关键词: 创伤后应激障碍, 长尾效应, 转归机制, 干预策略

Abstract:

Prevention and intervention of post-traumatic stress disorder (PTSD) in children is an important issue of the healthy China strategy. The world health organization (WHO) predicted that global burden of child injury will continue to rise, especially in low and middle-income countries. It is estimated that 10% to 20% of children after traumatic events will experience post-traumatic stress disorder symptoms such as warning, evasion, and negative emotions. PTSD confer a heavy long term burden of disease among children. And Child PTSD was indicated to have a long tail effect, as great heterogeneity exists among children with PTSD regarding their following health outcomes. In addition, post-traumatic stress disorder in children is highly correlated with behavior problems, depression, substance abuse, crime, and suicide, and its negative effects can last into adulthood and even have intergenerational transmission effects. Current studies on the developmental outcome of PTSD in children mostly focus on whether PTSD symptoms decrease, increase or persist in children, while ignoring the types, mechanisms of prognosis, and intervention strategies of Child PTSD. Specifically, the types, characteristics, and mechanism of the developmental outcome of PTSD (transforming into physical and mental health, behavioral health, and other problems) have rarely been systematically explored, especially in the Chinses cultural context. For the reduction in the occurrence and development of PTSD, the trauma-focused cognitive behavioral intervention was proved to be rather effective in reducing the level of PTSD. However, there is not enough evidence from large-sample-sized, long-term randomized controlled studies based on school settings, and a shortage of targeted interventions for different stages of PTSD development. Therefore, it is of great academic value and practical significance to clarify the pathway of the occurrence and trajectory of PTSD in children, provide joint intervention programs based on the school setting, and reduce the risk of their transition to other physical and mental diseases. Moreover, based on a school-based teacher-children-parents cooperation framework, we would provide targeted intervention services to reduce the risk of Child PTSD, further shed light on individual-centered care in clinical practice. The purpose of this study is to conduct a follow-up investigation and quasi-experimental study on children and adolescents, focusing on: (1) the developmental trajectory and outcome types of children with PTSD. (2) What is the mechanism of prognosis for PTSD among children? (3) Whether school-based intervention services can promote the recovery of children with PTSD and reduce the risk of their transition to other physical and mental disorders? (4) According to the characteristics of Chinese children, how to develop early health service plans focusing on reducing traumatic events and promoting the recovery ability of children with PTSD? This study will identify the long-term trajectory types and mechanisms of Child PTSD prognosis in China, reduce the risk of children's PTSD to other physical and mental diseases through the joint intervention program based on the school setting, verify the effect of comprehensive intervention services on promoting the recovery of children's PTSD, and provide evidence for children's PTSD intervention and personalized diagnosis and treatment. Simultaneously, multiple theories were integrated to build the early-warning model, to interpret prognosis mechanism and comprehensive intervention strategy. Based on the "long tail theory", the early-warning model explore the trajectory and trait of the PTSD children. The prognosis mechanism of Child PTSD, incorporated the basic essence of the stress model and the resilience model, will reveal the developmental mechanism of Child PTSD. The process-based intergrated intervention strategy synthesized the characteristics of the long term effect, psychological environmental mechanism and task-shifting model. And this strategy could provide theoretical guidance for the school-based interventions of Child PTSD in the Chinese context.

Key words: posttraumatic stress disorder, long tail effect, mechanism of prognosis, intervention strategy