Publications by Year: 2014

2014
Mclaughlin, K. (2014). Developmental Epidemiology. In M. Lewis & K. D. Rudolph (Ed.), Handbook of Developmental Psychopathology (3rd ed. pp. 87-107) . Springer. PDF
Keyes, K. M., Shmulewitz, D., Greenstein, E., McLaughlin, K., Wall, M., Aharonovich, E., Weizman, A., et al. (2014). Exposure to the Lebanon War of 2006 and effects on alcohol use disorders: The moderating role of childhood maltreatment. Drug and Alcohol Dependence , 134, 296–303. Publisher's VersionAbstract
{Background Civilian populations now comprise the majority of casualties in modern warfare, but effects of war exposure on alcohol disorders in the general population are largely unexplored. Accumulating literature indicates that adverse experiences early in life sensitize individuals to increased alcohol problems after adult stressful experiences. However, child and adult stressful experiences can be correlated, limiting interpretation. We examine risk for alcohol disorders among Israelis after the 2006 Lebanon War, a fateful event outside the control of civilian individuals and uncorrelated with childhood experiences. Further, we test whether those with a history of maltreatment are at greater risk for an alcohol use disorder after war exposure compared to those without such a history. Methods Adult household residents selected from the Israeli population register were assessed with a psychiatric structured interview; the analyzed sample included 1306 respondents. War measures included self-reported days in an exposed region. Results Among those with a history of maltreatment, those in a war-exposed region for 30+ days had 5.3 times the odds of subsequent alcohol disorders compared to those exposed 0 days (95%C.I. 1.01–27.76), controlled for relevant confounders; the odds ratio for those without this history was 0.5 (95%C.I. 0.25–1.01); test for interaction: X2=5.28
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Kessler, R. C., Adler, L. A., Berglund, P., Green, J. G., McLaughlin, K. A., Fayyad, J., Russo, L. J., et al. (2014). The effects of temporally secondary co-morbid mental disorders on the associations of DSM-IV ADHD with adverse outcomes in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A). Psychological Medicine , 44 (08), 1779–1792. Publisher's VersionAbstract
Background. Although DSM-IV attention deficit hyperactivity disorder (ADHD) is known to be associated with numerous adverse outcomes, uncertainties exist about how much these associations are mediated temporally by secondary comorbid disorders. Method. The US National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a national survey of adolescents aged 13–17 years (n = 6483 adolescent–parent pairs), assessed DSM-IV disorders with the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Statistical decomposition was used to compare direct effects of ADHD with indirect effects of ADHD through temporally secondary mental disorders (anxiety, mood, disruptive behavior, substance disorders) in predicting poor educational performance (suspension, repeating a grade, below-average grades), suicidality (ideation, plans, attempts) and parent perceptions of adolescent functioning (physical and mental health, interference with role functioning and distress due to emotional problems). Results. ADHD had significant gross associations with all outcomes. Direct effects of ADHD explained most (51.9–67.6%) of these associations with repeating a grade in school, perceived physical and mental health (only girls), interference with role functioning and distress, and significant components (34.5–44.6%) of the associations with school suspension and perceived mental health (only boys). Indirect effects of ADHD on educational outcomes were predominantly through disruptive behavior disorders (26.9–52.5%) whereas indirect effects on suicidality were predominantly through mood disorders (42.8–59.1%). Indirect effects on most other outcomes were through both mood (19.8–31.2%) and disruptive behavior (20.1–24.5%) disorders, with anxiety and substance disorders less consistently important. Most associations were comparable for girls and boys. Conclusions. Interventions aimed at reducing the adverse effects of ADHD might profitably target prevention or treatment of temporally secondary co-morbid disorders.
