Rebecca A. Graham

Resilience and Trajectories of Posttraumatic Stress Among Youth Exposed to Disaster

OBJECTIVE Multiple trajectories of posttraumatic stress (PTS) symptoms are hypothesized following disaster in a number of theoretical perspectives. Increasingly, those with rapidly declining, transient, or stable low symptoms are defined as resilient. This article examines trajectories to understand acute reactions to disaster, and explores the need to define resilience as more than just symptom trajectories. METHODS An urban school-based sample of youth exposed to both hurricanes Katrina and Gustav (n=141; grades 4 through 8) were assessed for PTS symptoms at 12 months and 6 months pre-Gustav (Times 1 and 2); and then again at 1 month post-Gustav (Time 3). RESULTS Data indicated that there were significant decreases in mean PTS symptoms post-Gustav, but individual trajectories were identified consistent with theory. Whereas an ostensibly resilient group was identified (stable low symptoms), results suggest that the group was heterogeneous in terms of disaster experiences, and that those with low symptoms but relatively high Katrina disaster exposure had a unique coping style. CONCLUSIONS Results provide prospective data to support theories of multiple trauma exposure trajectories, and highlight the importance of empirically identifying resilient youth in terms of both functioning and level of risk exposure in disaster samples.

Is TV Traumatic for All Youths? The Role of Preexisting Posttraumatic-Stress Symptoms in the Link Between Disaster Coverage and Stress

In youths, watching TV coverage of a disaster is associated with traumatic-stress symptoms. However, the role of predisaster symptoms in this link has not been addressed. In this study, urban-school youths who had experienced both Hurricanes Katrina and Gustav (N = 141; grades 4–8) were assessed 12 months and 6 months before Gustav and then 1 month after Gustav. The amount of TV viewing was associated with post-Gustav stress symptoms, controlling for pre-Gustav symptoms. However, pre-Gustav stress symptoms interacted with TV viewing in predicting post-Gustav symptoms such that for youths with higher preexisting symptoms, there was a stronger association between TV viewing and level of post-Gustav symptoms. The results advance the literature on the role of media coverage in stress reactions by showing that preexisting symptoms can be an important component of identifying which children are likely to be most negatively affected by TV coverage.

Memories of traumatic events in childhood fade after experiencing similar less stressful events: results from two natural experiments.

The long-term stability of youth reports of traumatic events is largely unknown. Translational animal research suggests that there may be an alteration of memories for traumatic events via memory reconsolidation processes, whereas clinical research suggests memory alteration may occur through augmentation by negative emotions. In this report, 2 natural experiments test reconsolidation model and augmentation model predictions about the course of traumatic memories in youth. Data are from 2 prospective studies that assessed reports of an initial traumatic event (Hurricane Katrina) and tested recall both pre and post a similar event (Hurricane Gustav). In the 1st (Sample 1; n = 94, initial Grade 9 followed to 11), youth were assessed at 4 time points: Times 1-3 were 13, 20, and 26 months post-Katrina and then Time 4 was 5 months post-Hurricane Gustav. In the 2nd (Sample 2; n = 141, Grades 4 through 8), youth were assessed at 12 months pre-Gustav (Time 1; 24 months post-Katrina) and then again at 1 month (Time 2) and 8 months (Time 3) post-Gustav. Those with relatively high Gustav exposure showed more stability in their reports of Katrina exposure events, whereas in those with low Gustav exposure, reports of Katrina events decreased. Time spans between recall, age, gender, symptoms of posttraumatic stress disorder, or cognitive/learning ability did not explain changes in the reports. The study provides the 1st long-term data on the consistency of youth reports of disaster-related experiences and provides initial evidence for the ecological validity of memory reconsolidation theory applied to traumatic events in youth.

Fitting Anxious Emotion-Focused Intervention into the Ecology of Schools: Results from a Test Anxiety Program Evaluation

Emotion-focused prevention and intervention efforts in schools have been promoted as a significant developmental and public health priority. This paper reports the results of a longitudinal study testing central premises of a school-based prevention model aimed at promoting positive emotional development through targeting test anxiety. Test anxiety interventions may be a practical strategy for conducting emotion-focused prevention and intervention efforts because of a natural fit within the ecology of the school setting. At-risk youth (n = 1,048) from urban public schools were screened and 325 with elevated test anxiety were offered the intervention in one of two waves (immediate intervention vs. waitlist). The intervention was associated with decreases in test anxiety, anxiety disorder, and depression symptoms. Critically, results suggest high participant satisfaction and growth curve analysis of follow-up assessments (end of the year, the next school year, and a subsequent school year) demonstrated positive developmental trajectories consistent with predictions (e.g., initial change in test anxiety predicted change in other symptoms). Findings provide evidence for the ecological validity of targeting test anxiety in school-based, emotion-focused prevention efforts.

