Posttraumatic stress disorder symptoms among trauma-exposed adolescents from low- and middle-income countries

This recent study by the ICMH – SG (Stupar et al., 2021) assessed the types of traumatic events experienced and the presence and predictors of PTSD symptoms in adolescents from ten low- and middle-income countries (LMICs) exposed to traumatic events in the preceding year. Adolescents (12-18 yrs old) were recruited in Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, the Palestinian Territories, the Philippines, Portugal, Romania, and Serbia. A sample (n = 3370) with a history of traumatic events is assessed for PTSD symptoms using the UCLA PTSD Reaction Index for DSM-5 (PTSD – RI – 5) modified to ensure cultural acceptance. We showed that nearly every third adolescent living in LMICs might have some PTSD symptoms after experiencing a traumatic event. In contrast, almost one in ten might have sufficient symptoms for a complete DSM-5 PTSD diagnosis. We also found that younger adolescents and those with a history of exposure to war or having been forced to have sex or with more severe PTSD symptoms (especially avoidance) were at a greater risk of having PTSD. Thus, there is a need for collaboration between the health and social care services sectors to devise joint policies and care pathways and suggest a stepped care approach to reduce strain on the limited health care services available in LMICs.

External locus-of-control partially mediates the association between cumulative trauma exposure and posttraumatic stress

Led by Dr. Atilola, we found three essential findings in a recent study of the ICMH-SG across ten countries:

– exposure to different minor stressful and significant traumatic events is widespread among adolescents,

– there is a direct relationship between a cumulative number of traumatic exposures and severity of PTSD symptoms, especially in girls and younger adolescents, and

– the relationship between cumulative trauma exposure and PTSD is mediated by an external locus of control, which we also identified for anxiety and depressive symptoms.

Daily Internet use time could assist in the screening of problematic Internet use

Our recent study has shown that the Internet use time of 190 mins/day or more, the total physical weekly activity of 60 mins or less, and the sleeping of 6 hours or less per day could be parameters for use to screen university students for problematic Internet use (PIU). Therefore, assessment of daily internet use time could assist in the periodic screening of students at-risk of problematic internet use (PIU). This would help early detection and referral to an appropriate mental health expert for further assessment and management.

Assessing the symptoms of Internet Gaming Disorder among college/university students

Looking for a scale to measure symptoms of Gaming disorder (GD) in college/university students (i.e., the ICMH-IGD scale), our study demonstrated three essential things: nine item-symptoms representing a single factor of the Internet Gaming Disorder (IGD) according to the DSM-5 is possible to measure, the ICMH-IGD scale is measuring IGD/GD invariantly in both genders, and symptom-items preoccupation with online gaming, loss of interest in previous hobbies and entertainment, and the use of gaming to relieve negative moods are perceived similarly across different languages.

The present study evaluated the psychometric properties of a self-report scale for assessing Internet gaming disorder (IGD) symptoms according to the DSM-5 and ICD-11 among 3270 college/university students (2095 [64.1%] females; age mean 21.6 [3.1] years) from different countries worldwide. It was tested the Croatian, English, Polish, Portuguese, Serbian, Turkish, and Vietnamese version of the scale. The study confirmed that the symptoms of IGD could be measured as a single underlying factor among college/university students. A nine-item-symptom scale following DSM-5, and a short four-item scale representing the main ICD-11 symptoms, had good internal consistency and discriminant validity. In addition, three symptom-items were found non-invariant across the language samples (i.e., preoccupation with online gaming, loss of interest in previous hobbies and entertainment, and the use of gaming to relieve negative moods). This study provides initial evidence for assessing IGD symptoms among college/university students. It fosters further research into gaming addiction in this population worldwide, especially considering language/cultural differences.

Correlates of Problematic Internet Use among college and university students in eight countries

This study led by Yatan showed that the overall prevalence of PIU is about 8.4% in college/university students and that depressive and anxiety symptoms were the most stable and most robust factors associated with PIU.

