Here is a video with simple instructions and tailored tips for those interested in mental health and/or trauma research, including how to join tomorrow’s journal club:

It covers how to:

1. Create a Twitter account
2. Fill out your profile and send your first tweet
3. Find trauma & PTSD experts to follow
4. Use hashtags, with examples specific for research and mental health
5. Join the #traumaresearch journal club via Twitter or Tweet chat

Let me know if any questions come up, I’m more than happy to help (@EvaAlisic).

The #traumaresearch Journal Club

The #traumaresearch journal club will take place Februari 23rd, 10pm GMT (which corresponds to 5pm New York, 23u Amsterdam, Friday 24th 9am Melbourne). We will discuss a recent systematic review on the effects of cognitive behavioral therapy for children with PTSD and topics of interest for future chats. Students, academics, clinicians, all are welcome.

The description of From the War Zone to the Home Front:

“One in three U.S. service members returning from Iraq or Afghanistan will experience signs of combat stress, depression, post-traumatic stress disorder (PTSD) or symptoms of a traumatic brain injury. Only 50% receive their health care through the VA. Other vets and their families will seek care in community settings by primary care and community mental health clinicians.

The Home Base Program in collaboration with the Veteran Administration’s National Center for PTSD is providing this free, CME-certified educational series to assist clinicians in the diagnosis and treatment of the silent wounds of war in returning veterans and their families. This live, on-line, interactive educational series is led by nationally recognized faculty with expertise in diagnosing and treating PTSD and TBI with traditional and complementary evidence-based therapy. The faculty will also address the needs of military families and review how to recognize and treat the emotional stress present in spouses, parents, and children of veterans with PTSD or TBI.”

The program is intended for a wide range of professionals, including primary care and community mental health providers, pediatricians, college and university health professionals, psychiatric nurses, and social workers.

An overview of the schedule:

For more information and free registration, see the From the War Zone to the Home Front website.

For those interested in trauma research discussions on Twitter:

We will chat about systematic reviews on the effects of cognitive behavioral therapy for children with PTSD this Thursday 10pm GMT (5pm New York, 23u Amsterdam, Friday 9am in Melbourne). The hashtag to find the chat is #traumaresearch. More information about how to read and how to join will be available tomorrow.

The Twitter journal club is in its trial period: if you have a preference, let me know whether you want it to be focused on child & adolescent mental health more broadly or on trauma recovery in particular, @EvaAlisic. 

Cognitive Behavioral Therapy (CBT) is probably the most used, or at least most recommended, treatment for children with Posttraumatic Stress Disorder (PTSD). As I am quite fond of systematic reviews and meta-analyses, the new meta-analysis on the efficacy of trauma focused CBT by Kowalik and colleagues quickly grabbed my attention. Although (and because?) I have a few critical questions regarding the publication, I think it merits attention from researchers and clinicians.

What is CBT?

CBT is a psychological treatment that addresses ‘associations between stimuli and conditioned fear responses, the influence of environmental factors on symptom expression, and cognitive and affective regulation.’ Cohen and colleagues, who have developed trauma focused CBT, use the PRACTICE acronym to describe its elements. It requires a little bit of fantasy (two P’s!) and it seems to have changed slightly over the years but it gives a succinct overview:

Parental treatment component, including parenting skills

Psychoeducation

Relaxation and stress management skills

Affective expression and modulation skills

Cognitive coping skills

Trauma narrative and cognitive processing of the child’s traumatic experiences

In vivo desensitization to trauma reminders

Conjoint child-parent sessions

Enhancing safety and future development

Selective set of studies?

The purpose of the review by Kowalik et al. was to calculate an estimate of the overall efficacy* of CBT in the treatment of PTSD in children. Randomized controlled trials were selected if they compared CBT to an active control group (e.g., supportive unstructured psychotherapy, nondirective supportive treatment, and child-centered therapy). The authors used somewhat particular search terms: PTSD OR posttraumatic stress disorder OR sexual abuse. The latter was a surprise; why include sexual abuse explicitly but not violence, disaster, road traffic accident, traumatic bereavement, etc? It would be interesting to see whether those terms would result in additional studies and potentially different effect sizes.

