Objective:The coronavirus pandemic has resulted in catastrophic levels of mortality among parents and caregivers worldwide. This study explored the benefit of a grief-enhanced trauma-informed safety preventive intervention in enhancing parental support, ameliorating maladaptive grief and posttraumatic stress reactions, and reducing suicidal risk among youth who have experienced a COVID-19-related death of a parent/relative. Method:This retrospective cohort study included youth with COVID-19-related maladaptive grief and posttraumatic stress disorder (PTSD) reactions and suicidality who received either reminder-focused positive psychiatry with suicide prevention (RFPP-S) (n = 62) or treatment as usual (TAU) (n = 62) at a large county psychiatric emergency room (PER). Clinical assessments were administered at baseline, day 2, and postdischarge weeks 1 and 4. Results:The prevalence of youth with PTSD and suicidality presenting at the PER was 61%; 40% had COVID-19-related PTSD, of whom 90% also had maladaptive grief reactions. On day 2, a significant reduction was noted in maladaptive grief reactions and PTSD symptoms, reactivity to trauma and loss reminders, guilt feelings, negative affectivity, and avoidance in youth receiving RFPP-S, but not in TAU youth (p = .001). RFPP-S, but not TAU, was associated with a significant reduction in Columbia-Suicide Severity Rating Scale scores, decreased length of stay, and rapid acute crisis stabilization (p = .001). A substantial increase in well-being, engagement, connectedness with caregivers, resilience and adaptability, posttraumatic growth, and enhanced coping skills was found in RFPP-S youth (p < .05), but not in TAU youth. Postdischarge follow-up was significantly enhanced in RFPP-S youth (100%) compared with TAU youth (32%). RFPP-S, but not TAU, was associated with no readmissions for suicidality postdischarge, sustained reduced maladaptive grief reactions and PTSD symptoms, and reduced reactivity to trauma/loss reminders at 1-month follow-up. Conclusion:This study suggests the feasibility and potential effectiveness of providing a grief-enhanced trauma-informed safety preventive intervention in a PER. This intervention was associated with reducing severity of maladaptive grief and posttraumatic stress reactions, improving mental well-being and youth-caregiver interactions, and promoting safety and acute crisis stabilization. Parental/PER therapeutic support has promise as an important public health strategy for this population of grieving suicidal youth. Diversity & Inclusion Statement:We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Multidimensional Grief Therapy (MGT) provides counselors, social workers, psychologists, and psychiatrists (as well as students in these fields) with a flexible program for assessing and supporting children and adolescents who have experienced bereavement. MGT is a strength-based intervention, designed to reduce unhelpful grief reactions that prevent adjustment, and promote adaptive grief reactions that enable children to cope better after a death. It also reduces associated symptoms of psychological distress and helps bereaved children and adolescents lead healthy, happy, productive lives. As young people grieve in different ways and “one-size-fits-all” treatments often lack effectiveness, MGT uses an assessment-driven, two-phased approach to effectively address the unique mental health needs of diverse youth. This manual provides a wealth of activities and handouts designed specifically to engage and empower youth after experiencing a death, including under traumatic circumstances.

