Association between days for concussion recovery and initial specialty clinic evaluation within 48 hours.

BACKGROUND: Researchers have highlighted the importance of early access to concussion care within one week of injury in reducing recovery times. However, a persisting question for concussion researchers is "just how early is important?" The purpose of this study was to examine differences in recovery time as predicted by the number of days elapsed since injury (DSI) to initial evaluation among patients who had access to a specialty concussion clinic within seven days. We hypothesized that DSI group membership, even within seven days, would significantly predict risk of protracted recovery (i.e., beyond 21 days). METHODS: In this archival study, retrospective data were gathered from electronic medical records between September 2020 to March 2022. Records of participants between ages 12-18, those diagnosed with a sports-related concussion based on initial clinic visit diagnosis by a medical provider and those who established care within seven days of injury at a large pediatric specialty concussion clinic were examined. Participants were divided into three DSI groups (patients seen in < 48 h: "acute", patients seen between 49 h < and < 96 h: "sub-acute", and patients seen between 97 < and < 168 h: "post-acute"). A general linear model was constructed to examine relationships between relevant concussion factors (e.g., Post Concussion Scale Score, neurodevelopmental history, psychiatric history, concussion history, migraine history, overall VOMS change score, cognitive testing, sex, age, race, and ethnicity) that were either significant in the preliminary analysis or in clinical judgement and recovery time. Adjusted odds ratios (OR) were derived from a binary logistic regression model, in which recovery time was normal (≤ 21 recovery days) or protracted (> 21 recovery days). RESULTS: A total of 856 participants were eligible. Adolescents in the acute group (M = 15.12, SD = 8.04) had shorter recovery times in days compared to those in the sub-acute (M = 17.98, SD = 10.18) and post-acute (M = 21.12, SD = 10.12; F = 26.00, p < .001) groups. Further, participants in the acute (OR = 4.16) and sub-acute (OR = 1.37) groups who accessed specialty concussion clinics within 48 h were 4 times more likely to have a normal recovery and recovered approximately 6 days faster than the post-acute care group. CONCLUSIONS: Earlier concussion care access predicted recovery times and was associated with lower risk for protracted recovery.

Cultural Correlates of Dating Violence in a Combined Gender Group of Latino College Students.

Prevalence rates of dating violence (DV) on college campuses are high. The documented effects of DV suggest substantial challenges across all domains of functioning; yet, DV is preventable. The research on risk and preventive factors for Latino college students is limited. This study used the social-ecological model to examine factors associated with DV at the individual, relationship, and societal levels. More specifically, we utilized structural equation modeling to build an acceptable model of physical and psychological intimate partner violence (IPV) experiences for Latino participants based on variables of gender role beliefs, acculturation, attitudes toward violence, and surveillance behavior, while considering development issues. We describe the practice and prevention implications of the study findings. Overall, the model showed excellent model fit (χ2[40] = 52.06, p < .09, root mean square error of approximation = 0.025, comparative fit index = 0.99, Tucker-Lewis Index = 0.98, and a coefficient of determination of 0.04), and several proposed pathways were found to be significant, exhibiting the utility of this model in understanding Latino Dating violence. Maternal education was found to be significantly negatively associated with Mexican orientation (ß = -.13, p = .02) and indirectly associated with both DV attitudes and surveillance through Mexican orientation, suggesting protective effects for lower maternal education and higher Mexican orientation. Machismo (ß = .18, p = .002) and caballerismo (ß = .26, p < .001) were both related to IPV attitudes. Machismo also directly increased the risk of surveillance (ß = .21, p < .001) and indirectly increased the risk of physical and psychological victimization through surveillance behavior. Mexican orientation predicted less endorsement of DV attitudes (ß = -.16, p < .001) and less surveillance (ß = -.09, p = .04). Victimization was predicted by caballerismo (ß = -.19, p < .001) and surveillance (ß = .33, p < .001).

The longitudinal relationship between social support and victimization among latino teens.

PURPOSE: This study examines the relationship between social support and victimization of Latino youth over time, utilizing the stress prevention and support deterioration models. METHODS: To address the research questions we utilized data from Waves 1 and 2 (n = 574) of the Dating Violence among Latino Adolescents (DAVILA) study, a national bilingual phone survey of self-identified Latino youth and their caregiver. Cross-lagged panel modeling was used to assess the fit of the two theoretical models to observed patterns of covariance among the victimization and social support variables specified. RESULTS: Results show that victimization at Wave 1 was positively and strongly related to victimization at Wave 2 and social support at Wave 1 was positively and moderately associated with social support at Wave 2. As hypothesized, higher levels of victimization at Wave 1 were significantly related to decreases in social support at Wave 2 (ß = -.15). Wave 1 social support was not significantly related to victimization at Wave 2. CONCLUSIONS: We did not find support for the stress prevention model but did find support for the support deterioration model. Teens who were victimized tended to have lower levels of subsequent social support, highlighting the need to equip peers, family, and significant others to adequately respond to victimization disclosures.

Group Cohesion in Psychoeducational Groups with Latinos: Examining Cultural Correlates.

