Clinical Child Psychology Program, University of Kansas, Dole Human Development Building, 1000 Sunnyside Avenue, Lawrence, KS, 66045, USA.
Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, 02906, USA; Bradley/Hasbro Children's Research Center, E.P. Bradley Hospital, Providence, RI, USA.
Child Abuse Negl. 2021 May;115:105026. doi: 10.1016/j.chiabu.2021.105026. Epub 2021 Mar 12.
Youth in foster care are more likely than non-foster care youth to experience posttraumatic stress disorder (PTSD). While research has identified maltreatment as a risk factor for PTSD, this research remains limited because it tends to only (a) examine a single type or dimension of maltreatment and ignore the polyvictimization and heterogeneity in exposure, and (b) study this relation across a short period time or retrospectively at the end of care.
The current study used survival analysis to simultaneously examine the influence of maltreatment characteristics on the risk of receiving a PTSD diagnosis at any time in care following entry into care.
PARTICIPANTS/SETTING: 291 youth (Mean age at entry = 9.71; 53 % female; 49 % Black) in foster care and their primary caregivers from a large, Midwestern county.
Information on PTSD diagnosis was extracted from Medicaid records, and information on maltreatment and time in care was extracted from case files. Survival analysis was then used to determine the association between maltreatment and risk of PTSD diagnosis.
When examined independently, each dimension (frequency, severity) of the four maltreatment types was significantly associated with PTSD diagnosis risk (all hazard ratio's [HR] > 1.00), except sexual abuse frequency. In the comprehensive model with all dimensions examined simultaneously, only neglect frequency for youth entering care in adolescence (HR: 1.13[1.03-1.23]), and neglect severity (HR: 1.27[1.05-1.52]) and emotional abuse frequency (HR: 1.24[1.00-1.53]) for youth entering care pre-adolescence, were associated with PTSD diagnosis risk. Additionally, age of entry into care was associated with PTSD diagnosis risk (HR: 2.34[1.88-2.92]), as adolescents tended to spend fewer days in care before receiving a diagnosis.
Results suggest that researchers who study PTSD in youth in foster care should consider the entirety of youth's maltreatment exposure and the context of care to more accurately determine what aspects of youth's history contributes to receiving a PTSD diagnosis.
与非寄养青年相比，寄养青年更有可能经历创伤后应激障碍（PTSD）。虽然研究已经确定了虐待是 PTSD 的一个风险因素，但这项研究仍然有限，因为它往往只 (a) 检查单一类型或虐待维度，而忽略了暴露的多受害和异质性，以及 (b) 在短时间内或在寄养结束时回顾性地研究这种关系。
本研究使用生存分析同时研究了在进入寄养后任何时间接受 PTSD 诊断的风险与虐待特征的关系。
参与者/设置：来自一个大的中西部县的 291 名寄养青年（进入寄养时的平均年龄=9.71；53%为女性；49%为黑人）及其主要照顾者。
从医疗补助记录中提取 PTSD 诊断信息，从病例记录中提取虐待和寄养时间信息。然后使用生存分析来确定虐待与 PTSD 诊断风险之间的关系。
当单独检查时，四种虐待类型的每个维度（频率、严重程度）都与 PTSD 诊断风险显著相关（所有危害比 [HR] > 1.00），除了性虐待频率。在同时检查所有维度的综合模型中，只有青少年进入寄养时的忽视频率（HR：1.13[1.03-1.23]）、忽视严重程度（HR：1.27[1.05-1.52]）和情感虐待频率（HR：1.24[1.00-1.53]）与青少年进入寄养前的 PTSD 诊断风险相关。此外，进入寄养的年龄与 PTSD 诊断风险相关（HR：2.34[1.88-2.92]），因为青少年在接受诊断之前往往在寄养中度过的天数较少。
结果表明，研究寄养青年 PTSD 的研究人员应考虑青年受虐待的全部经历和寄养背景，以更准确地确定青年历史的哪些方面有助于接受 PTSD 诊断。
