Posttraumatische Belastungsstörungen bei Kindern in der Heimerziehung und in Pflegeverhältnissen

 

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Zusammenfassung

Kinder in der Heimerziehung und in Pflegefamilien entwickeln oft eine posttraumatische Belastungsstörung (PTBS) aufgrund des häufigen Erlebens traumatischer Ereignisse. Ziel dieser Arbeit war es, die globale Prävalenz von Trauma und PTBS in der Heim- und Pflegepopulation unter Berücksichtigung von Risiko- und Schutzfaktoren zu untersuchen. Dafür wurde eine systematische Literaturanalyse der Originalarbeiten aus den Datenbanken Web of Science, PubMed, PsyInfo, PubPsych, Psyndex, CSA, FIS und PILOTS von 2003 bis 2014 durchgeführt. Die Analyse deutete auf höhere Prävalenzen von Trauma und PTBS in der Heim- und Pflegepopulation im Vergleich zu der Allgemeinbevölkerung hin. Während keine Geschlechtseffekte auf diese Prävalenzen beobachtet wurden, konnten geschlechtsspezifische Traumaprofile bezüglich des sexuellen Missbrauchs, der körperlichen Misshandlung und lebensbedrohlicher Unfälle identifiziert werden. Es wurden mehrere Risikofaktoren für eine PTBS untersucht. Analysiert wurde jedoch nur ein protektiver Faktor: die soziale Unterstützung. Die Ergebnisse betonen die Notwendigkeit von Psychotherapeuten in den stationären Settings der Jugendhilfe.

Summary

Children in out-of-home care often develop posttraumatic stress disorder (PTSD) due to their high exposure to traumatic experiences. The aim of this study was to determine the global prevalence of trauma and of PTSD in the population of looked-after children by examining risk and protective factors as well. For this purpose a systematic literature review was undertaken to identify original studies from 2003 to 2014 in the following databases: Web of Science, PubMed, PsyInfo, PubPsych, Psyndex, CSA, FIS and PILOT. The analysis showed a higher prevalence of trauma and PTSD in the population of children in out-of-home care compared to the general population. Whereas there were no gender effects on this prevalence, gender specific trauma profiles could be identified in the experience of physical and sexual abuse, and in life-threatening events as well. Although many risk factors for PTSD were examined, there was only one protective factor analyzed: the social support. The results emphasize the necessity to integrate the work of psychotherapists in stationary settings of child protective services.

