Trauma Exposure and Posttraumatic Stress Disorder in a National Sample of Adolescents


      Although exposure to potentially traumatic experiences (PTEs) is common among youths in the United States, information on posttraumatic stress disorder (PTSD) risk associated with PTEs is limited. We estimate lifetime prevalence of exposure to PTEs and PTSD, PTE-specific risk of PTSD, and associations of sociodemographics and temporally prior DSM-IV disorders with PTE exposure, PTSD given exposure, and PTSD recovery among U.S. adolescents.


      Data were drawn from 6,483 adolescent–parent pairs in the National Comorbidity Survey Replication Adolescent Supplement (NCS-A), a national survey of adolescents aged 13 through 17 years. Lifetime exposure to interpersonal violence, accidents/injuries, network/witnessing, and other PTEs was assessed along with DSM-IV PTSD and other distress, fear, behavior, and substance disorders.


      A majority (61.8%) of adolescents experienced a lifetime PTE. Lifetime prevalence of DSM-IV PTSD was 4.7% and was significantly higher among females (7.3%) than among males (2.2%). Exposure to PTEs, particularly interpersonal violence, was highest among adolescents not living with both biological parents and with pre-existing behavior disorders. Conditional probability of PTSD was highest for PTEs involving interpersonal violence. Predictors of PTSD among PTE-exposed adolescents included female gender, prior PTE exposure, and pre-existing fear and distress disorders. One-third (33.0%) of adolescents with lifetime PTSD continued to meet criteria within 30 days of interview. Poverty, U.S. nativity, bipolar disorder, and PTE exposure occurring after the focal trauma predicted nonrecovery.


      Interventions designed to prevent PTSD in PTE-exposed youths should be targeted at victims of interpersonal violence with pre-existing fear and distress disorders, whereas interventions designed to reduce PTSD chronicity should attempt to prevent secondary PTE exposure.

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        • Breslau N.
        • Kessler R.C.
        • Chilcoat H.D.
        • Schultz L.R.
        • Davis G.C.
        • Andreski P.
        Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma.
        Arch Gen Psychiatry. 1998; 55: 626-632
        • Finkelhor D.
        • Ormrod R.
        • Turner H.A.
        The developmental epidemiology of childhood victimization.
        J Interpers Violence. 2009; 24: 711-731
        • U.S. Census Bureau
        Licensed drivers and number in accidents by age: 2009.
        U.S. Census Bureau, Washington, DC2012
        • Turner H.A.
        • Finkelhor D.
        • Ormrod R.
        The effect of lifetime victimization on the mental health of children and adolescents.
        Soc Sci Med. 2006; 62: 13-27
        • Breslau N.
        • Wilcox H.C.
        • Storr C.L.
        • Lucia V.C.
        • Anthony J.C.
        Trauma exposure and posttraumatic stress disorder: a study of youths in urban America.
        J Urban Health Bull N Y Acad Med. 2004; 81: 530-544
        • Copeland W.E.
        • Keeler G.
        • Angold A.
        • Costello E.J.
        Traumatic events and posttraumatic stress in childhood.
        Arch Gen Psychiatry. 2007; 64: 577-584
        • Costello E.J.
        • Erkanli A.
        • Fairbank J.A.
        • Angold A.
        The prevalence of potentially traumatic events in childhood and adolescence.
        J Trauma Stress. 2002; 15: 99-112
        • Giaconia R.M.
        • Reinherz H.Z.
        • Silverman A.B.
        • Pakiz B.
        • Frost A.K.
        • Cohen E.
        Traumas and posttraumatic stress disorder in a community population of older adolescents.
        J Am Acad Child Adolesc Psychiatry. 1995; 34: 1369-1380
        • Cuffe S.P.
        • Addy C.L.
        • Garrison C.Z.
        • et al.
        Prevalence of PTSD in a community sample of older adolescents.
        J Am Acad Child Adolesc Psychiatry. 1998; 37: 147-154
        • Koenen K.C.
        • Moffit T.E.
        • Poulin R.
        • Martin J.
        • Caspi A.
        Early childhood factors associated with the development of post-traumatic stress disorder: results from a longitudinal birth cohort.
        Psychol Med. 2007; 37: 181-192
        • Storr C.L.