Internet use has increased exponentially over the past two decades, with no up-to-date cross-country comparison of Problematic Internet Use (PIU) and its correlations available. The present study aimed to explore the pattern and correlates of PIU across different countries in the European and the Asian continent. Further, the stability of factors associated with PIU across different countries were assessed. An international, cross-sectional study with a total of 2749 participants recruited from universities/colleges of eight countries: Bangladesh, Croatia, India, Nepal, Turkey, Serbia, Vietnam, and United Arab Emirates (UAE). Participants completed the Generalized Problematic Internet Use Scale -2 (GPIUS2) assessing PIU, and the Patient Health Questionnaire Anxiety-Depression Scale (PHQ-ADS) assessing the depressive and anxiety symptoms. A total of 2643 participants (mean age 21.3 ± 2.6; 63% females) were included in the final analysis. The overall prevalence of PIU for the entire sample was 8.4% (range 1.6% to 12.6%). The mean GPIUS2 standardized scores were significantly higher among participants from the five Asian countries when compared to the three European countries. Depressive and anxiety symptoms were the most stable and strongest factors associated with PIU across different countries and cultures. The PIU is an important emerging mental health condition among college/university going young adults, with psychological distress being the strongest and most stable correlate of PIU across different countries and cultures in this study. The present study highlighted the importance of screening university and college students for PIU.

Locus of control, negative live events, and psychopathological symptoms in collectivist adolescents

Paulo led a study showing that external LoC is linked to more psychological symptoms. The study examined the moderating and mediating effects of LoC on the relationship between adverse events and psychopathological symptoms (anxiety and depressive symptoms) in adolescents from collectivist countries (n = 2800). Consistent with prior research, negative life events and external LoC were associated with more psychopathological symptoms. However, unlike past studies with samples from individualist countries, the study did not produce clear evidence that LoC moderated or mediated this relationship. Results are discussed in terms of cultural differences in the (un)desirability of external control.

UCLA PTSD reaction index for DSM-5 (PTSD-RI-5): a psychometric study of adolescents sampled from communities in eleven countries

Background: Children and adolescents are often exposed to traumatic events, which may lead to the development of posttraumatic stress disorder (PTSD). It is therefore important for clinicians to screen for potential symptoms that can be signs of PTSD onset. PTSD in youth is a worldwide problem, thus congruent screening tools in various languages are needed. Objective: The aim of this study was to test the general psychometric properties of the Traumatic Stress Disorder Reaction Index for children and adolescents (UCLA PTSD) Reaction Index for DSM-5 (PTSD-RI-5) in adolescents, a self-report instrument intended to screen for trauma exposure and assess PTSD symptoms. Method: Data was collected from 4201 adolescents in communities within eleven countries worldwide (i.e. Brazil, Bulgaria, Croatia, Indonesia, Montenegro, Nigeria, Palestine-Gaza, Philippines, Portugal, Romania, and Serbia). Internal consistency, discriminant validity, and a confirmatory factor analysis of a four-factor model representing the main DSM-5 symptoms of the PTSD-RI-5 were evaluated. Results: The PTSD-RI-5 total score for the entire sample shows very good reliability (α = .92) as well as across all countries included (α ranged from .90 to .94). The correlations between anxiety/depressive symptoms and the PTSD-RI-5 scores were below .70 indicating on good discriminant validity. The four-factor structure of the scale was confirmed for the total sample and data from six countries. The standardized regression weights for all items varied markedly across the countries. The lack of a common acceptable model across all countries prevented us from direct testing of cross-cultural measurement invariance. Conclusions: The four-factor structure of the PTSD-RI-5 likely represents the core PTSD symptoms as proposed by the DSM-5 criteria, but there could be items interpreted in a conceptually different manner by adolescents from different cultural/regional backgrounds and future cross-cultural evaluations need to consider this finding.