Family functioning, trauma exposure and PTSD: A cross sectional study

Sarah Dorrington,Helena Zavos,Harriet Ball,Peter Mcguffin,Athula Sumathipala,Sisira Siribaddana,Fruhling Rijsdijk,Stephani L Hatch,Matthew Hotopf

doi:10.1016/j.jad.2018.11.056

Abstract

ObjectiveOnly a minority of trauma-exposed individuals go on to develop post traumatic stress disorder (PTSD). Previous studies in high income countries suggest that maladaptive family functioning adversities (MFFA) in childhood may partially explain individual variation in vulnerability to PTSD following trauma. We test in a lower middle-income setting (Sri Lanka) whether: (1) MFFA is associated with trauma exposure; (2) MFFA moderates the association between exposure to trauma and later (a) PTSD (b) other psychiatric diagnoses; and (3) any association between MFFA and PTSD is explained by experiences of interpersonal violence, cumulative trauma exposure or comorbid psychopathology. MethodsWe conducted a population study of 3995 twins and 2019 singletons residing in Colombo, Sri Lanka. Participants completed the Composite International Diagnostic Interview, including nine traumatic exposures and a questionnaire on MFFA. Results23.4% of participants reported exposure to MFFA. We found that (1) MFFA was strongly associated with trauma exposure (2) MFFA moderates the association between trauma exposure and both (a) PTSD and (b) other DSM psychiatric diagnosis. (3) This was not explained by interpersonal violence, cumulative trauma exposure or other psychopathology. ConclusionsMFFA moderates the association between trauma and PTSD, and the association between trauma and non-PTSD psychopathology.

Highlights

Cross sectional and cohort studies consistently show that the distribution of post traumatic stress disorder (PTSD) in populations is not solely a function of exposure to trauma (Brewin et al, 2000)
Stress proliferation theory suggests that maladaptive family functioning adversities (MFFA) is associated with social deprivation which in turn is associated with greater exposure to traumatic life events (Pearlin, 1989; Pearlin et al, 2005)
Because MFFA are associated with many other psychiatric disorders, and there is a strong relationship between PTSD and other psychiatric disorders, the relationship is confounded by psychiatric comorbidity (Breslau, 2009; Dorrington et al, 2014; Kessler, 1995)

Summary

Introduction

Cross sectional and cohort studies consistently show that the distribution of post traumatic stress disorder (PTSD) in populations is not solely a function of exposure to trauma (Brewin et al, 2000). One important risk factor is early adversity, including maladaptive family functioning adversities (MFFA)(Kessler et al, 2010; McLaughlin et al, 2017). These adversities include aspects of parenting, including neglect, antipathy, separation and punishment, and may partially explain individual variation in vulnerability to PTSD (Brewin et al, 2000; Iversen et al, 2007; Kessler et al, 2010; McLaughlin et al, 2017; Ozer et al, 2003). Because MFFA are associated with many other psychiatric disorders, and there is a strong relationship between PTSD and other psychiatric disorders, the relationship is confounded by psychiatric comorbidity (Breslau, 2009; Dorrington et al, 2014; Kessler, 1995)

Methods

Results

Conclusion