Handling traumatic grief reactions in children and adolescents post-9/11
October 1, 2019
Science Daily/Elsevier
In the wake of the World Trade Center attack on September 11, 2001 (9/11), researchers defined the 'traumatically bereaved' as those who experienced the loss of a mother, father, sister, brother, grandmother, grandfather, aunt, uncle, other family member, friend, and/or someone else after 9/11 happened. A new study reports that this disorder warrants separate clinical attention.
Grief reactions in traumatically bereaved youth, particularly in relation to a shared trauma, constitute a unique aspect of psychological distress. A new study in the Journal of the American Academy of Child and Adolescent Psychiatry (JAACAP), published by Elsevier, reports that this disorder warrants separate clinical attention.
In the wake of the World Trade Center attack on September 11, 2001 (9/11), researchers from Columbia University Medical Center (CUMC), New York defined the "traumatically bereaved" as those who experienced the loss of a mother, father, sister, brother, grandmother, grandfather, aunt, uncle, other family member, friend, and/or someone else after 9/11 happened.
"Study findings support the potential clinical relevance of a new bereavement disorder during sensitive developmental periods spanning from middle childhood to late-adolescence," said lead author Lupo Geronazzo-Alman, PhD, Assistant Professor of Clinical Medical Psychology, Division of Child and Adolescent Psychiatry at the New York State Psychiatric Institute, CUMC. "Grief reactions have added clinical value and merit clinical attention, because they describe maladaptive reactions after 9/11 that are not adequately captured by other disorders such as posttraumatic stress and major depression."
The findings, based on The World Trade Center (WTC) Board of Education (WTC-BOE) Study, are comprised of responses taken from a sample of 8,236 youth in grades 4 to 12, who answered a questionnaire six months after 9/11. It is representative of 715,966 New York City (NYC) public school students at the time of assessment.
The 277 youth (3.36 percent of the sample) experienced death of a family member; 576 (6.99 percent) and 1,003 (12.18 percent) youth experienced the death of a friend and of someone else they knew, respectively. In total, 1,696 youth were traumatically bereaved on 9/11, representing 133,446 (18.71 percent) 4th- through 12th-graders attending NYC public schools 6 months after 9/11.
The following five items selected from the UCLA Grief Screening Scale queried bereaved youth about the intensity of grief reactions during the previous month: missing the deceased person; continuing to feel connected to them; avoiding conversations; avoiding activities; and unhelpful rumination about the deceased person.
Symptoms of posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) were assessed with the Diagnostic Interview Schedule for Children (DISC-IV) Predictive Scales (DPS), a screening measure derived from the DISC-IV.
To establish whether a new bereavement disorder warrants a place in psychiatric nosology, the researchers provided four types of convergent evidence showing that the (1) predictors (i.e., non-loss-related trauma versus traumatic bereavement); (2) clinical correlates (new health problems since 9/11, functional impairment); (3) factorial structure; and (4) phenomenology of grief reactions are independent of, and distinct from, other common types of post-disaster child and adolescent psychopathology, and capture a unique aspect of bereavement-related distress.
Grief reactions, PTSD, and MDD all have different predictors; traumatic bereavement was associated with grief independently of PTSD and MDD but was not associated with PTSD and MDD after adjusting for grief reactions.
After controlling for PTSD and MDD, grief reactions were significantly associated with functional impairment. Furthermore, a factor analysis showed that grief reactions loaded on one factor, which was distinct from factors underlying PTSD and MDD symptoms. Finally, youth with severe grief reactions could be grouped into two classes characterized by (i) negligible and (ii) only moderate probability of co-occurring PTSD and MDD symptoms, respectively.
"A primary benefit of including a new definition of bereavement disorder into the main text of the DSM-V will fill in a current gap in how clinicians are able to describe and explain reactions to traumatic bereavement, allowing us to better predict and prescribe the most appropriate treatment," concluded Dr. Geronazzo-Alman.
https://www.sciencedaily.com/releases/2019/10/191001084005.htm
Childhood trauma has lasting effect on brain connectivity in patients with depression
April 8, 2019
Science Daily/University of Pennsylvania School of Medicine
A study lead by Penn Medicine researchers found that childhood trauma is linked to abnormal connectivity in the brain in adults with major depressive disorder (MDD). The paper, published this week in Proceedings of the National Academy of Sciences (PNAS), is the first data-driven study to show symptom-specific, system-level changes in brain network connectivity in MDD.
"With estimates of approximately 10 percent of all children in the United States having been subjected to child abuse, the significance of child maltreatment on brain development and function is an important consideration," said Yvette I. Sheline, MD, McLure professor of Psychiatry, Radiology, and Neurology, and director of the Center for Neuromodulation in Depression and Stress (CNDS) in the Perelman School of Medicine at the University of Pennsylvania. "This study not only confirms the important relationship between childhood trauma and major depression, but also links patients' experiences of childhood trauma with specific functional brain network abnormalities. This suggests a possible environmental contributor to neurobiological symptoms."
