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Caregiver influences on child psychological adjustment following trauma; a longitudinal study of a high adversity South African population

照顾者对创伤后儿童心理调整的影响；

基本信息

批准号：
ES/V002643/1
负责人：
Sarah Halligan
金额：
$ 78.51万
依托单位：
University of Bath
依托单位国家：
英国
项目类别：
Research Grant
财政年份：
2022
资助国家：
英国
起止时间：
2022 至无数据
项目状态：
未结题

来源：
https://gtr.ukri.org/projects?ref=ES%2FV002643%2F1
关键词：
Caregiver influences child psychological adjustment

项目摘要

Children who experience very frightening or traumatic events (such as car accidents, assaults, serious injuries) are vulnerable to developing posttraumatic stress disorder (PTSD) and other psychological difficulties following their experiences. Such problems can be extremely distressing, and affect a significant proportion of trauma exposed children. One factor that has the potential to influence such outcomes is the informal support that children receive from their parents/caregivers posttrauma. In research we have conducted in the UK, we found that certain aspects of caregiver responses can have an impact upon children's psychological recovery following trauma. In particular, where caregivers encourage ways of coping in children that allow them to avoid being reminded of the trauma, and/or talk to children about what happened in a way that emphasizes high levels of threat associated with the trauma, children are more likely to experience persistent symptoms of PTSD. These caregiver responses may influence child symptoms as a consequence of children themselves then making more negative appraisals in relation to what happened, and by influencing child coping behaviours.We propose to extend our UK work to the study of a high adversity international population. To date, only a small proportion of PTSD research has been conducted in low-and-middle-income countries (LMICs). This omission is important, as LMIC children may be particularly vulnerable to trauma exposure for a variety of reasons (e.g., poverty, crime, regional conflict). It is essential to establish whether psychological and social processes that have been linked to child PTSD in lower risk settings still apply in contexts where levels of ongoing threat and the likelihood of exposure to recurrent traumas are high. In particular, although we know that caregiver support is a key predictor of child psychological recovery following trauma in high income countries, our understanding of the elements of support that can help children from high adversity, lower income contexts is almost non-existent. This is important, as such children are almost certain to rely on such informal support following trauma exposure, due to limited access to formal psychological services. To address this critical gap in our knowledge, we plan to study the psychosocial factors that contribute to PTSD in a group of children (aged 8-16 years) from a deprived community in South Africa, in which rates of serious trauma exposure are extremely high. We will recruit 250 children who have experienced trauma within 2 weeks following the event. We measure how caregivers provide support, as well as children's initial levels of symptoms. We will then follow-up children and caregivers 3 months and 6 months later, measuring their PTSD symptoms. We will examine whether there are particular elements of caregiver support in the aftermath of trauma that are associated with higher or lower levels of symptoms in children further down the line. We we also will test whether caregiver influences operate via changing key psychological processes (trauma appraisals, coping) in the child, and will take account of caregivers' own trauma-related distress in our study. In addition to helping us to understand what kind of social support is best for children who experience trauma, our project will provide much needed information about the development of PTSD in children from high adversity, low income communities. This is important: at the moment we are lacking even basic information about risk of PTSD in the acute aftermath of trauma among such children, including the proportion who will initially develop this disorder following trauma, the window of time during which children may recover naturally following the event, and the proportion likely to experience persistent disorder and need intervention. This is a major barrier to developing screening and intervention programmes, which our study will be able to address.

经历过非常可怕或创伤性事件（例如车祸、袭击、重伤）的儿童很容易在经历后患上创伤后应激障碍（PTSD）和其他心理困难。这些问题可能非常令人痛苦，并且影响到很大一部分遭受过创伤的儿童。可能影响这种结果的因素之一是儿童在创伤后从父母/照顾者那里获得的非正式支持。在我们在英国进行的研究中，我们发现看护者反应的某些方面可能会对儿童创伤后的心理恢复产生影响。特别是，如果护理人员鼓励儿童采用让他们避免想起创伤的应对方式，和/或以强调与创伤相关的高水平威胁的方式与儿童谈论发生的事情，则儿童更有可能经历持续的 PTSD 症状。这些看护者的反应可能会影响儿童的症状，因为儿童本身会对所发生的事情做出更多负面评价，并影响儿童的应对行为。我们建议将我们在英国的工作扩展到对高度逆境的国际人口的研究。迄今为止，只有一小部分创伤后应激障碍研究是在中低收入国家（LMIC）进行的。这一遗漏很重要，因为中低收入国家儿童可能由于各种原因（例如贫困、犯罪、地区冲突）特别容易遭受创伤。有必要确定在低风险环境中与儿童创伤后应激障碍相关的心理和社会过程是否仍然适用于持续威胁程度和反复遭受创伤的可能性较高的环境。特别是，尽管我们知道看护者的支持是高收入国家创伤后儿童心理恢复的关键预测因素，但我们对能够帮助儿童摆脱逆境、低收入环境的支持要素的理解几乎不存在。这很重要，因为由于获得正规心理服务的机会有限，这些儿童在经历创伤后几乎肯定会依赖这种非正式的支持。为了弥补我们知识上的这一重大差距，我们计划对来自南非贫困社区的一组儿童（8-16 岁）进行 PTSD 的心理社会因素研究，该社区遭受严重创伤的比例极高。我们将招募 250 名在活动发生后两周内经历过创伤的儿童。我们衡量护理人员如何提供支持，以及儿童的初始症状水平。然后，我们将在 3 个月和 6 个月后对儿童和护理人员进行随访，测量他们的 PTSD 症状。我们将研究创伤后护理人员支持的特定因素是否与儿童未来更高或更低的症状水平相关。我们还将测试看护者的影响是否通过改变儿童的关键心理过程（创伤评估、应对）来发挥作用，并将在我们的研究中考虑看护者自己与创伤相关的痛苦。除了帮助我们了解什么样的社会支持最适合遭受创伤的儿童之外，我们的项目还将提供有关来自高逆境、低收入社区的儿童发生创伤后应激障碍（PTSD）的急需信息。这一点很重要：目前，我们甚至缺乏关于此类儿童在急性创伤后患 PTSD 风险的基本信息，包括创伤后最初出现这种疾病的比例、事件发生后儿童可以自然恢复的时间窗口，以及可能经历持续性障碍并需要干预的比例。这是制定筛查和干预计划的主要障碍，我们的研究将能够解决这一问题。