Psychological predictors of post-traumatic stress disorder in children and adolescents

Background The experience of trauma in childhood, for a minority of individuals, can lead to chronic and distressing symptoms of post-traumatic stress disorder (PTSD) and other mental health difficulties. Cognitive models of PTSD demonstrate key factors involved in the development of symptoms, however, research evidence regarding the role of different pre- peri- and post-trauma predictors of PTSD in children and adolescents is limited and variable. Furthermore, there is scope to understand predictors of mental health outcomes other than PTSD. With the expected publication of ICD-11 in 2018, further research is also necessary to develop our understanding of the new diagnostic category of ‘Complex PTSD’ in children and adolescents. Methods Firstly, a systematic literature review and meta-analysis was conducted, summarising the current evidence regarding the role of peritraumatic psychological risk factors in the development of PTSD. Secondly, empirical analysis of pre-existing data from a longitudinal study of children and adolescents experiencing a single-event trauma was conducted. Multiple linear regression models were used to assess four theory-derived predictive models of mental health outcomes (PTSD, CPTSD, depression and anxiety) of trauma in this sample. Results Population estimates of effect size were moderate for peritraumatic subjective threat and fear as risk factors for PTSD. Effect size estimates for peritraumatic dissociation were small, and evidence for data-driven processing was limited. The empirical study indicated that a cognitive model of predictors was most powerful in predicting the development of all four disorders following trauma, and psychosocial and objective event severity models were weak predictors of mental health outcomes. Conclusions Cognitive processes occurring during and after trauma may be valuable markers of which individuals may be at risk of developing PTSD, CPTSD, depression or anxiety after trauma. Further research of multiple predictors and outcomes of trauma is required in children and adolescents, particularly related to CPTSD

Psychological peritraumatic risk factors for post-traumatic stress disorder in children and adolescents: A meta-analytic review

Background Meta-analytic reviews concerning predictors of PTSD in children and adolescents have predominantly identified evidence relating to pre- and post-trauma risk factors; however, there is little evidence regarding peritraumatic risk factors. This paper comprised a systematic review and meta-analysis of studies exploring psychological peritraumatic risk factors for PTSD in youth. Methods Thirty-two studies were identified. Random effects meta-analyses were undertaken, with meta-regressions to explore the moderating role of study characteristics (gender, sex, timing of assessment after trauma, study quality, design and trauma type) on the size of effect of predictive factors. Results Peritraumatic subjective threat (k = 28; r = 0.37, 95% CI=0.31–0.42) yielded a medium effect size estimate, while dissociation (k = 5; r = 0.17, 95% CI=0.03–0.29) and data-driven processing (feeling muddled or confused during the trauma) (k = 2; r = 0.29, 95% CI=0.14–0.43) yielded smaller population effect size estimates for the relationship with PTSD symptoms. Perceived life threat yielded a medium sized effect (k = 12; r = 0.37, 95% CI=0.32–0.41). The relationship between subjective threat and PTSD symptoms was moderated by the percentage of female participants. Estimates of heterogeneity were high in studies assessing perceived threat and fear (I2 = 95%), but moderate and low within studies assessing dissociation and data-driven processing (I2 = 57% and 0%, respectively). Limitations Peritraumatic psychological processes were commonly assessed using single-item measures. Studies primarily concerned single-incident traumas, limiting generalisability. Conclusions Peritraumatic experiences, particularly relating to subjective threat, are important correlates of subsequent PTSD, which implicates timely assessment of these experiences in youth to inform identification of at-risk groups and implementation and design of intervention

Adolescents leaving mental health or social care services: predictors of mental health and psychosocial outcomes one year later.

