Search Results (210)

Background: Mild traumatic brain injuries (mTBIs) are a significant public health concern in the US. Understanding incidence and demographic patterns is essential for developing targeted prevention and intervention strategies. The most recent study using national healthcare records to examine incidence utilized data from 2016, highlighting the need for updated estimates that reflect current trends. Methods: The MarketScan^® Database was used for this study which includes person-specific clinical utilization, expenditures, and enrollment across different services. A query for mTBIs (S06.0x.xx) or post-concussion syndrome (F07.89) from January–December 2023 was performed for patients aged 0–64. Patients with the same diagnosis codes for the prior 12 months (i.e., chronic diagnosis), moderate to severe TBIs (S06.2–9), skull fractures (S02.xx), and/or brain hemorrhages (S06.3x) were excluded. Results: Out of 11,737,855 insured members with data in 2023, 43,213 new mTBIs were recorded (incidence rate = 0.37%), with the highest rate in adolescents (incidence rate = 1.27%). From the ages of 0–14 years, males had a higher incidence of concussion, but from 15 to 65 years, females had a higher incidence. Minimal differences were seen between urban and rural zip codes. Conclusions: Concussion incidence in adolescents is higher than other age groups, which may reflect increased participation in sports or heightened vulnerability during development. Males had a higher incidence than females during childhood, but females did later in life. These differences may reflect true disparities in injury risk, variations in reporting patterns, or a combination of both. Further research is warranted to understand the underlying mechanisms and to inform age- and sex-specific prevention efforts. Full article

Legal advocacy for parents involved in the public child welfare system in the United States is typically initiated only after a child has been removed and a dependency petition has been filed. For infants, removal at or shortly after birth constitutes a profound disruption of the parent–child attachment relationship and is increasingly recognized as an adverse childhood experience. This paper focuses on a summative program evaluation of the Family Intervention Response to Stop Trauma (FIRST) Legal Clinic in Washington State, a prevention-oriented model providing free, confidential legal advocacy and peer support to pregnant and postpartum parents prior to Child Protective Services (CPS) investigation or court involvement. Administrative data from 2019 to 2025 for 1232 eligible families were utilized to examine eligibility and referral patterns, reasons for ineligibility, and case outcomes. Findings demonstrated that eligible families with known outcomes avoided dependency court involvement entirely or experienced case closure without child removal, while a smaller proportion proceeded to dependency court filings. These findings highlight the need to reduce unnecessary child welfare system entry and mitigate traumatic disruption of the parent–child attachment relationship at birth by providing legal advocacy before investigation and court involvement. Full article

Background: Anorexia nervosa (AN) commonly emerges during adolescence and disproportionately affects girls. In recent years, problematic social media use (PSMU) has been identified as a potential sociocultural risk factor for eating disorder symptoms; however, the psychosocial pathways linking PSMU to AN symptomatology remain insufficiently understood. This study examined the associations between PSMU and AN symptoms in adolescent girls and explored the roles of perceived parenting style and childhood traumatic experiences as explanatory pathways. Methods: A cross-sectional, school-based survey was conducted with 463 adolescent girls aged 13–18 years in İstanbul, Türkiye. Participants completed validated self-report measures assessing AN symptoms (Eating Attitudes Test–26), problematic social media use (Social Media Disorder Scale), perceived parenting style (Parenting Styles and Dimensions Questionnaire), and childhood trauma (Childhood Trauma Questionnaire). Structural equation modeling was used to examine direct and indirect associations between PSMU and AN symptoms, controlling for age, body mass index, and socioeconomic indicators. Indirect effects were tested using bias-corrected bootstrapping. Results: Problematic social media use was directly associated with greater AN symptom severity (β = 0.18, p < 0.001). Significant indirect associations were also observed via perceived parenting style (β = 0.06, 95% CI [0.03, 0.11]) and childhood traumatic experiences (β = 0.07, 95% CI [0.04, 0.12]). Childhood trauma accounted for a larger proportion of the indirect association, while parenting style contributed a smaller but significant pathway. When both pathways were included simultaneously, the direct association between PSMU and AN symptoms remained significant, indicating partial mediation. Model fit indices indicated good overall fit. Conclusions: Problematic social media use is meaningfully associated with anorexia nervosa symptoms among adolescent girls, both directly and through indirect pathways involving parenting context and childhood trauma. Childhood trauma may be interpreted as a variable showing a significant indirect statistical association with both problematic social media use and anorexia nervosa symptoms, rather than a causal determinant within the present design. These findings underscore the importance of integrated, trauma-informed and family-sensitive prevention strategies that address adolescents’ digital environments alongside broader psychosocial vulnerabilities. Full article

