RELATIONS AMONG NIGHTMARES, PTSD, AND QUALITY OF LIFE IN TRAUMA EXPOSED ADOLESCENTS

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1 RELATIONS AMONG NIGHTMARES, PTSD, AND QUALITY OF LIFE IN TRAUMA EXPOSED ADOLESCENTS Barbara Peterson, Ph.D, RN, PMHCNS University of Minnesota School of Nursing

2 OBJECTIVES

3 TRAUMA Sudden, unpredictable, life-threatening event that is out of the ordinary life experience % adults report childhood trauma 794,000 children were victims of abuse and/or neglect (U.S. Department of Health and Human Services, 2009), Higher rates and more serious exposures to traumatic events: Poor and Urban Unstably housed Minority youth

4 THEORETICAL UNDERPINNINGS Trauma challenges assumptions about selfidentity, world view and spirituality: personal invulnerability, the world is meaningful and makes sense, view of self in a positive light (Janoff-Bulman & Frieze, 1983, 2010)

5 EXAMPLES OF TRAUMA

6 CUMULATIVE TRAUMA Co-occurring trauma exposures Individuals report on average that they have experienced nearly 5 traumatic events in their lifetime. The experience of trauma is simply not the rare exception, it is part of our world-wide, globallyconnected social reality.

7 TRAUMA AND NIGHTMARES Nightmares following trauma can be adaptive and often dissipate. For some, nightmares can become chronic and persistent. 36% to 61% of trauma survivors have frequent and chronic nightmares. Hallmark symptom of Posttraumatic Stress Disorder.

8 NIGHTMARE HISTORICAL Precursor to madness PERSPECTIVE Freud s wish fulfillment theory of dreams War Vets: Repetitive, chronic post-traumatic nightmares

9 SUMMARY OF LITERATURE Nightmares: PTSD, Sleep Quality, physical & emotional health problems in adults. No studies of effects of nightmares on quality of life in adolescents.

10 NIGHTMARES DEFINITION AND MEASUREMENT Very disturbing and unpleasant dreams that are vividly recalled and sometimes wakes you up Nightmare frequency (NMF) Number of nightmares per week Nightmare distress: (NMD) Amount of daytime distress attributed to nightmare

11 STUDY AIM Examine the associations of nightmare frequency and nightmare distress, sleep quality, PTSD symptoms, and quality of life in urban, trauma-exposed African American adolescents.

12 METHODS Design Cross-sectional, predictive Setting Adolescent Clinic at Children s Hospital of Michigan, Detroit Medical Center, Detroit, MI Primary Health; urban teens Sample African American teens, age 14 to recruited (88% response rate); discarded 13 N= 151 (111 girls, 40 boys)

13 SAMPLE CHARACTERISTICS Community Sample; receiving routine health care Mean age = (S.D. = 1.15) Average Household Income = $10,000 - $19, % of families receive welfare 69% had been suspended from school 23.2% had repeated at least one grade

14 TRAUMA EXPOSURE 100% of teens reported some exposure to trauma events. 54% reported 3 to 10 traumas. 6% Direct Trauma Exposure 54% 14% 26% 0 Traumas n = Traumas n = Traumas n = Traumas n = 9

15 NIGHTMARE FREQUENCY (NMF) 52% reported 1 NM in prior month % girls reported NMs 1 time/week Girls > boys (t (139.9) = -4.74, p.001). Gender Differences in Nightmare Frequency Males Females Number of Nightmares n % N % No nightmares time/month time/week times/week times/week times/ week

16 NIGHTMARE DISTRESS (NMD) Higher NMF associated with greater NMD (t (139.2) = -4.14, p =.006). Girls reported more NMD than boys (t (97.6) = -2.97, p =.004).

17 RESULTS Trauma is associated with nightmare frequency, nightmare distress, PTSD and poor sleep quality. Nightmare frequency and nightmare distress is associated with higher PTSD and poor sleep quality. Nightmare frequency and nightmare distress is associated with lower quality of life (physical, social, school, and social areas of life).

18 .07 Gender.08 NMF.10 PTSD QOL Trauma NMD Sleep Quality Final QOL model: - Good fit! #s = β - χ 2 = 269.8,df = 215, p = 0.006, RMSEA =

19 STRENGTHS AND LIMITATIONS Strengths Limitations Sample Instruments Data collection protocol Sophisticated statistical analysis Convenience sample Mostly girls Cross-sectional design Self-report

20 TREATMENT OPTIONS Sleep hygiene Imagery Rehearsal Therapy (IRT; Krakow, Kellner, Neidhardt, Pathak, & Lambert, 1993) Blog: Exposure, Relaxation, and Rescripting Therapy (ERRT; Davis, 2009)

21 TAKE HOME Trauma exposure related nightmares prevent youth from living live to the fullest, so. Nurses are front-line assessors: Asking about trauma Asking about nightmares Offering a safe place to share Nurses are knowledgeable advocates: Curbing violence Detecting early Knowing when the teen needs help Paving the way for more help and referrals

22 -QUESTIONS-

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