BACKGROUND: UK service structure necessitates a transition out of youth services at a time of increased risk for the development and onset of mental disorders. Little is currently known about the mental health and psychosocial outcomes of leaving services at this time. The aim of this study was to determine predictors of mental health and social adjustment in adolescents leaving mental health or social care services. METHODS: A cohort (n = 53) of 17 year olds were interviewed and assessed when preparing to leave adolescent services and again 12 months later. Their mental health and psychosocial characteristics were compared to a same-age community sample group (n = 1074). RESULTS: At discharge 34 (64%) met DSM IV criteria for a current psychiatric diagnosis and only 3 (6%) participants met operational criteria for successful outcomes at follow-up. Impairments in mental health, lack of employment, education or training and low preparedness were associated with poor outcomes. CONCLUSIONS: The findings suggest the current organisation of mental health and care services may not be fit for purpose and even unwittingly contribute to persistent mental illness and poor psychosocial outcomes. A redesign of services should consider a model where the timing of transition does not fall at the most hazardous time for young people, but is sufficiently flexible to allow young people to move on when they are personally, socially and psychologically most able to succeed. Assessment of a young person's readiness to transition might also be useful. A youth focused service across the adolescent and early adult years may be better placed to avoid young people falling through the service gap created by poor transitional management.This work was completed within the NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Cambridgeshire and Peterborough (now CLAHRC East of England). The CLAHRC is hosted by the University of Cambridge and the Cambridge and Peterborough NHS Foundation Trust. This work was partially supported by a Wellcome Trust programme grant (grant no. 74296) for the ROOTS data collection awarded to Ian Goodyer.This is the final version of the article. It first appeared from BioMed Central via http://dx.doi.org/10.1186/s12913-015-0853-

Acute Stress Disorder in children and adolescents: A systematic review and meta-analysis of prevalence following exposure to a traumatic event.

Background: Acute stress disorder (ASD) was proposed to encapsulate traumatic stress reactions within the first few months of exposure to trauma. The present systematic review and meta-analysis aimed to estimate the prevalence of ASD in children and adolescents, and the extent to which assessment, demographic and trauma variables moderate this. Method: Searches of EMBASE, MEDLINE (PubMed), PsycINFO, PsycARTICLES and PILOTS were conducted to identify studies published between 1 st January 1994 and 1 st January 2018. Seventeen studies were identified as meeting inclusion criteria (N=2918 participants). Results: The pooled prevalence estimate for ASD was 16.5% (95% CI 10.6–23.4%), with considerable heterogeneity between studies (Q[16]=261.12, p < .001, I 2=95.3%). Risk of bias was unrelated to prevalence estimates. Studies that used a clinical interview (k=8) yielded a higher estimate (24.0%, 95% CI 13.8–36.0%) than those that used a questionnaire which adhered to the diagnostic algorithm for DSM-IV ASD (k=6; 6.8%, 95% CI 3.6–10.9%). Studies comprising older participants yielded greater prevalence estimates. Prevalence was significantly greater in studies where the majority of participants had been exposed to interpersonal trauma (27.9%, 95% CI 15.1–42.8%; k=5) compared to non-interpersonal trauma (12.8%, 95% CI 7.2–19.7%; k=12). Conclusions: This review suggests that a significant minority of trauma-exposed children and adolescents meet criteria for ASD (in particular youth exposed to interpersonal trauma), but the findings are limited by a large degree of heterogeneity. DSM-IV ASD-specific self-report questionnaire measures may be too insensitive for identifying youth with this disorder

The impact of the initial COVID-19 outbreak on young adults’ mental health: a longitudinal study of risk and resilience factors

