PTSD after traumatic events: Which teens are at risk?

While most children cannot be shielded from emotionally traumatic events, clinicians can target those who are most vulnerable to developing post-traumatic stress disorder (PTSD), according to a large study from Boston Children's Hospital. Findings appear online in the August issue of the Journal of the American Academy of Child & Adolescent Psychiatry, accompanied by an editorial.

Researchers led by Katie McLaughlin, PhD, of the Departments of Pediatrics and Psychiatry at Boston Children's, analyzed data on 6,483 teen–parent pairs from the National Comorbidity Survey Replication, a survey of the prevalence and correlates of mental disorders in the United States.

Overall, 61 percent of the teens (ages 13 to 17) had been exposed to at least one potentially traumatic event in their lifetime, including interpersonal violence (such as rape, physical abuse or witnessing domestic violence), injuries, natural disasters and death of a close friend or family member. Nineteen percent had experienced three or more such events.

Risk factors associated most strongly with trauma exposure included:

• Lack of both biological parents in the home.
• Pre-existing mental disorders, particularly behavioral disorders like attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder.

Of all teens exposed to trauma, 4.7 percent had experienced PTSD under DSM-IV diagnostic criteria. Risk factors for PTSD included:

• Female gender: Of the total sample, girls had a lifetime prevalence of PTSD of 7.3 percent, and boys 2.2 percent.
• Events involving interpersonal violence: the lifetime prevalence of PTSD was 39 percent for teens who had been raped and 25 percent for those physically abused by a caregiver.
• Underlying anxiety and mood disorders (also a risk factor for exposure).

Risk factors for lack of recovery from PTSD included underlying bipolar disorder, exposure to an additional traumatic event, living in poverty and being a U.S. native.