CBCL as an outcome measure

The only outcome measure utilized with some consistency across studies turned out to be the Child Behavior Checklist (CBCL). The CBCL is a general scale for behavior problems in children, including composite scores for internalizing problems, externalizing problems, and total competency (i.a. social challenges, participation and school problems). It is not specific for PTSD. Moreover, there is some evidence that it isn’t a valid measure for PTSD. However, it does provide a general indication of child well-being and can be used as a relevant outcome measure.

Results

Eight trials satisfied the selection criteria. Of interest is that five of these were by Cohen et al. or Deblinger et al., the developers of the trauma focused CBT protocol.

The results: The total CBCL, internalizing and externalizing scores showed statistically significant differences between CBT and active control groups, in favor of CBT. There was no significant difference between the groups with regard to competency.

Evidence of efficacy of CBT?

The fail-safe N (i.e. the number of studies needed to overturn a significant effect) was 4 studies for total problems and internalizing scores and 0 for externalizing problems. Although the authors argue that this provides strong evidence that CBT is effective, I am not completely sure. Is it enough for such a conclusion? In favor of the authors’ argument is the fact that the comparisons were with active treatment, not with a waitlist-control. On the other hand, the authors do not mention that all of the eight studies are on sexual abuse victims only. Instead, the title of the review implies it covers PTSD in general. In my view, they should have described this limitation.

CBT seems to better address internalizing symptoms such as anxiety and depression than it does externalizing symptoms such as aggression and/or rule-breaking behaviors according to the review. That does make sense, knowing that PTSD is predominantly an internalizing disorder. The authors suggest that a next step would be to deconstruct components of CBT. One very recent example has just been published online. Salloum and colleagues compared two conditions within a trauma and grief intervention for children: a focus on building coping skills only, or building coping skills + a trauma narrative (the C and T from PRACTICE respectively). Their findings suggest that the trauma narrative is not a necessity for symptom reduction, unless children have high levels of symptoms.

In general, the evidence of the effectiveness of CBT for children with PTSD is quite convincing and extending quickly (see e.g. Cohen et al. 2009). This review adds knowledge with regard to CBCL outcomes in trials that compared CBT to active treatment after sexual abuse.

What’s your view on the paper? And what should be studied next? 

Leave a comment or join the #traumaresearch chat!

Kowalik, J., Weller, J., Venter, J., & Drachman, D. (2011). Cognitive behavioral therapy for the treatment of pediatric posttraumatic stress disorder: A review and meta-analysis Journal of Behavior Therapy and Experimental Psychiatry, 42 (3), 405-413 DOI: 10.1016/j.jbtep.2011.02.002

* The authors seem to use efficacy and effectiveness interchangeably. Efficacy usually refers to the effects under experimental conditions, while effectiveness refers to the effects in real-life (less-controlled) conditions.

Those described below are just a fraction of what is organized all over the world (apologies for the Australian bias ). If you’re interested, the ISTSS website has an extensive list of events.

1) World Congress on Traumatic Stress

This conference is always in always in some fantastic, exotic location… and it’s once every two years, if I’m right, so put it in your agenda for 2014. This year it’s May 23-26 in México City, México.

Theme: “Seeing what is in front of us: Addressing trauma in medical, emergency and mental health settings.”

Keynote speaker is Duncan Pedersen from Canada (McGill). He focuses on social and cultural aspects of mental health, in particular after organized violence.

Almost all members of the ISTSS leadership team will give lectures during the conference because they combine their conference attendance with board meetings. Therefore, the conference has a nice line-up of international speakers, including

• Daniel Mosca (Argentina) – Disaster Intervention in At-risk Populations from a Cultural and Social Perspective: From Katrina to Santa Fe
• Yoshiharu Kim (Japan) – Psychological Impacts of the Japan Great Eastern Earthquake, Tsunami and Nuclear Plant Accident
• Grete Dyb (Norway) – The Value of Outreach and Screening of Youth Exposed to the Terror Attack in Oslo 2011
• Elana Newman (USA) – Traumatic Stress and Journalism: Research and Clinical Directions
• Jonathan Bisson (UK) – Psychological First Aid

2) Australasian Conference of Child Trauma

A new conference! Deadline for abstract submissions is March 20. The meeting itself is July 4-6, on the Gold Coast, Australia (not a bad place to be, especially in July).