Group psychotherapy is an effective therapeutic modality for the treatment of many mental health and related issues. Group therapy is cost-effective and could decrease barriers to mental health services for ethnic minority populations, including Latinx people. Group cohesion is a therapeutic factor associated with positive outcomes in group psychotherapy according to meta-analyses. While information exists regarding the associations of group cohesion to other variables that may affect the effectiveness of group psychotherapy, there is no published research exploring the relationships between group cohesion and the Latinx cultural correlates of acculturation, machismo, caballerismo, marianismo, personalismo, individualism, and collectivism. We analyzed pre- and post-data from 235 Latinx college students who participated in eight sessions of one of two types of psychoeducational groups (one for dating violence prevention and one for stress management), using a multivariate general linear model (GLM) examining the relationships between our gender and cultural variables on two total group cohesion measures (GCS and GSRS). This finding partially supports our hypotheses regarding the association between cultural correlates and group cohesion: collectivistic attitudes among Latinx group members were associated with improved group cohesion. These findings have relevance for the implementation of group psychotherapy with Latinx people.

A Prospective Pilot Study of Anxiety Sensitivity and Adolescent Sports-Related Concussion.

OBJECTIVE: This study examined the relationship of that anxiety sensitivity (AS) with the initial and ongoing symptoms reported by adolescents after sustaining a sports-related concussion (SRC). METHOD: Participants were 40 adolescents, ages 13-18, presenting for treatment at a children's sports medicine specialty clinic following a diagnosis of either an SRC or a musculoskeletal injury. After the initial clinic intake, participants completed an online survey at three-time points. Survey measures included the self-report graded symptom checklist and the AS Index-3. Researchers used growth curve analysis to examine the relationship between AS Index-3 scores with initial and ongoing symptom reporting over time. The 20 participants sustaining an SRC were matched by age, gender, and race with 20 musculoskeletal injury controls. RESULTS: Concussed adolescents with higher AS scores reported more initial symptoms than did those reporting musculoskeletal injury. AS was not related to the rate of symptom reduction over time for either group. CONCLUSION: Higher AS moderated the relationship between injury type (concussion vs. musculoskeletal injury) and the total number of initial symptoms reported by adolescent participants, with every unit increase in AS yielding a four-unit increase in initial symptoms reporting. Previous research has shown that elevated initial symptom scores are a strong predictor of protracted recovery in concussion. AS is amenable to brief treatment interventions. It is a potential early target for treatment intervention following diagnosis of adolescent SRC.

DRIVEN to Stop Violence: A Group Intervention to Prevent Dating Violence Among Latino College Students.

We present results from the initial implementation of a psychoeducational group curriculum designed to prevent dating violence among Latino college students and fill a significant need for culturally responsive programming for this ethnic group. We developed the Dating Relationships Involving Violence End Now (DRIVEN) curriculum and tested it with a total of 112 Latino students attending a Hispanic Serving Institution located on the United States-Mexico border. Results from this initial study suggest DRIVEN had differing positive impacts on men (dating violence, attitudes, and the marianismo virtuosity subscale) and women (dating violence, perpetration, machismo, marianismo virtuosity subscale, and asserting displeasure). Implications include the need to implement and test culturally responsive group-based programs while considering the impact of gender dynamics.

Más allá de las barreras: Competency and practice considerations in language, cultural, and social issues when delivering group CPT to Hispanic immigrants.

High rates of under-assessed trauma and psychiatric disorders, particularly posttraumatic stress disorder (PTSD) have been reported among Hispanic immigrants, especially as related to immigration trauma. Multiple studies have shown group cognitive processing therapy (CPT) to be an effective evidence-based practice (EBP) for treatment of PTSD across a number of clinical populations. To date, however, no studies have examined important competency and practice issues in linguistic, cultural, and ethical areas that group CPT providers should consider when delivering group CPT to Hispanic immigrants. This paper aims to outline these and provide future directions for research.

Immigration Trauma among Hispanic Youth: Missed by Trauma Assessments and Predictive of Depression and PTSD Symptoms.

Few quantitative studies have examined the rate of exposure to traumatic events during immigration among Hispanics or its relation to mental health outcomes. Failing to capture traumatic events that occur during immigration may impede investigations of trauma and related mental health disparities with Hispanics. In order to better understand the need for immigration-related trauma assessment, interviews were conducted with 131 immigrant Hispanic youth. First, youth completed a comprehensive trauma assessment interview. Items were added to the interview to assess if each traumatic event occurred during the process of immigration. An immigration-focused module was then added to the end of the assessment. A substantial minority of youths reported experiencing a traumatic event during immigration (n = 39; 29.8%). The majority of these were not captured by the standard trauma assessment (n = 32; 82.1% of those with in-transit trauma). Of these, the majority stated that the process of immigration itself was traumatic, but had not indicated experiencing any event assessed during the standard trauma assessment (n = 28; 87.5% of those with unidentified in-transit trauma). The traumatic events that were not captured during the standard trauma assessment significantly predicted both depression (p < .001) and PTSD symptoms (p = .012). Results suggest that standard trauma assessments may not capture traumatic events that occur during immigration for Hispanic youth. Failing to capture these events during trauma assessment may have large implications for research on trauma-related mental health disparities, as the events that were not captured overlapped significantly with depression and PTSD.

