Predicting PTSD Risk in Children After Acute Traumatic Events

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DESCRIPTION (provided by applicant): Acute single-incident trauma is an unfortunately common experience for children and adolescents. Injury, disasters, and other acute traumas affect many millions of children each year. Among single-incident events, injury stands out in both prevalence and public health impact. Many trauma-exposed youth recover well, but a considerable number develop significant symptoms of posttraumatic stress disorder (PTSD) that impair psychological functioning and academic and social development. Well-validated screening strategies in the early post-trauma period are greatly needed by both clinicians and researchers, to reliably identify trauma-exposed children at highest risk of developing persistent PTSD symptoms. Brief screening tools designed for multiple time points in the early aftermath of child trauma, and suitable for use by a range of practitioners, would have the greatest public health impact. Such tools could expand the reach of screening and prevention efforts to pediatric medical settings, thus engaging trauma- exposed children unlikely to seek formal mental health services. The broad, long-term goal of this research is to develop and test risk assessment tools for screening children at multiple time points after acute trauma exposure. The proposed project will employ secondary analysis of existing data from studies that have prospectively assessed posttraumatic stress symptoms and PTSD following acute child trauma, primarily child injury. The specific aims of this exploratory / developmental project are to: 1) Establish a working infrastructure for data sharing and collaboration; 2) Determine best ways to combine available data to formulate predictor and outcome variables and predictive analyses; 3) Conduct analyses to develop a preliminary set of risk assessment tools for children. The project team combines expert content knowledge and methodological expertise, and will make available existing datasets with prospective data regarding more than 2500 children who have experienced acute trauma, primarily injury. These data were collected at numerous time points and include retrospective pre-trauma characteristics, peri-traumatic person and event characteristics, in-hospital biological data, and early and later post-traumatic responses. As part of the current project, the research team will develop a rich archive of prospective data on child trauma, and an infrastructure for collaboration and data-sharing that will have impact beyond the initial project period. In developing risk assessment tools, the planned approach is to design a multi-point screening process (an early screen suitable for the immediate post-trauma period, and later screen(s) within the first weeks to months post-trauma). The team will examine the efficacy of combinations of screening results across time and of single screening points. The results of this project will lay the groundwork for prospective testing and validation of sequenced risk assessment tools in different clinical and research settings and with children who have experienced distinct types of acute trauma. This project aims to advance the development of brief risk assessment tools that are feasible for use in the early aftermath of child trauma. Such tools would have great public health impact by expanding the reach of screening and prevention efforts to pediatric medical settings to engage trauma-exposed children unlikely to seek formal mental health services. This advances Healthy People 2010 goals to increase the number of persons seen in health care settings who receive mental health screening and assessment (Objective 18-6).