The theme: “Connected by Trauma: Research, Response, Recovery”. More specifically, the conference “invites participants to discover and contemplate how new advances in brain science, innovations in service delivery, education, program consultation, clinical assessment / treatment and research, are improving the lives of infants, young people, families and communities affected by trauma. The Conference will focus on the impact of traumatic experiences from a developmental perspective in all its forms including the implications of single event trauma (such as natural disasters, accidents, and assault) and complex multiple-event trauma (such as abuse, neglect, and war).”

Some of the invited speakers (with keywords on expertise because presentation titles aren’t available yet):

• Rachel Yehuda (USA) - traumatic stress and neurobiology of PTSD
• Beverley Raphael (Aus) – prevention and management of trauma, loss and grief
• Akemi Tomoda (Japan) – brain imaging and genetic research of child maltreatment
• Louise Newman (Aus) – disorders of early parenting and attachment difficulties in infants

3) Australian Conference on Traumatic Stress

A bi-annual conference as well, his time in Perth, Australia, September 6-8. The deadline for abstract submissions is approaching: March 31.

The conference theme is broad: “Trauma and Disaster: Complexity, Diversity, and Recovery”.

Three invited speakers:

Doug Zatzick (USA) - Public Health Approaches to the Development and Implementation of Trauma Focused Interventions in Post-disaster Contexts

Michael Scheeringa (USA) - Post-traumatic Stress in Very Young Children: Recognition, Treatment and Post-disaster Challenges

Pat Dudgeon (Aus) – Indigenous People and Trauma

4) Annual Meeting of the International Society for Traumatic Stress Studies

And finally, the annual meeting of the ISTSS. The conference is a little further away (November 1-3 in LA, USA) but the abstract deadline is not: March 15.

The theme is “Beyond Boundaries: Innovations to Expand Services and Tailor Traumatic Stress Treatments”.

“This meeting will provide a forum to discuss innovative strategies for outreach, assessment, treatments and programs that will enable us to deliver services in a wider variety of contexts and reach more trauma survivors”. No information on key note presenters available yet, but this is usually the biggest conference on traumatic stress that is organized, so there won’t be any shortage of interesting presentations and people.

Which conference(s) are you going to?

It’s a classic example of how thought suppression works: counterproductively. You will think of a pink elephant. Wegner and colleagues have shown that it is very difficult to suppress a thought. If you try, it’s very likely that you will think about it more than if you don’t.

This problematic nature of mental control doesn’t apply to fancy experimental settings only. It is thought to play an important role in posttraumatic stress symptoms. Survivors who try harder to avoid thoughts about (or images of) a terrifying moment such as a car crash, are more prone to develop posttraumatic stress disorder (PTSD). Avoidance of trauma-related thoughts makes it more difficult to challenge unhelpful beliefs related to the trauma (see the cognitive model by Ehlers & Clark).

Recently, researchers have started to look at the role of thought suppression in children. The first studies show strong relations with posttraumatic stress symptoms  (see also the meta-analysis by Trickey et al that I recently discussed). Understanding which cognitive processes take place in the development of PTSD in children is essential for our design of helpful interventions.

However, for high-quality evidence we need high-quality measures. So far, the widely used White Bear Suppression Inventory (which doesn’t ask questions about white bears at all…) had not been validated in a sample of children. Therefore, Vincken and colleagues (2012) set out to do so. They conducted two studies - one in a sample of primary school children and one in a sample of young road traffic accident survivors – to test the factor structure, internal consistency, test-retest reliability, and content validity of the self-report measure.

