Abstract
Abundant evidence demonstrates that traumatized adolescents are at increased risk of a host of negative psychoeducational and functional outcomes, but demographic disparities are often seen in access to and use of mental health services and supports. In light of this, the current study examines the prevalence of trauma experiences and traumatic stress in middle school students from a large urban school district serving a high proportion of diverse immigrant and low-income families. Descriptive statistics document the mean reported number of trauma experiences and posttraumatic stress subscale scores by participants’ sociodemographic variables. Inferential statistics report significant differences associated with race/ethnicity, gender, and type of trauma—including exposure as a victim or a witness. Results show complex and significant racial/ethnic group differences in the experience and symptomatology of trauma among the entire screened sample as well as the subset of youth with elevated distress. Furthermore, findings document the predictive value of particular trauma events related to early adolescents’ severity of self-reported traumatic stress. These in-depth findings underscore the need for routine, school-based screening to identify and bring culturally competent, trauma-informed support and interventions to middle school students experiencing traumatic stress.
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References
Achenbach, T. M. (1991a). Child Behavior Checklist (CBCL). Burlington, VT: Department of Psychiatry, University of Vermont.
Achenbach, T. M. (1991b). Youth Self Report (YSR). Burlington, VT: Department of Psychiatry, University of Vermont.
Adelman, H. S., & Taylor, L. (2012). Addressing trauma and other barriers to learning and teaching: Developing a comprehensive system of intervention. In E. Rossen & R. Hull (Eds.), Supporting and educating traumatized students: A guide for school-based professionals (pp. 265–286). New York: Oxford University Press.
Alisic, E., Jongmans, M. J., van Wesel, F., & Kleber, R. J. (2011). Building child trauma theory from longitudinal studies: A meta-analysis. Clinical Psychology Review, 31, 736–747.
Alisic, E., Zalta, A. K., Van Wesel, F., Larsen, S. E., Hafstad, G. S., Hassanpour, K., & Smid, G. E. (2014). Rates of post-traumatic stress disorder in trauma-exposed children and adolescents: Meta-analysis. British Journal of Psychiatry, 204, 335–340.
American Academy of Child and Adolescent Psychiatry. (1998). Practice parameters for the assessment and treatment of children and adolescents with posttraumatic stress disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 284–299.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.
Angold, A., Costello, E. J., Farmer, E. M. Z., Burns, B. J., & Erkanli, A. (1999). Impaired but undiagnosed. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 129–137.
Angold, A., Erkanli, A., Farmer, E. M. Z., Fairbank, J. A., Burns, B., Keeler, G., et al. (2002). Psychiatric disorder, impairment, and service use in rural African American and white youth. Archives of General Psychiatry, 59, 893–901.
Beers, S. R., & De Bellis, M. D. (2002). Neuropsychological function in children with maltreatment-related posttraumatic stress disorder. American Journal of Psychiatry, 159, 483–486.
Breslau, N., Wilcox, H. C., Storr, C. L., Lucia, V. C., & Anthony, J. C. (2004). Trauma exposure and posttraumatic stress disorder: A study of youths in urban America. Journal of Urban Health, 81, 530–544.
Briere, J. (1996). Trauma Symptom Checklist for Children (TSCC). Odessa, FL: Psychological Assessment Resources.
Brosky, B. A., & Lally, S. J. (2004). Prevalence of trauma, PTSD, and dissociation in court-referred adolescents. Journal of Interpersonal Violence, 19, 801–814.
Broussard, C. A. (2003). Facilitating home-school partnerships for multiethnic families: School social workers collaborating for success. Children and Schools, 25, 211–222.
Bunker, S. J., Colquhoun, D. M., & Esler, M. D. (2003). “Stress” and coronary heart disease: Psychosocial risk factors. Medical Journal of Australia, 178, 272–276.
Carlson, E. B., Furby, L., Armstrong, J., & Shales, J. (1997). A conceptual framework for the long-term psychological effects of traumatic childhood abuse. Child Maltreatment, 2, 272–295.
Cavaiola, A., & Schiff, M. (1988). Behavioral sequelae of physical and/or sexual abuse in adolescents. Child Abuse and Neglect, 12, 181–188.
Cole, S. F., O’Brien, J. G., Gadd, M. G., Ristuccia, J., Wallace, D. L., & Gregory, M. (2005). Helping traumatized children learn: Supportive school environments for children traumatized by family violence. Boston: Massachusetts Advocates for Children, Trauma and Learning Policy Initiative.
