Showing papers by "Mark Shevlin published in 2016"

“Where are all the lonely people?” A population-based study of high-risk groups across the life span

Abstract: Loneliness is a prevalent and urgent public health issue. Optimal planning of community approaches to loneliness requires a differentiated understanding of loneliness across the life span. We identified groups at high risk of loneliness by exploring the relationship between loneliness and socio-demographic and health-related factors across multiple age groups. This was a combined population-based questionnaire survey and register data study based on a representative sample, including 33,285 Danish individuals aged 16–102 years. Loneliness was measured using the Three-Item Loneliness Scale. The relation between loneliness and age took a shallow U-shaped distribution. Ethnic minority status, receiving disability pensions or being unemployed, living alone, prolonged mental disorder, and psychiatric treatment were strongly associated with severe loneliness. Socio-demographic and health-related factors were associated with an increased risk of severe loneliness in specific age groups. Being female, having a low educational level and living in a deprived area were only associated with loneliness in adolescence/emerging adulthood. Receiving disability pensions and living alone (i.e., divorced), on the other hand, were strongly associated with loneliness in early and middle adulthood and young-old age. Ethnic minority status, living alone, and prolonged mental disorder may well be key factors in determining the generic level of loneliness in a given population. Other conditions are associated with an increased risk of severe loneliness in specific age groups and may moderate the age–loneliness relation. These findings may help to identify populations within communities at risk of loneliness and thereby support the implementation of policies and public health interventions across the life span.

Evidence of complex posttraumatic stress disorder (CPTSD) across populations with prolonged trauma of varying interpersonal intensity and ages of exposure.

Abstract: The ICD-11 proposes different types of prolonged trauma as risk factors for complex PTSD (CPTSD). However, CPTSD's construct validity has only been examined in childhood abuse, and single trauma exposure samples. Thus, the extent to which CPTSD applies to other repeatedly traumatized populations is unknown. This study examined ICD-11's PTSD and CPTSD across populations with prolonged trauma of varying interpersonal intensity and ages of exposure, including: 1) childhood sexual abuse, 2) adulthood trauma of severe interpersonal intensity (refugees and ex-prisoners of war), and 3) adulthood trauma of mild interpersonal intensity (military veterans, and mental health workers). In support of the proposal, latent class analysis (N = 820) identified, a 4-class solution representing "PTSD", "CPTSD", and "non-pathological" classes, but also an "Anxiety symptoms" class, and an alternative 5-class solution, with a "Dissociative PTSD-subtype" class. ICD-11's CPTSD was not exclusively associated with childhood abuse, but also with exposure to adulthood trauma of severe interpersonal intensity. Furthermore, all types of prolonged trauma were equally associated with the "Anxiety symptoms" class. Finally, of all the classes, the "CPTSD" class was associated with the highest frequency of work-related functional impairment, indicating an association between the severity of prolonged trauma exposure and the level of posttraumatic residues.

Testing the validity of the proposed ICD-11 PTSD and complex PTSD criteria using a sample from Northern Uganda.

Abstract: Background : The International Classification of Diseases (ICD-11) is currently under development with proposed changes recommended for the posttraumatic stress disorder (PTSD) diagnosis and the inclusion of a separate complex PTSD (CPTSD) disorder. Empirical studies support the distinction between PTSD and CPTSD; however, less research has focused on non-western populations. Objective : The aim of this study was to investigate whether distinct PTSD and CPTSD symptom classes emerged and to identify potential risk factors and the severity of impairment associated with resultant classes. Methods : A latent class analysis (LCA) and related analyses were conducted on 314 young adults from Northern Uganda. Fifty-one percent were female and participants were aged between 18 and 25 years. Forty percent of the participants were former child soldiers ( n =124) while the remaining participants were civilians ( n =190). Results : The LCA revealed three classes: a CPTSD class (40.2%), a PTSD class (43.8%), and a low symptom class (16%). Child soldier status was a significant predictor of both CPTSD and PTSD classes (OR=5.96 and 2.82, respectively). Classes differed significantly on measures of anxiety/depression, conduct problems, somatic complaints, and war experiences. Conclusions : To conclude, this study provides preliminary support for the proposed distinction between PTSD and CPTSD in a young adult sample from Northern Uganda. However, future studies are needed using larger samples to test alternative models before firm conclusions can be made. Keywords: ICD-11; PTSD; complex PTSD; latent class analysis; Northern Uganda (Published: 8 September 2016) Responsible Editor: Chris Brewin, University College London, UK. Citation: European Journal of Psychotraumatology 2016, 7 : 32678 - http://dx.doi.org/10.3402/ejpt.v7.32678