The findings are promising: the measure showed a high internal consistency, some level of stability over time, a rather clear factor structure (one factor), and convergence with a measure for PTSD. Although I think that it’s difficult to confirm validity based on an association that is still subject to theoretical development and empirical testing. What would have happened if there wasn’t a relation with PTSD; would that show invalidity of the measure or invalidity of the hypothesis that thought suppression and PTSD are related in children? Nevertheless, we need to study the phenomenon of thought suppression in traumatized children and it will probably be by iteration that we will understand what happens. This study is a helpful step in that trajectory.

References:
Vincken, M., Meesters, C., Engelhard, I., & Schouten, E. (2012). Psychometric qualities of the White Bear Suppression Inventory in a Dutch sample of children and adolescents Personality and Individual Differences, 52 (3), 301-305 DOI: 10.1016/j.paid.2011.10.023

Ehlers, A., & Clark, D. (2000). A cognitive model of posttraumatic stress disorder Behaviour Research and Therapy, 38 (4), 319-345 DOI: 10.1016/S0005-7967(99)00123-0

Wenzlaff, R., & Wegner, D. (2000). Thought Suppression Annual Review of Psychology, 51 (1), 59-91 DOI: 10.1146/annurev.psych.51.1.59

The main arguments? It’s an ideal platform for sharing new publications, brainstorming on how to solve difficulties in your research, and finding support.

Two beautiful examples of active communities are #phdchat and #hcsmanz (although the latter is not focused on research per se, it does discuss it).

I received many positive reactions on the post (and on it’s succesor How to start with Twitter when you are a trauma researcher), including a number of people who joined Twitter (yes!).

Ouch..

So I thought it would be nice to organize a Tweet chat, to get to know each other and exchange some ideas & tips on the use of social media.

Ouch… there was only one participant, who had to run for a meeting after a few minutes… Possibly, I have been too quick with setting the chat up. Another option is that the timing was inconvenient for people. However, seeing the amount of interest in the past few weeks, I think there will be a moment that we’ll have that rich exchange.

Therefore, let’s see if we can find a good moment for a new chat. Even if the group is small (but preferably, more than two ), it can be valuable and fun.

When should the new Trauma Research Tweet Chat be?

Please indicate what suits you:

Update 14 Feb: The new chat, a journal club with the hashtag #traumaresearch, will be on Feb 23, 10pm GMT (5pm New York, 23h Amsterdam, Friday Feb 24 9am Melbourne).

It takes place at the end of February, depending on your preferences (cast your vote here!).

This post gives you all the details on how to participate.

What is a Tweet chat?

A Tweet chat is a virtual meeting on Twitter. The use of a specific search word or ‘hashtag’ (#… which one do you prefer?) enables you to see the comments of all participants, also of those who are not in your direct network. It allows you to meet researchers in your area of interest.

Our first chat will be on “Trauma Researchers and Social Media”. After a round of introductions, we will discuss the use of blogs and Twitter for dissemination, exchange, and data collection (I will introduce a few general questions to guide the conversation). We will also brainstorm on topics of interest for future Tweet chats.

How do I participate?

In order to join the chat, you need to set up a Twitter account.

You can follow the chat by typing the hashtag in Twitter’s search box, but it’s easier to use Tweetchat. After you authorized Tweetchat (click on ’sign in’), it automatically includes the hashtag when you write a tweet. It also gives you the option of blocking retweets (RT’s) which makes reading easier when the exchange goes quickly.

A few ‘rules’ of participation:

• Always include the hashtag (#… dependent on what we choose) in your tweets, otherwise other participants won’t be able to see your comments
• Feel free to retweet interesting tweets for your followers
• When you respond to a numbered question (Q1, Q2), please include the number in your tweet
• Everyone participates personally, not on behalf of an organization

If you would like to read some more tips, have a look at Janet Fouts’ How to Participate in a Tweet Chat. Don’t worry if it’s your first time on Twitter and/or a Tweet chat; you can always start by reading and then join the conversation at your own pace.

Because it’s the first time, I will be on Twitter 15 minutes earlier to answer any questions you may have with regard to signing in, using the hashtag etc. (make sure you have set up your Twitter account before though!). My Twitter name is @EvaAlisic.

Please cast your vote for the best time and hashtag for trauma research Tweet chats!