Collins, J. J., & Bailey, S. L. (1990). Traumatic stress disorder and violent behavior. Journal of Traumatic Stress, 3, 203–220.
Copeland, W. E., Keeler, G., Angold, A., & Costello, E. J. (2007). Traumatic events and post-traumatic stress in childhood. Archives of General Psychiatry, 64, 577–584.
Copeland, W., Shanahan, L., Costello, E. J., & Angold, A. (2011). Cumulative prevalence of psychiatric disorders by young adulthood: A prospective cohort analysis from the Great Smoky Mountains Study. Journal of the American Academy of Child and Adolescent Psychiatry, 50, 252–261.
Copeland, W. E., Wolke, D., Shanahan, L., & Costello, E. J. (2015). Adult functional outcomes of common childhood psychiatric problems: A prospective, longitudinal study. JAMA Psychiatry,. doi:10.1001/jamapsychiatry.2015.0730.
Costello, E. J., Angold, A., & Keeler, G. P. (1999). Adolescent outcomes of childhood disorders: The consequences of severity and impairment. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 121–128.
Costello, E. J., & Shugart, M. A. (1992). Above and below the threshold: Severity of psychiatric symptoms and functional impairment in a pediatric sample. Pediatrics, 90, 359–368.
Cox, C. M., Kenardy, J. A., & Hendrikz, J. K. (2008). A meta-analysis of risk factors that predict psychopathology following accidental trauma. Journal of Specialists in Pediatric Nursing, 13, 98–110.
Cuevas, C. A., Finkelhor, D., Clifford, C., Ormrod, R. K., & Turner, H. A. (2010). Psychological distress as a risk factor for re-victimization in children. Child Abuse and Neglect, 34, 235–243.
Cyr, K., Chamberland, C., Clement, M., Lessard, G., Wemmers, J., Collin-Vezina, D., et al. (2013). Polyvictimization and victimization of children and youth: Results from a populational survey. Child Abuse and Neglect, 37, 814–820.
Delaney-Black, V., Covington, C., Ondersma, S., Nordstrom-Klee, B., Templin, T., Ager, J., et al. (2002). Violence exposure, trauma, and IQ and/or reading deficits among urban children. Archives of Pediatrics and Adolescent Medicine, 156, 280–285.
Dudley, R. G. (2015, July). Childhood trauma and its effects: Implications for police. Harvard Executive Session on Policing and Public Safety 2008–2014: New perspectives in policing. Retrieved from http://www.hks.harvard.edu/programs/criminaljustice/research-publications/executive-sessions/executive-session-on-policing-and-public-safety-2008-2014/publications.
Edwards, V. J., Holden, G. W., Anda, R. F., & Felitti, V. J. (2003). Experiencing multiple forms of childhood maltreatment and adult mental health: Results from the Adverse Childhood Experiences (ACE) Study. American Journal of Psychiatry, 160, 1453–1460.
Elklit, A. (2002). Victimization and PTSD in a Danish national youth probability sample. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 174–181.
Erskine, H., Moffit, T. E., Copeland, W. E., Costello, E. J., Ferrari, A. J., Patton, G. C., et al. (2015). A heavy burden on young minds: The global burden of mental and substance use disorders in children and youth. Psychological Medicine, 45, 1551–1563.
Famularo, R., Fenton, T., Kinscherff, R., & Augustyn, M. (1996). Psychiatric comorbidity in childhood post traumatic stress disorder. Child Abuse and Neglect, 20, 953–956.
Farrell, A., & Bruce, S. (1997). Impact of exposure to community violence on violent behavior and emotional distress among urban adolescents. Journal of Clinical Child Psychology, 26, 2–14.
Finkelhor, D., Ormrod, R. K., & Turner, H. A. (2007). Revictimization patterns in a national longitudinal sample of children and youth. Child Abuse and Neglect, 31, 479–502.
Finkelhor, D., Turner, H. A., Ormrod, R. K., & Hamby, S. L. (2009). Violence, abuse, and crime exposure in a national sample of children and youth. Pediatrics, 124, 1–14.
Finkelhor, D., Turner, H. A., Shattuck, A., & Hamby, S. L. (2013). Violence, crime, and abuse exposure in a national sample of children and youth: An update. JAMA Pediatrics, 167, 614–621.
