Co-Occurring Depression and PTS: Implications of End of Treatment Symptom

Differences in trauma Exposed Youth

Jessica Eslinger, PhD

Ginny Sprang, PhD, co-author

This study was made possible in part by funding provided by SAMHSA (#SM058230, Sprang-PI)

Acknowledgments

To understand how co-occurring depression with symptoms of post traumatic stress may complicate recovery to help inform the nature and course of service delivery.

Purpose

Presence of co-morbid depression with post traumatic stress symptoms (Lai et al., 2013; Runyan, Faust, & Orvaschel, 2002)

Evidence-based treatments found to improve trauma-related symptoms following treatment (Cicchetti, Rogosch, & Toth, 2006; Cohen et al., 2004).

Fewer studies have specifically examined how depressive symptoms may complicate recovery (Stoner, Leon, &Fuller, 2003)

Introduction

Children with combined symptoms of PTS and depression will experience a more troubled symptom trajectory and will exhibit higher levels of PTS and depression at the end of treatment compared to children with PTS symptoms only at the start of treatment.

Hypothesis

180 children ages 6-16 57.2% female (n = 103), 42.8% male (n = 77) Average age = 10.74 (SD = 2.88) 43.1% state care, 28.7% biological, 7.2% adoptive, 20.4% relative care All children trauma-exposed Data obtained from eight study sites across Kentucky

(includes urban and rural clinics). All received TF-CBT

Participants

Secondary data from the University of Kentucky Child and Adolescent Trauma Treatment and Training Institute (CATTTI)

Standard battery of psychometrics completed at baseline and termination

Clinician assessed symptoms of PTS and depression at baseline assessment

PTS Only or PTS/Depression Combined Group

Procedure

Anxious/Depressed, Withdrawn/Depressed, Total Internalizing Scales from the CBCL (Achenbach & Rescrola, 2000, 2001)

Total PTS Scale from either the TSCYC (Briere, 2005) or TSCC-A (Briere, 1996)

Child Depression Inventory-Short Form (CDI; Kovacs, 1992)

Instruments

Paired samples t-tests and ANOVAs to examine differences in symptoms at baseline and end of treatment for the PTS Only and Combined PTS/Depression group

PASW 22

Analytic Plan

Scale Mean Diff t df p

Total PTS 12.8 7.82 94 .000*

Anxious/Depressed 3.78 3.39 84 .001*

Withdrawn/Depressed 4.52 3.86 83 .000*

Total Internalizing 6.25 4.91 84 .000*

CDI 8.42 5.66 75 .000*

Differences from Baseline to End of Treatment

Scale M (SD) F p

PTS Baseline (n=175) PTS Only Combined

71.29 (18.23) 64.97 (15.51)

4.734 .032*

PTS Termination (n=96) PTS Only Combined

51.89(10.54) 55.59 (16.30)

1.823 .180

Total PTS Group Differences at Baseline & Termination

Scale M (SD) F p

Anx/Dep Baseline (n=162) PTS Only Combined

60.58(11.66) 64.74 (10.92)

4.152 .045*

Anx/Dep Term (n=89) PTS Only Combined

55.39(8.23) 61.53 (11.13)

8.752 .004*

CBCL Anxious/Depressed Group Differences at Baseline & Termination

Scale M (SD) F p

With/Dep Baseline (n=161) PTS Only Combined

60.16 (10.60) 65.76 (11.04)

8.598 .004*

With/Dep Term (n=89) PTS Only Combined

55.19 (6.03) 60.28 (9.51)

9.453 .003*

CBCL Withdrawn/Depressed Group Differences at Baseline & Termination

Scale M (SD) F p

Tot Int Baseline (n=162) PTS Only Combined

58.81 (11.44) 65.50 (11.04

11.004 .001*

Tot Int Term (n=89) PTS Only Combined

49.29 (13.08) 59.41 (12.76)

12.304 .001*

CBCL Total Internalizing Group Differences at Baseline & Termination

Scale M (SD) F p

CDI Baseline (n=136) PTS Only Combined

48.91 (9.01) 56.12 (14.22)

11.603 .001*

CDI Termination (n=85) PTS Only Combined

45.47 (6.63) 46.31 (9.28)

.234 .630

CDI Group Differences at Baseline & Termination

Symptoms significantly improved from baseline to termination on all scales

Study hypothesis was partially supported:

Significant group differences found on the anxious/depressed, withdrawn/depressed and total internalizing scale scores on the CBCL at termination

Combined group exhibited higher scores except on PTS at baseline.

Discussion

High number of sample children in foster care

Prevalence of depression in foster care population (Stoner et al., 2013; McMillan, et al., 2005)

Past research examining complex trauma and symptom levels (Cloitre et al., 2009; Kisiel et al., 2009).

Past research examining child age and symptom levels (Greeson et al., 2011).

Discussion

Co-occurring depression with PTS may complicate symptom recovery

Importance of assessing for depressive symptoms at baseline

Purposeful focus on thoughts, feelings, beliefs connected to depressed mood during TF-CBT

Helpfulness of booster sessions to reinforce treatment gains following termination

Implications for Practice

Small non-random sample

Caregiver report of internalizing symptoms may affect the ability to get a true measurement of child emotional symptoms

Complexity of separating depression as part of PTS related symptoms vs. a mood disorder

Limitations

Center On Trauma and Children University of Kentucky

Jessica G. Eslinger PhD j.g.eslinger@uky.edu

ctac.uky.edu

Questions?

Cloitre, M., Stolbach, B. C., Herman, J. L., van der Kolk, B., Pynoos, R., Wang, J., & Petkova, E. (2009). A developmental approach to complex PTSD: Childhood and adult cumulative trauma as predictors of symptom complexity. Journal of Traumatic Stress, 22(5), 399-408.

Greeson, J. K. P., Briggs, E. C., Kisiel, C. L., Layne, C. M., Ake III, G. S., Ko, S. J., Gerrity, E. T., Steinberg, A. M., Howard, M. L., Pynoos, R. S., & Fairbank, J. A. (2011). Complex trauma and mental health in children and adolescents placed in foster care: Findings from the National Child Traumatic Stress Network. Child Welfare, 90(6), 91-108.

References

Kisiel, C. L., Fehrenbach, T., Small, L., & Lyons, J. (2009). Assessment of complex trauma exposure, responses, and service needs among children and adolescents in child welfare. Journal of Child and Adolescent Trauma, 2, 143-160.

Lai, B. S., La Greca, A. M., Auslander, B. A, & Short, M. B. (2013). Children’s symptoms of posttraumatic stress and depression after a natural disaster: Comorbity and risk factors. Journal of Affective Disorders, 146, 71-78.

McMillan, J. C., Zima, B. T., Scott, L. D., Auslander, W. F., Munson, M . R., Ollie, M. T., et al. (2005). Prevalence of psychiatric disorders among older youths in the foster care system. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 88-95.

References

Runyan, M. K., Faust, J., & Orvaschel, H. (2002). Differential symptom patterns of post-traumatic stress disorder (PTSD) in maltreated children with and without concurrent depression. Child Abuse & Neglect, 26, 39-53.

Stoner, A. M., Leon, S. C., & Fuller, A. K. (2013). Predictors of reduction in symptoms of depression for children and adolescents in foster care. J of Child Fam Stud, doi: 10.1007/s10826-013-9889-9

References