PTSD in Trauma-Exposed Adolescents: The Role of Interpersonal Problems and Trauma Type

Childhood trauma is associated with an array of negative outcomes throughout the lifespan, including Post-Traumatic Stress Disorder (PTSD). Youth have varying rates of PTSD after being exposed to a trauma, but the reason is unknown. Further, rates of PTSD vary based on trauma type (i.e. interpersonal and non-interpersonal traumas). While interpersonal problems have previously been associated with trauma, stress, anxiety, and depression, much less is known about if interpersonal problems play a role in the relationship between trauma and PTSD in adolescents. Given the uniqueness of adolescent relationships, and how adolescent behaviors can shape behaviors in adulthood, examining these associations could inform knowledge and future treatments for trauma-exposed adolescents. Associations between trauma, interpersonal problems, and PTSD symptom severity therefore were examined in a large, clinical sample of trauma-exposed adolescents with de-identified data from the National Child Traumatic Stress Network (NCTSN) Core Data Set. This secondary data analysis used path analyses to test a series of models that linked childhood trauma with PTSD symptom severity via interpersonal problems and that explored differences in these models by trauma type. Interpersonal problems were operationalized by examining parent-rated social problem behaviors and aggressive behaviors. Interpersonal problems partially mediated the relationship between childhood trauma and PTSD symptom severity via social problem behaviors (Aim 1). When interpersonal traumas and non-interpersonal traumas were examined in separate models, social problem behaviors fully mediated the relationship between interpersonal trauma and PTSD symptom severity; however, interpersonal problems did not mediate the association between non-interpersonal trauma and PTSD symptom severity (Aim 2). For the combined interpersonal and non-interpersonal trauma model, social problem behaviors partially mediated the relationship between interpersonal trauma and PTSD symptom severity. There were no direct or indirect associations between non-interpersonal trauma and PTSD symptom severity when the model accounted for the impact of the interpersonal trauma. These findings suggest that social problem behaviors, immature, dependent, and socially incompetent behaviors with peers and adults, are important in the association between trauma and PTSD symptom severity. Findings suggest that interpersonal traumas have a greater impact on social problem behaviors, and PTSD, than non-interpersonal traumas. In a scoping review that was conducted in addition to the statistical analyses, gaps in interventions focused on interpersonal problems for trauma-exposed adolescents were identified. Interventions that incorporate content on interpersonal problems could benefit adolescents who have experienced a trauma, specifically adolescents who experienced an interpersonal trauma.PhDNursingUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttps://deepblue.lib.umich.edu/bitstream/2027.42/151686/1/kabramos_1.pd