Background: Transgender and gender expansive (TGE) people experience high rates of interpersonal victimization, which has been linked to high rates of post-traumatic stress disorder (PTSD, a highly disabling and under-studied mental illness among TGE people). This systematic review identifies, classifies, critically appraises, and synthesizes the peer-reviewed literature describing the association between interpersonal victimization and post-traumatic stress among TGE people. This review collates what is known about the associations between victimization and PTSD among TGE people and makes recommendations to guide future research and intervention development. Methods: Searches were conducted across five databases (PubMed, Embase, Web of Science, PsycInfo, and CINAHL) following PRISMA guidelines. Inclusion criteria were: English language; peer-reviewed original research; articles describing the association between victimization and PTSD among TGE youth or adults; reporting TGE-specific data. Exclusion criteria were: reviews, commentaries without original data, dissertations or theses, conference abstracts, animal studies, studies without TGE-specific findings, and case studies. Quality appraisal was completed for all studies, which included a discussion of bias. Data extraction was completed by two independent authors, and conflicts were resolved by a third. Data were stratified by gender identity, race or ethnicity, and type of violence for further synthesis. Results: 25 studies were evaluated for design, measure quality, and key findings. Findings were highly consistent across studies: multiple forms of interpersonal violence (e.g., childhood maltreatment, sexual violence, intimate partner violence, and transgender-specific victimization) were significantly associated with PTSD symptom severity or diagnosis across diverse identities and geographic contexts. All studies examining childhood sexual abuse reported significant associations with PTSD outcomes, highlighting early life as a critical period of vulnerability. Samples were disproportionately White and adult, with limited examination of intersectional experiences shaped by race, ethnicity, and socioeconomic status. Discussion: Interpersonal violence-related PTSD among TGE populations reflects a pervasive and systemic pattern of trauma rooted in structural discrimination rather than isolated individual risk. Addressing this inequity requires multilevel prevention and intervention strategies. Future research should prioritize longitudinal designs, culturally responsive measurement tools, and intersectional analyses to inform prevention, clinical care, and policy responses. The majority of studies were cross-sectional designs, so causality cannot be inferred. Additionally, the samples were disproportionately White and adult, which may bias the magnitude of associations reported and limit generalizability to racially and ethnically diverse TGE populations. Although many studies reported race and ethnicity descriptively, none disaggregated violence-related PTSD outcomes by racial or ethnic group within TGE samples, representing a critical limitation for intersectional analysis. Full article

Background/Objectives: Sleep is an important biobehavioral process that supports child and adolescent health and development. However, many prior studies examining sleep and mental health have relied on total sleep scores, which may mask the heterogeneity of sleep disturbances. Youth exposed to childhood adversity are at increased risk for sleep disturbances and poor mental health, and thus it is important to examine the links between sleep and mental health within adversity-exposed samples, such as those involved with the child welfare system. Methods: This study used latent class analysis to identify underlying patterns of sleep disturbances and examine differences in mental health symptoms (assessed at baseline and at an 18-month follow-up) across the identified subgroups in a sample of child welfare-involved adolescents (N = 1041, M_age = 13.63 years, SD = 1.86). Our sample was derived from the second cohort of the National Survey on Child and Adolescent Well-Being (NSCAW) study. Results: We identified three subgroups of sleep disturbances: no sleep disturbances (38%), sleeping more than peers and overtired (16%), and trouble maintaining sleep (47%). We found significant mean differences in mental health symptoms across subgroups. Across internalizing, externalizing, and post-traumatic stress disorder (PTSD) symptoms at baseline and at an 18-month follow-up, those in the no sleep disturbances subgroup had overall lower levels of symptoms compared to those in the trouble maintaining sleep subgroup, which had higher levels of symptoms. Compared to those in the sleeping more than peers and overtired subgroup, the trouble maintaining sleep subgroup had higher levels of PTSD symptoms at baseline, and higher levels of externalizing and PTSD symptoms at the follow-up. Those in the sleeping more than peers and overtired subgroup had significantly higher levels of internalizing, externalizing, and PTSD symptoms at baseline compared to the no sleep disturbances subgroup, but there were no significant differences at the 18-month follow-up. Conclusions: The current study highlights the importance of considering the heterogeneity of sleep disturbances to identify child welfare-involved youth who may be more at risk for sleep disturbances and poor mental health and to inform more targeted sleep interventions for this population. Full article

