Teens at Greatest Risk for PTSD Identified

Caroline Cassels

August 08, 2013

Risk factors that identify teens at greatest risk of developing posttraumatic stress disorder (PTSD) following potentially traumatic experiences (PTE) have been identified — findings that may pave the way for the prevention and successful treatment of the disorder in this vulnerable population.

A large, epidemiologic study showed that the strongest vulnerability factors for PTSD included female sex, events involving interpersonal violence, and pre-existing anxiety and mood disorders before exposure to the worst traumatic stressor.

"Effective interventions have been developed to prevent the onset of PTSD in PTE-exposed adults and, more recently, in PTE-exposed children and adolescents. Our findings suggest that these interventions would most usefully be targeted at youths who are victims of interpersonal violence and those with pre-existing fear and stress disorders," the authors, led by Katie A. McLaughlin, PhD, Boston Children's Hospital and Harvard Medical School, in Massachusetts, write.

The study is published in the August issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Opportunity for Prevention

According to the researchers, although exposure to PTE is common among US youth, data on the link between PTE and PTSD are limited.

The investigators sought to estimate lifetime prevalence of exposure to PTEs and PTSD.

Using population-based data from the National Comorbidity Survey Replication Adolescent Supplement (NCS-A), the researchers examined the "epidemiology of PTE exposure and PTSD among youths, including prevalence and correlates of PTE exposure, variation in conditional probability of PTSD given PTE exposure, and PTSD recovery."

The study included data on 6483 adolescent-parent pairs aged 13 to 17 years that were based on adolescent interviews and long-form self-administered questionnaires that assessed lifetime exposure to interpersonal violence, accidents/injuries, network/witnessing, and other PTEs along with PTSD and other distress, fear, behavior, and substance disorders.

Overall, 61% of teens, or 3 in 5, reported exposure to at least 1 PTE in their lifetime, including interpersonal violence such as rape, physical abuse, or witnessing domestic violence, as well as injuries, natural disasters, and the death of a close friend or family member. A total of 19% of respondents reported 3 or more such events.

Prevalence of PTSD in those exposed to trauma was 4.5%, a rate that approaches that in US adults, and was significantly higher in females (7.3%) than males (2.2%).

Risk factors associated most strongly with PTE included the absence of both biological parents in the home and pre-existing mental disorders, particularly behavioral disorders, such as attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder.

Risk factors that predicted nonrecovery included poverty, being a Native American, having underlying bipolar disorder, and being exposed to an additional traumatic event.

"We have the opportunity to reduce the population burden of PTSD both by delivering timely preventive interventions in the wake of PTEs to those most at risk for PTSD, and by providing treatment to those with PTSD who are least likely to recover spontaneously," the authors write.

Landmark Study

In an accompanying editorial, Julian D. Ford, PhD, University of Connecticut, in Storrs, describes the article as a "meticulously conducted" study that "provides definitive evidence that trauma exposure is normative by the time children reach adolescence, and that adolescent PTSD prevalence levels approach those of adults."

Furthermore, he writes, "the results of this landmark study of trauma and PTSD in adolescence have substantial implications for practice, research, and policy in the field of child and adolescent psychiatry."

The authors and Dr. Ford report no relevant financial relationships.

J Am Acad Child Adolesc Psychiatry. 2013;8:815-830; 780-783. Abstract


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