Q1 and Q2 | 2022 Research Round Up

Here we provide summaries of nine research studies, published between January and June 2022, which provide new evidence with practical implications, highlighting a range of understudied and clinically relevant issues.

Interventions

1. The associations between caregivers’ trauma history and behaviours during trauma-focused treatment

Canale and colleagues (2022) examined whether caregivers’ trauma history, children’s baseline symptom severity and children’s distress during therapy sessions are associated with four areas of caregivers’ behaviour that are known to influence the outcome of trauma-focused cognitive behavioural therapy (TFCBT): support (parental concern, empathy, and care expressed for the child in relation to the trauma); cognitive-emotional processing (the extent to which a caregiver engages and attempts to make sense of issues related to the child’s trauma); avoidance (the attempt of the caregiver to distance or pull themselves away from trauma-related issues, cues and emotions); blame/criticism (the caregiver blaming or criticizing the child for the trauma occurrence and trauma-related difficulties). This study shows that caregivers’ trauma history and children’s level of distress during TF-CBT are associated with elevated caregivers’ behaviours known to reduce treatment efficacy, such as avoidance and blame/criticism.

Canale, C. A., Hayes, A. M., Yasinski, C., Grasso, D. J., Webb, C., & Deblinger, E. (2022). Caregiver Behaviors and Child Distress in Trauma Narration and Processing Sessions of Trauma-Focused Cognitive Behavioral Therapy (TF-CBT). Behavior therapy, 53(1), 64–79. https://doi.org/10.1016/j.beth.2021.06.001.

2. Trauma-focused treatment for children and adolescents is associated with executive function improvements

Lee and Brown (2022) examined whether trauma-focused cognitive behavioural therapy (TF-CBT) is beneficial for improving executive function skills (e.g. the explicit ability to plan, problem-solve, and manage emotional responses and behaviour) in children exposed to interpersonal childhood trauma. The results of this study suggest that TF-CBT can lead to a reduction in executive functioning difficulties in children and that such change may be associated with PTSD symptom improvements.

Lee, A. H., & Brown, E. (2022). Examining the effectiveness of trauma-focused cognitive behavioral therapy on children and adolescents’ executive function. Child abuse & neglect, 126, 105516. https://doi.org/10.1016/j.chiabu.2022.105516

3. Knowledge about a child being in foster care biases clinicians’ judgments about PTSD diagnosis and treatment decision-making

McGuire and colleagues (2022) examined whether the diagnosis of post-traumatic stress disorder (PTSD) and treatment recommendations may be influenced by
the knowledge that a young person receives statutory care.

The results of this study were consistent with previous findings showing that PTSD is often underdiagnosed in child welfare settings. Also, choosing PTSD as the primary diagnosis increased the likelihood of choosing an evidence-based treatment for PTSD. In sum, children in care may be less likely to be correctly diagnosed with PTSD, potentially preventing access to relevant trauma-focused evidence-based treatment.

McGuire, R., Halligan, S. L., Meiser-Stedman, R., Durbin, L., & Hiller, R. M. (2022). Differences in the diagnosis and treatment decisions for children in care compared to their peers: An experimental study on posttraumatic stress disorder. The British journal of clinical psychology, 61(4), 1075–1088. https://doi.org/10.1111/bjc.12379

4. A new parent-led trauma-focused intervention effectively reduces secondary mental health symptoms in children and parents following trauma exposure.

Stepped-care trauma-focused cognitive behavioural therapy (SC-TF-CBT) is a parent-led, therapist-assisted treatment developed as a potential first-step intervention. For those who do not benefit from the parent-led intervention, standard therapist-led TF-CBT is provided as the second step. Salloum and colleagues (2022) examined the effectiveness SC-TF-CBT in reducing secondary mental health outcomes in children (internalising symptoms, externalising behavioural difficulties, sleep disturbances) and their carers (post-traumatic stress symptoms, depression and parenting stress).

The authors found that improvement in all secondary outcomes was comparable for SC-TF-CBT and TF-CBT at follow-up. In sum, SC-TF-CBT was found to be a promising parent-led trauma-based intervention for reducing secondary mental health outcomes in children and parents.

Salloum, A., Lu, Y., Chen, H., Salomon, K., Scheeringa, M. S., Cohen, J. A., Swaidan, V., & Storch, E. A. (2022). Child and parent secondary outcomes in stepped care versus standard care treatment for childhood trauma. Journal of affective disorders, 307, 87–96. https://doi.org/10.1016/j.jad.2022.03.049

Impact of trauma

5. Reduced brain activity during reward and effort processing, found in children who have experienced maltreatment, predicts future depression and anxiety symptoms

Armbruster-Genç and colleagues (2022) examined whether childhood maltreatment affects the brain system responsible for deciding if potential rewards are worth the effort to obtain them.

The researchers found that a history of childhood maltreatment was associated with reduced effort-related activation of the anterior cingulated cortex (ACC), a critical brain region involved in reward processing. Moreover, this pattern of reduced brain activation among children with a history of maltreatment increased the likelihood of them experiencing higher depression and anxiety symptoms 18 months later. This is consistent with previous studies showing reduced ACC activation during effort processing in individuals with higher behavioural apathy (a common symptom in depression). In sum, following maltreatment exposure, a pattern of reduced brain response in the ACC during reward and effort processing predicts future symptoms of depression and anxiety.