Flannery, D. J., Wester, K. L., & Singer, M. I. (2004). Impact of exposure to violence in school on child and adolescent mental health and behavior. Journal of Community Psychology, 32, 559–573.
Forbes, D., Fletcher, S., Parslow, R., Phelps, A., O’Donnell, M., Bryant, R., et al. (2012). Trauma at the hands of another: Longitudinal study of differences in the posttraumatic stress disorder symptom profile following interpersonal compared with noninterpersonal trauma. Journal of Clinical Psychiatry, 73, 372–376.
Galea, S., Ahern, J., Resnick, H., Kilpatrick, D., Bucuvalas, M., Gold, J., et al. (2002). Psychological sequelae of the September 11 terrorist attacks in New York City. New England Journal of Medicine, 346, 982–987.
Garbarino, J., Dubrow, N., Kostelny, K., & Pardo, C. (1992). Children in danger: Coping with the consequences of community violence. San Francisco: Jossey-Bass.
Goenjian, A. K., Stilwell, B. M., Steinberg, A. M., Fairbanks, L. A., Galvin, M., Karayan, I., et al. (1999). Moral development and psychopathological interference with conscience functioning among adolescents after trauma. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 376–384.
Goenjian, A. K., Walling, D., Steinberg, A. M., Karayan, I., Najarian, L. M., & Pynoos, R. (2005). A prospective study of posttraumatic stress and depressive reactions among treated and untreated adolescents 5 years after a catastrophic disaster. American Journal of Psychiatry, 162, 2302–2308.
Goslin, M. C., Stover, C. S., Berkowitz, S., & Marana, S. (2013). Identifying youth at risk for difficulties following a traumatic event: Pre-event factors are associated with acute symptomatology. Journal of Traumatic Stress, 26, 475–482.
Harhay, M. O., & King, C. H. (2012). Global burden of disease in young people aged 10–24 years. Lancet, 379, 27–28.
Harvey, M. R. (1996). An ecological view of psychological trauma and trauma recovery. Journal of Traumatic Stress, 9, 3–23.
Hatch, S. L., & Dohrenwend, B. P. (2007). Distribution of traumatic and other stressful life events by race/ethnicity, gender, SES and age: A review of the research. American Journal of Community Psychology, 40, 313–332.
Herman, J. (1997). Trauma and recovery. New York, NY: Basic Books.
Hurt, H., Malmud, E., Brodsky, N. L., & Giannetta, J. (2001). Exposure to violence: Psychological and academic correlates in child witnesses. Archives of Pediatric and Adolescent Medicine, 155, 1351–1356.
Ippen, C. G., Ford, J., Racusin, R., Acker, M., Bosquet, M., Rogers, K., et al. (2002). Traumatic Events Screening Inventory—Children. Retrieved at http://www.ptsd.va.gov/professional/pages/assessments/assessment-pdf/TESI-C.pdf/.
Jaycox, L. H., Stein, B. D., Kataoka, S. H., Wong, M., Fink, A., Escudero, P., et al. (2002). Violence exposure, posttraumatic stress disorder, and depressive symptoms among recent immigrant schoolchildren. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1104–1110.
Kataoka, S., Zhang, L., & Wells, K. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159, 1548–1555.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.
Kibler, J. L., Joshi, K., & Ma, M. (2009). Hypertension in relation to posttraumatic stress disorder and depression in the U.S. National Comorbidity Survey. Behavioral Medicine, 34, 125–132.
Kilpatrick, D., Aciermo, R., Saunders, B., Resnick, H., & Best, C. (2000). Risk factors for adolescent substance abuse and dependence: Data from a national sample. Journal of Consulting and Clinical Psychology, 65, 1–12.
Kilpatrick, D. G., Saunders, B. E., & Smith, D. W. (2003). Research in brief: Youth victimization: Prevalence and implications (NCJ 194972). Washington, DC: U.S. Department of Justice, Office of Justice Programs.
Kim-Cohen, J., Caspi, A., Moffitt, T. E., Harrington, H., Milne, B. J., & Poulton, R. (2003). Prior juvenile diagnoses in adults with mental disorder: Developmental follow-back of a prospective-longitudinal cohort. Archives of General Psychiatry, 60, 709–717.
Kitzmann, K. M., Gaylord, N. K., Holt, A. R., & Kenny, E. D. (2003). Child witnesses to domestic violence: A meta-analytic review. Journal of Consulting and Clinical Psychology, 71, 339–352.