Social, familial and psychological risk factors for mood and anxiety disorders in childhood and early adulthood: a birth cohort study using the Danish Registry System

Abstract: Purpose A number of social, familial, and psychological factors have been identified to explain the onset of mood and anxiety disorders among adolescent and young adult populations. The purpose of this study is to identify the shared and unique predictors of anxiety and mood disorders by simultaneously testing a range of established psychosocial risk factors. Method A national birth cohort of the Danish population born in 1984 and tracked over the course of the first 21 years of their life was used in the current study (n = 54,458). Psychosocial risk factors including paternal and maternal history of any anxiety and mood disorder, parental history of self-harming behaviour, advanced paternal age, gender, urban dwelling, economic deprivation, family dissolution, and childhood adversity were used to predict diagnosis of both anxiety and mood disorders from ages 10 to 21 years. Results Binary logistic regression analysis showed that being female and a parental history of a mood or anxiety disorder are the strongest predictors of both disorders. Economic deprivation, and family dissolution also increase likelihood of both disorders. Urban dwelling and childhood adversity are predictors of anxiety disorders but not mood disorders. Conclusion Between the ages of 10 and 21 years, anxiety and mood disorders share many common risk factors. However, urban dwelling and childhood adversity appear to be unique predictors of anxiety disorders. Results suggest there is no dominant factor in the prediction of either disorder, rather the accumulation of different risk factors is most deleterious.

Prevalence and predictors of Axis I disorders in a large sample of treatment-seeking victims of sexual abuse and incest.

Abstract: Background : Childhood sexual abuse (CSA) is a common occurrence and a robust, yet non-specific, predictor of adult psychopathology. While many demographic and abuse factors have been shown to impact this relationship, their common and specific effects remain poorly understood. Objective : This study sought to assess the prevalence of Axis I disorders in a large sample of help-seeking victims of sexual trauma, and to examine the common and specific effects of demographic and abuse characteristics across these different diagnoses. Method : The participants were attendees at four treatment centres in Denmark that provide psychological therapy for victims of CSA ( N =434). Axis I disorders were assessed using the Millon Clinical Multiaxial Inventory-III (MCMI-III). Multivariate logistic regression analysis was used to examine the associations between CSA characteristics (age of onset, duration, number of abusers, number of abusive acts) and 10 adult clinical syndromes. Results : There was significant variation in the prevalence of disorders and the abuse characteristics were differentially associated with the outcome variables. Having experienced sexual abuse from more than one perpetrator was the strongest predictor of psychopathology. Conclusions : The relationship between CSA and adult psychopathology is complex. Abuse characteristics have both unique and shared effects across different diagnoses. Keywords: Childhood sexual abuse; Axis I disorders; help-seeking sample; sexual trauma; incest; multivariate analysis; multiple perpetrators; adult psychopathology (Published: 8 April 2016) Responsible Editor: Marylene Cloitre, National Center for PTSD in Palo Alto, CA, USA. For the abstract or full text in other languages, please see Supplementary files in the column to the right (under ‘Article Tools’). Citation: European Journal of Psychotraumatology 2016, 7 : 30686 - http://dx.doi.org/10.3402/ejpt.v7.30686

Insecure attachment orientations and posttraumatic stress in a female treatment-seeking sample of survivors of childhood sexual abuse: A cross-lagged panel study.

