背景:在美国,超过三分之二的儿童和青少年在16岁时经历了创伤。在生命早期暴露于创伤与整个生命周期中的一系列负面心理健康结果有关,特别是同时出现的创伤后应激(PTS)的症状,焦虑,和抑郁症。年轻人越来越多地采用数字心理健康干预措施(DMHI),特别是焦虑和抑郁。然而,对于参加DMHIs的青少年中创伤暴露和PTS症状的发生率以及PTS症状是否会影响焦虑和抑郁症状治疗反应,我们知之甚少.此外,尚不清楚在创伤暴露青少年中,参与针对焦虑和抑郁症状的DMHI是否与对PTS症状的继发性影响相关.
目的:本研究旨在利用参加DMHI的年轻人的回顾性数据(1)表征创伤发生率,PTS,(2)确定创伤暴露和PTS症状升高是否影响整个参与治疗过程中焦虑和抑郁症状的改善;(3)确定非创伤后DMHI的参与是否与PTS症状的减轻有关。
方法:本研究是使用参与儿科协同护理DMHI的成员(6至12岁儿童)的回顾性数据进行的。参与的护理人员报告了他们孩子的创伤暴露情况。PTS,焦虑,和抑郁症状严重程度每月使用经过验证的评估进行测量。
结果:在符合条件的参与者中(n=966),30.2%(n=292)报告至少1例创伤性事件。在创伤暴露和PTS症状升高的患者中(n=119),73%(n=87)表现出升高的焦虑症状,50%(n=59)表现出升高的抑郁症状。与没有创伤的孩子相比,PTS症状升高的儿童每月的焦虑症状减少较小,但抑郁症状没有减少(焦虑:F2,287=26.11;P<.001)。PTS症状在整个护理过程中也显著减少,96%(n=79)的参与者表现出症状减轻。
结论:这项研究为创伤暴露频率和共病精神症状提供了初步证据,以及创伤暴露和非创伤暴露青年之间治疗反应的差异,在儿科协作护理DMHI的参与者中。有创伤经历的年轻人可能比没有创伤史的同龄人表现出更多的精神病合并症和更慢的治疗反应。这些发现提供了令人信服的证据,表明协作护理DMHI可能非常适合解决有创伤史的儿童的心理健康症状,同时也强调了评估寻求治疗儿童PTS症状的迫切需要。
BACKGROUND: More than 2 out of 3 children and adolescents in the United States experience trauma by the age of 16 years. Exposure to trauma in early life is linked to a range of negative mental health outcomes throughout the lifespan, particularly co-occurring symptoms of posttraumatic stress (PTS), anxiety, and depression. There has been an increasing uptake of digital mental health interventions (DMHIs) among youths, particularly for anxiety and depression. However, little is known regarding the incidence of trauma exposure and PTS symptoms among youths participating in DMHIs and whether PTS symptoms impact anxiety and depressive symptom treatment response. Moreover, it is unclear whether participation in a
DMHI for anxiety and depressive symptoms is associated with secondary effects on PTS symptoms among trauma-exposed youths.
OBJECTIVE: This study aims to use retrospective data from youths participating in a
DMHI to (1) characterize rates of trauma, PTS, and comorbid anxiety and depressive symptoms; (2) determine whether trauma exposure and elevated PTS symptoms impact the improvement of comorbid anxiety and depressive symptoms throughout participation in care; and (3) determine whether participation in a non-posttraumatic
DMHI is linked to reductions in PTS symptoms.
METHODS: This study was conducted using retrospective data from members (children ages 6 to 12 years) involved in a pediatric collaborative care
DMHI. Participating caregivers reported their children\'s trauma exposure. PTS, anxiety, and depressive symptom severity were measured monthly using validated assessments.
RESULTS: Among eligible participants (n=966), 30.2% (n=292) reported at least 1 traumatic event. Of those with trauma exposure and elevated symptoms of PTS (n=119), 73% (n=87) exhibited elevated anxiety symptoms and 50% (n=59) exhibited elevated depressive symptoms. Compared to children with no trauma, children with elevated PTS symptoms showed smaller reductions per month in anxiety but not depressive symptoms (anxiety: F2,287=26.11; P<.001). PTS symptoms also decreased significantly throughout care, with 96% (n=79) of participants showing symptom reductions.
CONCLUSIONS: This study provides preliminary evidence for the frequency of trauma exposure and comorbid psychiatric symptoms, as well as variations in treatment response between trauma-exposed and nontrauma-exposed youths, among participants in a pediatric collaborative care
DMHI. Youths with traumatic experiences may show increased psychiatric comorbidities and slower treatment responses than their peers with no history of trauma. These findings deliver compelling evidence that collaborative care DMHIs may be well-suited to address mental health symptoms in children with a history of trauma while also highlighting the critical need to assess symptoms of PTS in children seeking treatment.