Sociodemographic Risk,Developmental Competence,and PTSD Symptoms in Young Children Exposed to Interpersonal Trauma in Early Life

Young children are disproportionately exposed to interpersonal trauma (maltreatment, witnessing intimate partner violence [IPV]) and appear particularly susceptible to negative sequelae. Little is known about the factors influencing vulnerability to traumatic stress responses and other negative outcomes in early life. This study examined associations among interpersonal trauma exposure, sociodemographic risk, developmental competence, and posttraumatic stress disorder (PTSD) symptoms in 200 children assessed from birth to first grade via standardized observations, record reviews, and maternal and teacher interviews. More severe PTSD symptoms were predicted by greater trauma exposure (r = .43), greater sociodemographic risk (r = .22), and lower developmental competence (rs = ?.31 and ?.54 for preschool and school‐age developmental competence, respectively). Developmental competence partially mediated the association between trauma exposure and symptoms. Trauma exposure fully mediated the association between sociodemographic risk and symptoms. Neither sociodemographic risk nor developmental competence moderated trauma exposure effects on symptoms. The findings suggest that (a) exposure to maltreatment and IPV has additive effects on posttraumatic stress risk in early life, (b) associations between sociodemographic adversity and poor mental health may be attributable to increased trauma exposure in disadvantaged populations, and (c) early exposures have a negative cascade effect on developmental competence and mental health.     

Associations Between Motor Vehicle Crashes and Mental Health Problems: Data From the National Survey of Adolescents‐Replication

Motor vehicle crashes (MVCs) are a leading cause of physical injuries and mortality among children and adolescents in the United States. The purpose of this study was to examine associations between having an MVC and mental health outcomes, including posttraumatic stress disorder (PTSD), depression, and drug and alcohol misuse in a nationally representative sample of adolescents. A sample of 3,604 adolescents, aged 12–17 years, was assessed as part of the 2005 National Survey of Adolescents‐Replication (NSA‐R) study. Data were weighted according to the 2005 U.S. Census estimates. Within this sample, 10.2% of adolescents reported having at least 1 serious MVC. The prevalence of current PTSD and depression among adolescents having an MVC was 7.4% and 11.2%, respectively. Analyses revealed that an MVC among adolescents aged 15 years and younger was independently associated with depression (OR = 2.17) and alcohol abuse (OR = 2.36) after adjusting for other risk factors, including a history of interpersonal violence. Among adolescents aged 16 years and older, an MVC was associated only with alcohol abuse (OR = 2.08). This study was the first attempt to explore adverse mental health outcomes associated with MVCs beyond traumatic stress symptoms among adolescents in a nationally representative sample.     

Coping Self‐Efficacy Moderates the Association Between Severity of Partner Violence and PTSD Symptoms Among Incarcerated Women

Previous research indicates self‐efficacy may function as a protective factor for survivors of partner violence (PV), including coping self‐efficacy specific to domestic violence. We hypothesized that domestic violence coping self‐efficacy would moderate the association between recent PV and posttraumatic stress disorder (PTSD) symptoms in a sample of incarcerated women, such that the association between PV and PTSD would be strongest at low levels of domestic violence coping self‐efficacy. Participants (N = 102) were incarcerated women who reported PV in the year prior to incarceration. They were aged 19–55 years (M = 33.57, SD = 9.32), identified predominantly as European American (84.3%), American Indian (15.7%), and Hispanic (14.7%), with 80.4% completing high school or more in terms of education. Participants responded to self‐report measures of PV, trauma history, domestic violence coping self‐efficacy, and current PTSD symptoms. In a series of sequential regression analyses, PV (β = .65, sr² = .06, p = .017) was significantly associated with current PTSD symptoms above and beyond past trauma history (β = .37, sr² = .14, p < .001), and this association was moderated by domestic violence coping self‐efficacy (Domestic Violence Coping Self‐Efficacy × Partner Violence; β = ?.54, sr² = .03, p = .044). The relationship between PV and PTSD symptoms was greatest at low and average levels of domestic violence coping self‐efficacy and nonsignificant at high levels of domestic violence coping self‐efficacy. These findings highlight the importance of assessing domestic violence coping self‐efficacy in incarcerated women with recent PV, given that domestic violence coping self‐efficacy appeared to be protective against symptoms of PTSD.     

