Latent classes of DSM-5 acute stress disorder symptoms in children after single-incident trauma: findings from an international data archive
Lonneke I. M. LenferinkMarthe R. EgbertsMarie‐Louise J. KullbergMaya G. MeentkenSarah ZimmermannYoki L. MertensAngela A. T. SchuurmansYaara SadehNancy Kassam‐AdamsAnnegret Krause-Utz
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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, based on a unique set of international data. Classifying children based on latent symptom profiles helps to identify target groups for prevention and intervention after exposure to a PTE.Keywords:
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Abstract Acute stress disorder ( ASD ) first appeared in the DSM‐IV as a diagnosis describing acute stress reactions occurring within a month following exposure to trauma. In response to accumulating evidence, DSM ‐5 no longer places the same emphasis on dissociative symptoms, and does not require a specific number of any cluster of symptoms for a diagnosis of ASD . Instead, it requires the presence of 9 of any of 14 potential symptoms of ASD , and prohibits the diagnosis until 3 days have elapsed post trauma. Although ASD predicts the onset of posttraumatic stress disorder ( PTSD ), relative to trauma‐exposed people who do not develop ASD , most individuals with PTSD do not meet ASD diagnostic criteria prior to the diagnosis of PTSD . Accordingly, the DSM ‐5 diagnosis of ASD intends to describe severe acute reactions rather than predict subsequent PTSD . Cognitive behavioral therapy reduces the rate of subsequent PTSD in individuals with ASD .
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The characteristic symptoms resulting from exposure to an extreme trauma include three clusters of symptoms: persistent experience of the traumatic event, persistent avoidance of stimuli associated with the trauma and persistent symptoms of increased arousal. Beyond the accepted clusters of symptoms for posttraumatic stress disorder exists a formation of symptoms related to exposure to extreme or prolonged stress e.g. childhood abuse, physical violence, rape, and confinement within a concentration camp. With accumulated evidence of the existence of these symptoms began a trail to classify a more complex syndrome, which included, but was not confined to the symptoms of posttraumatic stress disorder. This review addresses several subjects for study in complex posttraumatic stress disorder, which is a complicated and controversial topic. Firstly, the concept of complex posttraumatic stress disorder is presented. Secondly, the professional literature relevant to this disturbance is reviewed and finally, the authors present the polemic being conducted between the researchers of posttraumatic disturbances regarding validity, reliability and the need for separate diagnosis for these symptoms.
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The article summarises the Australian Guidelines for the Treatment of Adults with Acute Stress Disorder and Posttraumatic Stress Disorder. The Guidelines were developed jointly by the Australian Centre for Posttraumatic Mental Health and national trauma experts. The Guidelines assist psychologists in utilising the best approaches for patient care. The Guidelines will be disseminated to psychologists through a series of briefings in each State and symposia and workshops at professional conferences.
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Introduction: The ICD-11 includes a new grouping for “disorders specifically associated with stress” that contains revised descriptions of posttraumatic stress disorder (PTSD) and adjustment disorder (AjD) and new diagnoses in the form of complex PTSD (CPTSD) and prolonged grief disorder (PGD). These disorders are similar in that they each require a life event for the diagnosis; however, they have not yet been assessed together for validity within the same sample. We set out to test the distinctiveness of the four main ICD-11 stress disorders using a network analysis approach. Methods: A population-based, cross-sectional design. A nationally representative sample of adults from the Republic of Ireland aged 18 years and older (N = 1,020) completed standardized measures of PTSD, CPTSD, AjD, and PGD. A network analysis was conducted at the symptom level. Outcome measures included the International Trauma Questionnaire, the Inventory of Complicated Grief, and the International Adjustment Disorder Questionnaire. Results: Consistent with the taxonomic structure of the ICD-11, our results showed that although the four conditions clustered independently at the disorder level, the specific symptoms of PTSD, CPTSD, PGD, and AjD clustered together very strongly but more strongly than with symptoms of the other disorders. The majority (61%) of the variation in each symptom could be explained by its neighboring symptoms. The strongest transdiagnostically connecting symptom was “startle response.” Discussion/Conclusion: Mental health professionals caring for people who have experienced a range of stressors and traumatic life events can be confident in diagnosing these conditions that have clear diagnostic boundaries. Interventions addressing stress-associated disorders should be based on diagnostic assessment to ensure close fit between symptoms and treatment.
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Background: Traumatic events can lead to mental health disorders such as Acute Stress Disorder (ASD) and posttraumatic stress disorder (PTSD). ASD, measured within the first month after trauma, is used to identify individuals at risk of developing subsequent PTSD. The predictive power of full-threshold PTSD by ASD has been evaluated extensively, with varying results. The current study predicts full-threshold and subthreshold PTSD considering not only ASD Diagnosis but also the severity of ASD symptoms and the timing of their measurement post-trauma.Methods: A prospective cohort study was conducted on health workers at Saint George Hospital University Medical Center following the Beirut Port Blast in August 4th, 2020. Three waves of data collection were conducted using the ASD Scale 9-15 days, 21-27-days and the PTSD Checklist for DSM-5 6-7 months later. The study focuses on 426 individuals. Probit models were used to generate predictive values for full and subthreshold PTSD.Outcomes: Adding to the ASD diagnosis its intensity altered its ability to predict PTSD, both in its subthreshold and full-threshold forms. This effect was influenced by the timing of the assessment, and resulted in a positive predictive value of 71·29%, a negative predictive value of 95·35%, a sensitivity of 96·67%, and a specificity of 93·57%.Interpretation: ASD and its severity are good predictors of later response to trauma, including both full threshold and subthreshold PTSD. This is important to help identify which individuals may need early preventive measures after trauma. Delaying the measure of ASD can help avoid overestimating future PTSD.Funding: None.Declaration of Interest: The authors declare that there is no conflict of interest regarding the publication of this scientific manuscript.Ethical Approval: This study was approved by the Institutional Review Board (IRB) committee of the SGHUMC Faculty of Medicine, University of Balamand, Lebanon, which is registered with the U.S Office of Human Research Protections (OHRP) in the Department of Health and Human Services. "To begin the survey, participants initially responded to a few questions, including providing informed consent. If participants agreed to participate, they were prompted to provide their email address. By doing so, they would receive a PDF version of the consent form via email for their personal records.
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Objective: Certain thought control strategies for managing the intrusive symptoms of posttraumatic stress disorder (PTSD) are thought to play a key role in its onset and maintenance. Whereas measures exist for the empirical assessment of such thought control strategies in adults, relatively few studies have explored how children and adolescents manage posttraumatic intrusive phenomena. Methods: In a prospective longitudinal study of 10–16-year-olds with PTSD, who were survivors of road traffic collisions and assaults, a variety of thought control strategies were assessed in the acute phase. These included strategies thought to be protective (reappraisal, social support) as well as maladaptive (distraction, punishment, worry). Ruminative responses to the trauma were assessed at the follow-up assessment. Results: Posttraumatic stress symptoms (PTSS) at each assessment were associated with the use of punishment and reappraisal, whereas social support and rumination were associated with PTSS symptoms at follow-up. Distraction was unrelated to PTSS at any time point. Rumination accounted for variance in PTSS symptoms at follow-up, even when accounting for baseline PTSS, and was found to mediate the relationships between reappraisal and punishment at baseline and PTSS at the follow-up assessment. Conclusions: The present study found no evidence to support advocating any particular thought control strategy for managing the intrusive symptoms of PTSD in youth in the acute posttrauma phase, and raised concerns over the use of reappraisal coping strategies. The study underscores the importance of ruminative responses in the onset and maintenance of PTSD in trauma-exposed youth.
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