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Keyes, K. M., Shmulewitz, D., Greenstein, E., McLaughlin, K., Wall, M., Aharonovich, E., Weizman, A., et al. (2014). Exposure to the Lebanon War of 2006 and effects on alcohol use disorders: The moderating role of childhood maltreatment. Drug and Alcohol Dependence , 134, 296–303. Publisher's VersionAbstract
{Background Civilian populations now comprise the majority of casualties in modern warfare, but effects of war exposure on alcohol disorders in the general population are largely unexplored. Accumulating literature indicates that adverse experiences early in life sensitize individuals to increased alcohol problems after adult stressful experiences. However, child and adult stressful experiences can be correlated, limiting interpretation. We examine risk for alcohol disorders among Israelis after the 2006 Lebanon War, a fateful event outside the control of civilian individuals and uncorrelated with childhood experiences. Further, we test whether those with a history of maltreatment are at greater risk for an alcohol use disorder after war exposure compared to those without such a history. Methods Adult household residents selected from the Israeli population register were assessed with a psychiatric structured interview; the analyzed sample included 1306 respondents. War measures included self-reported days in an exposed region. Results Among those with a history of maltreatment, those in a war-exposed region for 30+ days had 5.3 times the odds of subsequent alcohol disorders compared to those exposed 0 days (95%C.I. 1.01–27.76), controlled for relevant confounders; the odds ratio for those without this history was 0.5 (95%C.I. 0.25–1.01); test for interaction: X2=5.28
McLaughlin, K. A., Busso, D. S., Duys, A., Green, J. G., Alves, S., Way, M., & Sheridan, M. A. (2014). Amygdala response to negative stimuli predicts PTSD symptom onset following a terrorist attack. Depression and Anxiety , 31 (10), 834–842.Abstract
OBJECTIVE: Individuals with posttraumatic stress disorder (PTSD) exhibit heightened amygdala reactivity and atypical activation patterns in the medial prefrontal cortex (mPFC) in response to negative emotional information. It is unknown whether these aspects of neural function are risk factors for PTSD or consequences of either trauma exposure or onset of the disorder. We had a unique opportunity to investigate this issue following the terrorist attacks at the 2013 Boston Marathon and the ensuing manhunt and shelter in place order. We examined associations of neural function measured prior to the attack with PTSD symptom onset related to these events. METHODS: A sample of 15 adolescents (mean age = 16.5 years) who previously participated in a neuroimaging study completed a survey assessing posttraumatic symptoms related to the terrorist attack. We examined blood oxygen level dependent (BOLD) response to viewing and actively down-regulating emotional responses to negative stimuli in regions previously associated with PTSD, including the amygdala, hippocampus, and mPFC, as prospective predictors of posttraumatic symptom onset. RESULTS: Increased BOLD signal to negative emotional stimuli in the left amygdala was strongly associated with posttraumatic symptoms following the attack. Reduced bilateral hippocampal activation during effortful attempts to down-regulate emotional responses to negative stimuli was also associated with greater posttraumatic symptoms. Associations of amygdala reactivity with posttraumatic symptoms were robust to controls for pre-existing depression, anxiety, and PTSD symptoms and prior exposure to violence. CONCLUSIONS: Amygdala reactivity to negative emotional information might represent a neurobiological marker of vulnerability to traumatic stress and, potentially, a risk factor for PTSD.
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Myers, B., McLaughlin, K. A., Wang, S., Blanco, C., & Stein, D. J. (2014). Associations between childhood adversity, adult stressful life events, and past-year drug use disorders in the National Epidemiological Study of Alcohol and Related Conditions (NESARC). Psychology of Addictive Behaviors: Journal of the Society of Psychologists in Addictive Behaviors , 28 (4), 1117–1126.Abstract
Stress sensitization, whereby CA lowers tolerance to later stressors, has been proposed as a potential mechanism explaining the association between exposure to childhood adversities (CA) and drug use disorders in adulthood. However, this mechanism remains untested. This paper begins to address this gap through exploring associations between CA exposure and stressful events in adulthood for predicting drug use disorders. We used data drawn from Wave 2 of the U.S. National Epidemiological Survey of Alcohol and Related Conditions (n = 34,653) to explore whether the association between past-year stressful life events and the 12-month prevalence of disordered cannabis, stimulant, and opiate use varied by the number of types of CA that an individual was exposed to. Past-year stressful life events were associated with an increased risk of cannabis, stimulant, and opiate use disorders among men and women. Exposure to CA was associated with increased risk for disordered cannabis use among men and women and opiate use among men only. Finally, we found significant associations between exposure to CA and past-year stressful life events in predicting disordered drug use, but only for women in relation to disordered stimulant and opiate use. Findings are suggestive of possible stress sensitization effects in predicting disordered stimulant and opiate use among women. Implications of these findings for the prevention and treatment of drug use disorders and for future research are discussed.