Background: Although trauma can adversely affect body esteem, the specific impact of complex post-traumatic stress disorder (CPTSD) remains underexplored among Mexican women. Objective: This study examined body esteem among trauma-exposed controls and women with either PTSD or CPTSD in a sample of female Mexican university students. Method: Using a cross-sectional design, we recruited 657 cisgender Mexican women (aged 18–66) who completed the Body Esteem Scale (BES), International Trauma Questionnaire (ITQ), and Adverse Childhood Experiences-International Questionnaire (ACE-IQ). Participants were classified into three groups: trauma-exposed controls (n = 526), PTSD (n = 68), and CPTSD (n = 63). Results: Total BES scores differed significantly across groups. Participants with CPTSD reported lower overall body esteem (M = 99.48, SD = 21.32) compared to those with PTSD (M = 114.24, SD = 26.68) and controls (M = 119.38, SD = 24.93). Significant group differences also emerged in the Sexual & Physical Attractiveness and Physical Condition & Weight Concern subscales. Furthermore, the negative correlation between BES scores and trauma symptoms was more pronounced in the CPTSD group (rho = −0.40) than in the PTSD group (rho = −0.25). Conclusions: CPTSD is associated with significantly diminished body esteem in this population. These findings underscore the critical need for culturally sensitive, trauma-informed interventions that address both the psychological and somatic dimensions of body image. Full article

Background/Objectives: Transgender and gender-diverse (TGD) individuals experience disproportionately high rates of childhood trauma and depression; however, the mechanisms linking gender identity and depressive symptoms remain insufficiently understood. This study examines differences in depressive symptoms and childhood trauma between cisgender (CG) and TGD adults. It investigates whether specific subtypes of childhood maltreatment mediate the association between gender identity and depression. Methods: The cross-sectional online study included 249 participants aged 18–72 years (M = 30.85, SD = 12.72), including 144 CG (75 women and 69 men) and 105 TGD individuals (44 transgender and 61 gender diverse individuals). Depression symptoms were assessed using the nine-item Patient Health Questionnaire (PHQ-9), while childhood trauma experiences were measured using the Childhood Trauma Questionnaire–Short Form (CTQ-SF). Results: The independent-sample Student’s t-test showed that TGD participants reported significantly higher levels of depressive symptoms and all forms of childhood trauma than cisgender individuals. Mediation analyses indicated that overall childhood trauma partially mediated the association between gender identity and depression. In parallel mediation models, emotional abuse emerged as the primary statistical mediator, with sexual abuse showing a smaller indirect effect. Conclusions: The findings extend prior prevalence-focused research by identifying specific childhood trauma pathways associated with depressive symptoms in TGD adults. Experiencing traumatic events during childhood may be a key factor contributing to an increased risk of depression in adulthood, particularly among the TGD population. Therefore, intervention and prevention programs should target TGD individuals and their families to minimize the risk of adverse childhood experiences and mental health disorders. The results underscore the importance of trauma-informed and gender-affirming mental health care and highlight emotional abuse as a particularly salient correlate of depression in this population. Full article