Posttraumatic stress disorder symptoms among low-income, African American women with a history of intimate partner violence and suicidal behaviors: self-esteem, social support, and religious coping

There is a dearth of research on risk/protective factors for posttraumatic stress disorder (PTSD) among low-income African American women with a history of intimate partner violence (IPV), presenting for suicidal behavior or routine medical care in a large, urban hospital. We examined self-esteem, social support, and religious coping as mediators between experiences of child maltreatment (CM) and IPV and symptoms of PTSD in a sample (N = 134) of low-income African American women. Instruments used included the Index of Spouse Abuse, the Childhood Trauma Questionnaire, the Taylor Self-Esteem Inventory, the Multidimensional Profile of Social Support, the Brief Religious Coping Activities Scale, and the Davidson Trauma Scale. Both CM and IPV related positively to PTSD symptoms. Risk and resilience individual difference factors accounted for 18% of the variance in PTSD symptoms over and above IPV and CM, with self-esteem and negative religious coping making unique contributions. Both variables mediated the abuse-PTSD symptom link. In addition, we tested an alternate model in which PTSD symptoms mediated the relationship between abuse and both self-esteem and negative religious coping.     

Ethnoracial variations in acute PTSD symptoms among hospitalized survivors of traumatic injury

Ethnoracial minority status contributes to an increased risk for posttraumatic stress disorder (PTSD) after trauma exposure, beyond other risk factors. A population‐based sampling frame was used to examine the associations between ethnoracial groups and early PTSD symptoms while adjusting for relevant clinical and demographic characteristics. Acutely injured trauma center inpatients (N = 623) were screened with the PTSD Checklist. American Indian and African American patients reported the highest levels of posttraumatic stress and preinjury cumulative trauma burden. African American heritage was independently associated with an increased risk of higher acute PTSD symptom levels. Disparities in trauma history, PTSD symptoms, and event related factors emphasize the need for acute care services to incorporate culturally competent approaches for treating these diverse populations.     

Patterns of Multiple Victimization Among Maltreated Children in Navy Families

The current study examined the cumulative risk associated with children's exposure to multiple types of parent‐inflicted victimization. The sample was comprised of 195 children who were 7 to 17 years old (64.1% female and 48.2% non‐White) at the time of referral to the United States Navy's Family Advocacy Program due to allegations of sexual abuse, physical abuse, or parental intimate partner violence. We conducted an exploratory latent class analysis to identify distinct subgroups of children based on lifetime victimization. We hypothesized that at least 2 classes or subgroups would be identified, with 1 characterized by greater victimization and poorer outcomes. Results indicated that 3 classes of children best fit the data: (a) high victimization across all 3 categories, (b) high rates of physical abuse and witnessing intimate partner violence, and (c) high rates of physical abuse only. Findings indicated that the high victimization class was at greatest risk for alcohol and substance use, delinquent behavior, and meeting criteria for posttraumatic stress disorder (PTSD) and/or depression 1 year later (odds ratio = 4.53). These findings highlight the serious mental health needs of a small but significantly high‐risk portion of multiply victimized children entering the child welfare system.     

Domestic violence in patients visiting general practitioners--prevalence, phenomenology, and association with psychopathology.

BACKGROUND: It has been suggested that domestic violence is not only highly prevalent and associated with significant morbidity, but that it is also overlooked by medical practitioners. Despite this, few studies have focused on domestic violence in the South African setting, so that there is a paucity of data here on its prevalence, phenomenology, and associated psychopathology. METHODS: Sixteen general practitioners from the South African Sentinel Practitioner Research Network (SASPREN) screened all their female patients aged 18 years or older for a 3-month period (N = 1,050). A sociodemographic questionnaire was completed, and symptoms of post-traumatic stress disorder (PTSD) and major depression were assessed, both in subjects with a history of domestic violence and in a control group without such a history. RESULTS: 21.5% of patients reported a history of domestic violence at screening. Patients and controls did not differ significantly in terms of age or race. However, patients with a history of domestic violence were significantly more likely to be married, not to have begun a high-school education, and to be working outside the home. Both PTSD and major depression were significantly more common in patients with a history of domestic violence (35.3% and 48.2%, respectively) than in controls (2.6% and 11.4%, respectively). Compared with other patients reporting domestic violence, those with either PTSD or major depression were subjected to more violence and were more likely to report a suicide attempt. CONCLUSION: In a large, diverse population of adult female patients presenting to a range of general practitioners in South Africa, there was a high prevalence of reported domestic violence. A significant association was found between domestic violence and both PTSD and major depression, with these diagnoses indicative of increased severity of abuse and increased morbidity. Routine screening by medical practitioners of all female patients for a history of domestic violence seems warranted, and patients with a history of domestic violence should be assessed for PTSD and depression.     