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Iverson, K. M., McLaughlin, K. A., Adair, K. C., & Monson, C. M. (2014). Anger-related dysregulation as a factor linking childhood physical abuse and interparental violence to intimate partner violence experiences. Violence and Victims , 29 (4), 564–578.Abstract
OBJECTIVE: Childhood family violence exposure is associated with increased risk for experiencing intimate partner violence (IPV) in adulthood, but the mechanisms underlying this relationship remain inadequately understood. Difficulties with emotion regulation may be one factor that helps to explain this relationship. METHOD: Childhood physical abuse and interparental violence, as well as subsequent IPV experiences, were assessed in a large sample of young adults (N = 670). Several indicators of anger-related dysregulation were also assessed. Structural equation modeling was used to create a latent variable of anger-related dysregulation, which was examined as a potential mediator of the associations between childhood family violence exposure and IPV. RESULTS: Childhood physical abuse and interparental violence were associated with greater physical, sexual, and emotional IPV victimization. Childhood physical abuse and interparental violence were also associated with anger-related dysregulation, which was positively associated with all three types of IPV experiences. Anger-related dysregulation fully mediated the association between witnessing interparental violence and physical IPV. Anger-related dysregulation partially mediated the association between witnessing interparental violence and psychological IPV and the associations of childhood physical abuse with all three forms of IPV. These associations were consistent across gender. CONCLUSIONS: Interventions aimed at reducing IPV risk among survivors of childhood family violence may benefit from including techniques to target anger-related emotion regulation skills.
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Rith-Najarian, L. R., McLaughlin, K. A., Sheridan, M. A., & Nock, M. K. (2014). The biopsychosocial model of stress in adolescence: self-awareness of performance versus stress reactivity. Stress (Amsterdam, Netherlands) , 17 (2), 193–203.Abstract
Extensive research among adults supports the biopsychosocial (BPS) model of challenge and threat, which describes relationships among stress appraisals, physiological stress reactivity, and performance; however, no previous studies have examined these relationships in adolescents. Perceptions of stressors as well as physiological reactivity to stress increase during adolescence, highlighting the importance of understanding the relationships among stress appraisals, physiological reactivity, and performance during this developmental period. In this study, 79 adolescent participants reported on stress appraisals before and after a Trier Social Stress Test in which they performed a speech task. Physiological stress reactivity was defined by changes in cardiac output and total peripheral resistance from a baseline rest period to the speech task, and performance on the speech was coded using an objective rating system. We observed in adolescents only two relationships found in past adult research on the BPS model variables: (1) pre-task stress appraisal predicted post-task stress appraisal and (2) performance predicted post-task stress appraisal. Physiological reactivity during the speech was unrelated to pre- and post-task stress appraisals and to performance. We conclude that the lack of association between post-task stress appraisal and physiological stress reactivity suggests that adolescents might have low self-awareness of physiological emotional arousal. Our findings further suggest that adolescent stress appraisals are based largely on their performance during stressful situations. Developmental implications of this potential lack of awareness of one's physiological and emotional state during adolescence are discussed.
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Keyes, K. M., Pratt, C., Galea, S., McLaughlin, K. A., Koenen, K. C., & Shear, M. K. (2014). The burden of loss: unexpected death of a loved one and psychiatric disorders across the life course in a national study. The American Journal of Psychiatry , 171 (8), 864–871.Abstract
OBJECTIVE: Unexpected death of a loved one is common and associated with subsequent elevations in symptoms of multiple forms of psychopathology. Determining whether this experience predicts novel onset of psychiatric disorders and whether these associations vary across the life course has important clinical implications. The authors examined associations of a loved one's unexpected death with first onset of common anxiety, mood, and substance use disorders in a population-based sample. METHOD: The relation between unexpected death of a loved one and first onset of lifetime DSM-IV disorders was estimated by using a structured interview of adults in the U.S. general population (analytic sample size=27,534). Models controlled for prior occurrence of any disorder, other traumatic experiences, and demographic variables. RESULTS: Unexpected death of a loved one was the most common traumatic experience and most likely to be rated as the respondent's worst, regardless of other traumatic experiences. Increased incidence after unexpected death was observed at nearly every point across the life course for major depressive episode, panic disorder, and posttraumatic stress disorder. Increased incidence was clustered in later adult age groups for manic episode, phobias, alcohol use disorders, and generalized anxiety disorder. CONCLUSIONS: The bereavement period is associated with elevated risk for the onset of multiple psychiatric disorders, consistently across the life course and coincident with the experience of the loved one's death. Novel associations between unexpected death and onset of several disorders, including mania, confirm multiple case reports and results of small studies and suggest an important emerging area for clinical research and practice.