Kotler, M., Iancu, I., Efroni, R., & Amir, M. (2001). Anger, impulsivity, social support, and suicide risk in patients with posttraumatic stress disorder. Journal of Nervous and Mental Disease, 189, 162–167.
Lanktree, C. B., & Briere, J. (1995). Outcome of therapy for sexually abused children: A repeated measures study. Child Abuse and Neglect, 19, 1145–1155.
Layne, C. M., Pynoos, R. S., & Cardenas, J. (2001). Wounded adolescence: School-based group psychotherapy for adolescents who sustained or witnessed violent injury. In M. Shafii & S. Shafii (Eds.), School violence: Contributing factors, management, and prevention (pp. 163–186). Washington, DC: American Psychiatric Press.
Le Brocque, R. M., Hendrikz, J., & Kenardy, J. A. (2010). The course of posttraumatic stress in children: Examination of recovery trajectories following traumatic injury. Journal of Pediatric Psychology, 35, 637–645.
Lewinsohn, P. M., Shankman, S. A., Gau, J. M., & Klein, D. N. (2004). The prevalence and co-morbidity of subthreshold psychiatric conditions. Psychological Medicine, 34, 613–622.
Malinkosky-Rummell, R., & Hansen, D. (1993). Long-term consequences of childhood physical abuse. Psychological Bulletin, 114, 68–79.
March, J. S., Amaya-Jackson, L., Murray, M. C., & Schulte, A. (1998). Cognitive–behavioral psychotherapy for children and adolescents with posttraumatic stress disorder after a single-incident stressor. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 585–593.
McFarlane, A. C. (2010). The long-term costs of traumatic stress: Intertwined physical and psychological consequences. World Psychiatry, 9, 3–10.
McLaughlin, K. A., Koenen, K. C., Hill, E. D., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., et al. (2013). Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 52, 815–830.
Nooner, K. B., Linares, L. O., Batinjane, J., Kramer, R. A., Silva, R., & Cloitre, M. (2012). Factors related to posttraumatic stress disorder in adolescence. Trauma, Violence, & Abuse, 13, 153–166. doi:10.1177/1524838012447698.
Olafson, E. (2011). Child sexual abuse: Demography, impact and interventions. Journal of Child and Adolescent Trauma, 4, 8–21.
Overstreet, S., Salloum, A., Burch, B., & West, J. (2011). Ecological factors and trauma. Challenges associated with childhood exposure to severe natural disasters: Research review and clinical implications. Journal of Child & Adolescent Trauma, 4, 52–68.
Perkonigg, A., Owashi, T., & Stein, M. B. (2009). Posttraumatic stress disorder and obesity: Evidence for a risk association. American Journal of Preventive Medicine, 36, 1–8.
Perry, B. D., Pollard, R. A., Blakely, T. L., Baker, W. L., & Vigilant, D. (1995). Childhood trauma, the neurobiology of adaptation, and use-dependent development of the brain: How states become traits. Infant Mental Health Journal, 16, 271–291.
Price, M., Higa-McMillan, C., Kim, S., & Frueh, B. (2013). Trauma experience in children and adolescents: An assessment of the effects of trauma type and role of interpersonal proximity. Journal of Anxiety Disorders, 27, 652–660.
Pynoos, R. S., Steinberg, A. M., & Piacentini, J. C. (1999). Developmental psychopathology of childhood traumatic stress and implications for associated anxiety disorders. Biological Psychiatry, 46, 1542–1554.
Pynoos, R. S., Steinberg, A. M., & Wraith, R. (1995). A developmental model of childhood traumatic stress. In D. Cicchetti & D. J. Cohen (Eds.), Developmental psychopathology, vol. 2: Risk, disorder, and adaptation (pp. 72–95). New York: Wiley.
Read, J. P., Ouimette, P., White, J., Colder, C., & Farrow, S. (2011). Rates of DSM-IV-TR trauma exposure and posttraumatic stress disorder among newly matriculated college students. Psychological Trauma: Theory, Research, Practice, and Policy, 3, 148–156.
Reebye, P., Moretti, M. M., Wiebe, V. J., & Lessard, J. C. (2000). Symptoms of posttraumatic stress disorder in adolescents with conduct disorder: Sex differences and onset patterns. Canadian Journal of Psychiatry, 45, 746–751.
Ribbe, D. (1996). Psychometric review of Traumatic Event Screening Instrument for Children (TESI-C). In B. H. Stramm (Ed.), Measurement of stress, trauma, and adaptation (pp. 386–387). Lutherville, MD: Sidran Press.