Maladaptive family interaction is one of the mechanisms through which trauma is transmitted across generations. The current intervention approach for trauma-affected families focuses on traumatized parents and child–parent dyads during childhood. This leaves a gap in how adult children, who might no longer live with their parents, can overcome the negative impacts of maladaptive childhood interactions with parents as a legacy of parental trauma history. This study focuses on the children of Vietnamese boat refugees in their 30s and 40s in two cities in Norway, applying narrative interviews to elicit long narratives about their lifespan experiences. A hybrid analytic approach utilizes Thematic Network Analysis, informed by a conceptual framework integrating salutogenesis theory and Bowen family systems theory. The findings reveal that maladaptive parent–child interactions in Vietnamese boat refugee families include parents’ high expectations, harsh parenting, children’s obligation to please parents, and adultification, which are trauma-shaped and mediated by Vietnamese culture. Developing a strong sense of coherence (SOC), characterized by enhancing one’s understanding of the self in relation to family, making meaning regarding the past, and playing an active role in reframing relationships with one’s parents, serves as a pathway to outgrow the impacts of maladaptive patterns in one’s family of origin. Overall, this paper contributes a salutogenic, lifespan-oriented framework for understanding recovery beyond childhood impacts of intergenerational trauma. Full article

Background: The clinical meaning of hip joint synovial cavity thickness (HJSCT) on ultrasound (US) in juvenile idiopathic arthritis (JIA) without effusion is uncertain. Methods: In this cross-sectional study, we analyzed 369 children (187 JIA; 182 controls) undergoing hip US at a referral center in Kraków, Poland. JIA examinations were performed upon initial referral, early in the care pathway. We excluded patients with hip effusion and pre-existing inflammatory, traumatic or degenerative hip pathology. HJSCT was defined as the distance from the outer capsule margin to the femoral neck cortex. We used a Toshiba Aplio 400 system with a 12 MHz probe to measure and derive mean bilateral HJSCT. Bilateral concordance was assessed. Iterative multivariable linear regression modeling was used to compare groups, adjusting for non-linear age effects (natural splines) and WHO height-for-age z-scores (HAZ). Results: Left–right HJSCT agreement was high (ICC 0.947; mean difference 0.03 mm; 95% limits of agreement −0.64–0.70). In unadjusted analysis, mean (SD) HJSCT was similar in JIA versus controls: 5.83 (1.09) vs. 5.95 (0.99) mm, respectively (p = 0.25). In the final model (adj. R2 0.656), HJSCT was strongly associated with age (non-linear, p < 0.001) but not significantly associated with HAZ (β = 0.04; p = 0.11) or JIA status (β = 0.07; p = 0.30). Predicted HJSCT showed a steep increment in childhood and plateau in adolescence. Conclusions: In children without hip effusion, HJSCT mainly reflects physiological growth and does not differ significantly between early JIA patients and healthy controls. These findings suggest that capsular thickening is not a reliable standalone marker for early disease in the absence of effusion. Full article

Introduction: Adverse Childhood Experiences (ACEs) refer to traumatic events occurring before the age of 18 that can negatively impact physical and mental health, often disrupting development. Numerous studies have shown associations between ACEs and the onset or severity of psychotic disorders. The aim of this study was to assess the prevalence of ACEs among patients with psychotic disorders and to examine an association between ACEs and the sociodemographic and clinical characteristics of psychosis. Material and Methods: The study was conducted at the Center for Mental Health and the Psychiatric Clinic of the University Clinical Center Nis, from March to July 2025. The sample included adult patients of both sexes diagnosed with psychotic spectrum disorders based on ICD-10 criteria. The Adverse Childhood Experiences Questionnaire (ACE-Q), along with sociodemographic and clinical data from medical records, was used. Results: The sample included 60 patients, with a mean age of 36.7 years. The average ACE-Q score was 2.57 ± 1.98, with one-third of patients reporting high exposure (≥4 ACEs) to childhood adversity. Patients with high ACEs exposure (≥4 ACEs) differed significantly from those with low to moderate or no exposure (<4 ACEs) in terms of economic status, family history of psychiatric disorders, substance use, and treatment adherence. Conclusion: Despite the small sample size, our results point to a potential link between childhood adversity and certain sociodemographic and clinical characteristics in patients with psychotic disorders. Integrating systematic assessments of trauma history into routine clinical practice may support the development of more effective treatment strategies. Full article