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McLaughlin, K. A., Sheridan, M. A., Alves, S., & Mendes, W. B. (2014). Child maltreatment and autonomic nervous system reactivity: identifying dysregulated stress reactivity patterns by using the biopsychosocial model of challenge and threat. Psychosomatic Medicine , 76 (7), 538–546.Abstract
{OBJECTIVE: Disruptions in stress response system development have been posited as mechanisms linking child maltreatment (CM) to psychopathology. Existing theories predict elevated sympathetic nervous system reactivity after CM, but evidence for this is inconsistent. We present a novel framework for conceptualizing stress reactivity after CM that uses the biopsychosocial model of challenge and threat. We predicted that in the context of a social-evaluative stressor, maltreated adolescents would exhibit a threat pattern of reactivity, involving sympathetic nervous system activation paired with elevated vascular resistance and blunted cardiac output (CO) reactivity. METHODS: A sample of 168 adolescents (mean age =14.9 years) participated. Recruitment targeted maltreated adolescents; 38.2% were maltreated. Electrocardiogram, impedance cardiography, and blood pressure were acquired at rest and during an evaluated social stressor (Trier Social Stress Test). Pre-ejection period (PEP), CO, and total peripheral resistance reactivity were computed during task preparation, speech delivery, and verbal mental arithmetic. Internalizing and externalizing symptoms were assessed. RESULTS: Maltreatment was unrelated to PEP reactivity during preparation or speech, but maltreated adolescents had reduced PEP reactivity during math. Maltreatment exposure (F(1,145) = 3.8-9.4
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Gooding, H. C., Milliren, C., McLaughlin, K. A., Richmond, T. K., Katz-Wise, S. L., Rich-Edwards, J., & Austin, S. B. (2014). Child maltreatment and blood pressure in young adulthood. Child Abuse & Neglect , 38 (11), 1747–1754.Abstract
Adverse childhood experiences are associated with hypertension in older adults. This study assessed whether an association between child maltreatment and blood pressure is detectable in young adults and whether any association differs by sex or is modified by genetic polymorphisms known to be involved in stress sensitivity. We examined these patterns in a sample of 12,420 young adults ages 24-32 years who participated in Wave IV of the National Longitudinal Study of Adolescent Health. Participants retrospectively reported history of physical, emotional, or sexual abuse before age 18 years. Participants with a systolic blood pressure (SBP) >=140 mmHg or a diastolic blood pressure (DBP) >=90 mmHg were classified as hypertensive. We used sex-stratified linear and logistic regression models to assess associations between each type of childhood maltreatment and SBP, DBP, and hypertension. We created interaction terms to assess for effect modification of any relationship between maltreatment and blood pressure by sex or SLC64A genotype. Fifteen percent of females and 31.5% of males were hypertensive. Frequent physical abuse in childhood was reported by 5%, frequent emotional abuse by 12%, and any sexual abuse by 5%. No association was observed between abuse history and blood pressure in either males or females, nor was effect modification present by SLC64A genotype. Child maltreatment exposure was not associated with blood pressure or hypertension in young adults in this study. Future studies should investigate additional critical windows for the effect of child maltreatment on cardiovascular health.
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McLaughlin, K. A., Sheridan, M. A., & Lambert, H. K. (2014). Childhood adversity and neural development: deprivation and threat as distinct dimensions of early experience. Neuroscience and Biobehavioral Reviews , 47, 578–591.Abstract
A growing body of research has examined the impact of childhood adversity on neural structure and function. Advances in our understanding of the neurodevelopmental consequences of adverse early environments require the identification of dimensions of environmental experience that influence neural development differently and mechanisms other than the frequently-invoked stress pathways. We propose a novel conceptual framework that differentiates between deprivation (absence of expected environmental inputs and complexity) and threat (presence of experiences that represent a threat to one's physical integrity) and make predictions grounded in basic neuroscience principles about their distinct effects on neural development. We review animal research on fear learning and sensory deprivation as well as human research on childhood adversity and neural development to support these predictions. We argue that these previously undifferentiated dimensions of experience exert strong and distinct influences on neural development that cannot be fully explained by prevailing models focusing only on stress pathways. Our aim is not to exhaustively review existing evidence on childhood adversity and neural development, but to provide a novel framework to guide future research.
