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Latent classes of adolescent posttraumatic stress disorder predict functioning and disorder after 1 year
E2
Abstracts / Comprehensive Psychiatry 52 (2011) E1–E18
Funding Source: The Longitudinal Investigation of Bipolar Spectrum Project is supported by the National Institute of Mental Health grants 52617, 52662, and 77908. doi:10.1016/j.comppsych.2011.04.009 Latent classes of adolescent posttraumatic stress disorder predict functioning and disorder after 1 year L. Ayer a, C.K. Danielson b, A.B. Amstadter c, K. Ruggiero b, B. Saunders b, D. Kilpatrick b a Vermont Center for Children, Youth, & Families Department of Psychiatry University of Vermont b National Crime Victims Research & Treatment Center Department of Psychiatry & Behavioral Sciences Medical University of South Carolina c Virginia Institute for Psychiatric & Behavioral Genetics Department of Psychiatry Virginia Commonwealth University Introduction: The aims were to identify latent classes of posttraumatic stress disorder (PTSD) symptoms in a national sample of adolescents and test their associations with PTSD and functional impairment 1 year later. Method: A total of 1119 trauma-exposed adolescents ages 12 to 17 (mean = 14.99, 51% female) participating in the National Survey of Adolescents– Replication were included in this study. Telephone interviews were conducted to assess PTSD symptoms and functional impairment at Waves 1 and 2. Results: Latent class analysis revealed 3 classes of adolescent PTSD at each time point: pervasive disturbance, intermediate disturbance, and no disturbance. Three numbing and 2 hyperarousal symptoms best distinguished the pervasive and intermediate disturbance classes at Wave 1. Three reexperiencing, 1 avoidance, and 1 hyperarousal symptom best distinguished these classes at Wave 2. The Wave 1 intermediate disturbance class was less likely to have a PTSD diagnosis, belong to the Wave 2 pervasive disturbance class, and report functional impairment 1 year later compared with the Wave 1 pervasive disturbance class. The Wave 1 no disturbance class was less likely to have PTSD, belong to the pervasive disturbance class, and report functional impairment at Wave 2. Conclusions: This study suggests that PTSD severity-distinguishing symptoms change substantially in adolescence and are not characterized by the numbing cluster, contrary to studies on adult samples. These results may help to explain inconsistent factor analytic findings on the structure and diagnosis of PTSD and emphasize that developmental context is critical to consider in both research and clinical work on PTSD assessment and diagnosis. Public Health Relevance: Accurate and developmentally sensitive characterization of PTSD symptoms and their associations with clinically relevant longitudinal outcomes is critical for effective assessment, prevention, and treatment of the disorder in trauma-exposed youth. Funding: This research was supported by the National Institute of Child Health and Human Development grant 1R01 HD046830-01 (Dean G Kilpatrick, principal investigator). The preparation of this article was partially supported by grant K23DA018686 (PI: CK Danielson) and grant R21MH086313 (PI: CK Danielson). doi:10.1016/j.comppsych.2011.04.010 Sleep disturbance moderates the relationship between PTSD symptomatology and aggression J.B. Barnes a, B.D. Dickstein a,c, A.B. Adler d, B.T. Litz a,b a National Center for PTSD, VA Boston Healthcare System b Boston University School of Medicine c Boston University Department of Psychology, Boston, MA d US Army Medical Research Unit–Europe and Walter Reed Institute of Research Introduction: Sleep disturbance and irritability are symptoms of PTSD that are particularly prevalent among veterans exposed to combat trauma (Brown & Boudewyne, 1996; Novaco & Chemtob, 1998). Although previous research with nonmilitary samples suggests that sleep disturbance and
anger-related problems are positively related (Ireland & Culpin, 2006), the causal relationship between these variables has not been adequately examined within the context of PTSD. Accordingly, we sought to examine the moderating effect of sleep disturbance on the relationship between PTSD and aggressive behavior using longitudinal data. Methods: Data were collected from 257 US soldiers deployed on a NATOled peacekeeping mission to Kosovo. Participants completed questionnaires near the end of a 6-month deployment and 8 to 9 months postdeployment. PTSD symptom severity was measured at deployment using the PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993). Aggressive behavior was measured at postdeployment using a 9-item revised version of the Conflict Tactics Scale (CTS; Straus, 1979). Sleep disturbance was also measured at postdeployment by asking participants to estimate the amount of sleep they received per night, on average, the week before assessment. Results: A significant interaction effect (B = −.009, SE B = .043, P = .015) was found in which the positive relationship between PTSD and aggression was intensified by sleep disturbance. Participants who reported both high levels of PTSD symptomatology and high levels of sleep disturbance reported the highest levels of aggression. Conclusions: Because we found that aggressive behavior was highest among soldiers reporting high levels of stress symptoms and low levels of