Identifying Moderators of the Link Between Parent and Child Anxiety Sensitivity: The Roles of Gender, Positive Parenting, and Corporal Punishment

A substantial body of literature suggests that anxiety sensitivity is a risk factor for the development of anxiety problems and research has now begun to examine the links between parenting, parent anxiety sensitivity and their child’s anxiety sensitivity. However, the extant literature has provided mixed findings as to whether parent anxiety sensitivity is associated with child anxiety sensitivity, with some evidence suggesting that other factors may influence the association. Theoretically, specific parenting behaviors may be important to the development of child anxiety sensitivity and also in understanding the association between parent and child anxiety sensitivity. In this study, 191 families (n = 255 children and adolescents aged 6–17 and their parents) completed measures of child anxiety sensitivity (CASI) and parenting (APQ-C), and parents completed measures of their own anxiety sensitivity (ASI) and their parenting (APQ-P). Corporal punishment was associated with child anxiety sensitivity and the child’s report of their parent’s positive parenting behaviors moderated the association between parent and child anxiety sensitivity. The child’s gender was also found to moderate the association between parent and child anxiety sensitivity, such that there was a positive association between girls’ and their parents anxiety sensitivity and a negative association in boys. The findings advance the understanding of child anxiety sensitivity by establishing a link with corporal punishment and by showing that the association between parent and child anxiety sensitivity may depend upon the parenting context and child’s gender.

Identity Distress Among Youth Exposed to Natural Disasters: Associations with Level of Exposure, Posttraumatic Stress, and Internalizing Problems

Identity distress involves intense or prolonged upset or worry about personal identity issues including long-term goals, career choice, friendships, sexual orientation and behavior, religion, values and beliefs, and group loyalties. Research suggests that trauma exposure and subsequent posttraumatic stress disorder (PTSD) symptoms may negatively affect identity development and psychological adjustment. However, little is known about their specific associations with identity distress and internalizing problems among disaster-exposed adolescents. This study aimed to examine these associations in a sample of 325 adolescents (60% female; 89% African American) who experienced a major natural disaster and its aftermath. The results indicated that identity distress was positively associated with age, hurricane exposure, PTSD symptoms, and internalizing problems. Linear regression analyses also showed that identity distress was uniquely associated with internalizing symptoms and that there was an indirect effect of hurricane exposure on identity distress via PTSD symptoms. PTSD symptoms moderated the link between identity distress and internalizing symptoms, with a significant positive slope found for youth with more PTSD symptoms. Findings were generally consistent with previous work and predictions, and they add to the extant knowledge about identity distress by providing data on the linkages among disaster exposure, posttraumatic stress, and internalizing problems in adolescents.

Parenting Behaviors, Parent Heart Rate Variability, and Their Associations with Adolescent Heart Rate Variability

Adolescence is a potentially important time in the development of emotion regulation and parenting behaviors may play a role. We examined associations among parenting behaviors, parent resting heart rate variability, adolescent resting heart rate variability and parenting behaviors as moderators of the association between parent and adolescent resting heart rate variability. Ninety-seven youth (11–17 years; 49.5 % female; 34 % African American, 37.1 % Euro-American, 22.6 % other/mixed ethnic background, and 7.2 % Hispanic) and their parents (n = 81) completed a physiological assessment and questionnaires assessing parenting behaviors. Inconsistent discipline and corporal punishment were negatively associated with adolescent resting heart rate variability, while positive parenting and parental involvement were positively associated. Inconsistent discipline and parental involvement moderated the relationship between parent and adolescent resting heart rate variability. The findings provide evidence for a role of parenting behaviors in shaping the development of adolescent resting heart rate variability with inconsistent discipline and parental involvement potentially influencing the entrainment of resting heart rate variability in parents and their children.

Identifying trajectories of change to improve understanding of integrated health care outcomes on PTSD symptoms post disaster.

Introduction: Addressing life stressors is an important function for integrated care, especially for health care homes located in disaster prone environments. This study evaluated trajectories of change for patients with postdisaster posttraumatic stress disorder (PTSD) who were seen in integrated care. In addition to describing the results, this article provides the methods of subgroup analyses as this may be useful for others working in real-world practice. Method: Patients (N = 340) receiving services at 5 rural health clinics self-reported PTSD symptoms as part of an ongoing evaluation to study the effectiveness of integrated health. Analysis of variance was used to assess differences overtime and trajectories were identified with cluster analyses. Disaster and trauma related factors associated with these trajectories were assessed using logistic regression. Results: Significant overall decreases in PTSD symptoms overtime were found; individual trajectories were identified and include stable low, steep declines, stable high symptoms, and increasing symptoms. Stress related to disaster and the number of other traumas patients experienced correctly classified trajectory membership. Discussion: Trajectories indicate that patients have differing treatment needs and cluster analysis as an evaluation technique may be useful in identifying what treatment works and for whom. The present study addresses a major concern for health care providers serving disaster prone communities and emphasizes the importance of identifying pre incident and disaster related risk vulnerabilities that contribute to mental health outcomes. Subgroup analyses are a useful tool for developing more targeted treatment within integrated care and may be an accessible research strategy for others working in such settings.

Developmental differences in the linkages between anxiety control beliefs and posttraumatic stress in youth

Anxiety control beliefs have emerged as a trans‐diagnostic risk factor for anxiety disorders and a potential mechanism of change in cognitive and behavioral therapies. The purpose of this study was to examine the association between anxiety control beliefs and anxiety disorder symptoms following exposure to hurricanes in youth and test a developmental hypothesis about those associations.