Abstract
The cognitive model posits that negative appraisals play an important role in posttraumatic stress disorder, in children as well as in adults. This study examined correlates of negative appraisals in relation to trauma exposure and their relationship to posttraumatic stress symptoms (PTSS) in 414 Sri Lankan adolescents, aged 12 to 16, living in areas impacted in varying degrees by the 2004 tsunami. In 2008, participants completed measures of negative appraisals, lifetime traumatic events, posttraumatic stress symptoms, internalizing symptoms, ongoing adversity, and social support. The majority (70 %) of the participants reported multiple traumatic events; 25 % met DSM-IV criteria for full or partial PTSD. Adolescents who had experienced more severe events, abusive events, greater cumulative trauma, or greater current adversity reported more negative appraisals. In regression analyses controlling for known risk factors such as female gender, cumulative trauma, ongoing adversity, and low social support, negative appraisals were the best predictor of PTSS, explaining 22 % of the variance. This relationship appeared specific to PTSS, as negative appraisals did not predict internalizing symptoms. Findings confirm the link between negative cognitions concerning traumatic events and persistent PTSS in adolescents, but longitudinal studies are needed to determine whether appraisals contribute to symptom maintenance over time.
Highlights
The cognitive model posits that negative appraisals play an important role in posttraumatic stress disorder, in children as well as in adults
Mediation analyses indicated that the effects on posttraumatic stress symptoms (PTSS) of three of the four significant predictors were partially mediated by negative appraisals (Criterion A event: direct effect=0.541, indirect=0.338, bootstrap SE=0.076, 95 % CI [0.207, 0.506], p
We considered whether the observed relationship between negative appraisals and PTSS might to some extent be explained by co-occurring internalizing symptoms: that is, adolescents with many internalizing symptoms may have developed more negative trauma appraisals, and the apparent link between appraisals and PTSS might be spurious
Summary
The cognitive model posits that negative appraisals play an important role in posttraumatic stress disorder, in children as well as in adults. Children may interpret traumatic experiences and subsequent symptoms (for example, intrusive thoughts and images) as evidence of personal weakness or permanent damage, and of the world as a dangerous place Such maladaptive cognitions maintain a sense of ongoing threat and can lead to persistent PTSD symptoms, long after the traumatic event. Little appears to be known about individual characteristics or features of traumatic experiences that increase the probability that a trauma-exposed child will develop negative cognitions concerning self and the world Demographic characteristics such as gender and age, for example, might be relevant. Given that female adolescents show a greater tendency to ruminate in response to stressful events (Trickey et al 2012), one might expect more negative cognitive appraisals in girls It appears that few studies have examined gender differences in appraisals in this age group. On the other hand, may be effective in reducing negative appraisals, as reported in studies of MVA victims (Tierens et al 2012) and sexually abused adolescents (Bal et al 2009)
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