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

经历了非常可怕或创伤性事件(如车祸、袭击、严重伤害)的儿童容易患上创伤后应激障碍(PTSD)和其他心理障碍。这样的问题可能非常令人苦恼，并影响到相当大比例的创伤暴露儿童。有可能影响这种结果的一个因素是儿童在创伤后从父母/照顾者那里得到的非正式支持。在我们在英国进行的研究中，我们发现照顾者反应的某些方面可以对儿童在创伤后的心理恢复产生影响。特别是，如果照顾者鼓励儿童采取应对方法，使他们能够避免被提醒创伤，和/或以强调与创伤相关的高度威胁的方式与儿童谈论所发生的事情，儿童更有可能经历持续的创伤后应激障碍症状。这些照顾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，并通过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逆境国际人口的研究。迄今为止，只有一小部分创伤后应激障碍研究是在低收入和中等收入国家(LMIC)进行的。这一遗漏很重要，因为LMIC儿童可能由于各种原因(例如贫困、犯罪、区域冲突)特别容易受到创伤的影响。必须确定在风险较低的环境中与儿童创伤后应激障碍有关的心理和社会过程是否仍然适用于持续威胁水平和反复遭受创伤的可能性很高的情况。特别是，尽管我们知道照顾者支持是高收入国家创伤后儿童心理康复的关键预测因素，但我们对能够帮助儿童摆脱高逆境、低收入环境的支持要素的理解几乎不存在。这一点很重要，因为由于获得正式心理服务的机会有限，这类儿童几乎肯定会在受到创伤后依赖这种非正式支持。为了解决我们知识中的这一关键差距，我们计划研究导致创伤后应激障碍的心理社会因素，这些因素来自南非一个严重创伤暴露发生率极高的贫困社区的一群儿童(8-16岁)。我们将招募250名在活动后2周内经历过创伤的儿童。我们衡量照顾者如何提供支持，以及儿童最初的症状水平。然后我们将在3个月和6个月后对儿童和照顾者进行随访，测量他们的创伤后应激障碍症状。我们将研究在创伤后是否有特定的照顾者支持因素与儿童更高或更低水平的症状有关。我们还将测试照顾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，并在我们的研究中考虑到照顾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对经历创伤的儿童最好，我们的项目还将提供急需的信息，了解来自高逆境、低收入社区的儿童的创伤后应激障碍的发展。这一点很重要：目前，我们甚至缺乏关于这类儿童创伤后急性创伤后应激障碍风险的基本信息，包括创伤后最初发展为这种疾病的比例，儿童在事件发生后可能自然恢复的时间窗口，以及可能经历持续性障碍和需要干预的比例。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。

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.