Latent classes of DSM-5 acute stress disorder symptoms in children after single-incident trauma: findings from an international data archive

Background: After a potentially traumatic event (PTE), children often show symptoms of acute stress disorder (ASD), which may evolve into posttraumatic stress (PTS) disorder. A growing body of literature has employed latent class analysis (LCA) to disentangle the complex structure underlying PTS symptomatology, distinguishing between homogeneous subgroups based on PTS presentations. So far, little is known about subgroups or classes of ASD reactions in trauma-exposed children. Objective: Our study aimed to identify latent classes of ASD symptoms in children exposed to a single-incident PTE and to identify predictors of class membership (gender, age, cultural background, parental education, trauma type, and trauma history). Method: A sample of 2287 children and adolescents (5–18 years) was derived from the Prospective studies of Acute Child Trauma and Recovery (PACT/R) Data Archive, an international archive including studies from the USA, UK, Australia, and Switzerland. LCA was used to determine distinct subgroups based on ASD symptoms. Predictors of class membership were examined using a three-step approach. Results: Our LCA yielded a three-class solution: low (42%), intermediate (43%) and high (15%) ASD symptom severity that differed in terms of impairment and number of endorsed ASD symptoms. Compared to the low symptoms class, children in the intermediate or high severity class were more likely to be of female gender, be younger of age, have parents who had not completed secondary education, and be exposed to a road traffic accident or interpersonal violence (vs. an unintentional injury). Conclusions: These findings provide new information on children at risk for ASD after single-incident trauma,

COVID-19 Unmasked Global Collaboration Protocol: longitudinal cohort study examining mental health of young children and caregivers during the pandemic

Background: Early empirical data shows that school-aged children, adolescents and adults are experiencing elevated levels of anxiety and depression during the COVID-19 pandemic. Currently, there is very little research on mental health outcomes for young children. Objectives: To describe the formation of a global collaboration entitled, ‘COVID-19 Unmasked’. The collaborating researchers aim to (1) describe and compare the COVID-19 related experiences within and across countries; (2) examine mental health outcomes for young children (1 to 5 years) and caregivers over a 12-month period during the COVID-19 pandemic; (3) explore the trajectories/time course of psychological outcomes of the children and parents over this period and (4) identify the risk and protective factors for different mental health trajectories. Data will be combined from all participating countries into one large open access cross-cultural dataset to facilitate further international collaborations and joint publications. Methods: COVID-19 Unmasked is an online prospective longitudinal cohort study. An international steering committee was formed with the aim of starting a global collaboration. Currently, partnerships have been formed with 9 countries (Australia, Cyprus, Greece, the Netherlands, Poland, Spain, Turkey, the UK, and the United States of America). Research partners have started to start data collection with caregivers of young children aged 1–5 years old at baseline, 3-months, 6-months, and 12-months. Caregivers are invited to complete an online survey about COVID-19 related exposure and experiences, child’s wellbeing, their own mental health, and parenting. Data analysis: Primary study outcomes will be child mental health as assessed by scales from the Patient-Reported Outcomes Measurement Information System–Early Childhood (PROMIS-EC) and caregiver mental health as assessed by the Depression Anxiety Stress Scale (DASS-21). The trajectories/time course of mental health difficulties and the impact of risk and protective factors will be analysed using hierarchical linear models, accounting for nested effects (e.g. country) and repeated measures

Mother, father and child traumatic stress reactions after paediatric burn: Within-family co-occurrence and parent-child discrepancies in appraisals of child stress

Aim: The current study examined occurrence and within-family associations of traumatic stress reactions after child burn injury, while in the same model addressing the role of parents’ own symptoms in their reports of child symptoms. Methods: One-hundred children (8–18 years old), and their mothers (n = 90) and fathers (n = 74) were assessed within the first month (T1) and three months (T2) after burn. Parents and children rated child traumatic stress reactions on the Children's Responses to Trauma Inventory (CRTI) and parents rated their own reactions on the Impact of Event Scale (IES). Cross-sectional associations at the two occasions were examined using a structural equation model. Results: Occurrence of traumatic stress symptoms in the clinical range was higher in parents (T1: 24–50%; T2: 14–31%) than children (T1: 0–11%; T2: 3–5%, depending on whether children, mothers or fathers reported on symptoms). Traumatic stress symptoms of mothers at T1 and of both parents at T2 were significantly related to child self-reported symptoms. Moreover, mothers who experienced higher stress symptoms themselves gave higher ratings of their child's symptoms at both time points, while for fathers, this was only found at T2. Conclusions: The current study demonstrates the impact of pediatric burn injury on the family level, and shows simultaneous existence of within-family interrelatedness of traumatic stress and an influence of parents’ own symptoms on their perception of child symptoms. Findings highlight the need for trauma symptom screening in all family members and for considering informants’ symptoms to understand the child's functioning in particular

