PDF(Pubmed)
Abstract：
BACKGROUND: Childhood traumatic experiences may result in post-traumatic stress disorder. Although pediatricians are encouraged to address these traumas in clinical encounters, measures of childhood traumatic stress have not been adopted by primary care clinicians. In this study, we describe the feasibility and potential utility of the UCLA Brief Screen, a validated screener for childhood traumatic stress symptoms, in pediatric primary care clinics.
METHODS: Children 6-17 years of age presenting for routine well-child care in community-based pediatric clinics were eligible for traumatic stress screening. We described the feasibility and acceptability of screening based on screener adoption by eligible pediatric clinicians. We assessed the potential utility of screening based on prevalence and distribution of potentially traumatic events and traumatic stress symptoms in this general pediatric population. Finally, we compared results of the UCLA Brief Screen with those of the Patient Health Questionnaire-A to evaluate associations between symptoms of traumatic stress, depression, and suicidality among adolescents in this community setting.
RESULTS: 14/18 (77.8%) pediatric clinicians in two clinics offered an adapted UCLA Brief Screen during 2359/4959 (47.6%) eligible well-child checks over 14 months. 1472/2359 (62.4%) of offered screeners were completed, returned, and scored. One-third (32.5%) of completed screeners captured a potentially traumatic event experience described by either children or caregivers. Moderate to severe traumatic stress symptoms were identified in 10.7% and 5.2% of patients, respectively. Concurrent depression screening revealed that 68.3% of adolescents with depressive symptoms reported a potentially traumatic event (PTE) and 80.5% had concurrent traumatic stress symptoms. Adolescents reporting a PTE were 3.5 times more likely to report thoughts of suicide or self-harm than those without this history.
CONCLUSIONS: Results from this pilot study suggest that traumatic stress screening in the pediatric primary care setting may be feasible and may identify and classify mental health symptoms missed with current screening practices for depression. The prevalence of PTEs and traumatic stress symptoms associated with PTEs support the potential utility of a standardized screening in early identification of and response to children with clinically important symptoms of childhood traumatic stress. Future research should evaluate meaningful clinical outcomes associated with traumatic stress screening.
METHODS: Children 6-17 years of age presenting for routine well-child care in community-based pediatric clinics were eligible for traumatic stress screening. We described the feasibility and acceptability of screening based on screener adoption by eligible pediatric clinicians. We assessed the potential utility of screening based on prevalence and distribution of potentially traumatic events and traumatic stress symptoms in this general pediatric population. Finally, we compared results of the UCLA Brief Screen with those of the Patient Health Questionnaire-A to evaluate associations between symptoms of traumatic stress, depression, and suicidality among adolescents in this community setting.
RESULTS: 14/18 (77.8%) pediatric clinicians in two clinics offered an adapted UCLA Brief Screen during 2359/4959 (47.6%) eligible well-child checks over 14 months. 1472/2359 (62.4%) of offered screeners were completed, returned, and scored. One-third (32.5%) of completed screeners captured a potentially traumatic event experience described by either children or caregivers. Moderate to severe traumatic stress symptoms were identified in 10.7% and 5.2% of patients, respectively. Concurrent depression screening revealed that 68.3% of adolescents with depressive symptoms reported a potentially traumatic event (PTE) and 80.5% had concurrent traumatic stress symptoms. Adolescents reporting a PTE were 3.5 times more likely to report thoughts of suicide or self-harm than those without this history.
CONCLUSIONS: Results from this pilot study suggest that traumatic stress screening in the pediatric primary care setting may be feasible and may identify and classify mental health symptoms missed with current screening practices for depression. The prevalence of PTEs and traumatic stress symptoms associated with PTEs support the potential utility of a standardized screening in early identification of and response to children with clinically important symptoms of childhood traumatic stress. Future research should evaluate meaningful clinical outcomes associated with traumatic stress screening.
摘要：
背景：童年创伤经历可能导致创伤后应激障碍。尽管鼓励儿科医生在临床中解决这些创伤，初级保健临床医生尚未采用儿童创伤应激的措施。在这项研究中,我们描述了加州大学洛杉矶分校简短屏幕的可行性和潜在实用性，经过验证的儿童创伤应激症状筛查，在儿科初级保健诊所。
方法：在社区儿科诊所接受常规儿童保健的6-17岁儿童符合创伤应激筛查的条件。我们根据合格的儿科临床医生采用筛选器描述了筛选的可行性和可接受性。我们根据潜在创伤事件和创伤应激症状在这一普通儿科人群中的患病率和分布评估了筛查的潜在效用。最后,我们比较了加州大学洛杉矶分校简短筛选的结果与患者健康问卷A的结果，以评估创伤应激症状之间的关联，抑郁症,以及这个社区环境中青少年的自杀倾向。
结果：两个诊所的14/18（77.8％）儿科临床医生在2359/4959（47.6％）的14个月内合格的良好儿童检查期间提供了经过调整的UCLA简短屏幕。1472/2359(62.4%)提供的筛查完成，返回,和得分。三分之一（32.5％）的完整筛查员捕捉到了儿童或护理人员描述的潜在创伤事件经历。在10.7％和5.2％的患者中发现了中度至重度的创伤应激症状，分别。同时进行的抑郁症筛查显示，有抑郁症状的青少年中有68.3％的人报告了潜在的创伤事件（PTE），而80.5％的人同时有创伤应激症状。报告PTE的青少年报告自杀或自残想法的可能性是没有这种病史的青少年的3.5倍。
结论：这项初步研究的结果表明，在儿科初级护理环境中进行创伤应激筛查可能是可行的，并且可以识别和分类当前抑郁症筛查实践中遗漏的心理健康症状。PTE的患病率和与PTE相关的创伤应激症状支持标准化筛查在早期识别和响应具有临床上重要的儿童创伤应激症状的儿童方面的潜在效用。未来的研究应该评估与创伤应激筛查相关的有意义的临床结果。
方法：在社区儿科诊所接受常规儿童保健的6-17岁儿童符合创伤应激筛查的条件。我们根据合格的儿科临床医生采用筛选器描述了筛选的可行性和可接受性。我们根据潜在创伤事件和创伤应激症状在这一普通儿科人群中的患病率和分布评估了筛查的潜在效用。最后,我们比较了加州大学洛杉矶分校简短筛选的结果与患者健康问卷A的结果，以评估创伤应激症状之间的关联，抑郁症,以及这个社区环境中青少年的自杀倾向。
结果：两个诊所的14/18（77.8％）儿科临床医生在2359/4959（47.6％）的14个月内合格的良好儿童检查期间提供了经过调整的UCLA简短屏幕。1472/2359(62.4%)提供的筛查完成，返回,和得分。三分之一（32.5％）的完整筛查员捕捉到了儿童或护理人员描述的潜在创伤事件经历。在10.7％和5.2％的患者中发现了中度至重度的创伤应激症状，分别。同时进行的抑郁症筛查显示，有抑郁症状的青少年中有68.3％的人报告了潜在的创伤事件（PTE），而80.5％的人同时有创伤应激症状。报告PTE的青少年报告自杀或自残想法的可能性是没有这种病史的青少年的3.5倍。
结论：这项初步研究的结果表明，在儿科初级护理环境中进行创伤应激筛查可能是可行的，并且可以识别和分类当前抑郁症筛查实践中遗漏的心理健康症状。PTE的患病率和与PTE相关的创伤应激症状支持标准化筛查在早期识别和响应具有临床上重要的儿童创伤应激症状的儿童方面的潜在效用。未来的研究应该评估与创伤应激筛查相关的有意义的临床结果。