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Sumner, J. A., McLaughlin, K. A., Walsh, K., Sheridan, M. A., & Koenen, K. C. (2014). CRHR1 genotype and history of maltreatment predict cortisol reactivity to stress in adolescents. Psychoneuroendocrinology , 43, 71–80.Abstract
This study examined the contributions of a polymorphism of the corticotropin-releasing hormone receptor type I (CRHR1) gene (rs110402) and a history of child maltreatment–alone and in interaction–to patterns of cortisol reactivity in adolescents. Adolescents between the age of 13 and 17 years with (n=61) and without (n=97) a history of child maltreatment were exposed to the Trier Social Stress Test (TSST). Salivary cortisol was assessed at baseline, and 15 and 30 min after the start of the speech portion of the TSST. Saliva samples for genotyping rs110402 also were collected. Adolescents with one or more G alleles of rs110402, relative to A allele homozygotes, and those exposed to maltreatment, relative to non-exposed adolescents, exhibited blunted cortisol reactivity to the TSST (although these associations approached, but did not reach, the level of statistical significance when accounting for underlying population structure in our racially and ethnically diverse sample). There was also a trend for a stronger child maltreatment association with cortisol hypo-reactivity among G allele carriers, but this association was not statistically significant. Findings suggest that CRHR1 variation may moderate the downstream effects of child maltreatment on HPA axis function, and implications for understanding mechanisms of risk associated with early adversity are discussed.
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Karam, E. G., Friedman, M. J., Hill, E. D., Kessler, R. C., McLaughlin, K. A., Petukhova, M., Sampson, L., et al. (2014). Cumulative traumas and risk thresholds: 12-month PTSD in the World Mental Health (WMH) surveys. Depression and Anxiety , 31 (2), 130–142.Abstract
BACKGROUND: Clinical research suggests that posttraumatic stress disorder (PTSD) patients exposed to multiple traumatic events (TEs) rather than a single TE have increased morbidity and dysfunction. Although epidemiological surveys in the United States and Europe also document high rates of multiple TE exposure, no population-based cross-national data have examined this issue. METHODS: Data were analyzed from 20 population surveys in the World Health Organization World Mental Health Survey Initiative (n = 51,295 aged 18+). The Composite International Diagnostic Interview (3.0) assessed 12-month PTSD and other common DSM-IV disorders. Respondents with 12-month PTSD were assessed for single versus multiple TEs implicated in their symptoms. Associations were examined with age of onset (AOO), functional impairment, comorbidity, and PTSD symptom counts. RESULTS: 19.8% of respondents with 12-month PTSD reported that their symptoms were associated with multiple TEs. Cases who associated their PTSD with four or more TEs had greater functional impairment, an earlier AOO, longer duration, higher comorbidity with mood and anxiety disorders, elevated hyperarousal symptoms, higher proportional exposures to partner physical abuse and other types of physical assault, and lower proportional exposure to unexpected death of a loved one than cases with fewer associated TEs. CONCLUSIONS: A risk threshold was observed in this large-scale cross-national database wherein cases who associated their PTSD with four or more TEs presented a more "complex" clinical picture with substantially greater functional impairment and greater morbidity than other cases of PTSD. PTSD cases associated with four or more TEs may merit specific and targeted intervention strategies.
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Sheridan, M. A., & McLaughlin, K. A. (2014). Dimensions of early experience and neural development: deprivation and threat. Trends in Cognitive Sciences , 18 (11), 580–585.Abstract
Over the past decade, a growing area of research has focused on adverse childhood experiences (ACEs) and their impacts on neural and developmental outcomes. Work in the field to-date has generally conceptualized ACEs in terms of exposure to stress while overlooking the underlying dimensions of environmental experience that may distinctly impact neural development. Here, we propose a novel framework that differentiates between deprivation (absence of expected cognitive and social input) and threat (presence of a threat to one's physical integrity). We draw support for the neural basis of this distinction from studies on fear learning and sensory deprivation in animals to highlight potential mechanisms through which experiences of threat and deprivation could affect neural structure and function in humans.