• Literatur

• 1 Petermann F. et al. Vorläufige Schutzmaßnahmen für gefährdete Kinder und Jugendliche. Kindh Entwickl 2014; 23 (02) 124-133.
  CrossrefGoogle Scholar
• 2 Leeb RT, Paulozzi L, Melanson C, Simon T, Arias I. Child Maltreatment Surveillance: Uniform Definitions for Public Health and Recommended Data Elements, Version 1.0. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2008
  Google Scholar
• 3 Kindler H. Kindeswohlgefährdung: Ein Forschungsupdate zu Ätiologie, Folgen, Diagnostik und Intervention. Prax Kinderpsychol Kinderpsychiatr 2009; 58 (10) 764-785.
  PubMedGoogle Scholar
• 4 Deutsches Institut für Medizinische Dokumentation und Information. ICD-10-GM 2014. Systematisches Verzeichnis: Internationale statistische Klassifikation der Krankheiten und verwandter Gesundheitsprobleme 11. Revision – German Modification. Köln: Deutscher Ärzte-Verlag; 2014
  Google Scholar
• 5 Tarren-Sweeney M. Retrospective and concurrent predictors of the mental health of children in care. Child Youth Serv Rev 2008; 30 (01) 1-25.
  Google Scholar
• 6 Pynoos RS, Steinberg AM, Piacentini JC. A developmental psychopathology model of childhood traumatic stress and intersection with anxiety disorders. Biol Psychiatry 1999; 46 (11) 1542-1554.
  CrossrefPubMedGoogle Scholar
• 7 Fegert JM, Petermann F. Sexueller Missbrauch, Kindesmisshandlung und Vernachlässigung. Kindh Entwickl 2011; 20 (02) 61-63.
  CrossrefGoogle Scholar
• 8 Schmid M, Petermann F, Fegert JM. Developmental trauma disorder: pros and cons of including formal criteria in the psychiatric diagnostic systems. BMC Psychiatry. 2013 13. (1), Art. 3.
  PubMedGoogle Scholar
• 9 Alisic E. et al. Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: meta-analysis. Br J Psychiatry 2014; 204 (05) 335-340.
  CrossrefPubMedGoogle Scholar
• 10 Copeland WE, Keeler G, Angold A, Costello EJ. Traumatic events and posttraumatic stress in childhood. Arch Gen Psychiatry 2007; 64 (05) 577-584.
  CrossrefPubMedGoogle Scholar
• 11 Essau CA, Conradt J, Petermann F. Häufigkeit der Posttraumatischen Belastungsstörung bei Jugendlichen: Ergebnisse der Bremer Jugendstudie. Z Kinder Jugendpsychiatr Psychother 1999; 27 (01) 37-45.
  CrossrefPubMedGoogle Scholar
• 12 Perkonigg A, Kessler RC, Storz S, Wittchen HU. Traumatic events and post ) traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatr Scand 2000; 101 (01) 46-59.
  CrossrefPubMedGoogle Scholar
• 13 Kultalahti TT, Rosner R. Risikofaktoren der Posttraumatischen Belastungsstörung nach Trauma-Typ-I bei Kindern und Jugendlichen. Kindh Entwickl 2008; 17 (04) 210-218.
  CrossrefGoogle Scholar
• 14 Tagay S. et al. Traumatische Ereignisse, psychische Belastung und Prädiktoren der PTBS-Symptomatik bei Kindern und Jugendlichen. Kindh Entwickl 2013; 22 (02) 70-79.
  CrossrefGoogle Scholar
• 15 Trickey D. et al. A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents. Clin Psychol Rev 32 (02) 122-138.
  Google Scholar
• 16 Stallard P, Smith E. Appraisals and cognitive coping styles associated with chronic post traumatic symptoms in child road traffic accident survivors. J Child Psychol Psychiatry 2007; 48 (02) 194-201.
  CrossrefPubMedGoogle Scholar
• 17 La Greca AM, Silverman WK, Lai B, Jaccard J. Hurricane-related exposure experiences and stressors, other life events, and social support: Concurrent and prospective impact on children’s persistent posttraumatic stress symptoms. J Consult Clin Psychol 2010; 78 (06) 794-805.
  CrossrefPubMedGoogle Scholar
• 18 Akister J, Owens M, Goodyer IM. Leaving care and mental health: outcomes for children in outof-home care during the transition to adulthood. Health Res Policy Syst 2010; 08 (01) 10-19.
  CrossrefPubMedGoogle Scholar
• 19 Oswald SH, Heil K, Goldbeck L. History of maltreatment and mental helath problems in foster children: A review of the literature. J Pediatr Psychol 2010; 35 (05) 462-472.
  CrossrefPubMedGoogle Scholar
• 20 Ahmad A. et al. A 2 year follow up of orphans’ competence, socioemotional problems and post traumatic stress symptoms in traditional foster care and orphanages in Iraqi Kurdistan. Child Care Health Dev 2005; 31 (02) 203-215.