        • Ialongo N.
        • Anthony J.C.
        • Breslau N.
        Childhod antecedents of exposure to traumatic events and posttraumatic stress disorder.
        Am J Psychiatry. 2007; 164: 119-125
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        Fourth Edition (DSM-IV). American Psychiatric Association, Washington, DC1994
        • Kessler R.C.
        Posttraumatic stress disorder: the burden to the individual and to society.
        J Clin Psychiatry. 2000; 61: 4-12
        • Kubzansky L.D.
        • Koenen K.C.
        • Spiro III, A.
        • Vokonas P.S.
        • Sparrow D.
        Prospective study of post-traumatic stress disorder symptoms and coronary heart disease in the Normative Aging Study.
        Arch Gen Psychiatry. 2007; 64: 109-116
        • Garrison C.Z.
        • Bryant E.S.
        • Addy C.L.
        • Spurrier P.G.
        Posttraumatic stress disorder in adolescents after Hurricane Andrew.
        J Am Acad Child Adolesc Psychiatry. 1995; 34: 1193-1201
        • Pynoos R.S.
        • Frederick C.
        • Nader K.
        • et al.
        Life threat and posttraumatic stress in school-age children.
        Arch Gen Psychiatry. 1987; 44: 1057-1063
        • Khamis V.
        Post-traumatic stress disorder among school age Palestinian children.
        Child Abuse Negl. 2005; 29: 81-95
        • Kessler R.C.
        • Sonnega A.
        • Bromet E.
        • Hughes M.
        • Nelson C.B.
        Posttraumatic stress disorder in the National Comorbidity Survey.
        Arch Gen Psychiatry. 1995; 52: 1048-1060
        • Perkonigg A.
        • Pfister H.
        • Stein M.B.
        • et al.
        Longitudinal course of posttraumatic stress disorder and posttraumatic stress disorder symptoms in a community sample of adolescents and young adults.
        Am J Psychiatry. 2005; 162: 1320-1327
        • Kessler R.C.
        • Avenevoli S.
        • Costello E.J.
        • et al.
        Design and field procedures in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A).
        Int J Methods Psychiatr Res. 2009; 18: 69-83
        • Kessler R.C.
        • Avenevoli S.
        • Costello E.J.
        • et al.
        National comorbidity survey replication adolescent supplement (NCS-A): II. Overview and design.
        J Am Acad Child Adolesc Psychiatry. 2009; 48: 380-385
        • Kessler R.C.
        • Merikangas K.R.
        The National Comorbidity Survey Replication (NCS-R): background and aims.
        Int J Methods Psychiatr Res. 2004; 13: 60-68
        • Kessler R.C.
        • Üstun T.B.
        The World Mental Health (WHM) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI).
        Int J Methods Psychiatr Res. 2004; 13: 93-121
        • Kaufman J.
        • Birmaher B.
        • Brent D.
        • et al.
        Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version (K-SADS-PL): initial reliability and validity data.
        J Am Acad Child Adolesc Psychiatry. 1997; 36: 980-988
        • Kessler R.C.
        • Avenevoli S.
        • Green J.G.
        • et al.
        The National Comorbidity Survey Adolescent Supplement (NCS-A): III. Concordance of DSM-IV/CIDI diagnoses with clinical reassessments.
        J Am Acad Child Adolesc Psychiatry. 2009; 48: 386-399
        • Halli S.S.
        • Rao K.V.
        Advanced Techniques of Population Analysis.
        Plenum, New York, NY1992
        • Willett J.B.
        • Singer J.D.
        Investigating onset, cessation, relapse, and recovery: why you should, and how you can, use discrete-time survival analysis to examine event occurrence.
        J Consult Clin Psychol. 1993; 61: 952-965
        • Kessler R.C.
        • Avenevoli S.
        • McLaughlin K.A.
        • et al.
        Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A).
        Psychol Med. 2012; 42: 1997-2010
        • Kilpatrick D.G.
        • Ruggiero K.J.
        • Acierno R.
        • Saunders B.E.
        • Resnick H.S.
        • Best C.L.
        Violence and risk of PTSD, major depression, substance abuse/dependence, and comorbidity: results from the National Survey of Adolescents.