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Stein, D. J., McLaughlin, K. A., Koenen, K. C., Atwoli, L., Friedman, M. J., Hill, E. D., Maercker, A., et al. (2014). DSM-5 and ICD-11 definitions of posttraumatic stress disorder: investigating "narrow" and "broad" approaches. Depression and Anxiety , 31 (6), 494–505.Abstract
BACKGROUND: The development of the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) and ICD-11 has led to reconsideration of diagnostic criteria for posttraumatic stress disorder (PTSD). The World Mental Health (WMH) Surveys allow investigation of the implications of the changing criteria compared to DSM-IV and ICD-10. METHODS: WMH Surveys in 13 countries asked respondents to enumerate all their lifetime traumatic events (TEs) and randomly selected one TE per respondent for PTSD assessment. DSM-IV and ICD-10 PTSD were assessed for the 23,936 respondents who reported lifetime TEs in these surveys with the fully structured Composite International Diagnostic Interview (CIDI). DSM-5 and proposed ICD-11 criteria were approximated. Associations of the different criteria sets with indicators of clinical severity (distress-impairment, suicidality, comorbid fear-distress disorders, PTSD symptom duration) were examined to investigate the implications of using the different systems. RESULTS: A total of 5.6% of respondents met criteria for "broadly defined" PTSD (i.e., full criteria in at least one diagnostic system), with prevalence ranging from 3.0% with DSM-5 to 4.4% with ICD-10. Only one-third of broadly defined cases met criteria in all four systems and another one third in only one system (narrowly defined cases). Between-system differences in indicators of clinical severity suggest that ICD-10 criteria are least strict and DSM-IV criteria most strict. The more striking result, though, is that significantly elevated indicators of clinical significance were found even for narrowly defined cases for each of the four diagnostic systems. CONCLUSIONS: These results argue for a broad definition of PTSD defined by any one of the different systems to capture all clinically significant cases of PTSD in future studies.
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Kessler, R. C., Rose, S., Koenen, K. C., Karam, E. G., Stang, P. E., Stein, D. J., Heeringa, S. G., et al. (2014). How well can post-traumatic stress disorder be predicted from pre-trauma risk factors? An exploratory study in the WHO World Mental Health Surveys. World psychiatry: official journal of the World Psychiatric Association (WPA) , 13 (3), 265–274.Abstract
Post-traumatic stress disorder (PTSD) should be one of the most preventable mental disorders, since many people exposed to traumatic experiences (TEs) could be targeted in first response settings in the immediate aftermath of exposure for preventive intervention. However, these interventions are costly and the proportion of TE-exposed people who develop PTSD is small. To be cost-effective, risk prediction rules are needed to target high-risk people in the immediate aftermath of a TE. Although a number of studies have been carried out to examine prospective predictors of PTSD among people recently exposed to TEs, most were either small or focused on a narrow sample, making it unclear how well PTSD can be predicted in the total population of people exposed to TEs. The current report investigates this issue in a large sample based on the World Health Organization (WHO)'s World Mental Health Surveys. Retrospective reports were obtained on the predictors of PTSD associated with 47,466 TE exposures in representative community surveys carried out in 24 countries. Machine learning methods (random forests, penalized regression, super learner) were used to develop a model predicting PTSD from information about TE type, socio-demographics, and prior histories of cumulative TE exposure and DSM-IV disorders. DSM-IV PTSD prevalence was 4.0% across the 47,466 TE exposures. 95.6% of these PTSD cases were associated with the 10.0% of exposures (i.e., 4,747) classified by machine learning algorithm as having highest predicted PTSD risk. The 47,466 exposures were divided into 20 ventiles (20 groups of equal size) ranked by predicted PTSD risk. PTSD occurred after 56.3% of the TEs in the highest-risk ventile, 20.0% of the TEs in the second highest ventile, and 0.0-1.3% of the TEs in the 18 remaining ventiles. These patterns of differential risk were quite stable across demographic-geographic sub-samples. These results demonstrate that a sensitive risk algorithm can be created using data collected in the immediate aftermath of TE exposure to target people at highest risk of PTSD. However, validation of the algorithm is needed in prospective samples, and additional work is warranted to refine the algorithm both in terms of determining a minimum required predictor set and developing a practical administration and scoring protocol that can be used in routine clinical practice.