  CrossrefPubMedGoogle Scholar
• 21 Blower A. et al. Mental health of ‘looked after’ Children: A needs assessment. Clinical Child Psychology and Psychiatry 2004; 09 (01) 117-129.
  CrossrefGoogle Scholar
• 22 Chambers MF, Saunders AM, New BD, Williams CL, Stachurska A. Assessment of children coming into care: Processes, pitfalls and partnerships. Clin Child Psychol Psychiatry 2010; 15 (04) 511-527.
  CrossrefPubMedGoogle Scholar
• 23 Ford JD. Traumatic victimization in childhood and persistent problems with oppositional-defiance. J Aggress Maltreat Trauma 2002; 06 (01) 25-58.
  CrossrefGoogle Scholar
• 24 Garrido EF, Culhane SE, Petrenko CL, Taussig HN. Psychosocial consequences of caregiver transitions for maltreated youth entering foster care: The moderating impact of community violence exposure. Am J Orthopsychiatry 2011; 81 (03) 382-389.
  CrossrefPubMedGoogle Scholar
• 25 Garrido EF, Culhane SE, Raviv T, Taussig HN. Does community violence exposure predict trauma symptoms in a sample of maltreated youth in foster care?. Violence Vict 2010; 25 (06) 755-769.
  CrossrefPubMedGoogle Scholar
• 26 Goldstein AL. et al. The relationship between posttraumatic stress symptoms and substance use among adolescents involved with child welfare: Implications for emerging adulthood. Int J Ment Health Addict 2011; 09 (05) 507-524.
  CrossrefGoogle Scholar
• 27 Grasso D. et al. Posttraumatic stress disorder: the missed diagnosis. Child Welfare 2008; 88 (04) 157-176.
  Google Scholar
• 28 Jonson-Reid M. et al. Dating violence among emancipating foster youth. Child Youth Serv Rev 2007; 29 (05) 557-571.
  CrossrefGoogle Scholar
• 29 Keller TE, Salazar AM, Courtney ME. Prevalence and timing of diagnosable mental health, alcohol, and substance use problems among older adolescents in the child welfare system. Child Youth Serv Rev 2010; 32 (04) 626-634.
  CrossrefPubMedGoogle Scholar
• 30 Kolko DJ. et al. Posttraumatic stress symptoms in children and adolescents referred for child welfare investigation a national sample of in-home and out-of-home care. Child Maltreat 2010; 15 (01) 48-63.
  CrossrefPubMedGoogle Scholar
• 31 McMillen JC. et al. Prevalence of psychiatric disorders among older youths in the foster care system. J Am Acad Child Adolesc Psychiatry 2005; 44 (01) 88-95.
  CrossrefPubMedGoogle Scholar
• 32 Meltzer H. et al. The mental health of young people looked after by local authorities in England: summary report. London: The Stationery Office; 2003
  Google Scholar
• 33 Meltzer H. et al. The mental health of young people looked after by local authorities in Scotland: summary report. London: The Stationery Office; 2004
  Google Scholar
• 34 Meltzer H. et al. The mental health of young people looked after by local authorities in Wales: summary report. London: The Stationery Office; 2004
  Google Scholar
• 35 Salazar AM, Keller TE, Gowen LK, Courtney ME. Trauma exposure and PTSD among older adolescents in foster care. Soc Psychiatry Psychiatr Epidemiol 2013; 48 (04) 545-551.
  CrossrefPubMedGoogle Scholar
• 36 Taussig HN, Culhane SE. Emotional maltreatment and psychosocial functioning in preadolescent youth placed in out-of-home care. J Aggress Maltreat Trauma 2010; 19 (01) 52-74.
  CrossrefPubMedGoogle Scholar
• 37 Wechsler-Zimring A, Kearney CA, Kaur H, Day T. Posttraumatic stress disorder and removal from home as a primary, secondary, or disclaimed trauma in maltreated adolescents. J Fam Violence 2012; 27 (08) 813-818.
  CrossrefGoogle Scholar
• 38 Wekerle C. et al. The contribution of childhood emotional abuse to teen dating violence among child protective services-involved youth. Child Abuse Negl 2009; 33 (01) 45-58.
  CrossrefPubMedGoogle Scholar
• 39 Arnold J. Prävalenz der Posttraumatischen Belastungsstörung bei Pflegekindern: Psychische Belastung, posttraumatische Symptomatik und kindliche Verhaltensauffälligkeiten [Unveröffentlichte Dissertation]. München: Ludwig-Maximilians-Universität; 2010
  Google Scholar
• 40 Groh EG. Die psychische Belastung bei Pflegekindern: Vorhersage ihrer posttraumatischen Symptomatik und Adaption eines neuen Instruments zur Erfassung ihrer allgemeinen psychischen Belastung [Unveröffentlichte Dissertation]. München: Ludwig-Maximilians-Universität; 2010