Pocas investigaciones cuantitativas han examinado la tasa de trauma que ocurre entre Hispanos durante el proceso de inmigración a los Estados Unidos. Cuando evaluaciones de trauma no capturan trauma de inmigración, puede impedir investigaciones de disparidades de salud mental y trauma para Hispanos. Para entender mejor la necesidad de incluir componentes de inmigración en evaluaciones de trauma, se entrevistaron 131 adolescentes Hispanos. Primero, los adolescentes cumplieron una entrevista comprensiva y estándar de trauma. Se añadieron preguntas a la entrevista para determinar si el evento ocurrió durante inmigración. Luego, se añadió una sección enfocada en inmigración. Una menoridad sustancial de adolescentes indicó trauma durante inmigración (n = 39; 29.8%). La mayoría de estos casos no se capturaron durante la evaluación estándar (n = 32; 82.1% de los quienes indicaron trauma durante inmigración). De estos, la mayoría indicaron que fue el proceso de inmigración que fue traumático (n = 28; 87.5% de los quienes no indicaron trauma durante la evaluación estándar). Los eventos los cuales no se capturaron en la evaluación estándar correlacionaron con síntomas ambos de depresión (p < .001) y estrés postraumático (p = .012). Los resultados sugieren que evaluaciones estándares de trauma no capturan eventos traumáticos que ocurren durante inmigración para adolescentes Hispanos. Además, el no capturar estos eventos tal vez tiene implicaciones para investigaciones de disparidades de trauma y salud mental, porque los eventos que no se capturaron correlacionaron con depresión y el estrés postraumático.

Peritraumatic dissociation and peritraumatic emotional predictors of PTSD in Latino youth: results from the Hispanic family study.

This is the 1st study to examine peritraumatic dissociation and peritraumatic emotions as they predict symptoms and diagnosis of posttraumatic stress disorder (PTSD) in Latino youth. Our aim was to test the hypothesis that the degree of peritraumatic dissociation would predict the number of PTSD symptoms and PTSD clinical diagnosis when the influences of other salient factors were statistically controlled. We also explored the possible contributions of peritraumatic emotional responses to PTSD symptomatology and PTSD diagnosis. We expected that peritraumatic dissociation would emerge as a significant predictor of PTSD. A total of 204 Latino youth (mean age = 12.37 years) completed semistructured individual clinical interviews with bilingual research assistants. These interviews assessed trauma exposure, peritraumatic responses, and current psychopathology. A linear regression analysis demonstrated significant relationships between lifetime number of traumatic events, peritraumatic dissociation, shame, and number of PTSD symptoms endorsed. Significant inverse (protective) relationships were demonstrated between anger and guilt and current PTSD symptomatology. Logistic regression analysis demonstrated significant relationships between peritraumatic dissociation, shame, lifetime number of traumatic events experienced, and PTSD diagnosis. The analyses examined both the number of PTSD symptoms as well as diagnosis of PTSD while simultaneously controlling for age, lifetime exposure to traumatic events, time residing in the United States, and gender. These results support an increasingly robust body of empirical literature suggesting that the peritraumatic dissociative and emotional responses to trauma are important predictors of future PTSD diagnosis. Possible cultural factors contributing to the dissociative responses in Latino youth and clinical implications are discussed.

Trastorno por estrés postraumático en niños: una revisión / Posttraumatic stress disorder in children: a review

La psicología clínica infantil se ha orientado cada vez más hacia cómo evaluar la ocurrencia e impacto de eventos traumáticos en niños, con el propósito específico de desarrollar técnicas terapéuticas eficaces y eficientes para ayudarles a manejar las secuelas de tales eventos. Este trabajo es una revisión general de la literatura psicológica sobre el trauma en la infancia. Nos centramos en asuntos de importancia para los clínicos que trabajan directamente con estos niños y sus familias, tales como: ¿cuántos niños experimentan eventos traumáticos?, ¿cuáles son los tipos de trauma que experimentan con más frecuencia?, ¿cómo deberían ser evaluados el trauma infantil y sus consecuencias en la práctica clínica?, ¿cuáles son las intervenciones terapéuticas disponibles?, ¿qué información se requiere y cuáles son los retos que hay que afrontar? A lo largo de este trabajo, consideraremos factores biológicos, individuales y culturales y prestaremos particular atención a cómo las innovaciones en la tecnología y la comunicación son una promesa en este campo (AU)

The field of child clinical psychology has increasingly focused on how to assess the occurrence and impact of traumatic events on children with the explicit goal of determining effective and efficient therapeutic techniques for helping children manage the sequelae of such events. This paper provides an overview of the psychological literature in childhood trauma. We address important questions most pertinent to clinicians working with children and families: How many children experience traumatic events? What types of trauma do children most often experience? How should childhood trauma and related outcomes be assessed in clinical practice? What therapeutic interventions are available? What information is yet needed and what challenges do we face? Throughout, we consider biological, individual, and cultural factors and pay particular attention to how innovations in technology and communications hold promise for this field