Armbruster-Genç, D. J., Valton, V., Neil, L., Vuong, V., Freeman, Z. C., Packer, K. C., … & McCrory, E. (2022). Altered reward and effort processing in children with maltreatment experience: a potential indicator of mental health vulnerability. Neuropsychopharmacology, 47(5), 1063-1070. https://doi.org/10.1038/s41386-022-01284-7

6. Socio-emotional development and mental health outcomes are affected by exposure to intimate partner violence during childhood

Bender and colleagues (2022) systematically reviewed the evidence on the impact of intimate partner violence (IPV) exposure during childhood on children’s socio-emotional competence (e.g., social skills, emphatic abilities, emotion regulation).

Twenty-six studies were included (sample size, age range, gender, and ethnic
composition of each study are summarised in the article; a composite value of these variables is not available). Most studies found that a history of exposure to IPV is associated with lower social competence and emotion regulation skills in children and adolescents. There was little evidence suggesting that IPV exposure affects empathic skills. Moreover, better socio-emotional competence was shown to reduce the likelihood of poor behavioural and psychological difficulties following IPV exposure. In sum, IPV exposure can negatively influence the development of social and emotional skills which are important to resilient mental health outcomes.

Bender, A. E., McKinney, S. J., Schmidt-Sane, M. M., Cage, J., Holmes, M. R., Berg, K. A., … & Voith, L. A.
(2022). Childhood exposure to intimate partner violence and effects on social-emotional competence: A systematic review. Journal of family violence, 37(8), 1263-1281. https://doi.org/10.1007/s10896-021-00315-z

7. The impact of childhood trauma on the mental health of LGBT+ youth

Jonas and colleagues (2022) systematically reviewed and analysed the data of studies on adverse childhood experiences and mental health among LGBT+ young people.

The authors conclude that more advocacy and support are required for LGBT+ young people who experience trauma and mental health difficulties. Also, more research is needed in which participants are followed-up over time to examine how traumatic childhood experiences in LGBT+ young people impact future mental health. In sum, this systematic review and meta-analysis finds that LGBT+ young people are at greater risk of experiencing trauma as well as depression and anxiety symptoms.

Jonas, L., Salazar de Pablo, G., Shum, M., Nosarti, C., Abbott, C., & Vaquerizo‐Serrano, J. (2022). A systematic review and meta‐analysis investigating the impact of childhood adversities on the mental health of LGBT+ youth. JCPP advances, 2(2), e12079. https://doi.org/10.1002/jcv2.12079

8. The experience of traumatic events that violate moral values is associated with poor mental health outcomes in young refugees

McEwen and colleagues (2023) examined the mental health impact among young people with refugee backgrounds of traumatic events that violate important moral values (“moral injury”).

These can include a wide range of traumatic experiences, such as exposure to torture and sexual assault, leaving family members behind when fleeing persecution, witnessing sacred religious objects being defiled, or being forced to commit violent acts. Questionnaires assessed moral injury, traumatic experiences, and mental health. Consistent with findings among adults, the researchers found that young refugees experienced high levels of moral injury, discrimination, stressful life events and mental health symptoms. The experience of moral injury was associated with poor mental health, including elevated externalising, internalising and trauma-related symptoms. In sum, this study suggests that the experience of moral injury among young people with a refugee background may contribute towards an increased risk of experiencing mental health difficulties.

McEwen, C., Alisic, E., & Jobson, L. (2023). Moral injury appraisals in young people from refugee backgrounds in Melbourne, Australia. Psychological trauma : theory, research, practice and policy, 15(1), 153–162. https://doi.
org/10.1037/tra0001214

9. The ‘natural trajectory’ of depression and trauma-related symptoms after exposure to a single-incident trauma in children and adolescents

Zhang and colleagues (2022) examined how depression and post-traumatic stress symptoms (PTSS) unfold in the initial months after trauma exposure (when no therapeutic input is provided). Children and adolescents attending hospital emergency departments due to exposure to a single-incident trauma (e.g., assault, road traffic accident and accidental injury) took part in this study.

The researchers found that PTSS and depression symptoms trajectories were highly consistent. Most participants (approximately 80%), even among those who showed elevated symptoms in the initial weeks post-trauma, had PTSS and depression symptoms below clinical range at 9-month follow-up assessment.

However, while all participants had PTSS below clinical range 9 months post-trauma, 20% of participants showed clinically significant symptoms of depression throughout the study. Moreover, the researchers found that negative appraisals measured at 2 weeks (i.e. the presence of maladaptive and excessively threatening interpretations of the traumatic event and its consequences) were an important shared risk factor for elevated symptoms of both PTSS and depression. In sum, this study shows that elevated depression symptoms can persist for several months after single incident trauma exposure in a minority of untreated children.

Zhang, J., Meiser-Stedman, R., Jones, B., Smith, P., Dalgleish, T., Boyle, A., Edwards, A., Subramanyam, D., Dixon, C., Sinclaire-Harding, L., Schweizer, S., Newby, J., & McKinnon, A. (2022). Trajectory of post-traumatic
stress and depression among children and adolescents following single-incident trauma. European journal of
psychotraumatology, 13(1), 2037906. https://doi.org/10.1080/20008198.2022.2037906