sleep, these results suggest that maintaining healthy sleep patterns after stressful events may lower aggressive behaviors among veterans experiencing symptoms of PTSD. This information contributes to the treatment of returning service members by illustrating the importance of incorporating the encouragement of healthy sleep habits into intervention approaches. Funding Source: The data come from a trial of Critical Incident Stress Debriefing, which was funded by the Military Operational Medicine, US Army Medical Research and Materiel Command. Data were collected under the Walter Reed Army Institute of Research (WRAIR) Protocol 862. doi:10.1016/j.comppsych.2011.04.011 Parental sensitivity to child distress accurately predicts PTSD symptom severity in children N. Bluestone a, A. Roberts a, A. Paradis a, A. Miller a, G. Saxe c, K. Koenen a,b a Boston, MA b Cambridge, MA c New York, NY Introduction: Parental support in the aftermath of a traumatic event is critical for a child's emotional recovery. This study focused on 2 aspects of the parent-child relationship following a traumatic event. First, we examined whether parent-child agreement, with regard to the child's acute dissociative symptoms, affects child PTSD symptom severity 3 months later. Second, we examined whether stress-related symptoms in parents affected their ability to accurately measure their child's distress. Methods: The sample is from a longitudinal study of physically injured children (PIs: Glenn Saxe and Karestan Koenen, funded by MH078928, MH063247, MH086309, and the Robert Wood Johnson Foundation). A total of 179 3- to 6-year-old children and their parents were recruited to participate in this study. Children were recruited following being admitted to the hospital for a physical injury. Two waves of data were collected over 3 months. The first wave measured the parent's assessment of their child's distress. Children were measured for dissociative symptoms and PTSD symptom severity. Parents were also measured for generalized symptoms of distress. At 3 months, children were reevaluated to track the progression of their PTSD symptom severity. All scores were normalized, and the absolute difference was calculated between the parental assessment of their child's distress and the child's own dissociation. A linear regression related the parents' own symptoms of distress with this difference. Regression models were used to determine the contributing factors of 3-month PTSD symptom severity in the child. Only the children and parents with complete data were included. Results: Lack of parent-child agreement with regard to the child's dissociation was significantly associated with child PTSD symptom severity at 3 months (R2 = .07; F1,72 = 5.98; P b .05; 95% CI, .079-.781). The
Abstracts / Comprehensive Psychiatry 52 (2011) E1–E18
Funding Source: The Longitudinal Investigation of Bipolar Spectrum Project is supported by the National Institute of Mental Health grants 52617, 52662, and 77908. doi:10.1016/j.comppsych.2011.04.009 Latent classes of adolescent posttraumatic stress disorder predict functioning and disorder after 1 year L. Ayer a, C.K. Danielson b, A.B. Amstadter c, K. Ruggiero b, B. Saunders b, D. Kilpatrick b a Vermont Center for Children, Youth, & Families Department of Psychiatry University of Vermont b National Crime Victims Research & Treatment Center Department of Psychiatry & Behavioral Sciences Medical University of South Carolina c Virginia Institute for Psychiatric & Behavioral Genetics Department of Psychiatry Virginia Commonwealth University Introduction: The aims were to identify latent classes of posttraumatic stress disorder (PTSD) symptoms in a national sample of adolescents and test their associations with PTSD and functional impairment 1 year later. Method: A total of 1119 trauma-exposed adolescents ages 12 to 17 (mean = 14.99, 51% female) participating in the National Survey of Adolescents– Replication were included in this study. Telephone interviews were conducted to assess PTSD symptoms and functional impairment at Waves 1 and 2. Results: Latent class analysis revealed 3 classes of adolescent PTSD at each time point: pervasive disturbance, intermediate disturbance, and no disturbance. Three numbing and 2 hyperarousal symptoms best distinguished the pervasive and intermediate disturbance classes at Wave 1. Three reexperiencing, 1 avoidance, and 1 hyperarousal symptom best distinguished these classes at Wave 2. The Wave 1 intermediate disturbance class was less likely to have a PTSD diagnosis, belong to the Wave 2 pervasive disturbance class, and report functional impairment 1 year later compared with the Wave 1 pervasive disturbance class. The Wave 1 no disturbance class was less likely to have PTSD, belong to the pervasive disturbance class, and report functional impairment at Wave 2. Conclusions: This study suggests that PTSD severity-distinguishing symptoms change substantially in adolescence and are not characterized by the numbing cluster, contrary to studies on adult samples. These results may help to explain inconsistent factor analytic findings on the structure and diagnosis of PTSD and emphasize that developmental context is critical to consider in both research and clinical work on PTSD assessment and diagnosis. Public Health Relevance: Accurate and developmentally sensitive characterization of PTSD symptoms and their