Model of Post-traumatic Growth in Newly Traumatized vs. Retraumatized Adolescents.

Hannah Pazderka,Vincent Io Agyapong,Shannon Noble,Deborah Terry Kitching,Pamela Brett-Maclean,Peter H Silverstone,Monica Mankowski,Matthew Rg Brown,Leslie A Hayduk,Joy Omeje,Caroline Beth Mcdonald-Harker,Bonnie Lee,Andrew James Greenshaw

doi:10.3389/fpsyt.2021.682055

Abstract

Background: In our analysis of adolescents affected by the 2016 Fort McMurray wildfire, we observed many negative mental health effects in individuals with a prior history of psychological trauma. Elevated rates of depression and markers of post-traumatic stress disorder (PTSD) were observed, consistent with the hypothesis that prior trauma may reduce sensitivity thresholds for later psychopathology (stress sensitization). Surprisingly, levels of anxiety did not differ based on prior trauma history, nor were retraumatized individuals at increased risk for recent (past month) suicidal ideation. These results are more suggestive of inoculation by prior trauma than stress sensitization. This led us to consider whether individuals with a prior trauma history showed evidence of Post-Traumatic Growth (PTG), a condition in which the experience of a previous trauma leads to areas of sparing or even improvement.Method: To investigate this issue, we generated a structural equation model (SEM) exploring the role of anxiety in previously traumatized (n = 295) and wildfire trauma alone (n = 740) groups. Specifically, models were estimated to explore the relationship between hopelessness, anxiety, PTSD symptoms, self-efficacy and potential protective factors such as friend and family support in both groups. The model was tested using a cross-sectional sample of affected youth, comparing effects between the two groups.Results: While both models produced relatively good fit, differences in the effects and chi-squared values led us to conclude that the groups are subject to different causal specifications in a number of areas, although details warrant caution pending additional investigation.Discussion: We found that adolescents with a prior trauma history appear to have a more realistic appraisal of potential difficulties associated with traumatic events, and seem less reactive to potentially unsettling PTSD symptoms. They also seemed less prone to overconfidence as they got older, an effect seen in the adolescents without a history of trauma. Our findings provide preliminary evidence that the construct of anxiety may work differently in newly traumatized and retraumatized individuals, particularly in the context of mass trauma events.

Highlights

It is generally recognized that a history of trauma in childhood and adolescence has negative effects on long-term functioning [1, 2], a finding that large, early investigations of Adverse Childhood Events (ACEs) [3] made evident
This led us to consider whether individuals with a prior trauma history showed evidence of PostTraumatic Growth (PTG), a condition in which the experience of a previous trauma leads to areas of sparing or even improvement
We found that adolescents with a prior trauma history appear to have a more realistic appraisal of potential difficulties associated with traumatic events, and seem less reactive to potentially unsettling post-traumatic stress disorder (PTSD) symptoms

Summary

Introduction

It is generally recognized that a history of trauma in childhood and adolescence has negative effects on long-term functioning [1, 2], a finding that large, early investigations of Adverse Childhood Events (ACEs) [3] made evident. It is hypothesized that prior trauma reduces the sensitivity threshold for these children and adolescents, such that presentation of a stressor later on makes them more reactive and more likely to endure negative effects This has been coined the stress sensitization hypothesis [7], and one implication of this theory is that exposure to prior trauma will make individuals more vulnerable to mental disorders in the wake of proximal stressors [8], perhaps by complicating their ability to adjust to negative events [9]. It has been suggested that adversities may need to cross a “severity threshold” to impact later stress vulnerability [10] Linking such observations to functioning of the autonomic nervous system, individuals with histories of adverse events showed higher levels of destabilized autonomic reactivity, as well as symptoms of worry, depression, and PTSD, in the wake of Covid-19 [12]. This led us to consider whether individuals with a prior trauma history showed evidence of PostTraumatic Growth (PTG), a condition in which the experience of a previous trauma leads to areas of sparing or even improvement

Methods

Results

Discussion

Conclusion