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. 2020 Nov 19;11(1):1832757.
doi: 10.1080/20008198.2020.1832757.

Latent classes of childhood maltreatment in children and adolescents in foster care: associations with ICD-11 PTSD and complex PTSD

Katharina Sölva  1 , Alexander Haselgruber  1 , Brigitte Lueger-Schuster  1
Affiliations

Latent classes of childhood maltreatment in children and adolescents in foster care: associations with ICD-11 PTSD and complex PTSD

Katharina Sölva et al. Eur J Psychotraumatol. .

Abstract
in English, Spanish, Chinese

Background: Children and adolescents in foster care often experience many co-occurring subtypes of maltreatment. However, little is known about different combinations of maltreatment subtypes, referred to as maltreatment classes. Furthermore, the association between those maltreatment classes and ICD-11 posttraumatic stress disorder (PTSD) and complex PTSD (CPTSD) has not been investigated in children and adolescents. In previous studies, classes characterized by cumulative maltreatment were associated with severe psychopathological symptoms. So far, no study investigated ICD-11 PTSD and CPTSD. Objective: The first aim of this study was the detection of distinct maltreatment classes by examining frequently co-occurring maltreatment subtypes. The second aim was the examination of the association between those maltreatment classes and ICD-11 PTSD and CPTSD. Method: Participants were 147 children and adolescents currently living in foster care institutions in Lower Austria. Maltreatment history, ICD-11 PTSD and CPTSD were assessed using standardized self-report questionnaires. Latent class analysis was applied to examine maltreatment subtypes. χ2 difference testing was used to examine class associations with PTSD and CPTSD. Results: Three latent classes that comprised different subtypes of maltreatment were identified (limited maltreatment, n = 49; high neglect, n = 53; cumulative maltreatment, n = 45). Cumulative maltreatment was associated with higher symptom severity of PTSD and CPTSD than the limited maltreatment and the high neglect class, with effect sizes ranging from 0.62 to 0.93. Conclusions: The association of the cumulative maltreatment class with the highest symptom severity of PTSD and CPTSD highlights the detrimental effect of cumulative maltreatment. The detection of a high neglect class identifies children and adolescents, who are at high-risk of experiencing future maltreatment because of their previous experiences of neglect and the associated lack of protection. The examination of the association of distinct maltreatment classes with ICD-11 PTSD and CPTSD might provide implications for targeted prevention, assessment and treatment.

Antecedentes: Los niños y adolescentes bajo cuidados alternativos a menudo experimentan muchos subtipos de maltrato concurrentes. Sin embargo, se sabe poco sobre las diferentes combinaciones de subtipos de maltrato, denominadas clases de maltrato. Además, la asociación entre esas clases de maltrato y el trastorno de estrés postraumático (TEPT) y el trastorno de estrés postraumático complejo (TEPTC) de la CIE-11 no se ha investigado en niños y adolescentes. En estudios anteriores, las clases caracterizadas por maltrato acumulativo se asociaron con síntomas psicopatológicos graves. Hasta ahora, ningún estudio investigó el TEPT y el TEPT-C de la CIE-11.Objetivo: El primer objetivo de este estudio fue la detección de distintas clases de maltrato mediante el examen de subtipos de maltrato que concurren con frecuencia. El segundo objetivo fue el examen de la asociación entre esas clases de maltrato y CIE-11 TEPT y TEPTC.Método: Los participantes fueron 147 niños y adolescentes que actualmente viven en instituciones de acogida en Baja Austria. Se evaluaron los antecedentes de maltrato, TEPT y TEPT-C de la CIE-11 mediante cuestionarios de auto-reporte estandarizados.Se aplicó un análisis de clases latentes para examinar los subtipos de maltrato. Se utilizó la prueba de diferencia de χ2 para examinar las asociaciones de clases con TEPT y TEPTC.Resultados: Se identificaron tres clases latentes que comprendían diferentes subtipos de maltrato (maltrato limitado, n = 49; alto nivel de negligencia, n = 53; maltrato acumulativo, n = 45). El maltrato acumulado se asoció con una mayor gravedad de los síntomas de TEPT y TEPTC que el maltrato limitado y la clase de alto nivel de negligencia, con tamaños de efecto que van de 0,62 a 0,93.Conclusiones: La asociación de la clase de maltrato acumulativo con la mayor gravedad de los síntomas de TEPT y TEPTC destaca el efecto perjudicial del maltrato acumulativo. La detección de una clase de alto nivel de negligencia identifica a los niños y adolescentes, que tienen un alto riesgo de sufrir maltrato en el futuro debido a sus experiencias anteriores de negligencia y la falta de protección asociada. El examen de la asociación de distintas clases de maltrato con TEPT y TEPTC de la CIE-11 podría proporcionar implicaciones para la prevención, evaluación y tratamiento específicos.

背景: 寄养的儿童和青少年经常会遭受多种并发的虐待。但是, 关于虐待亚型的不同组合 (称为虐待类别) 知之甚少。此外, 尚未在儿童和青少年中研究这些虐待类别与ICD-11创伤后应激障碍 (PTSD) 和复杂性PTSD (CPTSD) 之间的关联。在先前的研究中, 以累积虐待为特征的类别与严重的心理病理症状相关。到目前为止, 尚无研究考查ICD-11 PTSD和CPTSD。目的: 本研究的第一个目标是通过考查经常并发的虐待亚型来检测不同的虐待类别。第二个目标是考查这些虐待类别与ICD-11 PTSD和CPTSD之间的关联。方法: 参与者为目前居住在下奥地利州寄养机构中的147名儿童和青少年。使用标准化自我报告问卷评估了虐待史, ICD-11 PTSD和CPTSD。潜在类别分析用于考查虐待亚型。 χ2差异检验用于考查类别与PTSD和CPTSD的关联。结果: 识别出3种包含不同虐待亚型的潜在类别 (有限虐待类, n= 49; 高度忽视类, n= 53; 累积虐待类, n= 45) 。与有限虐待类和高度忽视类相比, 累积虐待类与更高的PTSD和CPTSD症状严重程度相关, 其效应量范围为0.62至0.93。结论: 累积虐待类与最高的PTSD和CPTSD症状严重程度的关联突显了累积虐待类的有害影响。发现高度忽视类识别出的儿童和青少年, 由于先前的被忽视经历和相关保护的缺乏, 具有未来遭受虐待的高风险。对不同虐待类别与ICD-11 PTSD和CPTSD关联的考查可能对于针对性预防, 评估和治疗有所启发.

Keywords: Children; ICD-11; abuse; adolescents; childhood maltreatment; complex PTSD; foster care; latent class analysis; neglect; posttraumatic stress disorder (PTSD).

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Conflict of interest statement

The authors declare that they have no competing financial or personal interests.

Figures

Figure 1.
Figure 1.
Graphic representation of the distinct classes
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