Abstract: Adult attachment theory is increasingly being conceptualized within a traumatic framework, however, few studies have examined temporal relationships between the insecure attachment orientations (attachment anxiety and attachment avoidance) and symptoms of posttraumatic stress (PTS). PTS refers to symptoms associated with posttraumatic stress disorder (PTSD) in the absence of a clinical diagnosis of PTSD. This prospective study assesses the temporal relations between the 2 attachment dimensions of anxiety and avoidance and PTS among a treatment-seeking sample of female survivors of childhood sexual abuse (CSA). Cross-lagged panel analysis was employed to assess the temporal relations between insecure attachment orientations and PTS using the Revised Adult Attachment Scale (RAAS) and the Harvard Trauma Questionnaire (HTQ). Initial assessment was on average 23 years after the onset of abuse (N = 405), and participants were followed-up after 6 months (N = 245) and 12 months (N = 119). PTS levels and insecure attachment declined over the 12-month period. Cross lagged panel analyses indicated that over the longer-term course of PTS, insecure attachment orientations are significantly related to PTS. While these associations were relatively weak in magnitude, temporal relations nevertheless remain. Specifically attachment avoidance appears to be the more relevant orientation in PTS across the 3 time points in the study. Current results provide insight into the temporal relations between insecure attachment orientations and symptoms of PTS. The findings are discussed in terms of the existing trauma literature.

Competing Factor Models of Child and Adolescent Psychopathology.

Abstract: Co-occurring psychological disorders are highly prevalent among children and adolescents. To date, the most widely utilised factor model used to explain this co-occurrence is the two factor model of internalising and externalising (Achenbach 1966). Several competing models of general psychopathology have since been reported as alternatives, including a recent three factor model of Distress, Fear and Externalising Dimensions (Krueger 1999). Evidence for the three factor model suggests there are advantages to utilising a more complex model. Using the British Child and Adolescent Mental Health Survey 2004 data (B-CAMHS; N = 7997), confirmatory factor analysis was used to test competing factor structure models of child and adolescent psychopathology. The B-CAMHS was an epidemiological survey of children between the ages of 5 and 16 in Great Britain. Child psychological disorders were assessed using the Strength and Difficulties Questionnaire (Goodman 1997), and the Development and Wellbeing Assessment (Goodman et al. 2000). A range of covariates and risk variables including trauma, parent mental health and family functioning where subsequently utilised within a MIMIC model framework to predict each dimension of the 2 and three factor structure models. Two models demonstrated acceptable fit. The first complimented Achenbach’s Internalising and Externalising structure. The three factor model was found to have highly comparable fit indices to the two factor model. The second order models did not accurately represent the data nor did an alternative three factor model of Internalising, Externalising and ADHD. The two factor and three factor MIMIC models observed unique profiles of risk for each dimension. The findings suggest that child and adolescent psychopathology may also be accurately conceptualised in terms of distress, fear and externalising dimensions. The MIMIC models demonstrated that the Distress and Fear dimensions have their own unique etiological profile of risk. This study directly informs future measurement models of child and adolescent psychopathology and demonstrates the effectiveness of a three factor model.

The Temporal Relations of PTSD Symptoms Among Treatment-Seeking Victims of Sexual Assault: A Longitudinal Study

Abstract: This prospective study assessed the temporal relationships between the symptom clusters of PTSD in two nonprobability samples of treatment-seeking victims of sexual abuse: rape victims and adult survivors of childhood sexual abuse. Both groups were assessed at three time periods using self-report measures of PTSD symptomology. Findings from two cross-lagged panel analyses indicated weak temporal relationships between the symptom clusters of PTSD; however, avoidance and emotional numbing symptoms were found to exert the strongest cross-lagged effects. Avoidance and emotional numbing symptoms were also found to be the strongest predictor of subsequently meeting caseness for PTSD in both samples. Results suggest that there are minimal cross-lagged effects between the PTSD symptom clusters after three months from traumatic exposure.

Social, Familial and Psychological Risk Factors for Psychosis: A Birth Cohort Study Using the Danish Registry System.

