Dagfinn Winje

Early trauma-focused cognitive-behavioural therapy to prevent chronic post-traumatic stress disorder and related symptoms: A systematic review and meta-analysis

BackgroundEarly trauma-focused cognitive-behavioural therapy (TFCBT) holds promise as a preventive intervention for people at risk of developing chronic post-traumatic stress disorder (PTSD). The aim of this review was to provide an updated evaluation of the effectiveness of early TFCBT on the prevention of PTSD in high risk populations.MethodsWe performed a systematic literature search in international electronic databases (MEDLINE, EMBASE, PsycINFO, CENTRAL, CINAHL, ISI and PILOTS) and included randomised controlled trials comparing TFCBT delivered within 3 months of trauma, to alternative interventions. All included studies were critically appraised using a standardised checklist. Two independent reviewers selected studies for inclusion and assessed study quality. Data extraction was performed by one reviewer and controlled by another. Where appropriate, we entered study results into meta-analyses.ResultsSeven articles reporting the results of five RCTs were included. All compared TFCBT to supportive counselling (SC). The study population was patients with acute stress disorder (ASD) in four trials, and with a PTSD diagnosis disregarding the duration criterion in the fifth trial. The overall relative risk (RR) for a PTSD diagnosis was 0.56 (95% CI 0.42 to 0.76), 1.09 (95% CI 0.46 to 2.61) and 0.73 (95% CI 0.51 to 1.04) at 3–6 months, 9 months and 3–4 years post treatment, respectively. A subgroup analysis of the four ASD studies only resulted in RR = 0.36 (95% CI 0.17 to 0.78) for PTSD at 3–6 months. Anxiety and depression scores were generally lower in the TFCBT groups than in the SC groups.ConclusionThere is evidence for the effectiveness of TFCBT compared to SC in preventing chronic PTSD in patients with an initial ASD diagnosis. As this evidence originates from one research team replications are necessary to assess generalisability. The evidence about the effectiveness of TFCBT in traumatised populations without an ASD diagnosis is insufficient.

Long-term outcome of trauma in adults: the psychological impact of a fatal bus accident

The psychological impact of trauma on 36 parents and spouses was examined 1 year (1989), 3 years (1991), and 5 years (1993) after a fatal school bus accident in Western Norway in 1988. The course and outcome of posttraumatic symptoms (Impact of Event Scale [IES]) and symptoms of general psychological distress (SCL-90) were examined in relation to type of trauma (loss vs. no loss) and prior exposure to trauma. A large proportion of the sample reported high levels of symptoms on SCL-90 and IES (Intrusion). No associations were observed between type of trauma and any of the symptom measures. Prior exposure to trauma did not affect the scores on IES but was associated with a sustained vulnerability for general psychological distress (SCL-90). Different trajectories of the symptoms indicate that two psychological processes may be involved in long-term adjustment to trauma.

Psychometric properties of the Norwegian version of the Childhood Trauma Questionnaire in high-risk groups

The Childhood Trauma Questionnaire--Short Form (CTQ-SF) is widely used to measure childhood abuse of all types. In the present study, we examined the psychometric properties of the Norwegian version of the instrument. The participants constituted four subsamples (n = 517): substance abusers (n = 126), psychiatric patients (n = 210), prisoners (n = 109) and adolescents in out-of-home placements (n = 72). Confirmatory factor analysis revealed a reasonable fit of the data to the original five-factor structure of the CTQ-SF. Measurement invariance was found across gender and the four subsamples. It was concluded that the Norwegian version of the CTQ-SF has acceptable psychometric properties, with good reliability and satisfactory accuracy, to assess different dimensions of childhood trauma.

Traumatic Events and Posttraumatic Reactions among Children and Adolescents in Out-of-Home Placement: A 25-Year Systematic Literature Review

The present study aims to review empirical research focusing on traumatic events and posttraumatic stress among children and adolescents in out-of-home placement and identify future directions for research. A search in PsychInfo, ISI, and PubMed for the period 1985–2010 and use of citation alerts from 2006 to 2010 yielded 27 studies meeting our inclusion criteria. The included studies applied a diversity of assessment instruments and methods. Only six studies reported when the traumatic event(s) had occurred and/or time of assessment posttrauma. The studies comprised two main categories of traumatic events: war related trauma and sexual/physical abuse. There was a male majority exposed to studies focusing on war-related trauma, and studies on sexual trauma had a female majority. Studies on war-related trauma included foster children from Africa and Asia, whereas studies on abuse trauma included mainly North American samples. The review reflects a scarcity of empirical studies with a trauma perspective in this vulnerable population.

