Abstract
A greater understanding of why some people are more at risk of developing PTSD is required. We examine the relationship between temperament traits in early childhood and subsequent trauma exposure and risk of PTSD. We used data on 2017 participants from the Avon Longitudinal Study of Parents and Children (ALSPAC). Temperament was measured using the Carey Infant Temperament Scale (average score from ages 6 and 24 months). This provided data on 9 individuals traits, and Easy, Medium, and Difficult temperament clusters. Trauma exposure was measured from 0 to 17 years, and PTSD at age 23 years using the PTSD Checklist for DSM-V (PCL-5). Regression models were used to estimate associations between temperament and both trauma and PTSD, and to examine mediation (of temperament to PTSD pathway) and interaction (temperament X trauma on PTSD) effects. 1178 (58.4%) individuals were exposed to a trauma in childhood and 112 (5.5%) had PTSD. Higher levels of Intensity were associated with a small increase in trauma exposure (ORadjusted 1.23, 95% CI 1.12, 1.34; p < 0.001) and PTSD (ORadjusted 1.27, 95% CI 1.05, 1.54; p = 0.012). Higher levels of Activity, Adaptability, Mood and Threshold temperament traits were also associated with trauma exposure. Medium (ORadjusted 1.49, 95% CI 1.21, 1.84; p < 0.001) and Difficult (ORadjusted 1.47, 95% CI 1.18, 1.84; p = 0.001) temperament clusters were associated with increased trauma exposure compared to an Easy cluster, but were not associated with PTSD. The relationship between trait Intensity and adult PTSD was partially mediated by childhood/adolescent trauma (Indirect ORadjusted 1.08, 95% CI 1.01, 1.16, p = 0.024, proportion mediated 26.2%). There was some evidence that trait Intensity modified the relationship between trauma and PTSD (ORadjusted 1.66, 95% CI 1.07, 2.55, p = 0.023). PTSD in early adulthood is more common in those with intense stimuli responsiveness in childhood. Temperament traits might be useful predictors of trauma exposure and mental health outcomes and offer potential targets for supportive interventions.
Highlights
Post-traumatic stress disorder (PTSD) can occur following exposure to a traumatic event such as a near-death experience or a physical or sexual assault (American Psychiatric Association, 2013)
The aim of this study is to examine, using a cohort study design, whether individual temperament traits in early childhood are associated with trauma exposure through childhood and adolescence, and with PTSD in early adulthood
In a sensitivity analysis, where we omitted individuals exposed to trauma early in childhood to minimize the likelihood that temperament traits were being influenced by exposure to trauma very early in child hood, we found that the associations with later childhood/adolescent trauma were almost unchanged for Activity and Intensity, and those for Adaptability, Mood and Threshold were weaker
Summary
Post-traumatic stress disorder (PTSD) can occur following exposure to a traumatic event such as a near-death experience or a physical or sexual assault (American Psychiatric Association, 2013). It is charac terised by three key symptom clusters: re-experiencing of the event, avoidance of reminders of the trauma, and an exaggerated threat response (World Health Organization, 2019). More recent classification systems recognise complex PTSD, usually occurring following repeated exposure to trauma, often in childhood, and characterised by an additional symptom cluster of disturbances in self-organisation (World Health Organization, 2019). Factors directly relating to the trauma, such as type of trauma (Bryant, 2019) and level of threat to life (Trickey et al, 2012; Ozer et al, 2003), show the strongest association with risk of developing PTSD, other pre- and peri-trauma characteristics are associated with higher PTSD risk, including level of social support around the time of the trauma (Trickey et al, 2012; Ozer et al, 2003), pre-existing mental illness (Brewin et al, 2000), family history of mental disorder (Ozer et al, 2003; Brewin et al, 2000; Breslau, 2002), lower cognitive ability (DiGangi et al, 2013) and female sex (Breslau, 2002)
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