Trauma and post-traumatic stress disorder among psychiatric inpatient children and adolescents

Abstract

Posttraumatic stress disorder (PTSD) is common in young people in need of inpatient and outpatient mental health services but PTSD is underdiagnosed in clinical settings (Havens et al., 2012). Despite the high prevalence and clinical significance of early recognition of trauma exposure and PTSD in mental health settings, currently there are few empirical data that shed light on the treatment implications in acute care: 40–50% of children and adolescents up to the age of 18 have been exposed to traumatic events and 6% suffer from PTSD. In psychiatric inpatients, the percentages are 46–96% and 21–29% respectively (Gudiño et al., 2014). Young people are also at risk of presenting with psychiatric symptoms, including anxiety, depression, delinquent behaviour, separation anxiety and self-harming behaviours (Havens et al., 2012). The under-identification of PTSD symptoms in clinical settings may hinder effective treatments.In order to examine the rates of trauma exposure and PTSD in inpatient psychiatric settings, we conducted a study of 56 children and adolescents who were admitted to the inpatient unit of the Department of Child Psychiatry, Athens University Medical School at the Aghia Sophia Children’s General Hospital, Athens, Greece, over a three-year period, Results revealed that 75% of the hospitalized children and adolescents had been exposed to violent events, either in their family or in the community. Of them, 26% (19% of the total inpatient population) had developed PTSD while the majority had presented symptoms of PTSD.In addition, of those children and adolescents with PTSD symptoms, 60% required longer hospitalizations and need acute care treatment. Youth diagnosed with PTSD presented with high levels of clinical severity and complexity. High rates of comorbidity were also observed among those with PTSD; the main comorbid disorders found were mood disorders (75% of all cases), but also somatization, conduct, generalized anxiety and, in some, eating and psychotic disorders. In 73% of PTSD cases and in 48.4% of those exposed to traumatic events, suicidal attempts were reported (67 and 53% had reported suicidal ideation) while the percentage of the inpatients with attempted suicides as a result of other psychiatric disorders was 19%. Youth with exposure to trauma and PTSD presented at admission with major impairment in functioning in several areas as measured by the Children’s Global Assessment Scale (C-GAS) (mean score = 32.8, with 91–100 showing superior functioning in all areas). Nevertheless, there is limited research on functioning (i.e. academic performance, peer relationships) in youth with PTSD which is much needed considering that it affects executive cognitive functions and mood. It is worth reporting that in our study, the systematic use of Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version (K-SADS-PL) in the inpatient unit mainly led to the identification of trauma and consequent PTSD. The discrepancy between rates of PTSD at the intake and later throu...

Fear, Neglect, Coercion, and Dehumanization: Is Inpatient Psychiatric Trauma Contributing to a Public Health Crisis?

“…The many identified traumatic occurrences help explain why the experience of psychiatric hospitalization may play a causal role in some eventual suicides (21). Although the presence of PTSD in inpatient settings has received considerable research (22), there is little literature on inpatient psychiatric hospitalization as a cause for diagnoses of PTSD, among other distressing responses to adversity. Nevertheless, given the apparent traumatic potential of hospitalization, and the association between PTSD and post-discharge suicides (23), more research must consider the potentially longstanding harms of psychiatric hospitalization.…”

Nurse and patient factors: Predicting seclusion in adolescent psychiatric units

“…Furthermore, patients may respond differently to male and female nurses or perceive them differently (e.g., they might view female nurses as more empathic), which has been demonstrated regarding healthcare practitioners (Shin et al, 2015). Many adolescents entering psychiatric inpatient units have experienced trauma (Belivanaki et al, 2017; Reay et al, 2015; Vidal et al, 2020) and perpetrators of severe physical and sexual violence/abuse towards children and adolescents are more likely to be male (Hurren et al, 2018; US Department of Health and Human Services, 2005). Some patients re‐enact/re‐experience trauma, which means nurses need to be aware of patients who have a history of re‐enacting trauma, particularly when male nurses are on shift (Cutcliffe et al, 2018; Frewen & Lanius, 2006; Lahav et al, 2019; Penning & Collings, 2014; Vidal et al, 2020).…”

Psychotraumatology in Greece

“…In a recent study of undergraduate and postgraduate students of Athens universities, high rates of early traumatic experience were found; the most frequent types of trauma were corporal punishment (89.9%), emotional abuse (67.2%) and sexual abuse (27%) (Antonopoulou, Konstantakopoulos, Τzinieri-Coccosis, & Sinodinou, 2017). Belivanaki’s presentation focused on a previous study on traumatic exposure to violence and PTSD among psychiatric inpatient children and adolescents (Belivanaki et al, 2017). …”

“…More than 200 professionals and young scientists attended this successful conference which is expected to be developed into an annual international conference. The programme included a welcome by Ntre, president of the organizing society, presentations on trauma across the genders (Olff, 2017), on trauma and PTSD in youth populations (Kolaitis, 2017) and on the impact of trauma and PTSD on physical and mental health or neurobiological outcomes (Agorastos, 2017; Lazaratou, 2017; Pervanidou, Agorastos, Kolaitis, & Chrousos, 2017; Thomadaki, 2017); presentations addressed trauma and psychiatric sequelae in different populations (Belivanaki, Ropi, Kanari, Tsiantis, & Kolaitis, 2017; Charitaki, Pervanidou, Tsiantis, Chrousos, & Kolaitis, 2017; Farmakopoulou, Triantafyllou, & Kolaitis, 2017; Triantafyllou, Ntre, & Kolaitis, 2017) and specific forms of psychotherapy of trauma and PTSD (Kalantzi-Azizi & Anastasiou, 2017; Papanikolopoulos & Prattos-Spongalides, 2017; Syros, 2017). …”