The relationship between cognitive processes and psychopathology following a trauma in children and adolescents: A systematic review and meta-analysis

Introduction Cognitive models highlight the role of maladaptive appraisals and rumination in the development and maintenance of post-traumatic stress disorder (PTSD) in children and adolescents. Recent research has highlighted that such factors may also be linked to the development of depression post-trauma. This systematic review and meta-analysis examined the role of maladaptive appraisals and rumination in the development and maintenance of PTSD and depression following trauma. Method A systematic search was conducted across three databases; PsycInfo, MEDLINE and PTSDpubs. Forty-seven studies were identified which met inclusion criteria, comprising 14,194 children and adolescents. Random effects meta-analyses were conducted. Results Strong cross-sectional relationships were identified between appraisals and both PTSD (r = 0.54 [95 %CI = 0.47, 0.61]; k = 29) and depression (r = 0.60 [95 % CI = 0.47, 0.70; k = 12). This relationship retains strength across trauma types. A medium-sized relationship between rumination and PTSD (r = 0.40 [95 % CI = 0.27, 0.51]; k = 14) was identified. These findings were consistent prospectively, suggesting that maladaptive appraisals (r = 0.60 [95 % CI = 0.44, 0.73]; k = 4) and rumination (r = 0.38 [95 % CI = 0.28, 0.48]; k = 8) are predictive of PTSD. There was not enough evidence to comment on the link between rumination and depression. All estimates were characterised by a high degree of heterogeneity. Conclusion The relevance and impact of maladaptive appraisals goes beyond PTSD alone and is also linked to the development of depression post-trauma. Targeting maladaptive appraisals in treatment following a traumatic experience may therefore help to reduce both PTSD and depression symptoms. The role of rumination in post-traumatic depression has received insufficient attention and is not clearly understood.