Hiller Rachel M, Meiser-Stedman Richard, Elliott Elizabeth, Banting Rosie, Halligan Sarah L
Department of Psychology, University of Bath, Bath, UK.
Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, UK.
J Child Psychol Psychiatry. 2021 Jan;62(1):48-57. doi: 10.1111/jcpp.13232. Epub 2020 Mar 20.
Young people in out-of-home care are substantially more likely to meet criteria for PTSD than their peers, while their early maltreatment exposure may also place them at greater risk of developing the newly proposed complex PTSD. Yet, there remains limited empirical evidence for the mechanisms that might drive either PTSD or complex features in this group, and ongoing debate about the suitability of existing cognitive behavioural models and their related NICE-recommended treatments. In a prospective study of young people in out-of-home care, we sought to identify demographic and cognitive processes that may contribute to the maintenance of both PTSD symptom and complex features.
We assessed 120 10- to 18-year-olds in out-of-home care and their primary carer at two assessments: an initial assessment and 12-month follow-up. Participants completed questionnaires on trauma history, PTSD symptoms and complex features, while young people only also self-reported on trauma-related (a) maladaptive appraisals, (b) memory quality and (c) coping. Social workers reported on maltreatment severity.
Young people's maltreatment severity was not a robust predictor of either PTSD symptoms or complex features. All three cognitive processes were moderately-to-strongly correlated with baseline and 12-month PTSD symptoms and complex features, with maladaptive appraisals the most robust unique driver of both, even when controlling for initial PTSD symptom severity.
Existing cognitive models of PTSD are applicable in this more complex sample of young people. The model was also found to be applicable to the additional features of complex PTSD, with the same processes driving both outcomes at both time points. Clinical implications are discussed.
与同龄人相比，接受院外照料的年轻人患创伤后应激障碍（PTSD）的可能性要高得多，而他们早年遭受的虐待也可能使他们更易患上新提出的复杂性创伤后应激障碍。然而，对于可能导致该群体出现PTSD或复杂性特征的机制，实证证据仍然有限，关于现有认知行为模型及其相关的英国国家卫生与临床优化研究所（NICE）推荐治疗方法的适用性也存在持续的争论。在一项针对接受院外照料的年轻人的前瞻性研究中，我们试图确定可能导致PTSD症状和复杂性特征持续存在的人口统计学和认知过程。
我们在两次评估中对120名10至18岁接受院外照料的青少年及其主要照料者进行了评估：一次初始评估和12个月的随访。参与者完成了关于创伤史、PTSD症状和复杂性特征的问卷，而青少年还自行报告了与创伤相关的（a）适应不良的评估、（b）记忆质量和（c）应对方式。社会工作者报告了虐待的严重程度。
青少年遭受虐待的严重程度并非PTSD症状或复杂性特征的有力预测因素。所有这三个认知过程与基线及12个月时的PTSD症状和复杂性特征均呈中度至高度相关，即使在控制初始PTSD症状严重程度的情况下，适应不良的评估仍是两者最有力的独特驱动因素。
现有的PTSD认知模型适用于这个更复杂的青少年样本。该模型也被发现适用于复杂性PTSD的附加特征，相同的过程在两个时间点驱动了这两种结果。文中讨论了临床意义。
