Soraya Seedat, Wendy Rossouw, Tessa Middleton, Sharain Suliman and Dan J Stein
Although there is a rich body of literature on trauma-related precipitating events (eg, school shootings, bombings, physical assault, or war) for PTSD and other psychopathology, in community-based studies the literature on trauma-exposed adolescents with and without PTSD in clinical contexts is somewhat limited. Several lines of evidence suggest that traumatized treatment-seeking adolescents have far higher prevalence rates of PTSD (ranging from 15% to more than 90%) than adolescents in general population samples.1 Clinic-referred adolescents are also two times more likely to report a trauma,2 are more likely to experience multiple traumatic events, and have a higher rate of PTSD.3 Depending on the index event, they may also be 25 times more likely to report symptoms of posttraumatic stress compared with adolescents in the community.2 While studies among adults suggest that approximately 25% of individuals exposed to trauma develop symptoms of PTSD,4
5 the situation differs somewhat in children and adolescents where many factors (eg, trauma severity, time lapsed since the trauma, and definition of outcome) may produce greater variability in estimates.6 Based on a review of 260 studies, the authors concluded that youth were more likely than adults to experience impairment following disasters.7
Partial posttraumatic stress disorder (PTSD), like the full syndrome is associated with significant distress and impairment in adults. As few studies have focused on the assessment and functional impact of full and partial PTSD in trauma-exposed, treatment-seeking adolescents in clinic settings, we undertook this, as well as to examine the prevalence and phenomenology of PTSD, and gender differences in adolescents who were exposed to at least one PTSD-qualifying event.
One hundred and seventy adolescents with a mean age of 13.8 (±2.9) years completed an assessment battery comprising a clinician-administered diagnostic interview and several self-report measures.
The most common index traumas were witnessing serious domestic violence (48.2%) and sexual abuse (45.9%). Forty-seven percent of subjects met criteria for full PTSD and 19% met partial symptom criteria. No significant differences were observed in adolescents with full or partial PTSD with respect to symptom persistence or impairment in school, family, or social functioning. Those with full PTSD were, however, significantly more likely to meet criteria for depression (p<.05). Although no gender differences were observed in trauma exposure and PTSD (full and partial) rates, girls did suffer significantly more severe childhood abuse (p<.01) and negative life events (p<.05). They were also likely to experience significantly more interference in social (p<.05) and family (p<.05) functioning from PTSD symptoms and to meet criteria for depression (p<.05).
These data support the utility of assessing for partial PTSD in traumatized adolescents who, despite exhibiting fewer PTSD symptoms, may experience significant impairment and distress. Furthermore, gender-related differences in PTSD may well manifest in greater functional impairment and associated morbidity in girls.
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