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

经历过非常可怕或创伤性事件（如车祸、袭击、严重伤害）的儿童很容易患上创伤后应激障碍（PTSD）和其他心理问题。这些问题可能是非常令人痛苦的，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会对儿童创伤后的心理恢复产生影响。特别是，当照顾者鼓励儿童的应对方式，使他们能够避免被提醒创伤，和/或与儿童谈论发生的事情，强调与创伤相关的高水平威胁时，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，然后作出更多的负面评价，在发生了什么事，并通过影响儿童的应对behaviors.We建议延长我们的英国工作的高逆境国际人口的研究。迄今为止，只有一小部分PTSD研究是在中低收入国家进行的。这一疏忽是重要的，因为LMIC儿童可能特别容易受到创伤暴露的各种原因（例如，贫困、犯罪、区域冲突）。至关重要的是要确定在低风险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创伤可能性很高的情况。特别是，虽然我们知道照顾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，但我们对可以帮助高逆境儿童的支持要素的理解，低收入环境几乎是不存在的。这一点很重要，因为这些儿童在遭受创伤后，由于获得正规心理服务的机会有限，几乎肯定会依赖这种非正式支助。为了解决我们知识中的这一关键差距，我们计划研究一组来自南非贫困社区的儿童（8-16岁）中导致PTSD的心理社会因素，其中严重创伤暴露率极高。我们将招募250名在事件发生后2周内经历过创伤的儿童。我们衡量照顾者如何提供支持，以及儿童的初始症状水平。然后，我们将在3个月和6个月后随访儿童和照顾者，测量他们的PTSD症状。我们将研究是否有照顾者的支持，在创伤后，与更高或更低水平的症状在儿童进一步下线的特定元素。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，并将在我们的研究中考虑照顾者自己的创伤相关痛苦。除了帮助我们了解什么样的社会支持是最适合经历创伤的儿童，我们的项目将提供急需的信息，关于创伤后应激障碍的发展，在儿童从高逆境，低收入社区。这一点很重要：目前，我们甚至缺乏关于这些儿童在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这种障碍的比例，儿童在事件发生后自然恢复的时间窗口，以及可能经历持续障碍并需要干预的比例。这是发展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.