Monday, August 17, 2009

Article Review: Polytraumatization and psychological symptoms in children and adolescents

This is a brief article review I did for my current class - but it deals with the difference between Big-T traumas and small-t traumas. We are beginning to learn that an accumulation of small traumas, especially interpersonal traumas, can be more problematic than a single large trauma or repeated trauma.

[I copied this in from Word, so the formatting is funky.]

Article Review: Polytraumatization and psychological symptoms in children and adolescents

In their article, “Polytraumatization and psychological symptoms in children and adolescents,” Per E. Gustafsson, Doris Nilsson, and Carl Goran Svedin (2009) looked at the impact of multiple traumas from a variety of sources on the prevalence of psychological symptoms in children and adolescents.

The authors suggest that the traditional model of looking only at a specific form of trauma, or repeated exposure to single type of trauma, has failed in at least three ways. First, looking only at specific traumas in specific populations does not allow an understanding of the “frequency and severity” of trauma in the population at large. Second, such studies ignore the finding that traumatic events tend to co-occur, and then fail to adequately represent the overall prevalence of trauma. Finally, failing to see the multiplicity of traumatic events may result in “overestimation of the impact of the single measured trauma type.”

The authors cite studies that show that the cumulative impact of many traumatic events produces more psychological symptoms than a single critical event, for example, an accident or a natural disaster, and also more than a prolonged exposure to a single type of trauma. They call their model the “polytraumatization model.”

"The polytraumatization model, which considers non-specificity of experiences and effects, may be viewed as complementary to the stressor-outcome specificity model [21], which may identify certain traumas to have particularly harmful consequences [8]. The separation of non-specificity and specificity in considering the effects of traumatic experiences is an important field of study that may yield a better understanding of the complex pathways to adjustment and maladjustment following trauma."

The present study was part of a larger look at the impact of trauma on mental health in children and adolescents.

The study found that traumatic events were common in the children [63% (n = 170)] and even more common in the adolescents [89.5% (n = 357)]. What follows are some bullet points summarizing their findings:

  • The impact of polytraumatization was greater than the impact of a singular event in both age groups
  • The lower incidence reporting in the younger children likely resulted from the lesser ratings of the impact of trauma and its symptoms by the parents, although some measures were more likely to occur with teens than younger children
  • Interpersonal traumatic events were more strongly correlated with psychological symptoms than were non-interpersonal traumatic events:
    “This importance of interpersonal events could possibly be explained by viewing the betrayal of one human being by another as a traumatic experience that the child has to cope with in addition to the threat of the event itself.”
  • The connection between polytraumatization and symptoms was stronger in boys than in girls in the children, but the connection was stronger in girls in the adolescent sample
  • Cause and effect is inferred, but it is acknowledged that the likelihood of suffering from traumatic events is “influenced by the mental health of the child”

This study suggests that the multiplicity of traumatic experiences, polytraumatization, and the occurrence of interpersonal trauma are particularly problematic for both children and adolescents. In addition, it seems that gender is a determinant of the impact in the trauma, possibly due to differences in developmental vulnerability.

Reference

Gustafsson, P. E., Nilsson, D., & Svedin, C. G. (2009). Polytraumatization and psychological symptoms in children and adolescents. European Child & Adolescent Psychiatry, 18, 274–283.

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