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Co-Occurring Depression and PTS: Implications of End of Treatment Symptom
Differences in trauma Exposed Youth
Jessica Eslinger, PhD
Ginny Sprang, PhD, co-author
This study was made possible in part by funding provided by SAMHSA (#SM058230, Sprang-PI)
Acknowledgments
To understand how co-occurring depression with symptoms of post traumatic stress may complicate recovery to help inform the nature and course of service delivery.
Purpose
Presence of co-morbid depression with post traumatic stress symptoms (Lai et al., 2013; Runyan, Faust, & Orvaschel, 2002)
Evidence-based treatments found to improve trauma-related symptoms following treatment (Cicchetti, Rogosch, & Toth, 2006; Cohen et al., 2004).
Fewer studies have specifically examined how depressive symptoms may complicate recovery (Stoner, Leon, &Fuller, 2003)
Introduction
Children with combined symptoms of PTS and depression will experience a more troubled symptom trajectory and will exhibit higher levels of PTS and depression at the end of treatment compared to children with PTS symptoms only at the start of treatment.
Hypothesis
180 children ages 6-16 57.2% female (n = 103), 42.8% male (n = 77) Average age = 10.74 (SD = 2.88) 43.1% state care, 28.7% biological, 7.2% adoptive, 20.4% relative care All children trauma-exposed Data obtained from eight study sites across Kentucky
(includes urban and rural clinics). All received TF-CBT
Participants
Secondary data from the University of Kentucky Child and Adolescent Trauma Treatment and Training Institute (CATTTI)
Standard battery of psychometrics completed at baseline and termination
Clinician assessed symptoms of PTS and depression at baseline assessment
PTS Only or PTS/Depression Combined Group
Procedure
Anxious/Depressed, Withdrawn/Depressed, Total Internalizing Scales from the CBCL (Achenbach & Rescrola, 2000, 2001)
Total PTS Scale from either the TSCYC (Briere, 2005) or TSCC-A (Briere, 1996)
Child Depression Inventory-Short Form (CDI; Kovacs, 1992)
Instruments
Paired samples t-tests and ANOVAs to examine differences in symptoms at baseline and end of treatment for the PTS Only and Combined PTS/Depression group
PASW 22
Analytic Plan
Scale Mean Diff t df p
Total PTS 12.8 7.82 94 .000*
Anxious/Depressed 3.78 3.39 84 .001*
Withdrawn/Depressed 4.52 3.86 83 .000*
Total Internalizing 6.25 4.91 84 .000*
CDI 8.42 5.66 75 .000*
Differences from Baseline to End of Treatment
Scale M (SD) F p
PTS Baseline (n=175) PTS Only Combined
71.29 (18.23) 64.97 (15.51)
4.734 .032*
PTS Termination (n=96) PTS Only Combined
51.89(10.54) 55.59 (16.30)
1.823 .180
Total PTS Group Differences at Baseline & Termination
Scale M (SD) F p
Anx/Dep Baseline (n=162) PTS Only Combined
60.58(11.66) 64.74 (10.92)
4.152 .045*
Anx/Dep Term (n=89) PTS Only Combined
55.39(8.23) 61.53 (11.13)
8.752 .004*
CBCL Anxious/Depressed Group Differences at Baseline & Termination
Scale M (SD) F p
With/Dep Baseline (n=161) PTS Only Combined
60.16 (10.60) 65.76 (11.04)
8.598 .004*
With/Dep Term (n=89) PTS Only Combined
55.19 (6.03) 60.28 (9.51)
9.453 .003*
CBCL Withdrawn/Depressed Group Differences at Baseline & Termination
Scale M (SD) F p
Tot Int Baseline (n=162) PTS Only Combined
58.81 (11.44) 65.50 (11.04
11.004 .001*
Tot Int Term (n=89) PTS Only Combined
49.29 (13.08) 59.41 (12.76)
12.304 .001*
CBCL Total Internalizing Group Differences at Baseline & Termination
Scale M (SD) F p
CDI Baseline (n=136) PTS Only Combined
48.91 (9.01) 56.12 (14.22)
11.603 .001*
CDI Termination (n=85) PTS Only Combined
45.47 (6.63) 46.31 (9.28)
.234 .630
CDI Group Differences at Baseline & Termination
Symptoms significantly improved from baseline to termination on all scales
Study hypothesis was partially supported:
Significant group differences found on the anxious/depressed, withdrawn/depressed and total internalizing scale scores on the CBCL at termination
Combined group exhibited higher scores except on PTS at baseline.
Discussion
High number of sample children in foster care
Prevalence of depression in foster care population (Stoner et al., 2013; McMillan, et al., 2005)
Past research examining complex trauma and symptom levels (Cloitre et al., 2009; Kisiel et al., 2009).
Past research examining child age and symptom levels (Greeson et al., 2011).
Discussion
Co-occurring depression with PTS may complicate symptom recovery
Importance of assessing for depressive symptoms at baseline
Purposeful focus on thoughts, feelings, beliefs connected to depressed mood during TF-CBT
Helpfulness of booster sessions to reinforce treatment gains following termination
Implications for Practice
Small non-random sample
Caregiver report of internalizing symptoms may affect the ability to get a true measurement of child emotional symptoms
Complexity of separating depression as part of PTS related symptoms vs. a mood disorder
Limitations
Center On Trauma and Children University of Kentucky
Jessica G. Eslinger PhD [email protected]
ctac.uky.edu
Questions?
Cloitre, M., Stolbach, B. C., Herman, J. L., van der Kolk, B., Pynoos, R., Wang, J., & Petkova, E. (2009). A developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22(5), 399-408.
Greeson, J. K. P., Briggs, E. C., Kisiel, C. L., Layne, C. M., Ake III, G. S., Ko, S. J., Gerrity, E. T., Steinberg, A. M., Howard, M. L., Pynoos, R. S., & Fairbank, J. A. (2011). Complex trauma and mental health in children and adolescents placed in foster care: Findings from the National Child Traumatic Stress Network. Child Welfare, 90(6), 91-108.
References
Kisiel, C. L., Fehrenbach, T., Small, L., & Lyons, J. (2009). Assessment of complex trauma exposure, responses, and service needs among children and adolescents in child welfare. Journal of Child and Adolescent Trauma, 2, 143-160.
Lai, B. S., La Greca, A. M., Auslander, B. A, & Short, M. B. (2013). Children’s symptoms of posttraumatic stress and depression after a natural disaster: Comorbity and risk factors. Journal of Affective Disorders, 146, 71-78.
McMillan, J. C., Zima, B. T., Scott, L. D., Auslander, W. F., Munson, M . R., Ollie, M. T., et al. (2005). Prevalence of psychiatric disorders among older youths in the foster care system. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 88-95.
References
Runyan, M. K., Faust, J., & Orvaschel, H. (2002). Differential symptom patterns of post-traumatic stress disorder (PTSD) in maltreated children with and without concurrent depression. Child Abuse & Neglect, 26, 39-53.
Stoner, A. M., Leon, S. C., & Fuller, A. K. (2013). Predictors of reduction in symptoms of depression for children and adolescents in foster care. J of Child Fam Stud, doi: 10.1007/s10826-013-9889-9
References