A Test of Adolescent Internalizing and Externalizing Symptoms as Prospective Predictors of Type of Trauma Exposure and Posttraumatic Stress Disorder

The present study utilized longitudinal data from a high‐risk community sample (N = 377; 166 trauma‐exposed; 202 males; 175 females; 73% non‐Hispanic Caucasian) to test pretrauma measures of adolescent internalizing and externalizing symptoms as unique prospective predictors of type of trauma exposure and PTSD over and above the influence of correlated family adversity (a composite of family conflict, stress, and parental psychopathology). Data were analyzed with logistic and multinomial logistic regressions. Results indicated that females, but not males, with higher levels of internalizing (OR = 2.91) and externalizing (OR = 2.37) symptoms during adolescence were significantly more likely to be exposed to assaultive violence (over and above family adversity). In fact, males with higher levels of internalizing symptoms were significantly less likely to be exposed to assaultive violence (OR = 0.54). Neither internalizing nor externalizing symptoms uniquely predicted exposure to traumatic events that did not involve assaultive violence. Among trauma‐exposed participants, the unique association between internalizing symptoms and later PTSD yielded an odds ratio of 1.79 (p = .07) over and above the influences of family adversity, type of trauma exposure, and gender. Assaultive violence exposure fully mediated the association between females’ externalizing symptoms and future PTSD. Findings may help inform the prevention of both assaultive violence exposure and PTSD.     

PTSD Symptomatology and Hazardous Drinking as Risk Factors for Sexual Assault Revictimization: Examination in European American and African American Women

A sexual victimization history is a risk factor for experiencing further sexual victimization. Posttraumatic stress disorder (PTSD) symptoms have been posited as predictors of revictimization through multiple pathways, including through their association with risk recognition and alcohol use. There is, however, limited longitudinal research examining these revictimization risk factors, including the extent to which they predict risk for forcible rape (rape involving threat or force) and incapacitated rape (rape of a victim incapacitated by substances). Additionally, there is no research evaluating ethnic differences in revictimization risk pathways. The current study examined PTSD symptoms and hazardous drinking as predictors of new forcible and incapacitated rape over 1 year in a community sample of European American (n = 217) and African American (n = 272) sexual assault victims (M = 34 years; 84% high school education or above). We hypothesized that PTSD symptoms would predict both types of revictimization and hazardous drinking would predict incapacitated rape. Results supported that PTSD symptoms predicted both types of rape (forcible rape, β = .34; incapacitated rape, β = .20), and hazardous drinking predicted incapacitated rape (β = .24). PTSD symptoms predicted hazardous drinking in African American women only (β = .20). Thus, there is a need to evaluate risk pathways for specific types of victimization among diverse samples.     

Public Mental Health Clients with Severe Mental Illness and Probable Posttraumatic Stress Disorder: Trauma Exposure and Correlates of Symptom Severity

Individuals with severe mental illness (SMI) are at greatly increased risk for trauma exposure and for the development of posttraumatic stress disorder (PTSD). This study reports findings from a large, comprehensive screening of trauma and PTSD symptoms among public mental health clients in a statewide community mental health system. In 851 individuals with SMI and probable PTSD, childhood sexual abuse was the most commonly endorsed index trauma, followed closely by the sudden death of a loved one. Participants had typically experienced an average of 7 types of traumatic events in their lifetime. The number of types of traumatic events experienced and Hispanic ethnicity were significantly associated with PTSD symptom severity. Clients reported experiencing PTSD in relation to events that occurred on average 20 years earlier, suggesting the clinical need to address trauma and loss throughout the lifespan, including their prolonged after‐effects.     

Pervasive exposure to violence and posttraumatic stress disorder in a predominantly African American Urban Community: the Detroit Neighborhood Health Study

Exposure to traumatic events is common, particularly among economically disadvantaged, urban African Americans. There is, however, scant data on the psychological consequences of exposure to traumatic events in this group. We assessed experience with traumatic events and posttraumatic stress disorder (PTSD) among 1,306 randomly selected, African American residents of Detroit. Lifetime prevalence of exposure to at least 1 traumatic event was 87.2% (assault = 51.0%). African Americans from Detroit have a relatively high burden of PTSD; 17.1% of those who experienced a traumatic event met criteria for probable lifetime PTSD. Assaultive violence is pervasive and is more likely to be associated with subsequent PTSD than other types of events. Further efforts to prevent violence and increase access to mental health treatment could reduce the mental health burden in economically disadvantaged urban areas.     