associations with clinically relevant longitudinal outcomes is critical for effective assessment, prevention, and treatment of the disorder in trauma-exposed youth. Funding: This research was supported by the National Institute of Child Health and Human Development grant 1R01 HD046830-01 (Dean G Kilpatrick, principal investigator). The preparation of this article was partially supported by grant K23DA018686 (PI: CK Danielson) and grant R21MH086313 (PI: CK Danielson). doi:10.1016/j.comppsych.2011.04.010 Sleep disturbance moderates the relationship between PTSD symptomatology and aggression J.B. Barnes a, B.D. Dickstein a,c, A.B. Adler d, B.T. Litz a,b a National Center for PTSD, VA Boston Healthcare System b Boston University School of Medicine c Boston University Department of Psychology, Boston, MA d US Army Medical Research Unit–Europe and Walter Reed Institute of Research Introduction: Sleep disturbance and irritability are symptoms of PTSD that are particularly prevalent among veterans exposed to combat trauma (Brown & Boudewyne, 1996; Novaco & Chemtob, 1998). Although previous research with nonmilitary samples suggests that sleep disturbance and
anger-related problems are positively related (Ireland & Culpin, 2006), the causal relationship between these variables has not been adequately examined within the context of PTSD. Accordingly, we sought to examine the moderating effect of sleep disturbance on the relationship between PTSD and aggressive behavior using longitudinal data. Methods: Data were collected from 257 US soldiers deployed on a NATOled peacekeeping mission to Kosovo. Participants completed questionnaires near the end of a 6-month deployment and 8 to 9 months postdeployment. PTSD symptom severity was measured at deployment using the PTSD Checklist (PCL; Weathers, Litz, Herman, Huska, & Keane, 1993). Aggressive behavior was measured at postdeployment using a 9-item revised version of the Conflict Tactics Scale (CTS; Straus, 1979). Sleep disturbance was also measured at postdeployment by asking participants to estimate the amount of sleep they received per night, on average, the week before assessment. Results: A significant interaction effect (B = −.009, SE B = .043, P = .015) was found in which the positive relationship between PTSD and aggression was intensified by sleep disturbance. Participants who reported both high levels of PTSD symptomatology and high levels of sleep disturbance reported the highest levels of aggression. Conclusions: Because we found that aggressive behavior was highest among soldiers reporting high levels of stress symptoms and low levels of sleep, these results suggest that maintaining healthy sleep patterns after stressful events may lower aggressive behaviors among veterans experiencing symptoms of PTSD. This information contributes to the treatment of returning service members by illustrating the importance of incorporating the encouragement of healthy sleep habits into intervention approaches. Funding Source: The data come from a trial of Critical Incident Stress Debriefing, which was funded by the Military Operational Medicine, US Army Medical Research and Materiel Command. Data were collected under the Walter Reed Army Institute of Research (WRAIR) Protocol 862. doi:10.1016/j.comppsych.2011.04.011 Parental sensitivity to child distress accurately predicts PTSD symptom severity in children N. Bluestone a, A. Roberts a, A. Paradis a, A. Miller a, G. Saxe c, K. Koenen a,b a Boston, MA b Cambridge, MA c New York, NY Introduction: Parental support in the aftermath of a traumatic event is critical for a child's emotional recovery. This study focused on 2 aspects of the parent-child relationship following a traumatic event. First, we examined whether parent-child agreement, with regard to the child's acute dissociative symptoms, affects child PTSD symptom severity 3 months later. Second, we examined whether stress-related symptoms in parents affected their ability to accurately measure their child's distress. Methods: The sample is from a longitudinal study of physically injured children (PIs: Glenn Saxe and Karestan Koenen, funded by MH078928, MH063247, MH086309, and the Robert Wood Johnson Foundation). A total of 179 3- to 6-year-old children and their parents were recruited to participate in this study. Children were recruited following being admitted to the hospital for a physical injury. Two waves of data were collected over 3 months. The first wave measured the parent's assessment of their child's distress. Children were measured for dissociative symptoms and PTSD symptom severity. Parents were also measured for generalized symptoms of distress. At 3 months, children were reevaluated to track the progression of their PTSD symptom severity. All scores were normalized, and the absolute difference was calculated between the parental assessment of their child's distress and the child's own dissociation. A linear regression related the parents' own symptoms of distress with this difference. Regression models were used to determine the contributing factors of 3-month PTSD symptom severity in the child. Only the children and parents with complete data were included. Results: Lack of parent-child agreement with regard to the child's dissociation was significantly associated with child PTSD symptom severity at 3 months (R2 = .07; F1,72 = 5.98; P b .05; 95% CI, .079-.781). The