This is a guest post by Dr. Meghan Marsac. Meghan is a behavioral researcher and the Director of Training at the Center for Injury Research & Prevention at The Children’s Hospital of Philadelphia. Meghan has recently led the development of Coping Coach, a web-based video game for children experiencing acute traumatic stress, and The Cellie Coping Kit, a toolkit for children with chronic diseases and their families.    

As a field, we have made significant progress in developing models and identifying key risk factors associated with the development of post-traumatic stress disorder (PTSD) in children who experience  acute medical traumatic events (see these key publications). Additionally, we have given much attention to the evaluation of preventive interventions. For example, our team has recently evaluated After The Injury, a web-based intervention for parents of injured children.

However, a standard process for the development of preventive interventions is less clear, and therefore this post provides you with some starting points. Below is a list of tips to consider and questions to ask when beginning to develop a new preventive intervention:

1. Identify the problem and purpose of the intervention

• What is the problem that needs addressed? 
• What specific behaviors are the focus of the intervention?

2. Link intervention goals to past research and theory

• What are the current techniques or theories in the field that can be integrated into or adapted for the intervention?

3. Select the target population and determine the level of the intervention

• Who will complete the intervention?
• What cultural factors should be considered?
• Is this a universal intervention for any child who has experienced a medical trauma or is the intervention for children at-risk for difficulties?

4. Identify potential barriers of intervention implementation

• What would get in the way of someone in the target audience being able to complete this intervention?

5. Before fully developing the intervention, consider evaluation

• How will the intervention objectives and goals be measured?
• What will determine whether or not the intervention is efficacious?
• How can a need for potential changes or revisions be identified?

6. Draft intervention content to match intervention goals

• What intervention activity or component teaches the knowledge or skills needed to solve the identified problem and meet the intervention goals?
• Are there effective techniques currently that can be translated and integrated into the new intervention?

7. Build an intervention prototype and complete engagement and usability testing

• Would the target audience be interested in this type of an intervention?
• What would encourage potential audience members to use this intervention?
• What would prevent them from engaging in this intervention program?
• If applicable, what should the intervention look and feel like?
• Are members of the target population able to complete intervention tasks without additional assistance?

8. Evaluate intervention and revise if indicated

• Was the intervention implemented as intended?
• Were the intervention goals achieved?
• If not, what needs changed or strengthened to be able to achieve initial goals? Or do initial goals need revised?

Meghan’s team currently has training opportunities for students!

References:

Kazak AE, Kassam-Adams N, Schneider S, Zelikovsky N, Alderfer MA, & Rourke M (2006). An integrative model of pediatric medical traumatic stress. Journal of pediatric psychology, 31 (4), 343-55 PMID: 16093522

Marsac ML, Kassam-Adams N, Hildenbrand AK, Kohser KL, & Winston FK (2011). After the injury: initial evaluation of a web-based intervention for parents of injured children. Health education research, 26 (1), 1-12 PMID: 20858769

This week I explain how to start with Twitter and I invite you for a live Tweet chat.

A few examples of interesting tweets in the past few days:

Setting up 

Setting up your Twitter account is easy. Go to www.twitter.com and within 3 minutes you’re up and running with Twitter’s straightforward instructions to sign up and to get started. Make sure your username as short as possible without losing meaning: when people ‘retweet’ (repeat) or reply to one of your tweets, they will need to include your username within the 140 characters.

When people consider following you on Twitter, they look at your profile. They don’t tend to follow empty ones. Therefore, take another 5 minutes for 4 important steps:

1. Upload a picture in your profile; either of yourself or of something that represents you. Don’t stay an egg.
2. Write a short bio (maximum 160 characters) with your main interests.
3. Write your first Tweet! And your second. And your third. Then you’re ready to be followed.
4. Let me (@EvaAlisic) know you are on Twitter; I’ll send around a tweet with your name and interests.

Who to follow?