Posttraumatic Stress Disorder Among Incarcerated Battered Women: A Comparison of Battered Women Who Killed Their Abusers and Those Incarcerated for Other Offenses

The present study examined differences in the amount and severity of spousal violence and posttraumatic stress symptoms between incarcerated battered women who killed/seriously assaulted their abusers and battered women incarcerated for other offenses. Additionally, several risk and buffering variables suggested by trauma research were tested to determine their ability to predict present posttraumatic stress disorder (PTSD) symptomatology. Findings revealed that battered women who killed/seriously assaulted their batterers experienced more frequent and severe spousal abuse than those in the comparison group. No significant group differences were found for present PTSD symptom levels. Predictors of present PTSD symptomatology included: childhood sexual abuse, childhood physical abuse, past PTSD symptomatology, length of time elapsed since living with partner and receiving counseling in prison. The implications of the findings are discussed.     

Examining posttraumatic stress symptoms in a national sample of homicide survivors: prevalence and comparison to other violence victims

The present study examined posttraumatic stress disorder (PTSD) symptoms among friends and family members of homicide victims (homicide survivors). Out of a national sample of 1,753 young adults who completed follow-up interviews after participating in the National Survey of Adolescents, 268 homicide survivors and 653 victims of other interpersonal violence were selected for the study. Participants completed structured telephone interviews that covered the loss of a family member or close friend to homicide, violence exposure, and PTSD symptomatology. Findings indicated that 39% of homicide survivors met criteria for all 3 symptom clusters and 30% of homicide survivors met criteria for 2 PTSD clusters (functional impairment was not assessed). Multivariate logistic regression analyses demonstrated that homicide survivors were more likely than victims of other violence to meet criteria for all 3 PTSD symptom clusters (OR = 1.91, p < .05) and 2 symptom clusters (OR = 1.77, p < .05) when demographic characteristics and number of violent events were included in the model. These findings highlight the high prevalence of subthreshold PTSD symptoms among homicide survivors. Results suggest that homicide survivors are at elevated risk for PTSD symptoms in comparison to victims of other interpersonal violence.     

Trauma and Posttraumatic Stress Disorder Among Transition‐Age Youth With Serious Mental Health Conditions

There is little information on trauma, posttraumatic stress disorder (PTSD), and associated risk factors in transition‐age youth with mental health conditions. This study aimed at understanding the correlates and predictors of PTSD in 84 transition‐age youth, between 16 and 21 years old, residing in supported community housing. Chi‐square analyses and t tests were used to compare youth with a diagnosis of PTSD to those without a PTSD diagnosis. Stepwise logistic regression analyses were performed to identify unique predictors of PTSD. Of the 84 individuals, 79 (94%) reported a history of trauma, of whom 30 (36%) had PTSD. Sexual abuse was significantly associated with a PTSD diagnosis (r = .47) and the only unique predictor of PTSD (Cox r² = .20). Transition‐age youth in supported community housing had higher rates of trauma exposure and PTSD than the general adolescent population, suggesting the need for routine assessment and treatment of PTSD in this population.     

Predictors of rape: findings from the National Survey of Adolescents

The current report examines data for 872 female adolescents obtained during the initial and follow-up interviews of the National Survey of Adolescents, a nationally representative sample. Lifetime prevalence of violence exposure reported was 12% and 13% for sexual assault, 19% and 10% for physical assault/punishment, and 33% and 26% for witnessing violence at Waves I and II, respectively. Racial/ethnic status, posttraumatic stress disorder (PTSD), childhood sexual abuse (CSA), and family drug problems emerged as significant predictors of new rape. Each of the PTSD symptom clusters significantly predicted new rape and analyses supported the mediational role of PTSD between CSA and new rape. African American or other racial identity was associated with lower risk.     

A Prospective Study on the Association Between Caregiver Psychological Symptomatology and Symptom Clusters of Pediatric Posttraumatic Stress Disorder

This study investigated the influence of caregiver psychological symptoms on posttraumatic stress disorder (PTSD) symptoms in traumatized children. One‐hundred eleven children and caretakers were assessed in this study. Children (N = 59) with a history of exposure to interpersonal violence were evaluated for reexperiencing, avoidance/numbing, and hyperarousal symptom clusters using the Clinician‐Administered PTSD Scale for Children and Adolescents (CAPS‐CA). The 52 primary caregivers were evaluated using the Symptom Checklist‐90‐Revised (SCL‐90‐R) on 9 domains of psychological symptomatology: anxiety, depression, hostility, interpersonal sensitivity, obsessive–compulsive disorder, paranoid ideation, phobic anxiety, psychoticism, and somatization. At 14‐month follow‐up, 45 of the children were re‐evaluated with the CAPS‐CA. Caregiver psychological symptoms in the domains of anxiety, depression, interpersonal sensitivity, obsessive–compulsive disorder, and paranoid ideation were associated with less improvement in total pediatric PTSD symptoms. Analysis of PTSD symptoms by cluster showed that greater caregiver symptomatology in the domains of anxiety, depression, interpersonal sensitivity, and obsessive–compulsive disorder were associated with less improvement in the hyperarousal symptom cluster. These results suggest caregiver symptomatology may be specifically associated with hyperarousal symptoms in pediatric trauma.     

