Co-Occurring Depression and PTS: Implications of End of Treatment Symptom Differences in trauma Exposed Youth. Jessica Eslinger, PhD

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1 Co-Occurring Depression and PTS: Implications of End of Treatment Symptom Differences in trauma Exposed Youth Jessica Eslinger, PhD

2 Acknowledgments Ginny Sprang, PhD, co-author This study was made possible in part by funding provided by SAMHSA (#SM058230, Sprang-PI)

3 Purpose 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.

4 Introduction Presence of co-morbid depression with post traumatic stress symptoms (Lai et al., 2013; Runyan, Faust, & Orvaschel, 2002) Evidence-based treatments found to improve traumarelated 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)

5 Hypothesis 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.

6 Participants 180 children ages % female (n = 103), 42.8% male (n = 77) Average age = (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

7 Procedure 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

8 Instruments Anxious/Depressed, Withdrawn/Depressed, Total Internalizing Scales from the CBCL (Achenbach & Rescrola, 2000, 2001) Total PTS Scale from either the TSCYC (Briere, 2005) or TSCC-A (Briere,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)

9 Analytic Plan 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

10 Differences from Baseline to End of Treatment Scale Mean Diff t df p Total PTS * Anxious/Depressed * Withdrawn/Depressed * Total Internalizing * CDI *

11 Total PTS Group Differences at Baseline & Termination Scale M (SD) F p PTS Baseline (n=175) PTS Only Combined (18.23) (15.51) * PTS Termination (n=96) PTS Only Combined 51.89(10.54) (16.30)

12 CBCL Anxious/Depressed Group Differences at Baseline & Termination Scale M (SD) F p Anx/Dep Baseline (n=162) PTS Only Combined 60.58(11.66) (10.92) * Anx/Dep Term (n=89) PTS Only Combined 55.39(8.23) (11.13) *

13 CBCL Withdrawn/Depressed Group Differences at Baseline & Termination Scale M (SD) F p With/Dep Baseline (n=161) PTS Only Combined (10.60) (11.04) * With/Dep Term (n=89) PTS Only Combined (6.03) (9.51) *

14 CBCL Total Internalizing Group Differences at Baseline & Termination Scale M (SD) F p Tot Int Baseline (n=162) PTS Only Combined (11.44) ( * Tot Int Term (n=89) PTS Only Combined (13.08) (12.76) *

15 CDI Group Differences at Baseline & Termination Scale M (SD) F p CDI Baseline (n=136) PTS Only Combined (9.01) (14.22) * CDI Termination (n=85) PTS Only Combined (6.63) (9.28)

16 Discussion 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.

17 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).

18 Implications for Practice 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

19 Limitations 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

20 Questions? Center On Trauma and Children University of Kentucky Jessica G. Eslinger PhD ctac.uky.edu

21 References 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), 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),

22 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, 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, 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,

23 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, 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: /s