MDD is a common mental disorder characterized by a variety of symptoms -- including persistently depressed mood, loss of interest, low energy, insomnia or hypersomnia, and more. These symptoms impair daily life and increase the risk of suicide. In addition, experiences of childhood trauma, including physical, sexual, or emotional abuse, as well as physical or emotional neglect, have been associated with the emergence and persistence of depressive and anxiety disorders. However, the neurobiological mechanisms underlying MDD are still largely unknown.
To address this challenge, a team led by Sheline utilized functional magnetic resonance imaging (fMRI) to investigate the brain networks and patterns that underlie the disorder. Researchers compared brain activity in 189 participants with MDD to activity of 39 healthy controls. First author Meichen Yu, a post-doctoral fellow in the CNDS, conducted statistical analyses to determine the associations between temporal correlations in connectivity within and between 10 well-established, large-scale resting state networks (RSNs) and clinical measures, including both past history of trauma and current clinical symptoms, such as depression, anxiety, suicidality. These symptoms were measured by 213 item-level survey questions.
The authors found that in patients with MDD, while the strongest correlations were with childhood trauma, abnormal network connectivity was also associated with current symptoms of depression. Even though participants in this study were not selected as participants based on a history of trauma, and the brain imaging took place decades after trauma occurred, prior trauma was evident in abnormal functional connectivity.
"These results suggest that resting-state network connectivity may point to some of the brain mechanisms underlying the symptoms of major depressive disorder," Sheline explains. "It may have the potential to serve as an effective biomarker, aiding in the development of depression biotypes and opening up the possibility of targeted diagnosis."
https://www.sciencedaily.com/releases/2019/04/190408161610.htm
PTSD in children quickly and effectively treatable within hours
June 29, 2017
Science Daily/Universiteit van Amsterdam (UVA)
Children and adolescents with posttraumatic stress syndrome (PTSD) can be successfully treated with only a few hours of EMDR or cognitive behavioral writing therapy (CBWT), report researchers.
PTSD is a psychiatric disorder which can develop after exposure to a traumatic event such as a terrorist attack, a road traffic accident, sexual or physical abuse. Previous research shows that PTSD can be treated effectively in adults with Eye Movement Desensitization and Reprocessing (EMDR) or trauma-focused cognitive behavioral therapy/imaginary exposure. Until now, however, strong evidence for the efficacy of EMDR in children has been lacking.
For their study, Carlijn de Roos, a clinical psychologist and UvA researcher, and her fellow researchers compared the effect of EMDR with that of Cognitive Behavioral Writing Therapy (WRITEjunior) in children and adolescents in the age group 8 to 18 who had experienced a single traumatic event like a traffic accident, rape, physical assault or traumatic loss. Both forms of treatment confront the traumatic memory without any preparatory sessions. In EMDR the traumatic memory is activated while at the same time the child's working memory is taxed with an external task (following the fingers of the therapist with the eyes). In writing therapy, the child writes a story on a computer, together with the therapist, about the event and the consequences, including all the horrid aspects of the memory. In the last session, the child shares the story of what happened to him or her with important others.
A total of 103 children and adolescents took part in the study. On average, four sessions were sufficient for successful treatment. 'EMDR and writing therapy were equally effective in reducing posttraumatic stress reactions, anxiety and depression, and behavioral problems. What's more, both proved to be brief and therefore cost effective', says De Roos. 'We literally used a stopwatch to time the length of both trauma treatments. This showed that EMDR reaches positive effects fastest (2 hours and 20 minutes on average) compared to the writing therapy (3 hours and 47 minutes on average). The most important thing, of course, was that the results were lasting, as shown during a follow-up measurement one year later.'
About 16% of children who are exposed to trauma develop PTSD. 'Children who do not get the right treatment suffer unnecessarily and are at risk of developing further problems and being re-traumatized', says De Roos. 'The challenge for health professionals is to identify symptoms of PTSD as quickly as possible and immediately refer for trauma treatment.' According to De Roos, screening for PTSD should become standard practice within the field of childcare for all disorders. 'When PTSD is determined, a brief trauma-focused treatment can significantly diminish symptoms. A brief treatment will not only reduce suffering by child and family, but also lead to tremendous healthcare savings.'
It is important to conduct follow-up research into the effects of EMDR and writing therapy in children with PTSD symptoms who have suffered from multiple traumatic experiences and in children younger than eight, De Roos adds.
https://www.sciencedaily.com/releases/2017/06/170629085311.htm