Objectives: Latinx Americans represent the largest ethnic minority group (nearly 19% of the U.S. population). Their behavioral health has received increasing attention as they exhibit elevated prevalence rates of anxiety (ANX), depression (DEP), and substance use disorders (SUDs). The National Latino and Asian American Study (NLAAS) is the first national population-based mental health study of Latinx Americans and is the most comprehensive resource for understanding their behavioral health. This systematic review aims to synthesize peer-reviewed publications using the NLAAS dataset to identify psychosocial determinants of the three key outcomes. Method: We followed PRISMA to search for English peer-reviewed articles published in EBSCO, Embase, PsycINFO, Web of Science, and PubMed. Inclusion criteria were as follows: (1) Latinx in the NLAAS database; (2) ANX, DEP, or SUD; (3) risk or protective factors; and (4) peer-reviewed publications in English. Search terms such as Latino, Latina, anxiety, depressive symptoms, substance abuse, and NLAAS were used to search for relevant articles. Two authors screened the articles independently and extracted data from each study. Results: Thirty-two studies published between 2007 and 2024 were included in our final review. Among them, 12 studies investigated ANX, and 17 studies examined DEP and SUD, respectively. Sixteen studies assessed protective factors. Ten articles assessed multiple key outcomes. All risk factors were grouped into three categories: Trauma and negative relationships (e.g., childhood maltreatment, negative family relationship, traumatic life experience), acculturation- and immigration-related factors (e.g., nativity, acculturation experience, English proficiency, discrimination), and sociodemographic and social participation factors (e.g., gender, education, income level). Protective factors such as family cohesion, religious activity, gender, and education were also identified. Conclusion: This first systematic review provided comprehensive NLAAS findings on multifaceted cultural, social, and intrapersonal factors that were either negatively or positively associated with three behavioral health outcomes within the U.S. Latinx population. Potential mechanisms by which risk and protective factors influence their mental health, as well as limitations of this review, were discussed. Findings of this review can inform culturally responsive prevention strategies and interventions to reduce behavioral health disparities and to improve mental health outcomes among Latinx Americans. Full article

Background/Objectives: This narrative review examines how developmentally appropriate safety and health education interventions in early childhood settings impact the incidence and severity of pediatric conditions requiring neurosurgical intervention, and which educational approaches most effectively promote neurological health and injury prevention among preschool-aged children. Methods: This narrative review employed a systematic literature search across medical and educational databases (ERIC, PsycINFO, MEDLINE, CINAHL, Education Source, and specialized neurosurgical sources) to identify relevant studies from 2000 to 2025. Results: Structured, play-based safety education in early childhood settings significantly reduces traumatic brain injury incidence. Programs integrating parent–educator partnerships have shown greater effectiveness in establishing protective behaviors than classroom-only approaches. Culturally responsive interventions have demonstrated specific success in high-risk communities, reducing complications from untreated hydrocephalus resulting from infections. Early childhood education can significantly impact recognition of neurological warning signs. Conclusions: Early, developmentally appropriate health education establishes protective behaviors that reduce pediatric neurosurgical cases. Implementation should prioritize experiential safety learning, recognition of neurological warning signs, and strong family–educator partnerships. Findings support integrating neurosurgical prevention strategies within early childhood curricula and developing interdisciplinary approaches connecting medical specialists with early childhood educators to reduce traumatic brain injuries, acquired hydrocephalus, and neural tube defects. Full article