Ryb, G. E., Soderstrom, C. A., Kufera, J. A., & Dischinger, P. (2006). Longitudinal study of suicide after traumatic injury. Journal of Trauma: Injury, Infection and Critical Care, 61, 799–804.
Sadowski, C. M., & Friedrich, W. N. (2000). Psychometric properties of the Trauma Symptom Checklist for Children (TSCC) with psychiatrically hospitalized adolescents. Child Maltreatment, 5, 364–372.
Saigh, P. A., Mroueh, M., & Bremner, J. D. (1997). Scholastic impairments among traumatized adolescents. Behavior Research and Therapy, 35, 429–436.
Saltzman, W. R., Pynoos, R. S., Layne, C. M., Steinberg, A., & Aisenberg, E. (2001). Trauma/grief-focused intervention for adolescents exposed to community violence: Results of a school-based screening and group treatment protocol. Group Dynamics: Theory, Research, and Practice, 5, 291–303.
Santiago, C. D., Kataoka, S. H., Hu-Cordova, M., Alvarado-Goldberg, K., Maher, L. M., & Escudero, P. (2015). Preliminary evaluation of a family treatment component to augment a school-based intervention serving low-income families. Journal of Emotional and Behavioral Disorders, 23, 28–39.
Schilling, E. A., Aseltine, R. H., & Gore, S. (2007). Young women’s social and occupational development and mental health in the aftermath of child sexual abuse. American Journal of Community Psychology, 40, 109–124.
Schwab-Stone, M. E., Ayers, T. S., Kasprow, W., Voyce, C., Barone, C., Shriver, T., et al. (1995). No safe haven: A study of violence exposure in an urban community. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1343–1352.
Spitalny, K., Gurian, A., & Goodman, R. F. (2002). Helping children and teens cope with traumatic events and death: The role of school health professionals. School Nurse News, 19, 32–35.
Stein, B. D., Jaycox, L. H., Elliott, M. N., Collins, R., Berry, S., Marshall, G. N., et al. (2004). The emotional and behavioral impact of terrorism on children: Results from a national survey. Applied Developmental Science, 8, 184–194.
Stein, B. D., Jaycox, L. H., Kataoka, S. H., Wong, M., Tu, W., Eliot, M. N., et al. (2003). A mental health intervention for school children exposed to violence: A randomized controlled trial. Journal of the American Medical Association, 290, 603–611.
Stevens, J., Kelleher, K. J., Ward-Estes, J., & Hayes, J. (2006). Perceived barriers to treatment and psychotherapy attendance in child community mental health centers. Community Mental Health Journal, 42(5), 449–458.
Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.
Tierens, M., Bal, S., Crombez, G., Loeys, T., Antrop, I., & Deboutte, D. (2012). Differences in posttraumatic stress reactions between witnesses and direct victims of motor vehicle accidents. Journal of Traumatic Stress, 25, 280–287.
Turner, H. A., Finkelhor, D., & Ormrod, R. K. (2010). Poly-victimization in a national sample of children and youth. American Journal of Preventive Medicine, 38, 323–330.
Vranceanu, A. M., Hobfoll, S. E., & Johnson, R. J. (2007). Child multi-type maltreatment and associated depression and PTSD symptoms: The role of social support and stress. Child Maltreatment, 31, 71–84.
Warren, M. R., Hong, S., Rubin, C. L., & Uy, P. S. (2009). Beyond the bake sale: A community-based relational approach to parent engagement in schools. Teachers College Record, 111, 2209–2254.
Acknowledgments
The authors would like to gratefully acknowledge Jennifer Yu, Elizabeth Davies-Mercier, and Asha Goldweber for their guidance and feedback on the manuscript; the SRI CEHS staff for their assistance with data collection; and the entire community of students, teachers, and school clinicians who partnered and participated in this research.
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The contents of this research report were developed under a $3.4 million grant from the U.S. Department of Education (R324A110027). However, those contents do not necessarily represent the policy of the Department of Education, and you should not assume endorsement by the Federal Government.
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Woodbridge, M.W., Sumi, W.C., Thornton, S.P. et al. Screening for Trauma in Early Adolescence: Findings from a Diverse School District. School Mental Health 8, 89–105 (2016). https://doi.org/10.1007/s12310-015-9169-5
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DOI: https://doi.org/10.1007/s12310-015-9169-5