Parents' posttraumatic stress after burns in their school-aged child : A prospective study

OBJECTIVE: This prospective study examined the course and potential predictors of parents' posttraumatic stress symptoms (PTSS) after burn injury in their child (Age 8 to 18 years). METHOD: One hundred eleven mothers and 91 fathers, representing 118 children, participated in the study. Within the first month after the burn event and subsequently at 3, 12, and 18 months postburn, both parents completed the Impact of Event Scale (IES). Parental emotions related to the burn event and appraisal of threat to the child's life were assessed, which were investigated in a multilevel regression model. RESULTS: Within the first month postburn, 48% of the mothers and 26% of the fathers reported clinically significant PTSS (IES ≥26), which decreased to, respectively, 19% and 4% 18 months postburn. Symptoms of intrusion were mainly individually experienced, whereas parents within a couple were more similar in terms of their avoidance symptoms. The perceived life threat and feelings of guilt and anger linked to the burn event were significantly related to parental PTSS, especially in mothers. CONCLUSIONS: The results indicate that a burn event to a child has a severe (acute) psychological impact on parents and that clinical levels of PTSS may persist in a subgroup of parents. The findings underline the need to incorporate parent support in burn care, especially for mothers with a strong emotional response during the first months after the burn event. (PsycINFO Database Recor

Parents' posttraumatic stress after burns in their school-aged child : A prospective study

OBJECTIVE: This prospective study examined the course and potential predictors of parents' posttraumatic stress symptoms (PTSS) after burn injury in their child (Age 8 to 18 years). METHOD: One hundred eleven mothers and 91 fathers, representing 118 children, participated in the study. Within the first month after the burn event and subsequently at 3, 12, and 18 months postburn, both parents completed the Impact of Event Scale (IES). Parental emotions related to the burn event and appraisal of threat to the child's life were assessed, which were investigated in a multilevel regression model. RESULTS: Within the first month postburn, 48% of the mothers and 26% of the fathers reported clinically significant PTSS (IES ≥26), which decreased to, respectively, 19% and 4% 18 months postburn. Symptoms of intrusion were mainly individually experienced, whereas parents within a couple were more similar in terms of their avoidance symptoms. The perceived life threat and feelings of guilt and anger linked to the burn event were significantly related to parental PTSS, especially in mothers. CONCLUSIONS: The results indicate that a burn event to a child has a severe (acute) psychological impact on parents and that clinical levels of PTSS may persist in a subgroup of parents. The findings underline the need to incorporate parent support in burn care, especially for mothers with a strong emotional response during the first months after the burn event. (PsycINFO Database Recor

Mothers' emotions after paediatric burn injury: longitudinal associations with posttraumatic stress-and depressive symptoms

Background: A child’s burn injury is an emotional experience that places parents at risk of developing posttraumatic stress disorder (PTSD) symptoms. Although the wide range of emotions implicated in PTSD is acknowledged, longitudinal research examining changes in emotions and PTSD over time is scarce (McLean & Foa, 2017).  Objective: To examine the longitudinal relationships of mothers’ trauma-related emotions with symptoms of posttraumatic stress and depression 18 months after their child’s burn injury. Method: Mothers (n = 296) reported intensity of burn-related emotions within the first month (T1) and at 12 months postburn (T2). The Impact of Event Scale (IES) and the depression subscale of the Hospital and Anxiety Depression Scale (HADS-D) were administered at T1 and 18 months postburn (T3).  Results: Based on two Exploratory Factor Analyses (EFA), emotion variables were merged into two factors: basic emotions (fear, sadness, horror and anger) and self-conscious emotions (guilt and shame). Path analyses indicated that persistence of basic emotions (from T1 to T2) was related to persistence of posttraumatic stress- and depressive symptoms. Self-conscious emotions showed concurrent associations with posttraumatic stress-and depressive symptoms at T1 and were longitudinally related to depressive, but not posttraumatic stress, symptoms.  Conclusions: Initial high levels of basic emotions that persist appear to increase the risk of chronic posttraumatic stress and of co-occurring depressive symptoms. Over and above these relationships, self-conscious emotions are indicated to contribute to long-term depressive symptoms

Mothers' emotions after paediatric burn injury: longitudinal associations with posttraumatic stress-and depressive symptoms