        J Consult Clin Psychol. 2003; 71: 692-700
        • Perkonigg A.
        • Kessler R.C.
        • Storz S.
        • Wittchen H.U.
        Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity.
        Acta Psychiatr Scand. 2000; 101: 46-59
        • Turner H.A.
        • Finkelhor D.
        • Ormrod R.
        Family structure variations in patterns and predictors of child victimization.
        Am J Orthopsychiatry. 2007; 77: 282-295
        • Lauritsen J.L.
        How families and communities influence youth victimization.
        Office of Juvenile Justice and Delinquency Prevention, Washington, DC2003
        • Kessler R.C.
        • McLeod J.D.
        Sex differences in vulnerability to undesirable life events.
        Am Sociol Rev. 1984; 49: 620-631
        • Burke J.D.
        • Loeber R.
        • Birmaher B.
        Oppositional defiant disorder and conduct disorder: a review of the past 10 years, part II.
        J Am Acad Child Adolesc Psychiatry. 2002; 41: 1275-1293
        • Schaeffer C.M.
        • Petras H.
        • Ialongo N.
        • Poduska J.
        • Kellam S.
        Modeling growth in boys' aggressive behavior across elementary school: links to later crime involvement, conduct disorder, and antisocial personality disorder.
        Dev Psychol. 2003; 39: 1020-1035
        • Ge X.
        • Conger R.D.
        • Cadoret R.J.
        • Neiderhiser J.M.
        • Yates W.
        • Troughton E.
        The developmental interface between nature and nurture: a mutual influence model of child antisocial behavior and parent behavior.
        Dev Psychol. 1996; 32: 574-589
        • Moffitt T.E.
        The new look of behavioral genetics in developmental psychopathology: gene-environment interplay in antisocial behaviors.
        Psychol Bull. 2005; 131: 533-554
        • Vasey M.W.
        • Daleiden E.L.
        • Williams L.L.
        • Brown L.M.
        Biased attention in childhood anxiety disorders: a preliminary study.
        J Abnorm Child Psychol. 1995; 23: 267-279
        • Smith S.M.
        • Smith D.B.
        • Penn C.E.
        • Ward D.B.
        • Tritt D.
        Intimate partner physical abuse perpetration and victimization risk factors: a meta-analytic review.
        Aggress Violent Behav. 2004; 10: 65-98
        • Roberts A.L.
        • Gilman S.E.
        • Breslau J.
        • Breslau N.
        • Koenen K.C.
        Race/ethnic differences in exposure to traumatic events, development of post-traumatic stress disorder, and treatment-seeking for post-traumatic stress disorder in the United States.
        Psychol Med. 2011; 41: 71-83
        • Brewin C.R.
        • Andrews B.
        • Valentine J.D.
        Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults.
        J Consult Clin Psychol. 2000; 68: 748-766
        • Ozer E.J.
        • Best S.R.
        • Lipsey T.L.
        • Weiss D.S.
        Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis.
        Psychol Bull. 2003; 129: 52-73
        • Breslau N.
        • Davis G.C.
        • Andreski P.
        • Peterson E.L.
        Sex differences in posttraumatic stress disorder.
        Arch Gen Psychiatry. 1997; 54: 1044-1048
        • Stroud L.R.
        • Papandonatos G.D.
        • Williamson D.
        • Dahl R.
        Sex differences in the effects of pubertal development on responses to corticotropinreleasing hormone challenge.
        Ann N Y Acad Sci. 2004; 1021: 348-351
        • Wang J.
        • Korczykowski M.
        • Rao H.
        • et al.
        Gender differences in neural response to psychological stress.
        Soc Cogn Affect Neurosci. 2007; 2: 227-239
        • Inslicht S.S.
        • Metzler T.J.
        • Garcia N.M.
        • et al.
        Sex differences in fear conditioning in posttraumatic stress disorder.
        J Psychiatr Res. 2013; 47: 64-71
        • Breslau N.
        • Chilcoat H.D.
        • Kessler R.C.
        • Davis G.C.
        Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma.
        Am J Psychiatry. 1999; 156: 902-907
        • Bromet E.
        • Sonnega A.
        • Kessler R.C.
        Risk factors for DSM-III-R posttraumatic stress disorder: findings from the National Comorbidity Survey.