Childhood trauma in schizophrenia spectrum disorder as compared to other mental health disorders

Abstract Background: Childhood trauma (CT) is a potential risk factor in psychosis, and the prevalence of CT may be higher in patients with psychosis compared to other mental health disorders. The aim of the study was to investigate the potential specificity of CT in psychosis. Methods: The sample consisted of 52 patients with schizophrenia spectrum disorders and 52 matched patients with other mental health disorders. CT was measured by the CTQ-SF. The groups were compared on CTQ-SF sum and subscale scores indicating rates of CT, in addition to rates of none/low vs. moderate/severe levels of CT. Results: The psychosis group had significantly higher CTQ-SF sum scores, and reported significantly higher levels of, and more severe, physical and sexual abuse and physical neglect. Also, 67.3% of the psychosis group reported ≥ 1 CT above the cut-off, compared to 38.5% in the non-psychosis group. No patients in the non-psychosis group reported ≥ 4 CT, compared to 9.6% in the psychosis group. Conclusions: Patients with psychosis reported more severe and frequent CT compared to non-psychotic patients. Our results may indicate some specificity for moderate and severe levels of physical and sexual abuse, and physical neglect, in schizophrenia spectrum disorders.

Cumulative childhood maltreatment and its dose-response relation with adult symptomatology: Findings in a sample of adult survivors of sexual abuse

In the present study, we examined the role of cumulative childhood maltreatment experiences for several health related outcomes in adulthood, including symptoms of psychological distress as well as perceived social support and hardiness. The sample comprised adult survivors of sexual abuse (N=278, 95.3% women, mean age at first abusive incident=6.4 years). One-way ANOVAs revealed a statistically significant dose-response relation between cumulative childhood maltreatment scores and self-reported symptoms of posttraumatic stress (PTSS), anxiety, depression, eating disorders, dissociation, insomnia, nightmare related distress, physical pain, emotional pain, relational problems, self-harm behaviors as well as on a measure of symptom complexity. Cumulative childhood maltreatment was also associated with lower levels of work functioning. An inverse dose-response relation was found for perceived social support and hardiness. Using a Bonferroni corrected alpha level, cumulative childhood maltreatment remained significantly associated with all outcome measures with the exception of eating disorder symptoms after controlling for abuse-related independent variables in hierarchical regression analyses. Results add to previous literature by showing that dose-response relation between cumulative childhood adversities and adult symptom outcomes could also be identified in a sample characterized by high exposure to adversities, and lends support to the notion put forth by previous authors that cumulative childhood adversities seem to be related to the severity of adult health outcomes in a rule-governed way.

Posttraumatic symptom profiles among adult survivors of childhood sexual abuse: A longitudinal study

In the present study, our aim was to examine longitudinal posttraumatic stress symptom (PTSS) trajectories in a Norwegian sample of adults who had experienced sexual abuse during childhood, and to identify predictors of PTSS-trajectory belongingness. The sample consisted of 138 adult survivors of childhood sexual abuse (96.4% women, mean age=42.9years, mean age at the first abuse=5.9 years), recruited from support centers for sexual abuse survivors. The majority (78.3%) reported penetrative abuse, and a large proportion of the sample reported that the perpetrator was a biological parent (38.4%) or someone they trusted (76.1%), reflecting a high severity level of the abusive experiences. Latent Profile Analyses revealed the best overall fit for a two PTSS-trajectories model; one trajectory characterized by sub-clinical and decreasing level of PTSS (54.9%), and the other by high and slightly decreasing level of PTSS (45.1%). Increased odds for belonging to the trajectory with clinical level symptoms was found among those who reported higher levels of exposure to other types of childhood maltreatment (OR=3.69, p=0.002), sexual abuse enforced by physical violence (OR=3.04, p=0.003) or threats (OR=2.56, p=0.014), very painful sexual abuse (OR=2.73, p=0.007), or who had experienced intense anxiety, helplessness or fear during the abuse (OR=2.97, p=0.044). Those in the trajectory with clinical level PTSS reported lower levels of perceived social support and more relational difficulties compared to those in the sub-clinical PTSS trajectory. In conclusion, different longitudinal PTSS trajectories can be found among adult survivors of childhood sexual abuse. Significant predictors of PTSS-trajectory belongingness are discussed alongside their potential implications for preventive efforts and clinical interventions.