Abstract: A broad range of biological, genetic, environmental, and psychological risk factors for psychosis have been reported. Large-scale cohort studies using registry data are a reliable means of measuring the impact of these risk factors; however, previous studies employing this methodology have focused on a narrow range of variables. The aim of this study was to use data from a large birth cohort to examine the associations between ICD-10 psychotic diagnosis and a broad range of familial factors (advanced paternal age, family dissolution, parental psychosis), environmental factors (urbanicity, deprivation), psychological factors (childhood adversity) and gender. Data came from the Danish Civil Registration System and the Danish Psychiatric Central Register (N = 54,458). Multivariate binary logistic regression analysis indicated that five of the seven risk factors conferred unique risk for psychosis, with familial history and childhood adversity having the strongest effects. Overall, these findings indicate that familial, environmental and psychological risk factors confer unique risk for psychotic disorder.

Development of a Health Related Quality of Life Measure for Adolescents and Young Adults Following Invasive Meningococcal Disease

Abstract: This study describes the key areas that matter to adolescent survivors of Invasive Meningococcal Disease (IMD) Satisfaction with Life After Meningitis is a brief multidimensional measure of health related quality of life that is reliable and correlates with criterion variables in a theoretically meaningful way To develop a Health Related Quality of Life (HRQoL) measure for adolescent and young adult survivors of (IMD) we used a cross-sectional study and focus groups The study was conducted in two phases In Phase 1 a pool of potential items were generated based on the following: a review of existing measures, focus groups with IMD survivors, and an expert group consultation Phase 2 involved administration of the questionnaire to a sample of adolescent and young adult IMD survivors Factor analysis suggested a correlated four factor solution: Wellbeing, Positive about Future, Social Support, and Confidence These factors were significantly correlated in a theoretically predictable way with scores from the Beck Depression Inventory (correlations ranged from −077 to −081) and the eight domains of the SF-36 Health Survey (correlations ranged from 032 to 079) The reliability of all subscales was high ranging from 085 to 092 The Satisfaction with Life After Meningitis (SLAM) questionnaire is a HRQoL self-report measure that produces reliable scores and is appropriate for use with young survivors of IMD There is also evidence of concurrent validity with existing measures of physical and psychological well-being

Less is more?: Assessing the validity of the ICD-11 model of PTSD across multiple trauma samples

Abstract: Background : In the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the symptom profile of posttraumatic stress disorder (PTSD) was expanded to include 20 symptoms. An alternative model of PTSD is outlined in the proposed 11th edition of the International Classification of Diseases (ICD-11) that includes just six symptoms. Objectives and method : The objectives of the current study are: 1) to independently investigate the fit of the ICD-11 model of PTSD, and three DSM-5-based models of PTSD, across seven different trauma samples ( N =3,746) using confirmatory factor analysis; 2) to assess the concurrent validity of the ICD-11 model of PTSD; and 3) to determine if there are significant differences in diagnostic rates between the ICD-11 guidelines and the DSM-5 criteria. Results : The ICD-11 model of PTSD was found to provide excellent model fit in six of the seven trauma samples, and tests of factorial invariance showed that the model performs equally well for males and females. DSM-5 models provided poor fit of the data. Concurrent validity was established as the ICD-11 PTSD factors were all moderately to strongly correlated with scores of depression, anxiety, dissociation, and aggression. Levels of association were similar for ICD-11 and DSM-5 suggesting that explanatory power is not affected due to the limited number of items included in the ICD-11 model. Diagnostic rates were significantly lower according to ICD-11 guidelines compared to the DSM-5 criteria. Conclusions : The proposed factor structure of the ICD-11 model of PTSD appears valid across multiple trauma types, possesses good concurrent validity, and is more stringent in terms of diagnosis compared to the DSM-5 criteria. Keywords: CFA; PTSD; DSM-5; ICD-11; latent structure (Published: 7 October 2015) Responsible Editor: Chris Brewin, University College London, UK. For the abstract or full text in other languages, please see Supplementary files in the column to the right (under ‘Article Tools’). Citation: European Journal of Psychotraumatology 2015, 6 : 28766 - http://dx.doi.org/10.3402/ejpt.v6.28766