The Journal of Pediatrics
Volume 146, Issue 3 , Pages 309-310, March 2005

Post-traumatic stress and its effect on health outcomes in children

  • Jacqueline Grupp-Phelan, MD, MPH

      Affiliations

    • Corresponding Author InformationReprint requests: Dr Jacqueline Grupp-Phelan, Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229.

Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229

Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, Washington

See related article, p 349.

Article Outline

 

Acute stress responses in children following exposure to violence can predict posttraumatic sequelae.1 However, little is known about the effect of post-violence stress on health outcomes in children. Understanding the interrelationships between childhood violence exposure, posttraumatic symptomatic response, and long-term health outcomes is fundamental in the development of interventions targeting improvement in post-exposure health status.

In this issue of The Journal, Graham-Bermann and Seng add supporting evidence to the association of violence and traumatic stress symptoms with negative health status in children.2 Although many studies have linked maltreatment and interparental and community violence to increased rates of anxiety, aggression, and future violent behavior, studies examining the effect on health outcomes, particularly in children, are limited.3 This investigation documents that childhood traumatic stress exposure and posttraumatic symptomatic distress make significant independent contributions to the explanation of childhood health problems over and above the contributions of key demographic, family, and maternal characteristics (eg, child sex, family income, maternal substance use).

This seminal cross-sectional study raises a series of questions that may be best addressed in future prospective longitudinal studies. Prospective investigations in trauma-exposed older adolescents and adults suggest that posttraumatic stress, depressive, and somatic symptoms may be interrelated.4 Investigations corroborating this observation in trauma-exposed youth may have important implications for the detection and treatment of posttraumatic disturbances.

Knowing that an association exists between a history of traumatic events such as domestic or child abuse and somatic complaints or health problems such as gastrointestinal illness or asthma has important ramifications for pediatric healthcare providers. Other studies suggest that somatic symptom amplification in children is associated with greater health service use and poorer functional outcome such as missed school days.5 Future prospective investigation in youth may establish that trauma exposure is integrally related to symptomatic distress and enduring functional impairment. These studies may elucidate the direction of the association: Does exposure to trauma mediate or add to health problems, or do health problems exacerbate a child's resilience to traumatic events? Finally, understanding childhood resilience to trauma and those children who might be more vulnerable to stress reactions even after controlling for poverty will be an important area of investigation.

The results of the Graham-Bermann and Seng investigation also highlight the importance of including domestic and child abuse screening by pediatric healthcare providers and suggest that an ongoing investigation into maternal health and distress may be important.6, 7 When symptoms such as headache, back pain, chest pain, abdominal pain, and numbness and tingling are endorsed without a medical comorbidity, screening for child and maternal traumatic exposure and resultant stress should be ascertained during the review of symptoms. In addition, future directions should include interventions to improve child health by supporting safety and maternal mental and physical health and treating child traumatic stress symptoms.

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References 

  1. March JS. Acute stress disorder in youth: a multivariate prediction model. Biol Psychiatry. 2003;53:809–816
  2. Graham-Bermann S, Seng J. Violence exposure and traumatic stress symptoms as additional predictors of health problems in high-risk children. J Pediatr. 2005;
  3. Schnurr PP, Green BL. Understanding relationships among trauma, post-tramatic stress disorder, and health outcomes. Adv Mind Body Med. 2004;20:18–29
  4. Zatzick DF, Russo JE, Katon W. Somatic, posttraumatic stress, and depressive symptoms among injured patients treated in trauma surgery. Psychosomatics. 2003;44:479–484
  5. Campo JV, Comer DM, Jansen-McWilliams L, Gardner W, Kelleher KJ. Recurrent pain, emotional distress, and health service use in childhood. J Pediatr. 2002;141:76–83
  6. Grupp-Phelan J, Whitaker RC, Naish AB. Depression in mothers of children presenting for emergency and primary care: impact on mothers' perceptions of caring for their children. Ambul Pediatr. 2003;3:142–146
  7. Winston FK, Kassam-Adams N, Garcia-Espana F, Ittenbach R, Cnaan A. Screening for risk of persistent posttraumatic stress in injured children and their parents. JAMA. 2003;290:643–649

PII: S0022-3476(04)01167-9

doi:10.1016/j.jpeds.2004.12.015

Refers to article:

  • Violence exposure and traumatic stress symptoms as additional predictors of health problems in high-risk children

    Sandra A. Graham-Bermann, Julia Seng
    The Journal of Pediatrics March 2005 (Vol. 146, Issue 3, Pages 349-354)

The Journal of Pediatrics
Volume 146, Issue 3 , Pages 309-310, March 2005

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