When you follow people, you see their tweets in your feed. The easiest way to start, is to click on this Twitterlist of trauma, PTSD and recovery researchers & institutions. When you’re logged in on Twitter, you can click on ‘subscribe’ to follow the entire list, or you can click ‘follow’ on the profiles of members you are most interested in. Some examples:

• @nctsn - the US National Child Traumatic Stress Network: “Raising the standard of care and improving access to services for traumatized children, their families, and communities throughout the US.”
• @traumareport - Trauma Lab: “The Trauma and Attachment Report is a weekly online research report published out of York University in Toronto, Canada”
• @safetymd - Flaura Winston, MD: “Mother,engineer,pediatrician, researcher. Credible info to keep children & adolescents safe.”

I also follow a few people who tweet on psychology in general, for example:

The London School of Economics’ Impact blog has a number of interesting lists of tweeting academics. Chris Jarrett has made a list on the British Psychological Society’s Research Digest.

What to tweet?

Everything you want, basically. For example:

• questions you have about particular methods / theories / …
• links to your own and others’ papers
• PhD scholarships and academic positions that become available in your Department
• interesting news items
• upcoming seminars & conferences

And along the way, you’ll start to know people and interact with them.

What style? And how often?

LSE Impact blog has made a nice overview of three styles you could adopt, from very formal to very personal. Tips that I have often seen: take your time to develop your ‘voice’; have a look at what other people do and decide what you like; and experiment with different styles. Yesterday, Inger Mewburn (aka @thesiswhisperer) referred to this article on thin vs. thick tweets on her blog.

Regarding the frequency: I think checking Twitter twice a day is ideal but once a day is a good starting point. It will keep you updated and people will slowly but surely get to know you.

#tprres?

Hashtags are used on Twitter to categorize tweets so they become searchable and follow-able. A hashtag for trauma research will allow you to follow discussions, ask questions, and find interesting people in your research domain. So far, #tprres (Trauma, PTSD & Recovery Research), has been suggested. But we could also use a more straightforward one, such as #traumaresearch. Please cast your vote for the best hashtag (second poll on the page).

Tweet chat

If there is enough interest, we’ll have Tweet chats (live chats on Twitter) among trauma researchers. Would you like to participate in one in the next few weeks? Please cast your vote for the best date & time (first poll on the page).

Recently, a fourth meta-analysis on predictors of posttraumatic stress in children has been published, which makes it interesting to compare findings and methods (yes, in that order, for busy people). It gives clinicians insight in risk factors for PTSD and it shows academics what needs to be studied in the next few years.

These are the four meta-analyses I know of, published over a period of 6 years: Kahana et al. (2006), Cox et al. (2008), Alisic et al. (2011), and Trickey et al. (2012). In a nutshell, the reviews combined correlational effect sizes to see which risk factors are associated with children’s posttraumatic stress symptoms. Their methods varied, which I will summarize below, but the findings converge to a number of interesting conclusions.

For clinical practice: what we do know

Applying Cohen’s criteria for correlational effect sizes (see note below; 0 is a near zero effect, # is a small, ## a medium, and ### a large effect), these are the findings of the meta-analyses for those risk factors measured in at least 5 studies:

In general, the variables that are more psychological (‘proximal’) are more strongly associated with posttraumatic stress then those variables that are more objective/demographical (‘distal’). This has also been found for adults (Ozer et al., 2003). We don’t get very far by measuring demographics and a few characteristics of the event. As Trickey et al. conclude, we should not overestimate female gender as  a risk factor. It’s effect has quite consistently shown to be rather small. Instead, we need to measure acute stress reactions and other psychological problems such as depressive symptoms. In addition, family functioning, parental distress, and to what extent a child thought that he/she might die, seem to be (very) important.

Interestingly, age showed quite consistently not to be a very good predictor of posttraumatic stress. Does that mean that we can apply all adult literature to children now? I don’t expect that to be the case. We are looking only at the relationship between age and amount of stress symptoms as measured according to the DSM. That’s quite specific. It doesn’t tell us anything about the different combinations of symptoms that children may have, nor about symptoms that are not included in the DSM yet but tend to be child-specific (see e.g. the work of Michael Scheeringa and colleagues). Also, age may have a moderating effect or it’s relation with PTSD may be moderated by something else. For example, Trickey et al. found that younger children tended to be more vulnerable to developing posttraumatic stress after group trauma then after individual trauma.