The COVID-19 pandemic has resulted in catastrophic levels of death among parents and caregivers worldwide. This study explored the benefit of a grief-enhanced trauma-informed safety-preventive intervention in enhancing parental support, ameliorating maladaptive grief and posttraumatic stress reactions, and reducing suicidal risk. This study included youths with COVID-19–related maladaptive-grief reactions and PTSD and suicidality who received either reminder-focused positive-psychiatry with suicide-prevention (RFPP-S) plus the standard of care, Safe Alternatives for Teens and Youths (SAFETY-A) (N = 62), or treatment as usual (TAU) (N = 62) at a large-county psychiatry emergency room (PER). The clinical assessments and batteries were measured at baseline, Day 2, and postdischarge at weeks 1 and 4. The prevalence of youth with PTSD and suicidality presenting at the PER was 61%, constituting 40% with COVID-19–related PTSD, of whom 90% also had grief reactions. On day 2, there was a significant reduction in maladaptive-grief reactions (76 ± 4 vs 39 ± 3, 51%) and PTSD (44 ± 4 vs 32 ± 2, 29%), as well as a reduction in reactivity to trauma/loss-reminders (RTLR) (19 ± 3 vs 10 ± 2, 53%), guilt-feelings (9 ± 1 vs 5 ± 1, 45%), negative-affectivity and avoidance (12 ± 1 vs 8 ± 1, 34%) in response to RFPP-S (p = .001), but not in TAU. A significant reduction in C-SSRS scores in RFPP-S, but not in TAU, was noted (4 ± 1 on day 1 vs 1.5 ± 0.75 on day 2, p = .001). A significant increase in well-being (273%), engagement, and connectedness with caregivers (250%), resilience and adaptability (325%), posttraumatic growth, and enhanced coping skills (415%) in response to RFPP-S, but not TAU, was also observed (p < .05). While readmission for suicidality was 26% (16) for TAU, there were no readmissions for suicidality postdischarge, with reduced maladaptive grief and PTSD symptoms and reduced RTLR in RFPP-S. This study demonstrates the feasibility and effectiveness of delivering a grief-enhanced trauma-informed safety-preventive intervention in a PER setting by ameliorating maladaptive grief and posttraumatic stress reactions, improving mental well-being and child-caregiver interactions, and achieving safety and acute crisis stabilization.

OBJECTIVE:Experiencing traumatic events places children and adolescents at risk for developing posttraumatic stress disorder (PTSD), often leading to adverse mental health consequences. Although well-validated measures of PTSD are available, very brief screening tools are needed to assess PTSD when resources are limited. This study was conducted to develop and validate the four-item University of California at Los Angeles (UCLA) PTSD Reaction Index for DSM-5-Very Brief Form (RI-5-VBF) to be used in settings requiring rapid and efficient screening. METHOD:Item response theory (IRT) models were used to derive RI-5-VBF scores from the UCLA PTSD Reaction Index for DSM-5 and assess its internal consistency using a sample of 1,785 youth (Mage = 12.32 years, SD = 2.78) seeking support at an academic medical center clinic or bereavement center. Receiver operating characteristic (ROC) analyses and diagnostic efficiency statistics were used to assess discriminant groups validity and screening utility of the RI-5-VBF scores. Differential item functioning (DIF) analyses were used to examine possible bias across age, gender, race, ethnicity, and clinical setting versus bereavement center setting. RESULTS:IRT models identified four items with the highest discrimination within each PTSD subscale. The RI-5-VBF scores exhibited acceptable internal consistency (α = .74). ROC analyses indicated that an RI-5-VBF score of 9 maximized sensitivity and specificity. DIF analyses did not find evidence of bias across age, gender, race, ethnicity, or clinical versus bereavement center settings. CONCLUSION:These findings provide support for the reliability and validity of the RI-5-VBF. Findings highlight the utility of the RI-5-VBF as a brief screening measure for PTSD in children and adolescents. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

This feasibility study investigated the impact of a trauma-informed reminder-focused positive psychiatry Body Mind intervention (RFPP-BM) on posttraumatic stress symptoms, reactivity to trauma reminders, cardiovascular function, neuromuscular performance, connectedness, and resilience in adults with PTSD. Twelve individuals who met the DSM-5 diagnostic criteria for PTSD (30 ± 5 years old; 60% female) underwent 1 session of RFPP-BM. RFPP-BM consists of: 1) 15 minutes of enhanced recognition of and coping with physiological and psychological reactions to trauma/loss reminders through self-compassion and gratitude exercises; and 2) 30 minutes of physical and emotional resilience building by high-intensity functional training (HIFT). Before and after RFPP-BM, all participants completed the UCLA PTSD Reaction Index for DSM-5 (RI), the Prolonged Grief Disorder Checklist (PGDC), the Connor-Davidson Resilience Scale (CD-RISC), an operator-independent Audio-Visual Artificial Intelligence (AVAI) for PTSD and prolonged grief disorder (PGD), heart rate variability (HRV) and autonomous nervous system (ANS) reactivity, and positive psychiatry batteries. All participants completed RFPP-BM with a satisfaction rate of 4.8 out of 5. Compared to the baseline, a 55% increase in HRV and ANS, a 25% reduction in RI total score, and a 45% reduction in the reactivity to trauma reminder (RTR) after RFPP-BM was noted (p < .05). Compared to baseline, a 70% increase in neuromuscular performance, 70% in CD-RISC score, and a 60% improvement in PERMA (positive emotion, engagement, relationships, meaning, and accomplishment) score was noted (p < .05). RFPP-BM is associated with improvement in PTSD symptoms, an improvement in neuromuscular and vascular function, and an increase in well-being. This highlights the potential benefit of trauma-informed reminder-focused strength-based body-mind intervention in adults with PTSD.

