Estres Postraumatico

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Posttraumatic Stress Disorder and Physical Comorbidity Among Female Children and Adolescents: Results From Service-Use Data Julia S. Seng, Sandra A. Graham-Bermann, M. Kathleen Clark, Ann Marie McCarthy and David L. Ronis Pediatrics 2005;116;e767-e776 DOI: 10.1542/peds.2005-0608

The online version of this article, along with updated information and services, is located on the World Wide Webat: http://www.pediatrics.org/cgi/content/full/116/6/e767

PEDIATRICS is the official journal of the American Academy of Pediatrics. A monthly publication, it has been published continuously since 1948. PEDIATRICS is owned, published, and trademarked by the American Academy of Pediatrics, 141 Northwest Point Boulevard, Elk Grove Village, Illinois, 60007. Copyright © 2005 by the American Academy ofPediatrics. All rights reserved. Print ISSN: 0031-4005. Online ISSN: 1098-4275.

Downloaded from www.pediatrics.org. Provided by Hospital Nacional de Pediatria Juan P. Garrahan on January 6, 2011

Posttraumatic Stress Disorder and Physical Comorbidity Among Female Children and Adolescents: Results From Service-Use Data
Julia S. Seng, PhD, CNM, RN*‡§; Sandra A. Graham-Bermann, PhD ; M.Kathleen Clark, PhD, RN¶; Ann Marie McCarthy, PhD, RN, PNP¶; and David L. Ronis, PhD‡#
ABSTRACT. Objective. In adults, posttraumatic stress disorder (PTSD) is associated with adverse health outcomes and high medical utilization and cost. PTSD is twice as common in women and is associated with increased risk for a range of diseases, chronic conditions, and reproductive-health problems. Little is knownabout the health effects of PTSD in children. The purpose of this study was to explore patterns of physical comorbidity in female children and adolescents with PTSD by using population data. Methods. This study was a cross-sectional, descriptive epidemiologic case-control analysis of a Midwestern state’s Medicaid eligibility and paid-claims data for girls (0 – 8 years old) and teens (9 –17 yearsold). Data were from 1994 –1997. All those with the PTSD diagnostic code were compared with randomly selected controls in relation to 3 sets of outcomes: (1) International Classification of Diseases, Ninth Revision (ICD-9) categories of disease; (2) chronic conditions previously associated with sexual trauma and PTSD in women; and (3) reproductive-health problems. Analyses included bivariate oddsratios (OR) and logistic-regression models that control for the extent of insurance coverage and the independent associations of victimization and psychiatric comorbidity with the 3 sets of outcomes. The mental health covariate was categorical to allow consideration of a range of severity. There were 4 categories for the young girls: neither PTSD nor depression, PTSD without depression, depressionwithout PTSD, and PTSD depression. For the adolescent analysis, a fifth category reflecting a “complex PTSD” was added, defined as having PTSD complicated by a dissociative disorder or borderline personality disorder diagnosis. Results. There were 647 girls and 1025 adolescents with the PTSD diagnosis. Overall, PTSD was associated with adverse health outcomes in both age strata. Victimization wassometimes independently associated with adverse health outcomes, but PTSD often was a mediator, especially in the adolescent age stratum. The importance of PTSD diagnosis as a predictor of the ICD-9 categories of disease or chronic conditions seemed to increase with age.
From the *Institute for Research on Women and Gender, ‡School of Nursing, and Departments of §Obstetrics and Gynecology andPsychology, University of Michigan, Ann Arbor, Michigan; ¶College of Nursing, University of Iowa, Iowa City, Iowa; and #Ann Arbor VA Medical Center, Ann Arbor, Michigan. Accepted for publication Jul 19, 2005. doi:10.1542/peds.2005-0608 No conflict of interest declared. Address correspondence to Julia S. Seng, PhD, CNM, RN, Institute for Research on Women and Gender, University of Michigan, G120...
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