For future research: what we don’t know yet

In my view it’s quite shocking that there isn’t a lot of empirical literature, while the question of vulnerability and causes of posttraumatic stress is of great importance. Variables that may be very important, haven’t been studied often enough to be summarized in a robust manner (I applied the 5 studies minimum here). A lack of social support is found to be one of the most important predictors of  posttraumatic stress in adults. In children, a few studies show tentative evidence that it is a key factor in children’s recovery.

Also, as Trickey et al. pointed out, there are a number of cognitive factors, which influence make sense from a theoretical point of view but which haven’t been studied in-depth in children yet. For example,  thought suppression and rumination would be of relevance for future research.

The list of what still needs to be studied is quite long. To finish with a more general note, we will gradually need to look not only at the ‘simple’ relations between risk factors and amount of stress but also at the specific processes that are underlying these relations. Parental distress and family functioning are predictive of child posttraumatic stress; what then, happens there exactly? What would we need to do to help parents and families to be more supportive of children’s recovery?

A review of the methods

A quick and dirty overview of the main differences between the four meta-analyses to finish…

________________________________________________________________________

________________________________________________________________________

My personal stance is that it is important to look at longitudinal relations between risk factors and outcomes such as PTSD. Looking at cross-sectional relationships, may induce biased thinking about causality (even with longitudinal relations, we’re not sure about causality, but at least it’s closer and allows us to speak of predictors). Take the example of measuring appraisal of life threat at the same time as level of posttraumatic stress. It may well be that appraisal of life threat causes PTSD but it may also be that children with higher stress scores are simply more prone to remembering life threat than children with lower stress scores.

Similarly, it is incredibly difficult to make choices regarding measures. Trickey et al. have required measures to be validated in the literature, Cox et al. also accepted psychometrics described in the articles themselves, while our only criterion was that the intrusion and avoidance had to be included in the measure and that the outcome measurement took place at least three months post-trauma. These differences in decision making along the way may have caused different findings.

However, when we start taking all methodological differences and related limitations too seriously into consideration, we’ll get desperate. It’s only by accumulating good primary studies, having independent groups replicating each other’s work (see Kahana et al), and synthesizing this evidence repeatedly according to the latest standards, that we’ll make progress. So, back to work tomorrow .

_________________________________________________________________________

Notes:

For the table on findings, I have applied Cohen’s criteria, with correlational effect sizes below .10 = negligible (0), .10 = small (#), .30 = medium (##), .50 = large (###). I have conversed Kahana et al.’s findings from d to r. With regard to Trickey et al.’s analysis, I have applied Cohen’s criteria to their rhos, however, it may well be that this is an underestimation (the authors once state .30 as a large effect, and .47 once as a medium to large effect if I understood it correctly). Any suggestions for making the findings optimally comparable are very welcome.

For the table on methodology, I have made a selection of characteristics and could add according to interest/suggestions. The difference longitudinal/cross-sectional: only longitudinal studies have been selected/analyzed vs. cross-sectional studies, potentially mixed with longitudinal studies, in the analyses.

Articles:
Kahana, S., Feeny, N., Youngstrom, E., & Drotar, D. (2006). Posttraumatic Stress in Youth Experiencing Illnesses and Injuries: An Exploratory Meta-Analysis Traumatology, 12 (2), 148-161 DOI: 10.1177/1534765606294562
Cox CM, Kenardy JA, & Hendrikz JK (2008). A meta-analysis of risk factors that predict psychopathology following accidental trauma. Journal for specialists in pediatric nursing : JSPN, 13 (2), 98-110 PMID: 18366377

Alisic E, Jongmans MJ, van Wesel F, & Kleber RJ (2011). Building child trauma theory from longitudinal studies: a meta-analysis. Clinical psychology review, 31 (5), 736-47 PMID: 21501581

Trickey D, Siddaway AP, Meiser-Stedman R, Serpell L, & Field AP (2011). A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clinical psychology review, 32 (2), 122-138 PMID: 22245560