Duke University School of Medicine, Durham, NC, USA.
J Interpers Violence. 2014 Jan;29(1):3-19. doi: 10.1177/0886260513504495. Epub 2013 Oct 1.
Despite significant advances in knowledge and availability of evidence-based models for child traumatic stress, many children simply do not complete treatment. There remain notable gaps in the services research literature about treatment completion among youth, particularly those who have experienced trauma and related sequelae. This study investigated the linkages among child physical and sexual trauma, posttraumatic stress disorder (PTSD) symptomatology, and treatment completion utilizing a clinical sample drawn from a large database from community treatment centers across the United States specializing in childhood trauma. Results from regression analyses indicated that neither the experience of sexual nor physical trauma directly predicted successful treatment completion. The links between sexual trauma and treatment completion, however, were mediated by PTSD avoidance symptoms. Children and youth experiencing sexual trauma reported higher levels of avoidance symptoms that were, in turn, significantly associated with a lower likelihood of completing trauma-focused mental health treatment. Practice implications are discussed and include strategies for clinicians to intervene during pivotal points of treatment to improve rates of service utilization and treatment completion.
尽管在儿童创伤后应激障碍的知识和循证模型方面取得了重大进展，但许多儿童根本没有完成治疗。在有关青年治疗完成情况的服务研究文献中，特别是在经历创伤和相关后果的青年中，仍存在明显的差距。本研究利用来自美国各地专门从事儿童创伤的社区治疗中心的大型数据库中的临床样本，调查了儿童身体和性创伤、创伤后应激障碍（PTSD）症状与治疗完成之间的联系。回归分析的结果表明，性创伤和身体创伤的经历都不能直接预测治疗的成功完成。然而，性创伤与治疗完成之间的联系是由 PTSD 回避症状介导的。经历性创伤的儿童和青少年报告了更高水平的回避症状，而回避症状又与完成创伤聚焦型心理健康治疗的可能性显著降低相关。讨论了实践意义，包括临床医生在治疗关键时期采取干预措施的策略，以提高服务利用率和治疗完成率。