There is a paucity of long-term treatment outcome studies among children and adolescents after natural disasters. This chapter summarizes findings from three long-term studies among severely traumatized early adolescents after the 1988 Spitak earthquake in Armenia, including a twenty-five-year follow-up that represents the most extended prospective treatment outcome study to date after a disaster. School-based trauma-grief-focused psychotherapy was provided at 1.5 years post-earthquake. The intervention addressed trauma and loss experiences due to the earthquake; post-trauma distress reactions, including PTSD and grief; current problems and adversities; trauma and loss reminders, interpersonal conflicts, and developmental progression. The findings showed significant long-term benefits of treatment in reducing PTSD and depressive symptoms. We also present findings regarding differences in recovery trajectories among treated and not treated subjects and risk and protective factors associated with PTSD and depression. Despite the improvements, a sub-group of the students continued to experience earthquake-related chronic PTSD and depressive symptoms at twenty-five-year follow-up, indicating the need for ongoing surveillance of severely traumatized survivors. The findings underscore the benefit of post-disaster therapeutic intervention, social support by family members and friends, and the need for assistance by governmental and non-governmental agencies to mitigate post-disaster adversities that contributed significantly to the chronicity of symptoms.

This chapter summarizes the organizational and clinical lessons learned in implementing and conducting a post-disaster recovery program. It underscores the importance of a hierarchical approach with a centralized chain of command. This approach can facilitate recovery by mitigating adversities and removing roadblocks to community recovery. Supporting and empowering affected local governments and civil society, however incremental, plays a central role in extending assistance to underprivileged sectors. Likewise, working with the school hierarchy provides the necessary support to implement a school-based psychological intervention. Working with international donors and relief organizations should be a centralized “demand-driven” process rather than an “all aid is welcome” approach. Care for those with serious medical conditions, the displaced elderly, the homeless, and orphans should take priority over non-urgent mental health needs.

This chapter provides an overview of the components of the evolving conceptual model since the 1988 Spitak earthquake that guided the intervention and research arms of our work in Armenia. With the concept of traumatic stress as the gateway to post-trauma sequelae and recovery, we recognized the important contributions made by post-trauma adversities and the pervasiveness of trauma and loss reminders in the aftermath. Individual and ecological factors were seen as making powerful contributions to the impact and course of recovery, especially in terms of factors associated with resistance, resilience, vulnerability, adjustment, maladjustment, and pathology. The traumatic stress pathway is embedded in a developmental perspective, with the understanding that child, adolescent, and adult development plays an overarching role across all aspects of the conceptual framework. In addition, cultural and religious factors are also seen as integral. Implications of the conceptual model for data collection metrics and methodology, as well as intervention strategies are also discussed.

OBJECTIVE:This study aimed to investigate the effect of brief reminder-focused positive psychiatry and suicide prevention (RFPP-S) on suicidal ideation, posttraumatic stress disorder (PTSD) symptoms, and clinical outcomes among youths with PTSD treated in psychiatric emergency rooms.METHODS:This study included youths with PTSD and suicidality who received either RFPP-S (N=50) or treatment as usual (N=150). The Columbia Suicide Severity Rating Scale (C-SSRS), Clinician-Administered PTSD Scale for children and adolescents, University of California, Los Angeles Trauma Reminder Inventory, Patient Health Questionnaire-9, Positive Emotion, Engagement, Relationships, Meaning, and Accomplishment Scale, and positive psychiatry test batteries were administered at baseline, on day 2, and 1 week and 1 month after discharge.RESULTS:On day 2, the RFPP-S group showed a greater reduction in PTSD symptoms (55%) and reactivity to trauma and loss reminders (80%) compared with the control group (10% for both) (p=0.001). A significantly greater reduction in C-SSRS score for RFPP-S (80%), compared with treatment as usual (15%), was noted (p=0.001), and RFPP-S showed more rapid stabilization (mean±SD=2.0±0.5 days) and enhanced postdischarge follow-up (100%) compared with treatment as usual (5.0±2.0 days and 50%, respectively) (p<0.05). RFPP-S, but not treatment as usual, was associated with significant increases in well-being, flexible thinking, and coping skills (p<0.05). Hospital readmission due to suicidality 1 month after discharge was 0% for the RFPP-S group and 20% for the control group.CONCLUSIONS:RFPP-S was associated with reduced PTSD symptoms, enhanced coping skills while experiencing trauma reminders, adoption of safety skills, rapid stabilization of acute crises of PTSD with suicidality, adherence to post-emergency room visits and treatment, and favorable clinical outcomes.

