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Objectives: To explore the factor structure of the Checklist of Children's Distress Symptoms (CCDS); to examine whether there is a higher-order single construct underlying the CCDS measure; and, to assess the association between children's distress symptoms, as reflected by the CCDS factors, and children's self-reported exposure to community violence (both victimization and witness events). Designs: Community-based cross-sectional survey. Settings: Ten public housing developments in an eastern metropolis. Participants: A total of 349 low-income urban African American children and adolescents (198 males; 151 females), 9 through 15 years of age. Measures: Children's distress symptoms, exposure to community violence, and selected demographic information including parental education, parental employment status, perceived health status, and school performance. Analysis: Exploratory factor analysis was performed to determine the factorial structure of the CCDS measure. Second-order confirmatory factor analysis was performed to determine if there is a higher-order single underlying construct among CCDS factors. Pearson correlation coefficients were computed to assess the relationship between exposure to violence and CCDS factors. Major Findings:The exploratory factor analysis yielded a 6-factor solution for the CCDS measure with satisfactory internal consistency. The confirmatory factor model with a single second-order construct yielded a good fit to the data. In general, youth who experienced violent victimization or witnessed violent events reported higher levels of distress symptoms than those who did not. Distress symptoms labeled as 'intrusive thoughts,' 'distraction,' and 'lack of belongingness' were most frequently associated with exposure to violence. Distress symptoms did not differ on the basis of sex or age. Conclusions: The CCDS has utility as a measure of distress symptoms among urban African American children and adolescents. Whereas analysis provided support for a single higher-order construct, using the proposed 6-factor structure should enhance our understanding of the psychological impact of exposure to violence on youth and contribute to more effective intervention efforts. Arch Pediatr Adolesc Med. 1998; 152:569-577, The Checklist of Children's Distress Symptoms (CCDS) appears to be effective in diagnosing psychological distress in African-American children and teenagers. Researchers used the CCDS on 349 urban African-American children and teenagers. Children and teens who experienced violence either as a witness or victim were more likely to have higher scores than those who did not. When the CCDS questions were grouped into six categories, questions that assessed intrusive thoughts, distraction and lack of belongingness were most often associated with exposure to violence.

Nurse psychotherapists and nurse practitioners should work with school counselors to identify psychological stress in adolescents exposed to a natural disaster. A study of 507 high school students exposed to Hurricane Hugo found that 12% had symptoms of stress. They were identified by a nurse practitioner who referred them to a nurse psychotherapist. The Mental Health Assessment Tool used needs to be verified in future studies.