Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria.
Department of Clinical and Health Psychology, University of Vienna, Vienna, Austria
BMJ Open. 2023 Aug 1;13(8):e067860. doi: 10.1136/bmjopen-2022-067860.
Foster children are disproportionately exposed to complex trauma, which may lead to multifaceted impairments that manifest in comorbid emotional and behavioural problems. As little is known about the interactions between comorbid disorders over time, the present study aims to explore the co-development of traumatic stress (TS) symptoms and externalising behaviour problems (EBP), as well as the influence of complex trauma operationalised as cumulative child maltreatment (CM).
As part of a 3-year longitudinal study, children from six foster care facilities in Lower Austria were interviewed at three measurement points.
Of, in total, 263 participating children, the data of 124 children aged 10-18 years (M=13.5, 28% female) could be analysed.
Latent growth curve models were used to examine the co-development of TS symptoms (International Trauma Questionnaire) and EBP (Child Behaviour Checklist) over time; gender, age and cumulative CM (Childhood Trauma Questionnaire) acted as time-invariant covariates.
While average TS symptoms decreased over time, EBP remained stable. Findings revealed that the initial severity of EBP was both related to the initial severity of TS symptoms and predictive of their rate of change. Cumulative CM was a significant predictor of initial TS symptoms and EBP even after controlling for age and gender, but not for the rates of change.
Taken together, our results indicate that EBP and TS symptoms are not only cross-sectionally associated but interact with each other over time. Furthermore, an underlying complex trauma could at least partly determine the severity of the two symptom groups. In accordance with a trauma-informed care approach, our study highlights the importance of trauma-specific screening of high-risk children with complex or diffuse symptoms and argues for the benefits of treatments that focus on improving emotion regulation and social skills in addition to addressing trauma.
寄养儿童不成比例地遭受复杂创伤，这可能导致多种功能障碍，表现为情绪和行为问题共病。由于人们对共病障碍随时间的相互作用知之甚少，本研究旨在探讨创伤后应激症状（TS）和外化行为问题（EBP）的共同发展，以及作为累积儿童虐待（CM）的复杂创伤的影响。
作为一项为期 3 年的纵向研究的一部分，来自下奥地利州六家寄养机构的儿童在三个测量点接受了访谈。
在总共 263 名参与的儿童中，有 124 名 10-18 岁（M=13.5，28%为女性）的儿童的数据可以进行分析。
潜增长曲线模型用于研究 TS 症状（国际创伤问卷）和 EBP（儿童行为检查表）随时间的共同发展；性别、年龄和累积 CM（儿童创伤问卷）作为时间不变协变量。
虽然平均 TS 症状随时间逐渐下降，但 EBP 保持稳定。研究结果表明，EBP 的初始严重程度与 TS 症状的初始严重程度有关，并且可以预测其变化率。即使在控制年龄和性别后，累积 CM 仍然是 TS 症状和 EBP 的一个重要预测因素，但不是变化率的预测因素。
综上所述，我们的研究结果表明，EBP 和 TS 症状不仅是横断面相关的，而且随着时间的推移相互作用。此外，潜在的复杂创伤至少可以部分决定这两个症状群的严重程度。根据以创伤为中心的护理方法，我们的研究强调了对具有复杂或弥漫性症状的高危儿童进行创伤特异性筛查的重要性，并认为除了治疗创伤外，还应注重提高情绪调节和社会技能的治疗方法的好处。