This chapter provides an overview of basic concepts that lie in the pathway from traumatic stress to a broad range of clinical and life-trajectory outcomes, including characterization of the nature and role of a variety of mediating and moderating factors. Such intervening factors fall within categories of child intrinsic and child extrinsic features. The individual/family and community types of early interventions for children and adolescents after trauma are reviewed. Although many early interventions hold promise, a good deal more methodologically sound research is required to support their use across a variety of contexts. Increased knowledge of mediating and moderating factors on the outcome of trauma can inform development of improved evidence-based screening, clinical assessment, early and intermediate interventions, trauma-informed services for traumatized children and their families across stages of recovery, and public policy.

Given the devastation caused by disasters and mass violence, it is critical that intervention policy be based on the most updated research findings. However, to date, no evidence-based consensus has been reached supporting a clear set of recommendations for intervention during the immediate and the mid-term post mass trauma phases. Because it is unlikely that there will be evidence in the near or mid-term future from clinical trials that cover the diversity of disaster and mass violence circumstances, we assembled a worldwide panel of experts on the study and treatment of those exposed to disaster and mass violence to extrapolate from related fields of research, and to gain consensus on intervention principles. We identified five empirically supported intervention principles that should be used to guide and inform intervention and prevention efforts at the early to mid-term stages. These are promoting: 1) a sense of safety, 2) calming, 3) a sense of self- and community efficacy, 4) connectedness, and 5) hope.

ObjectiveTo investigate the impact of reminder-focused positive psychiatry (RFPP) on attention-deficit/hyperactive disorder (ADHD) and posttraumatic stress disorder (PTSD) symptoms, vascular-function, inflammation and well-being of adolescents with comorbid ADHD and PTSD.MethodsAfter obtaining informed-consent, 11 adolescents were randomized to RFPP (n = 5) or trauma-focused cognitive-behavioral therapy (TF-CBT) (n = 6). Eight participants (RFPP: n = 4, TF-CBT: n = 4) completed the twice-weekly intervention for a 6-week trial. The RFPP intervention was inclusive of positive psychiatry interventions on (1) traumatic reminders and (2) avoidance and negative cognition. Vascular function measured as temperature rebound, C-reactive protein, homocysteine, ADHD Swanson, Nolan, and Pelham (SNAP) Questionnaire, Clinician-Administered PTSD Scale for DSM-5-Child/Adolescent Version (CAPS-CA), and neuropsychiatric-measures were measured at baseline and 6 weeks. Subjects were followed for 12 months. The study was conducted from September 2016 to June 2018.ResultsA significant improvement in CAPS-CA, SNAP scores, and vascular function of both RFPP and TF-CBT groups was noted at follow-up, but was more-robust in the RFPP group (P < .05). At the sixth week, a significant increase in PERMA, gratitude, resilience, and Posttraumatic Growth Inventory scores and a significant decrease in homocysteine and C-reactive protein levels in the RFPP group, but not the TF-CBT group, were noted (P < .05). At 12-month follow-up, there was no psychiatry hospitalization or suicide ideation reported in either group. A continuation of significant improvement in CAPS-CA and SNAP scores in both groups was noted but was more robust in the RFPP group (P < .05). Similarly, a continuation of significant increase in PERMA, gratitude, resilience and Posttraumatic Growth Inventory scores was noted in the RFPP group but not in the TF-CBT group (P < .05).ConclusionsRFPP is associated with improvement in core PTSD and ADHD symptoms, decrease in inflammation, and increase in well-being, vascular function, and posttraumatic growth, as well as a favorable long-term clinical outcome. This finding highlights the importance of the dual role of RFPP in addressing vulnerability symptoms as well as enhancing well-being in youth with comorbid ADHD and PTSD.Trial RegistrationClinicalTrials.gov identifier: NCT04336072.

