TY  - JOUR
AU  - Lawrence-Sidebottom, Darian
AU  - Huffman, Landry Goodgame
AU  - Beam, Aislinn Brenna
AU  - Guerra, Rachael
AU  - Parikh, Amit
AU  - Roots, Monika
AU  - Huberty, Jennifer
PY  - 2024
DA  - 2024/2/27
TI  - Rates of Trauma Exposure and Posttraumatic Stress in a Pediatric Digital Mental Health Intervention: Retrospective Analysis of Associations With Anxiety and Depressive Symptom Improvement Over Time
JO  - JMIR Pediatr Parent
SP  - e55560
VL  - 7
KW  - collaborative care model
KW  - telehealth
KW  - childhood trauma
KW  - DMHI
KW  - digital health
KW  - mental health
KW  - telemedicine
KW  - trauma
KW  - traumatic
KW  - pediatric
KW  - pediatrics
KW  - paediatric
KW  - paediatrics
KW  - child
KW  - children
KW  - youth
KW  - adolescent
KW  - adolescents
KW  - teen
KW  - teens
KW  - teenager
KW  - teenagers
KW  - retrospective
KW  - anxiety
KW  - depression
KW  - depressive
KW  - co-occurring
KW  - comorbid
KW  - comorbidity
KW  - comorbidities
KW  - association
KW  - associations
KW  - correlation
KW  - correlations
KW  - correlate
AB  - Background: More than 2 out of 3 children and adolescents in the United States experience trauma by the age of 16 years. Exposure to trauma in early life is linked to a range of negative mental health outcomes throughout the lifespan, particularly co-occurring symptoms of posttraumatic stress (PTS), anxiety, and depression. There has been an increasing uptake of digital mental health interventions (DMHIs) among youths, particularly for anxiety and depression. However, little is known regarding the incidence of trauma exposure and PTS symptoms among youths participating in DMHIs and whether PTS symptoms impact anxiety and depressive symptom treatment response. Moreover, it is unclear whether participation in a DMHI for anxiety and depressive symptoms is associated with secondary effects on PTS symptoms among trauma-exposed youths. Objective: This study aims to use retrospective data from youths participating in a DMHI to (1) characterize rates of trauma, PTS, and comorbid anxiety and depressive symptoms; (2) determine whether trauma exposure and elevated PTS symptoms impact the improvement of comorbid anxiety and depressive symptoms throughout participation in care; and (3) determine whether participation in a non–posttraumatic DMHI is linked to reductions in PTS symptoms. Methods: This study was conducted using retrospective data from members (children ages 6 to 12 years) involved in a pediatric collaborative care DMHI. Participating caregivers reported their children’s trauma exposure. PTS, anxiety, and depressive symptom severity were measured monthly using validated assessments. Results: Among eligible participants (n=966), 30.2% (n=292) reported at least 1 traumatic event. Of those with trauma exposure and elevated symptoms of PTS (n=119), 73% (n=87) exhibited elevated anxiety symptoms and 50% (n=59) exhibited elevated depressive symptoms. Compared to children with no trauma, children with elevated PTS symptoms showed smaller reductions per month in anxiety but not depressive symptoms (anxiety: F2,287=26.11; P<.001). PTS symptoms also decreased significantly throughout care, with 96% (n=79) of participants showing symptom reductions. Conclusions: This study provides preliminary evidence for the frequency of trauma exposure and comorbid psychiatric symptoms, as well as variations in treatment response between trauma-exposed and nontrauma-exposed youths, among participants in a pediatric collaborative care DMHI. Youths with traumatic experiences may show increased psychiatric comorbidities and slower treatment responses than their peers with no history of trauma. These findings deliver compelling evidence that collaborative care DMHIs may be well-suited to address mental health symptoms in children with a history of trauma while also highlighting the critical need to assess symptoms of PTS in children seeking treatment. 
SN  - 2561-6722
UR  - https://pediatrics.jmir.org/2024/1/e55560
UR  - https://doi.org/10.2196/55560
UR  - http://www.ncbi.nlm.nih.gov/pubmed/38412001
DO  - 10.2196/55560
ID  - info:doi/10.2196/55560
ER  -