Few studies assessing the effects of COVID-19 on mental health include prospective markers of risk and resilience necessary to understand and mitigate the combined impacts of the pandemic, lockdowns, and other societal responses. This population-based study of young adults includes individuals from the Neuroscience in Psychiatry Network (n = 2403) recruited from English primary care services and schools in 2012–2013 when aged 14–24. Participants were followed up three times thereafter, most recently during the initial outbreak of the COVID-19 outbreak when they were aged between 19 and 34. Repeated measures of psychological distress (K6) and mental wellbeing (SWEMWBS) were supplemented at the latest assessment by clinical measures of depression (PHQ-9) and anxiety (GAD-7). A total of 1000 participants, 42% of the original cohort, returned to take part in the COVID-19 follow-up; 737 completed all four assessments [mean age (SD), 25.6 (3.2) years; 65.4% female; 79.1% White]. Our findings show that the pandemic led to pronounced deviations from existing mental health-related trajectories compared to expected levels over approximately seven years. About three-in-ten young adults reported clinically significant depression (28.8%) or anxiety (27.6%) under current NHS guidelines; two-in-ten met clinical cut-offs for both. About 9% reported levels of psychological distress likely to be associated with serious functional impairments that substantially interfere with major life activities; an increase by 3% compared to pre-pandemic levels. Deviations from personal trajectories were not necessarily restricted to conventional risk factors; however, individuals with pre-existing health conditions suffered disproportionately during the initial outbreak of the COVID-19 pandemic. Resilience factors known to support mental health, particularly in response to adverse events, were at best mildly protective of individual psychological responses to the pandemic. Our findings underline the importance of monitoring the long-term effects of the ongoing pandemic on young adults’ mental health, an age group at particular risk for the emergence of psychopathologies. Our findings further suggest that maintaining access to mental health care services during future waves, or potential new pandemics, is particularly crucial for those with pre-existing health conditions. Even though resilience factors known to support mental health were only mildly protective during the initial outbreak of the COVID-19 pandemic, it remains to be seen whether these factors facilitate mental health in the long term

Brain-behaviour modes of covariation in healthy and clinically depressed young people

Abstract: Understanding how variations in dimensions of psychometrics, IQ and demographics relate to changes in brain connectivity during the critical developmental period of adolescence and early adulthood is a major challenge. This has particular relevance for mental health disorders where a failure to understand these links might hinder the development of better diagnostic approaches and therapeutics. Here, we investigated this question in 306 adolescents and young adults (14–24 y, 25 clinically depressed) using a multivariate statistical framework, based on canonical correlation analysis (CCA). By linking individual functional brain connectivity profiles to self-report questionnaires, IQ and demographic data we identified two distinct modes of covariation. The first mode mapped onto an externalization/internalization axis and showed a strong association with sex. The second mode mapped onto a well-being/distress axis independent of sex. Interestingly, both modes showed an association with age. Crucially, the changes in functional brain connectivity associated with changes in these phenotypes showed marked developmental effects. The findings point to a role for the default mode, frontoparietal and limbic networks in psychopathology and depression

An expanding manifold in transmodal regions characterizes adolescent reconfiguration of structural connectome organization

Funder: Canada Research Chairs; FundRef: http://dx.doi.org/10.13039/501100001804Funder: Fonds de la Recherche du Quebec – SantéFunder: Autism Research TrustFunder: Canadian Institutes of Health Research; FundRef: http://dx.doi.org/10.13039/501100000024Funder: BrainCanadaFunder: MNI-Cambridge collaborative awardAdolescence is a critical time for the continued maturation of brain networks. Here, we assessed structural connectome development in a large longitudinal sample ranging from childhood to young adulthood. By projecting high-dimensional connectomes into compact manifold spaces, we identified a marked expansion of structural connectomes, with strongest effects in transmodal regions during adolescence. Findings reflected increased within-module connectivity together with increased segregation, indicating increasing differentiation of higher-order association networks from the rest of the brain. Projection of subcortico-cortical connectivity patterns into these manifolds showed parallel alterations in pathways centered on the caudate and thalamus. Connectome findings were contextualized via spatial transcriptome association analysis, highlighting genes enriched in cortex, thalamus, and striatum. Statistical learning of cortical and subcortical manifold features at baseline and their maturational change predicted measures of intelligence at follow-up. Our findings demonstrate that connectome manifold learning can bridge the conceptual and empirical gaps between macroscale network reconfigurations, microscale processes, and cognitive outcomes in adolescent development