Abstract
SummaryBackgroundDespite the emphasis placed on childhood trauma in psychiatry, comparatively little is known about the epidemiology of trauma and trauma-related psychopathology in young people. We therefore aimed to evaluate the prevalence, clinical features, and risk factors associated with trauma exposure and post-traumatic stress disorder (PTSD) in young people.MethodsWe carried out a comprehensive epidemiological study based on participants from the Environmental Risk Longitudinal Twin Study, a population-representative birth-cohort of 2232 children born in England and Wales in 1994–95. At the follow-up home visit at age 18 years, participants were assessed with structured interviews for trauma exposure, PTSD, other psychopathology, risk events, functional impairment, and service use. Risk factors for PTSD were measured prospectively over four previous assessments between age 5 and 12 years. The key outcomes were the prevalence, clinical features, and risk factors associated with trauma exposure and PTSD. We also derived and tested the internal validity of a PTSD risk calculator.FindingsWe found that 642 (31·1%) of 2064 participants reported trauma exposure and 160 (7·8%) of 2063 experienced PTSD by age 18 years. Trauma-exposed participants had high rates of psychopathology (187 [29·2%] of 641 for major depressive episode, 146 [22·9%] of 638 for conduct disorder, and 102 [15·9%] of 641 for alcohol dependence), risk events (160 [25·0%] of 641 for self-harm, 53 [8·3%] of 640 for suicide attempt, and 42 [6·6%] of 640 for violent offence), and functional impairment. Participants with lifetime PTSD had even higher rates of psychopathology (87 [54·7%] of 159 for major depressive episode, 43 [27·0%] of 159 for conduct disorder, and 41 [25·6%] of 160 for alcohol dependence), risk events (78 [48·8%] of 160 for self-harm, 32 [20·1%] of 159 for suicide attempt, and 19 [11·9%] of 159 for violent offence), and functional impairment. However, only 33 (20·6%) of 160 participants with PTSD received help from mental health professionals. The PTSD risk calculator had an internally validated area under the receiver operating characteristic curve of 0·74, indicating adequate discrimination of trauma-exposed participants with and without PTSD, and internally validated calibration-in-the-large of −0·10 and calibration slope of 0·90, indicating adequate calibration.InterpretationTrauma exposure and PTSD are associated with complex psychiatric presentations, high risk, and significant impairment in young people. Improved screening, reduced barriers to care provision, and comprehensive clinical assessment are needed to ensure that trauma-exposed young people and those with PTSD receive appropriate treatment.FundingThe Medical Research Council, the National Institute of Child Health and Development, the Jacobs Foundation, the Nuffield Foundation, the National Society for Prevention of Cruelty to Children, the Economic and Social Research Council, the National Institute for Health Research, MQ, and Canadian Institutes for Advanced Research.
Highlights
Traumas—namely, events that involve danger of death, injury, or sexual violation1—pose substantial challenges in clinical practice and public health, including the assessment and treatment of psychopathology in traumaexposed individuals and planning of service provision.[2,3] These challenges are salient in young people, who are exposed to the highest rates of trauma[4,5] and might be more vulnerable to the effects of stressors due to ongoing neurobiological, emotional, and social development.[6]
It is necessary to characterise comprehensively the prevalence, clinical features, and risk factors associated with trauma exposure and subsequent post-traumatic stress disorder (PTSD) in young people
Evidence before this study Relatively little is known about the epidemiology of trauma exposure and post-traumatic stress disorder (PTSD) in representative samples of young people
Summary
Traumas—namely, events that involve danger of death, injury, or sexual violation1—pose substantial challenges in clinical practice and public health, including the assessment and treatment of psychopathology in traumaexposed individuals and planning of service provision.[2,3] These challenges are salient in young people, who are exposed to the highest rates of trauma[4,5] and might be more vulnerable to the effects of stressors due to ongoing neurobiological, emotional, and social development.[6]. Evidence before this study Relatively little is known about the epidemiology of trauma exposure and post-traumatic stress disorder (PTSD) in representative samples of young people. We identified population-based studies of trauma exposure and PTSD in young people done in high-income countries. This search was supplemented by reviewing reference lists and forward citations of relevant articles. Taken together, these studies suggest that trauma exposure and PTSD in young people are prevalent, are associated with a large health burden, and are linked to pre-existing risk factors. Studies to date have not tested the prediction performance of identified risk factors for PTSD to inform the development of screening programmes
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