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Slopen, N., McLaughlin, K. A., & Shonkoff, J. P. (2014). Interventions to improve cortisol regulation in children: a systematic review. Pediatrics , 133 (2), 312–326.Abstract
Childhood adversity is associated with physiologic dysregulation across multiple biological systems; however, relatively little is known about whether these changes are reversible with intervention. The objective of this review was to examine evidence for the effectiveness of interventions to promote healthy cortisol regulation in children. We selected articles from English-language publications in PubMed and EBSCO databases through 2012. Two independent reviewers assessed articles against eligibility criteria. Eligible studies were randomized controlled or quasi-experimental studies designed to improve relationships, environments, or psychosocial functioning in children and examined cortisol as an outcome. We identified 19 articles. There was substantial heterogeneity across studies with regard to age, selection criteria, intervention design, cortisol assessment, and follow-up duration. Eighteen of the 19 articles reported at least 1 difference in baseline cortisol, diurnal cortisol, or cortisol responsivity between intervention and control participants. Importantly, however, there was remarkable inconsistency with regard to how the interventions influenced cortisol. Therefore, studies that included a low-risk comparison group (n = 8) provided critical insight, and each found some evidence that postintervention cortisol levels in the intervention group approximated the low-risk comparison group and differed from children receiving usual care. In conclusion, existing studies show that cortisol activity can be altered by psychosocial interventions. These findings are promising, not only because they indicate physiologic plasticity that can be leveraged by interventions but also because they suggest it may be possible to repair regulatory systems after childhood adversity, which could inform strategies for reducing health disparities and promoting lasting improvements in health.
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Busso, D. S., McLaughlin, K. A., & Sheridan, M. A. (2014). Media exposure and sympathetic nervous system reactivity predict PTSD symptoms after the Boston marathon bombings. Depression and Anxiety , 31 (7), 551–558.Abstract
BACKGROUND: Terrorist attacks have been shown to precipitate posttraumatic stress disorder (PTSD) symptomatology in children and adolescents, particularly among youths with high exposure to media coverage surrounding such events. Media exposure may be particularly likely to trigger PTSD symptoms in youths with high physiological reactivity to stress or with prior psychopathology or exposure to violence. We examined the interplay between media exposure, preattack psychopathology, autonomic nervous system (ANS) reactivity, and prior violence exposure in predicting PTSD symptom onset following the terrorist attack at the 2013 Boston Marathon. METHODS: A community sample of 78 adolescents (mean age = 16.7 years, 65% female) completed a survey about the bombings, including media exposure to the event and PTSD symptoms. All respondents participated in a study assessing psychopathology prior to the attack, and sympathetic and parasympathetic reactivity to a laboratory-based stressor was assessed in a subset (N = 44) of this sample. We examined the associations of media exposure, ANS reactivity, preattack psychopathology, and prior violence exposure with onset of PTSD symptoms related to the bombings. RESULTS: Media exposure, preattack psychopathology, and prior violence exposure were associated with PTSD symptoms. Moreover, media exposure interacted with sympathetic reactivity to predict PTSD symptom onset, such that adolescents with lower levels of sympathetic reactivity developed PTSD symptoms only following high exposure to media coverage of the attack. CONCLUSIONS: We provide novel evidence that physiological reactivity prior to exposure to an unpredictable traumatic stressor predicts PTSD symptom onset. These findings have implications for identifying youths most vulnerable to PTSD following wide-scale trauma.
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Aldao, A., McLaughlin, K. A., Hatzenbuehler, M. L., & Sheridan, M. A. (2014). The Relationship between Rumination and Affective, Cognitive, and Physiological Responses to Stress in Adolescents. Journal of Experimental Psychopathology , 5 (3), 272–288.Abstract
Although previous studies have established that rumination influences responses to stressful life events, the mechanisms underlying this relationship remain inadequately understood. The current study examines the relationship between trait rumination and affective, cognitive, and physiological responses to a standardized laboratory-based stressor in adolescents. A community-based sample of adolescents (N = 157) aged 13-17 completed the Trier Social Stress Test (TSST). Affective, cognitive, and physiological responses were obtained before, during, and after the TSST. Adolescents who engaged in habitual rumination experienced greater negative affect and more negative cognitive appraisals in response to the TSST than adolescents with lower levels of rumination. Rumination was unrelated to heart rate reactivity, but predicted slower heart rate recovery from the TSST, indicating that rumination might be specifically associated with physiological recovery from stress. Rumination is associated with negative affective, cognitive, and physiological responses following stressors, suggesting potential mechanisms through which it might increase risk for psychopathology.
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