Bettale Chiara M, Pomales Melyrene, Boy Angie, Moran Tim, Agarwal Maneesha, Powers Abigail
Emory University School of Medicine, Atlanta, GA.
Department of Psychiatry & Behavioral Sciences, Emory University School of Medicine, Atlanta, GA.
Med Care. 2025 Jan 1;63(1):38-42. doi: 10.1097/MLR.0000000000002065. Epub 2024 Oct 3.
Evidence suggests that screening and provider-led discussions of parental adverse childhood experiences (ACEs) may help identify at-risk families and be linked to positive health outcomes in caregivers and their children. However, the direct effect of ACEs screening and discussions on posttraumatic stress disorder (PTSD) has yet to be studied.
To determine if screening or provider-led discussions of parental ACEs are associated with inadvertent worsening of PTSD symptoms 1 week after screening.
Data was obtained as part of a cluster randomized controlled trial to examine the effects of ACEs screening and provider-led discussions on child health care utilization outcomes. Baseline surveys were completed before scheduled infant well child checks (WCCs). Providers were randomized into the standard of care or intervention (discussion) conditions. Intervention providers were trained in delivering brief trauma-informed discussions about the impact of ACEs on parenting during WCCs.
Caregivers in a pediatric primary care clinic serving predominantly Hispanic and low socioeconomically resourced families (N=179, 93% female, 87% Hispanic).
The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5), Brief Resilience Scale (BRS), and ACEs screening were completed at baseline. PC-PTSD-5 was repeated 1-week after screening.
Mixed-effects ordinal logistic regression analysis of PTSD scores from baseline to 1-week postscreening with the full sample showed no significant effect of time [odds ratio (OR)=1.21, P=0.68], group (OR=1.68, P=0.33), or their interaction (OR=0.48, P=0.21).
Screening or brief discussion of ACEs with providers trained in trauma-informed care were not associated with worsening PTSD symptoms.
有证据表明，对父母童年不良经历（ACEs）进行筛查以及由医疗服务提供者主导的相关讨论，可能有助于识别有风险的家庭，并与照顾者及其子女的积极健康结果相关联。然而，ACEs筛查和讨论对创伤后应激障碍（PTSD）的直接影响尚未得到研究。
确定对父母ACEs进行筛查或由医疗服务提供者主导的讨论是否与筛查后1周PTSD症状的意外加重有关。
数据是作为一项整群随机对照试验的一部分获得的，该试验旨在研究ACEs筛查和由医疗服务提供者主导的讨论对儿童医疗保健利用结果的影响。在预定的婴儿健康检查（WCCs）之前完成基线调查。医疗服务提供者被随机分为常规护理组或干预（讨论）组。干预组的医疗服务提供者接受了培训，以便在WCCs期间就ACEs对养育子女的影响进行简短的创伤知情讨论。
一家主要为西班牙裔和社会经济资源匮乏家庭服务的儿科初级保健诊所的照顾者（N = 179，93%为女性，87%为西班牙裔）。
在基线时完成《精神疾病诊断与统计手册第5版》初级保健PTSD筛查量表（PC-PTSD-5）、简易复原力量表（BRS）和ACEs筛查。在筛查后1周重复进行PC-PTSD-5测量。
对全样本从基线到筛查后1周的PTSD评分进行混合效应有序逻辑回归分析，结果显示时间[优势比（OR）= = 1.21，P = 0.68]、组间（OR = 1.68，P = 0.33）或它们的交互作用（OR = 0.48，P = 0.21）均无显著影响。
对接受过创伤知情护理培训的医疗服务提供者进行ACEs筛查或简短讨论，与PTSD症状加重无关。