  Google Scholar
• 41 Bücker J. et al. Cognitive impairment in schoolaged children with early trauma. Compr Psychiatry 2012; 53 (06) 758-764.
  CrossrefPubMedGoogle Scholar
• 42 Greeson JK. et al. Complex trauma and mental health in children and adolescents placed in foster care: Findings from the National Child Traumatic Stress Network. Child Welfare 2011; 90 (06) 91-108.
  PubMedGoogle Scholar
• 43 Oswald SH, Fegert JM, Goldbeck L. Posttraumatic stress symptoms in foster children following maltreatment and neglect. Verhaltenstherapie 2010; 20 (01) 37-44.
  CrossrefGoogle Scholar
• 44 Pérez T, Di Gallo A, Schmeck K, Schmid M. Zusammenhang zwischen interpersoneller Traumatisierung, auffälligem Bindungsverhalten und psychischer Belastung bei Pflegekindern. Kindh Entwickl 2011; 20 (02) 72-82.
  CrossrefGoogle Scholar
• 45 Rosner R, Arnold J, Groh EM, Hagl M. Predicting PTSD from the Child Behavior Checklist: Data from a field study with children and adolescents in foster care. Child Youth Serv Rev 2012; 34 (09) 1689-1694.
  CrossrefGoogle Scholar
• 46 Atilola O. Different points of a continuum? Cross sectional comparison of the current and pre-contact psychosocial problems among the different categories of adolescents in institutional care in Nigeria. BMC Public Health 2012; 12 (01) 554-565.
  CrossrefPubMedGoogle Scholar
• 47 Atwoli L. et al. Impact of domestic care environment on trauma and posttraumatic stress disorder among orphans in Western Kenya. PloS one 2014; 09 (03) e89937.
  CrossrefPubMedGoogle Scholar
• 48 Hasanoviæ M. et al. Psychological disturbances of war-traumatized children from different foster and family settings in Bosnia and Herzegovina. Croat Med J 2006; 47 (01) 85-94.
  PubMedGoogle Scholar
• 49 Leenarts LE. et al. Relationships between interpersonal trauma, symptoms of posttraumatic stress disorder, and other mental health problems in girls in compulsory residential care. J Trauma Stress 2013; 26 (04) 526-529.
  CrossrefPubMedGoogle Scholar
• 50 Rahman A. et al. Behavioral and emotional problems in a Kuala Lumpur children’s home. Pediatr Int 2013; 55 (04) 422-427.
  CrossrefPubMedGoogle Scholar
• 51 Schmid M, Kölch M, Fegert JM, Schmeck K. Abschlussbericht für den Fachausschuss für die Modellversuche und das Bundesamt für Justiz. Zusammenfassung der wichtigsten Ergebnisse und Erkenntnisse des Modellversuches Abklärung und Zielerreichung in stationären Maßnahmen (MAZ). Basel: 2011
  Google Scholar
• 52 Singer H. Traumatische Erlebnisse, Psychopathologie und Delinquenz bei Heimjugendlichen im Schweizer Jugendhilfeund Jugendstrafsystem [Unveröffentlichte Dissertation]. Universität Ulm: 2010
  Google Scholar
• 53 Gustafsson PE, Nilsson D, Svedin CG. Polytraumatization and psychological symptoms in children and adolescents. Eur Child Adolesc Psychiatry 2009; 18 (05) 274-283.
  CrossrefPubMedGoogle Scholar
• 54 Walker JL. et al. Gender differences in the prevalence of childhood sexual abuse and in the development of pediatric PTSD. Arch Womens Ment Health 2004; 07 (02) 111-121.
  CrossrefPubMedGoogle Scholar
• 55 Margolin G, Gordis EB. The effects of family and community violence on children. Annu Rev Psychol 2000; 51 (01) 445-479.
  CrossrefPubMedGoogle Scholar
• 56 Idsoe T, Dyregrov A, Idsoe EC. Bullying and PTSD symptoms. J Abnorm Child Psychol 2012; 40 (06) 901-911.
  CrossrefPubMedGoogle Scholar
• 57 Hébert M, Lavoie F, Blais M. Post Traumatic Stress Disorder/PTSD in adolescent victims of sexual abuse: resilience and social support as protection factors. Cien Saude Colet 2014; 19 (03) 685-694.
  CrossrefPubMedGoogle Scholar
• 58 Ziegenhein U. et al. Inobhutnahme und Bindung. Kindh Entwickl 2014; 23 (04) 257-268.
  Google Scholar
• 59 Furman W, Buhrmester D. Age and sex differences in perceptions of networks of personal relationships. Child Dev 1992; 63 (01) 103-115.
  CrossrefPubMedGoogle Scholar
• 60 Scheeringa MS, Zeanah CH, Cohen JA. PTSD in children and adolescents: toward an empirically based algorithma. Depressi Anxiety 2011; 28 (09) 770-782.
  Google Scholar