Background: A child’s burn injury is an emotional experience that places parents at risk of developing posttraumatic stress disorder (PTSD) symptoms. Although the wide range of emotions implicated in PTSD is acknowledged, longitudinal research examining changes in emotions and PTSD over time is scarce (McLean & Foa, 2017).  Objective: To examine the longitudinal relationships of mothers’ trauma-related emotions with symptoms of posttraumatic stress and depression 18 months after their child’s burn injury. Method: Mothers (n = 296) reported intensity of burn-related emotions within the first month (T1) and at 12 months postburn (T2). The Impact of Event Scale (IES) and the depression subscale of the Hospital and Anxiety Depression Scale (HADS-D) were administered at T1 and 18 months postburn (T3).  Results: Based on two Exploratory Factor Analyses (EFA), emotion variables were merged into two factors: basic emotions (fear, sadness, horror and anger) and self-conscious emotions (guilt and shame). Path analyses indicated that persistence of basic emotions (from T1 to T2) was related to persistence of posttraumatic stress- and depressive symptoms. Self-conscious emotions showed concurrent associations with posttraumatic stress-and depressive symptoms at T1 and were longitudinally related to depressive, but not posttraumatic stress, symptoms.  Conclusions: Initial high levels of basic emotions that persist appear to increase the risk of chronic posttraumatic stress and of co-occurring depressive symptoms. Over and above these relationships, self-conscious emotions are indicated to contribute to long-term depressive symptoms

Mothers’ emotions after pediatric burn injury: longitudinal associations with posttraumatic stress- and depressive symptoms 18 months postburn

Background: various emotions are implicated in posttraumatic stress disorder (PTSD). Longitudinal studies examining temporal associations between emotions and posttraumatic stress may reveal who is at risk of chronic psychological problems. This study examined the longitudinal relationships of mothers’ trauma-related emotions with posttraumatic stress and depressive symptoms after pediatric burn injury.Methods: data from two cohort studies were used (n = 296). Mothers reported the intensity of burn-related emotions within the first month (T1) and 12 months postburn (T2). The Impact of Event Scale (IES) and the Hospital and Anxiety Depression Scale (HADS-D; depression subscale) were administered at T1 and 18 months postburn (T3).Results: based on two exploratory factor analyses, emotion variables were combined into acute and long-term basic emotions (fear, sadness, horror, anger) and self-conscious emotions (guilt, shame). The path model showed a positive relationship between acute and long-term basic emotions. Higher long-term basic emotions were related to persistence of posttraumatic stress and depressive symptoms. Acute self-conscious emotions showed associations with posttraumatic stress and depressive symptoms at T1 and were longitudinally related to depressive, but not posttraumatic stress, symptoms.Limitations: the posttraumatic stress measure was not based on DSM-5 PTSD criteria and results require replication using these criteria.Conclusions: this study suggests that mothers’ acute self-conscious and long-term basic emotions in relation to their child's burn injury are involved in the development of posttraumatic stress and depressive symptoms. Clinically, assessing and monitoring parents’ early posttraumatic stress, depressive symptoms and burn-related emotions may be useful to identify parents at risk

The prospective relationship between child personality and perceived parenting: Mediation by parental sense of competence

This study examined the prospective relationship between childhood Big Five personality characteristics and perceived parenting in adolescence. In addition, we investigated whether this relationship was mediated by parental sense of competence, and whether associations were different for mothers and fathers. For 274 children, teachers reported on children’s Big Five personality characteristics at Time 1, mothers and fathers reported on their sense of competence at Time 2, and the children (who had now become adolescents) rated their parents’ warmth, overreactivity and psychological control at Time 3. Mediation analysis revealed both direct and indirect effects. No differences in associations were found for perceived parenting of mothers and fathers. This study demonstrates that child personality in late childhood is significantly related to perceived parental warmth, overreactivity and psychological control in adolescence. In addition, parental sense of competence mediates the relationship between child conscientiousness and perceived parental warmth, overreactivity and psychological control

Topical Review: Medical Trauma During Early Childhood

OBJECTIVE: Early childhood is a high-risk period for exposure to traumatic medical events due to injury/illness. It is also one of the most important and vulnerable periods due to rapid development in neurobiological systems, attachment relationships, cognitive and linguistic capacities, and emotion regulation. The aim of this topical review is to evaluate empirical literature on the psychological impact of medical trauma during early childhood (0-6 years) to inform models of clinical care for assessing, preventing, and treating traumatic stress following injury/illness. METHODS: Topical review of empirical and theoretical literature on pediatric medical traumatic stress (PMTS) during early childhood. RESULTS: There are important developmental factors that influence how infants and young children perceive and respond to medical events. The emerging literature indicates that up to 30% of young children experience PMTS within the first month of an acute illness/injury and between 3% and 10% develop posttraumatic stress disorder. However, significant knowledge gaps remain in our understanding of psychological outcomes for infants and young children, identification of risk-factors and availability of evidence-based interventions for medical trauma following illness. CONCLUSIONS: This topical review on medical trauma during early childhood provides: (a) definitions of key medical trauma terminology, (b) discussion of important developmental considerations, (c) summary of the empirical literature on psychological outcomes, risk factors, and interventions, (d) introduction to a stepped-model-of-care framework to guide clinical practice, and (e) summary of limitations and directions for future research