Background: Exposure to potentially traumatic events (PTEs) during childhood and adolescence is relatively common and may result in the development of post-traumatic stress disorder (PTSD). Recent studies have demonstrated the utility of the network approach for examining PTSD symptoms. However, to date, no systematic review has focused exclusively on network-analytic evidence from child and adolescent samples, who require developmental specific evidence to inform clinical practice. Therefore, the present review aimed to summarize network-analytic studies investigating PTSD symptoms among trauma-exposed youth. Methods: Guided by the PRISMA guidelines, a systematic search for network-analytic studies exploring the symptom structure of PTSD-only in children and adolescents was conducted using PubMed and EBSCOHost. The methodological quality of included studies was assessed using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. Results: Twelve studies (n = 12498; k = 18) were retrieved, with seven rated as of fair quality. Studies examined DSM-IV (n = 10) and DSM-5 (n = 2) PTSD symptoms in children and/or adolescents exposed to PTEs (mostly natural disasters). Although central symptoms varied, heightened physiological reactivity consistently emerged among the most central. The strongest associations were observed between symptoms within the same PTSD cluster, and preliminary evidence suggests that network connectivity may increase with time since exposure. Conclusions: Heightened physiological reactivity to trauma-related cues appears to be a clinically relevant feature of youth exposed to PTEs, warranting consideration in assessment and intervention. Clinical and methodological implications and future directions for pediatric PTSD research are discussed. Full article

Traumatic brain injury (TBI) in childhood is a major global health concern and a leading cause of morbidity and mortality in the pediatric population. Its incidence is rising worldwide, with early childhood and adolescence representing the most vulnerable age groups. Beyond acute neurological injury, post-traumatic endocrine dysfunction has emerged as an underrecognized but clinically significant sequela, with potential long-term consequences for growth, puberty, metabolism, and overall quality of life. The hypothalamic–pituitary axis (HPA) is uniquely vulnerable due to its anatomical and vascular characteristics, making pituitary cells—particularly somatotrophs and gonadotrophs—susceptible to ischemic, traumatic, and inflammatory damage. Reported prevalence of post-TBI pituitary dysfunction in children ranges from 5 to 57%, reflecting a deep heterogeneity in injury severity, diagnostic methods, and timing of evaluations. Growth hormone deficiency (GHD) is the most frequently reported abnormality, with presentations varying from transient to persistent forms. Gonadal axis disturbances, including hypogonadotropic hypogonadism and, less commonly, central precocious puberty, highlight the impact of TBI on pubertal development. Adrenal dysfunctions, though less frequent, may be life-threatening if unrecognized, while posterior pituitary disorders, such as diabetes insipidus, usually revealed acutely, are often transient. Importantly, many endocrine sequelae manifest months to years after the initial trauma, complicating a timely diagnosis. Current evidence underscores the need for structured, longitudinal endocrine surveillance after pediatric TBI, with baseline and follow-up assessments at defined intervals. Early recognition and intervention, including hormone replacement when appropriate, may improve neurocognitive recovery and overall rehabilitation outcomes. Future multicenter studies and standardized screening protocols should be considered essential to clarify incidence, natural history, and optimal management strategies for post-traumatic endocrine dysfunction in children. Full article

Adverse childhood experiences (ACEs) are established predictors of long-term health risks. While pediatric practices increasingly screen for social drivers of health (SDOH) and other family psycho-social stressors, routine ACEs screening is not recommended due to lack of evidence for long-term benefit and concerns over stigmatization, re-traumatization, and non-standardized follow-up protocols. We piloted routine ACEs screening in Pediatric Primary Care practices that already routinely screen for SDOH, maternal depression and intimate partner violence (IPV). This retrospective chart review (2016–2020) explored the extent to which these family psycho-social screenings could serve as a relative proxy for ACEs identification. Among 1492 participants (738 children aged 0–5 and 690 caregivers mean age 30.3 ± 6.9), ACE and SDOH screening results were significantly associated (p < 0.002), particularly with housing insecurity (p < 0.014). However, 51.7% of individuals who reported a positive ACE screen were not flagged by the SDOH measure (false negatives), indicating relatively poor sensitivity. The negative predictive value for negative SDOH screens and negative ACEs was higher at 86%. These findings suggest that SDOH screening misses over half of true positives, and therefore reliance on SDOH screening alone may underestimate ACE exposure in pediatric primary care. Full article