Cognitive model predicts poor mental health among youth following a single-event trauma

Key takeaways:

• At 9 weeks, 36% of patients met the criteria for PTSD, complex PTSD, depression or anxiety.
• A youth’s perspective of a trauma played a key role in their development of psychopathological symptoms.

A cognitive model of PTSD best predicted PTSD, complex PTSD, depression and anxiety among youth who experienced a single-event trauma, according to research published in Psychological Medicine.

The results further showed that maladaptive appraisals of a traumatic event strongly predicted all four disorders.

“We found that cognitive psychological factors — like features of their memories for the trauma and how they see themselves after the trauma — were the most powerful predictors of all forms of poor mental health,” Katie Lofthouse, clinical psychologist-in-training with the department of clinical psychology and psychological therapies at Norwich Medical School of University of East Anglia in England, said in a press release related to the study. “Aspects of how severe the trauma was, or a child’s age or sex were much less important.”

No prior studies of psychopathological outcomes of trauma have focused on youth, according to the researchers. Further, complex PTSD (CPTSD) has recently emerged as a new diagnosis to encapsulate the traditional core PTSD criteria along with disturbances in self-organization, including affect dysregulation, negative self-concept and interpersonal difficulties. I

Therefore, Lofthouse and colleagues performed a study to investigate risk factors for PTSD, CPTSD, depression and anxiety among youth exposed to trauma by comparing four predictive models. These included those based on psychosocial factors, including demographic data, parents’ education level and prior trauma; cognitive factors, including cognitive processing during the trauma, negative trauma-related appraisals, trauma memory quality, post-traumatic dissociation, trauma-related rumination and self-blame; and subjective (peritraumatic processes) and objective (pain and injury related) event severity.

The analysis included 260 youths aged 8 to 17 years (mean age, 13.9 years; 43.5% girls) who visited EDs between September 2010 and April 2013 in England following a trauma event. Overall, 118 (45%) experienced a road traffic collision, 82 (32%) an accidental injury, 43 (17%) an assault, 15 (6%) a dog attack and two (1%) had an acute medical emergency.

The researchers obtained data 2 and 9 weeks after the trauma events via self-report questionnaires, structured interviews and hospital reports.

At 9 weeks, Lofthouse and colleagues found that 84 participants (36%) met the criteria for at least one out of four disease diagnoses, with 55 (23.5%) meeting criteria for PTSD. Further, 20 (8.5%) exhibited CPTSD disturbances of self-organization symptoms and 12 (5.2%) met all the criteria for CPTSD. Some participants also had developed clinically significant symptoms of depression (23.9%) and generalized anxiety disorder (10.7%).

Although all the models significantly predicted each disorder, the researchers found that the cognitive model was the best fit for all four disorders, accounting for the greatest variance in symptoms and achieving the lowest Akaike and Bayesian Information Criteria values. However, the model demonstrated poor disorder specificity, with some overlap in significant predictors of disorders.

Specifically, the cognitive model showed that dissociation, memory quality, appraisals and rumination significantly predicted PTSD, whereas dissociation, appraisals and self-blame predicted CPTSD. Only appraisal significantly predicted depression, and both dissociation and appraisals were significantly associated with generalized anxiety disorder.

“Negative thoughts about the traumatic event were a major predictor of all types of mental health problems studied,” Lofthouse said. “This supports the use of treatments like trauma-focused cognitive behavioral therapy, which aims to address these negative thoughts.”

The researchers noted several limitations to this study, including its small sample size and lack of a validated measure for CPTSD when this study was being planned.

“Overall, the significance of subjective peritraumatic factors and post-traumatic cognitive processes consistently demonstrated the importance of assessing how a child experienced an event in understanding their potential susceptibility to psychopathological symptoms,” Lofthouse and colleagues wrote.

These findings should not be generalized to children with exposure to multiple traumas or different forms of single-event trauma, which require further investigation, they added.

Reference:

• New research identifies key mental health risk factors for children after trauma. https://www.eurekalert.org/news-releases/1060879. Published Oct. 10, 2024. Accessed Oct. 16, 2024.