Anke de Haan1,2, Markus A Landolt1,2, Eiko I Fried3, Kristian Kleinke4, Eva Alisic5, Richard Bryant6, Karen Salmon7, Sue-Huei Chen8, Shu-Tsen Liu8, Tim Dalgleish9,10, Anna McKinnon11, Alice Alberici12, Jade Claxton13, Julia Diehle14, Ramón Lindauer14,15, Carlijn de Roos15, Sarah L Halligan16,17, Rachel Hiller16, Christian H Kristensen18, Beatriz O M Lobo18, Nicole M Volkmann19, Meghan Marsac20,21, Lamia Barakat22,23, Nancy Kassam-Adams21, Reginald D V Nixon24, Susan Hogan24, Raija-Leena Punamäki25, Esa Palosaari26, Elizabeth Schilpzand27, Rowena Conroy28, Patrick Smith29,30, William Yule31, Richard Meiser-Stedman32. 1. Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland. 2. Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, Zurich, Switzerland. 3. Department of Clinical Psychology, Leiden University, Leiden, The Netherlands. 4. Institute of Psychology, University of Siegen, Siegen, Germany. 5. Jack Brockhoff Child Health and Wellbeing Program, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Vic, Australia. 6. School of Psychology, University of New South Wales, Sydney, NSW, Australia. 7. School of Psychology, Victoria University of Wellington, Wellington, New Zealand. 8. Department of Psychology, National Taiwan University, Taipei, Taiwan. 9. Medical Research Council Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, UK. 10. Cambridgeshire and Peterborough NHS Foundation Trust (CPFT), Cambridge, UK. 11. Department of Psychology, Centre for Emotional Health Clinic, Macquarie University, Sydney, NSW, Australia. 12. Sussex Partnership NHS Foundation Trust, West Sussex Child and Adolescent Mental Health Service, West Sussex, UK. 13. Norfolk & Suffolk Foundation Trust, Norwich, UK. 14. Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. 15. De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands. 16. Department of Psychology, University of Bath, Bath, UK. 17. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa. 18. Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Brazil. 19. Department of Human Development, Institute of Psychology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil. 20. Kentucky Children's Hospital, University of Kentucky, Lexington, KY, USA. 21. Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, USA. 22. Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA, USA. 23. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 24. School of Psychology, Flinders University, Adelaide, SA, Australia. 25. Faculty of Social Sciences, Psychology, University of Tampere, Tampere, Finland. 26. School of Management, University of Tampere, Tampere, Finland. 27. Murdoch Childrens Research Institute, Melbourne, Vic, Australia. 28. Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Vic, Australia. 29. Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK. 30. South London and Maudsley NHS Foundation Trust, London, UK. 31. Department of Psychology, King's College London Institute of Psychiatry, London, UK. 32. Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK.
Abstract
BACKGROUND: The latest version of the International Classification of Diseases (ICD-11) proposes a posttraumatic stress disorder (PTSD) diagnosis reduced to its core symptoms within the symptom clusters re-experiencing, avoidance and hyperarousal. Since children and adolescents often show a variety of internalizing and externalizing symptoms in the aftermath of traumatic events, the question arises whether such a conceptualization of the PTSD diagnosis is supported in children and adolescents. Furthermore, although dysfunctional posttraumatic cognitions (PTCs) appear to play an important role in the development and persistence of PTSD in children and adolescents, their function within diagnostic frameworks requires clarification. METHODS: We compiled a large international data set of 2,313 children and adolescents aged 6 to 18 years exposed to trauma and calculated a network model including dysfunctional PTCs, PTSD core symptoms and depression symptoms. Central items and relations between constructs were investigated. RESULTS: The PTSD re-experiencing symptoms strong or overwhelming emotions and strong physical sensations and the depression symptom difficulty concentrating emerged as most central. Items from the same construct were more strongly connected with each other than with items from the other constructs. Dysfunctional PTCs were not more strongly connected to core PTSD symptoms than to depression symptoms. CONCLUSIONS: Our findings provide support that a PTSD diagnosis reduced to its core symptoms could help to disentangle PTSD, depression and dysfunctional PTCs. Using longitudinal data and complementing between-subject with within-subject analyses might provide further insight into the relationship between dysfunctional PTCs, PTSD and depression.
BACKGROUND: The latest version of the International Classification of Diseases (ICD-11) proposes a posttraumatic stress disorder (PTSD) diagnosis reduced to its core symptoms within the symptom clusters re-experiencing, avoidance and hyperarousal. Since children and adolescents often show a variety of internalizing and externalizing symptoms in the aftermath of traumatic events, the question arises whether such a conceptualization of the PTSD diagnosis is supported in children and adolescents. Furthermore, although dysfunctional posttraumatic cognitions (PTCs) appear to play an important role in the development and persistence of PTSD in children and adolescents, their function within diagnostic frameworks requires clarification. METHODS: We compiled a large international data set of 2,313 children and adolescents aged 6 to 18 years exposed to trauma and calculated a network model including dysfunctional PTCs, PTSD core symptoms and depression symptoms. Central items and relations between constructs were investigated. RESULTS: The PTSD re-experiencing symptoms strong or overwhelming emotions and strong physical sensations and the depression symptom difficulty concentrating emerged as most central. Items from the same construct were more strongly connected with each other than with items from the other constructs. Dysfunctional PTCs were not more strongly connected to core PTSD symptoms than to depression symptoms. CONCLUSIONS: Our findings provide support that a PTSD diagnosis reduced to its core symptoms could help to disentangle PTSD, depression and dysfunctional PTCs. Using longitudinal data and complementing between-subject with within-subject analyses might provide further insight into the relationship between dysfunctional PTCs, PTSD and depression.
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