High‐risk behaviors and drinking‐to‐cope as mediators of lifetime abuse and PTSD symptoms in clients with severe mental illness

Face‐to‐face interviews with 276 community mental health clients (56.2% women; 42.8% men) diagnosed with schizophrenia spectrum disorders (44.6%) and major mood disorders (55.4%) were used to examine mediating relationships among physical and sexual abuse, high‐risk behaviors, drink‐to‐cope motives, and posttraumatic stress disorder (PTSD) symptom severity. Structural equation modeling revealed that both high‐risk behaviors and drinking‐to‐cope significantly mediated the relationship between lifetime abuse and PTSD symptom severity with an excellent fit of model to data. Alternative models using PTSD symptom level as mediator were also tested, but did not meet optimal goodness‐of‐fit standards. Implications of findings call for vigilant screening for trauma, substance abuse, and high risk behaviors in clients with severe mental illnesses to inform treatment, and the need for longitudinal studies to test causal pathways.     

Killing versus witnessing in combat trauma and reports of PTSD symptoms and domestic violence

Active participation in combat trauma increased reports of posttraumatic stress disorder (PTSD) symptoms over passive witnessing of trauma. Using archival data from 376 U.S. soldiers who took part in the family interview component of the 1988 National Vietnam Veteran Readjustment Study (NVVRS), findings are that even after statistically accounting for witnessing combat trauma, U.S. soldiers who likely killed enemy soldiers in combat reported elevated levels of PTSD symptoms. Both inference and direct self-reports were used to measure killing in combat, and both measures accounted equally well for variance in PTSD symptoms. The likelihood of a soldier killing enemy combatants was also weakly related to his spouse's report of physical domestic violence in the past year. Diagnosing the mental health symptoms of combat soldiers should specifically assess whether they actively participated in wounding or killing the enemy.     

The Cycle of Violence: Associations Between Exposure to Violence,Trauma‐Related Symptoms and Aggression—Findings from Congolese Refugees in Uganda

War‐related trauma exposure has been linked to aggression and enhanced levels of community and family violence, suggesting a cycle of violence. Reactive aggression—an aggressive reaction to a perceived threat—has been associated with posttraumatic stress disorder (PTSD). In contrast, appetitive aggression—a hedonic, intrinsically motivated form of aggression—seems to be negatively related to PTSD in offender and military populations. This study examined the associations between exposure to violence, trauma‐related symptoms and aggression in a civilian population. In semistructured interviews, 290 Congolese refugees were questioned about trauma exposure, PTSD symptoms, and aggression. War‐related trauma exposure correlated positively with exposure to family and community violence in the past month (r = .31, p < .001), and appetitive (r = .18, p = .002) and reactive aggression (r = .29, p < .001). The relationship between war‐related trauma exposure and reactive aggressive behavior was mediated by PTSD symptoms and appetitive aggression. In a multiple sequential regression analysis, trauma exposure (β = .43, p < .001) and reactive aggression (β = .36, p < .001) were positively associated with PTSD symptoms, whereas appetitive aggression was negatively associated (β = ?.13, p = .007) with PTSD symptoms. Our findings were congruent with the cycle of violence hypothesis and indicate a differential relation between distinct subtypes of aggression and PTSD.     

PTSD symptoms and partner abuse: low income women at risk

Aspects of partner abuse (types, severity, chronicity, treatment of injury, fear, etc.) were addressed with low income community women, half of whom scored above the cutoff on the Crime Related PTSD scale. Using this cutoff, 47% of women who sustained moderate violence were high in CR-PTSD symptoms. If their partner also raped them, the rate (63%) was similar to women who sustained severe violence (65%) or severe violence and rape (71%). No ethnic differences were found for rates or severity of CR-PTSD symptoms. A MANCOVA by ethnicity (African Americans, Euro-Americans, Mexican Americans) and CR-PTSD symptoms (low vs. high) identified ethnic differences only on total sexual aggression and recent threats of violence. The high symptom group reported more abuse on all measures. Results from the CR-PTSD and the general lack of ethnic differences support the notion that SES contributes more to women's vulnerability to abuse and stress symptoms than does ethnicity.