom data and 2) clinicians’ perceived symptom relations (PSR). Results: Both the network based on empirical data and the network based on clinicians’ PSR showed that symptoms of PTSD and depression related most strongly within each respective cluster (connected mainly via sleeping problems), externalizing symptoms were somewhat related to PTSD symptoms and intrusions were central. Some differences were found within the clinicians’ PSR as well as between the PSR and the empirical network. Still, the general PSR-network structure showed a moderate to good fit to the empirical data. Conclusion: Our results suggest that sleeping problems and intrusions play a central role in the symptomatology of refugee children, which has tentative implications for diagnostics and treatment. Further, externalizing symptoms might be an indicator for PTSD-symptoms. Finally, using clinicians’ PSR for network construction offered a promising possibility to gain information on symptom networks and their clinical validity

Depression among refugee youth in an outpatient healthcare center—prevalence and associated factors

BackgroundDue to armed conflict and other crises, many children worldwide have to flee their home country and are, consequently, at a high risk for mental health problems.ObjectiveAs the majority of previous research on refugee minors focused on post-traumatic stress disorder (PTSD), we aimed to assess the prevalence and risk factors for depression in a clinical sample of refugee youth.MethodsData were collected during the standard diagnostic process in an outpatient refugee clinic in Germany. We assessed the prevalence of depression based on a diagnostic interview and investigated the association between age, gender, duration of flight, accompanying status, number of interpersonal traumatic experiences, residence status, and PTSD diagnosis with a depression diagnosis. More specifically, we conducted a Bayesian logistic regression with these associated factors as predictors and the presence of depression as the outcome. Additionally, we conducted a Bayesian network analysis including all these variables.ResultsThe majority of the 575 included refugee children were male (n = 423, 73.6%) and, on average, 15.1 years old (SD = 2.69). Nearly half of the children (n = 243, 42.3%) met the diagnostic criteria for depression, of which most also showed a comorbid PTSD diagnosis. We found strong evidence that age, gender, number of traumatic experiences, and a diagnosis of PTSD were related to depression. The network analysis indicated that only age, gender, and PTSD were directly associated to depression. Flight-related factors were only indirectly associated with depression due to their associations with number of traumatic experiences and PTSD diagnosis.ConclusionThe high prevalence of depression and its strong associations with PTSD suggest that refugee minors are likely to experience depressive symptoms which might develop from PTSD symptoms. This implies a need for monitoring depressive symptoms in refugee minors, especially when these have a PTSD diagnosis

DataSheet_1_Depression among refugee youth in an outpatient healthcare center—prevalence and associated factors.pdf

BackgroundDue to armed conflict and other crises, many children worldwide have to flee their home country and are, consequently, at a high risk for mental health problems.ObjectiveAs the majority of previous research on refugee minors focused on post-traumatic stress disorder (PTSD), we aimed to assess the prevalence and risk factors for depression in a clinical sample of refugee youth.MethodsData were collected during the standard diagnostic process in an outpatient refugee clinic in Germany. We assessed the prevalence of depression based on a diagnostic interview and investigated the association between age, gender, duration of flight, accompanying status, number of interpersonal traumatic experiences, residence status, and PTSD diagnosis with a depression diagnosis. More specifically, we conducted a Bayesian logistic regression with these associated factors as predictors and the presence of depression as the outcome. Additionally, we conducted a Bayesian network analysis including all these variables.ResultsThe majority of the 575 included refugee children were male (n = 423, 73.6%) and, on average, 15.1 years old (SD = 2.69). Nearly half of the children (n = 243, 42.3%) met the diagnostic criteria for depression, of which most also showed a comorbid PTSD diagnosis. We found strong evidence that age, gender, number of traumatic experiences, and a diagnosis of PTSD were related to depression. The network analysis indicated that only age, gender, and PTSD were directly associated to depression. Flight-related factors were only indirectly associated with depression due to their associations with number of traumatic experiences and PTSD diagnosis.ConclusionThe high prevalence of depression and its strong associations with PTSD suggest that refugee minors are likely to experience depressive symptoms which might develop from PTSD symptoms. This implies a need for monitoring depressive symptoms in refugee minors, especially when these have a PTSD diagnosis.</p

Using Clinical Expertise and Empirical Data in Constructing Networks of Trauma Symptoms in Refugee Youth

Background In recent years, many adolescents have fled their home countries due to war and human rights violations, consequently experiencing various traumatic events and putting them at risk of developing mental health problems. The symptomatology of refugee youth was shown to be multifaceted and often falling outside of traditional diagnoses. The present study aims to investigate the symptomatology of this patient group by assessing the network structure of a wide range of symptoms. Further, we assess clinicians’ perceptions of symptoms relations in order to evaluate the clinical validity of the empirical network. Methods Empirical data on Post-Traumatic Stress Disorder (PTSD), depression and other trauma symptoms from N=366 refugee youth was collected during the routine diagnostic process of an outpatient centre for refugee youth in Germany. Additionally, four clinicians of this outpatient centre were asked how they perceive symptom relations in their patients using a newly developed tool. Separate networks were constructed based on 1) empirical symptom data and 2) clinicians’ perceived symptom relations (PSR). Results Both the network based on empirical data and the network based on clinicians’ PSR showed that symptoms of PTSD and depression related most strongly within each respective cluster, externalizing symptoms were weakly connected to the network and intrusions were central. Some differences were found within the clinicians’ PSR as well as between the PSR and the empirical network. Still, the general PSR-network structure showed a moderate to good fit to the empirical data. Conclusion Our results suggest that due to their limited connectedness, both central PTSD symptoms and central depression symptoms need to be targeted in treatment, with a focus on intrusions. Further, using clinicians’ PSR for network construction offered a promising possibility to gain information on symptom networks and their clinical validity

NTCU treatment increased the mitotic index of tracheal basal cells.

<p><b>(A-B</b>) Tracheal tissue sections from mice treated with vehicle or NTCU for 32 weeks were stained for K5 (green), BrdU (red) and DAPI (blue). Representative pictures from n = 4 mice per group was used. <b>(C)</b> Quantification was performed by counting BrdU⁺ nuclei throughout the trachea from proximal to distal axis and represented as % of DAPI⁺ nuclei. Statistical analyses were performed as described in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0122823#pone.0122823.g005" target="_blank">Fig 5</a>.</p

Summary of events post NTCU.

<p>A graphical representation of change in cell type frequencies in the trachea (solid line) and bronchial epithelium (dashed line) during NTCU time-course. Time points where changes are statistically significant are shown by * symbol.</p

Molecular phenotype of the cells present in NTCU-induced bronchial dysplasia.

<p>Bronchial epithelium from mice treated for 32 weeks with vehicle <b>(A-B)</b> or NTCU <b>(C-F).</b> Tissues were stained with antibodies against <b>(A)</b> CCSP (green), ACT (red) and <b>(B & C)</b> K5 (green). Expression of other basal cell markers was detected by staining with <b>(D</b>) K14 (red), <b>(E)</b> p63 (red) and K5 (green), and <b>(F)</b> nerve growth factor receptor (NGFR, red). DAPI staining (blue) in all images depicts nuclei. Representative images from 10 mice treated with vehicle or NTCU.</p