Childhood maltreatment and adult mental health

Background: The relationship between reported childhood maltreatment and general psychological and post-traumatic distress was examined in a sample of 551 adults from different risk samples. Aims: Exposure to childhood maltreatment was assessed using the Childhood Trauma Questionnaire Short Form, which detects physical, emotional and sexual abuse and past physical and emotional neglect. Methods: The participants’ current levels of post-traumatic stress symptoms and general psychological stress symptoms were measured with the Impact of Event Scale – Revised and the Symptom Checklist 90 – Revised, respectively. Results: The results reveal a high prevalence of reported childhood maltreatment in both men and women, and the severity levels of the five types of childhood maltreatment showed significant associations with the extent of current post-traumatic and general psychological distress. Conclusion: The findings emphasize the need for appropriate procedures for identifying childhood maltreatment.

Childhood trauma in schizophrenia spectrum disorders as compared to substance abuse disorders

The prevalence of childhood trauma (CT) in schizophrenia spectrum disorders (SSDs) and substance abuse disorders (SUDs) is high. Direct comparisons of CT in these disorders are lacking, and it is not known whether there are differences in self-reported CT in SSDs as compared to SUDs. We aimed to compare the frequency, severity and types of CT in SDDs and SUDs. Patients with SSDs (n = 57) and SUDs (n = 57) were matched for age and gender. Overall levels of CT and CT subtypes were measured retrospectively by the Childhood Trauma Questionnaire Short-Form (CTQ-SF), and grouped into none/low and moderate/severe levels of CT. Group differences in CTQ-SF sum score and subscale scores, as well as differences in the severity of overall CT and CT subtypes were all non-significant. In both groups, 64.9% reported ≥ 1 subtypes of CT above cut-off. Of those who reported CT above the cut-off, 13.5% in the psychosis group reported ≥ 4 subtypes, as compared to 2.7% in the substance abuse group. We did not find statistically significant differences between SSDs and SUDs in terms of exposure to CT frequency or severity, all effect sizes were small (r < 0.15).

S3. CHILDHOOD TRAUMA AND COGNITIVE FUNCTIONING IN SCHIZOPHRENIA SPECTRUM DISORDERS: EFFECT OF FREQUENCY AND TYPE OF CHILDHOOD TRAUMA

Abstract Background Cognitive impairment is a core feature of schizophrenia spectrum disorders (SSDs). Exposure to childhood trauma (CT), defined as physical, sexual and emotional abuse, and physical and emotional neglect, has been associated with SSDs across study designs and populations. Possibly, there is a relationship between exposure to CT and cognitive impairment in individuals with SSDs. Research has shown that a history of CT may be related to decline in cognitive performance in the general population, as well as in SSDs, whereas other studies have failed to find evidence for an association between CT and cognitive impairments in patients with SSDs. Findings on the relation between CT and cognitive impairment in individuals with SSDs is not conclusive, and a minority of the studies to date have examined the effects of frequency and severity of CT subtypes in SSDs and the relation to cognitive abilities. We hypothesize that there will be a negative relationship between the frequency and severity of CT and cognitive functioning, possibly in a dose dependent matter. CT subtypes may influence this relationship. Methods The present study is part of the Bergen Psychosis project 2 (BP2), Haukeland University Hospital, Norway. Patients were recruited at the Medical University in Innsbruck, Innsbruck, Austria; Stavanger University Hospital, Stavanger, Norway; and Haukeland University Hospital, Bergen, Norway, and gave informed consent to participate. To be included, patients had to meet ICD-10 criteria for SSDs (F20-F29), be > 16 years of age, and score ≥ 4 on at least one of the psychosis items on the Positive and Negative Syndrome Scale (PANSS). Childhood trauma (physical, emotional, sexual abuse, and physical, emotional neglect) was measured by the Childhood Trauma Questionnaire Short-Form (CTQ-SF). Cognitive functioning was examined by means of a comprehensive neuropsychological test battery. The following cognitive domains were assessed: verbal and visuospatial abilities, learning, memory, attention and working memory, executive functioning, and processing speed. The assessments were completed within three months of inclusion to the study. Results The relationship between the frequency and severity of CT and cognition will be examined, in addition to the possible influence of CT subtypes. Preliminary findings will be reported. Discussion The clinical implications of our findings will be discussed.