        Am J Epidemiol. 1998; 147: 353-361
        • McLaughlin K.A.
        • Conron K.J.
        • Koenen K.C.
        • Gilman S.E.
        Childhood adversity, adult stressful life events, and risk of past-year psychiatric disorder: a test of the stress sensitization hypothesis in a population-based sample of adults.
        Psychol Med. 2010; 40: 1647-1658
        • McLaughlin K.A.
        • Kubzansky L.D.
        • Dunn E.C.
        • Waldinger R.
        • Vaillant G.
        • Koenen K.C.
        Childhood social environment, emotional reactivity to stress, and mood and anxiety disorders across the life course.
        Depress Anxiety. 2010; 27: 1087-1094
        • Breslau N.
        • Peterson E.L.
        • Schultz L.R.
        A second look at prior trauma and the posttraumatic stress disorder effects of subsequent trauma: a prospective epidemiological study.
        Arch Gen Psychiatry. 2008; 65: 431-437
        • Koenen K.C.
        • Moffit T.E.
        • Caspi A.
        • Gregory A.
        • Harrington H.
        • Poulton R.
        The developmental mental-disorder histories of adults with posttraumatic stress disorder: a prospective longitudinal birth cohort study.
        J Abnorm Psychol. 2008; 117: 460-466
        • Breslau N.
        • Davis C.G.
        Posttraumtic stress disorder in an urban population of young adults: risk factors for chronicity.
        Am J Psychiatry. 1992; 149: 671-675
        • Koenen K.C.
        • Stellman J.M.
        • Stellman S.D.
        • Sommer Jr., J.F.
        Risk factors for course of posttraumatic stress disorder in Vietnam veterans: a 14-year follow-up of American Legionnaires.
        J Consult Clin Psychol. 2003; 71: 980-986
        • Breslau J.
        • Aguilar-Gaxiola S.
        • Borges G.
        • Kendler K.S.
        • Su M.
        • Kessler R.C.
        Risk for psychiatric disorder among immigrants and their US-born descendants: evidence from the National Comorbidity Survey Replication.
        J Nerv Ment Dis. 2007; 195: 189-195
        • Vega W.A.
        • Kolody B.
        • Aguilar-Gaxiola S.
        • Alderete E.
        • Catalano R.
        • Caraveo-Anduaga J.
        Lifetime prevalence of DSM-III-R psychiatric disorders among urban and rural Mexican Americans in California.
        Arch Gen Psychiatry. 1998; 55: 771-778
        • Breslau N.
        • Peterson E.L.
        • Poisson L.M.
        • Schultz L.R.
        • Lucia V.C.
        Estimating post-traumatic stress disorder in the community: lifetime perspective and the impact of typical traumatic events.
        Psychol Med. 2004; 34: 889-898
        • Karam E.G.
        • Andrews G.
        • Bromet E.
        • et al.
        The role of criterion A2 in the DSM-IV diagnosis of post-traumatic stress disorder.
        Biol Psychiatry. 2010; 68: 465-473
        • Stein D.J.
        • Koenen K.C.
        • Friedman M.J.
        • et al.
        Dissociation in posttraumatic stress disorder: evidence from the World Mental Health Surveys.
        Biol Psychiatry. 2013; 73: 302-312
        • Dohrenwend B.P.
        • Turner J.B.
        • Turse N.A.
        • et al.
        The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods.
        Science. 2006; 313: 979-982
        • Foa E.B.
        • Hearst-Ikeda D.
        • Perry K.J.
        Evaluation of a brief cognitive-behavioral program for the prevention of chronic PTSD in recent assault victims.
        J Consult Clin Psychol. 1995; 63: 948-955
        • Berkowitz S.J.
        • Stover C.S.
        • Marans S.R.
        The Child and Family Traumatic Stress Intervention: secondary prevention for youth at risk of developing PTSD.
        J Child Psychol Psychiatry. 2011; 52: 676-685
        • Cohen J.A.
        • Deblinger E.
        • Mannarino A.P.
        • Steer R.A.
        A multisite, randomized controlled trial for children with sexual abuse-related PTSD symptoms.
        J Am Acad Child Adolesc Psychiatry. 2004; 43: 393-402