Childhood maltreatment and its related PTSD are significant public health concerns in the United States, with a prevalence of 0.9%-4%. Trauma-informed screening and intervention are comprised of training on basic concepts of the traumatic stress field and application of those concepts to clinical cases. This proposal reviews a trauma-informed screening model and the Trauma and Grief Component Therapy for Adolescents (TGCTA) for adolescent PTSD.

Objective This study examined bereavement‐related risk markers (number of deaths, cause of death, and relationship to deceased) of mental and behavioral health problems (suicidal thoughts or behaviors, self‐injury, depression, posttraumatic stress, and substance use) in a national sample of clinic‐referred bereaved adolescents. Method Participants included 1281 bereaved youth aged 12–21 years (M=15, SD=1.8; 62.1% female), from the National Child Traumatic Stress Network Core Data Set. Results Generalized linear mixed‐effects regression models controlling for demographics and other traumas revealed that youth bereaved by multiple deaths had higher posttraumatic stress scores than youth bereaved by a single death (Estimated difference ±SE=3.36 ± 1.11, p=0.003). Youth bereaved by suicide were more likely to report experiencing suicidal thoughts or behaviors (AOR=1.68, p=0.049) and alcohol use (AOR=2.33, p<0.001) than youth bereaved by natural causes. Youth bereaved by homicide were at greater risk for substance use than youth bereaved by natural death (AOR=1.76, p=0.02). Compared to parentally bereaved youth, youth who lost a peer were more likely to use alcohol (AOR=2.32, p=0.02) or other substances (AOR=2.41, p=0.01); in contrast, parentally bereaved youth were more likely to experience depression compared to those who experienced the death of an adult relative or unrelated adult (range of AOR: 0.40 to 0.64, p‐values<0.05). Conclusion These bereavement‐related contextual factors can serve as early markers of mental and behavioral health problems among bereaved youth.

We previously reported that PTSD is independently associated with subclinical atherosclerosis measured by coronary artery calcium (CAC). This study investigated the effect of sleep disturbances on CAC in sleep-disordered breathing (SDB) patients with PTSD.

AbstractBackgroundThere is a paucity of long-term prospective disaster studies of the psychological sequelae among survivors.MethodsAt 1½ and 25 years after the Spitak earthquake, 142 early adolescents from two cities were assessed: Gumri (moderate–severe exposure) and Spitak (very severe exposure). The Gumri group included treated and not-treated subjects, while the Spitak group included not-treated subjects. Instruments included: DSM-III-R PTSD-Reaction Index (PTSD-RI); DSM-5 PTSD-Checklist (PCL); Depression Self-Rating Scale (DSRS); and Center for Epidemiological Studies-Depression Scale (CES-D).Results(1) Between 1½ and 25 years, PTSD rates and mean scores decreased significantly in the three groups (over 50%). However, at 25 years 9.1–22.4% met DSM-5 PTSD criteria. (2) At 1½ years, the Spitak group had higher PTSD-RI (p < 0.001) and DSRS scores (p < 0.001) compared to the Gumri-not-treated group. At 25 years, the Spitak group that had experienced fewer post-earthquake adversities (p < 0.03), had a greater decrease in PTSD-RI scores (p < 0.02), and lower CES-D scores (p < 0.01). (3) Before treatment, PTSD-RI and DSRS scores did not differ between the Gumri-treated and not-treated groups. At 25-years, the Gumri-treated group showed a greater decrease in PTSD-RI scores (p < 0.03), and lower mean PTSD-RI (p < 0.02), PCL (p < 0.02), and CES-D (p < 0.01) scores. (4) Predictors of PTSD symptom severity at 25-years included: home destruction, treatment, social support, post-earthquake adversities, and chronic medical illnesses.ConclusionPost-disaster PTSD and depressive symptoms can persist for decades. Trauma-focused treatment, alleviation of post-disaster adversities, improving the social ecology, and monitoring for chronic medical illnesses are essential components of recovery programs.