Home > The epidemiology of trauma and post-traumatic stress disorder in a representative cohort of young people in England and Wales.

Lewis, Stephanie J and Arseneault, Louise and Caspi, Avshalom and Fisher, Helen L and Matthews, Timothy and Moffitt, Terrie E and Odgers, Candice L and Stahl, Daniel and Teng, Jia Ying and Danese, Andrea . (2019) The epidemiology of trauma and post-traumatic stress disorder in a representative cohort of young people in England and Wales. The Lancet. Psychiatry, 6 (3)

URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC63842...

BACKGROUND: Despite the emphasis placed on childhood trauma in psychiatry, comparatively little is known about the epidemiology of trauma and trauma-related psychopathology in young people. We therefore aimed to evaluate the prevalence, clinical features, and risk factors associated with trauma exposure and post-traumatic stress disorder (PTSD) in young people.

METHODS: We carried out a comprehensive epidemiological study based on participants from the Environmental Risk Longitudinal Twin Study, a population-representative birth-cohort of 2232 children born in England and Wales in 1994-95. At the follow-up home visit at age 18 years, participants were assessed with structured interviews for trauma exposure, PTSD, other psychopathology, risk events, functional impairment, and service use. Risk factors for PTSD were measured prospectively over four previous assessments between age 5 and 12 years. The key outcomes were the prevalence, clinical features, and risk factors associated with trauma exposure and PTSD. We also derived and tested the internal validity of a PTSD risk calculator.

FINDINGS: We found that 642 (31·1%) of 2064 participants reported trauma exposure and 160 (7·8%) of 2063 experienced PTSD by age 18 years. Trauma-exposed participants had high rates of psychopathology (187 [29·2%] of 641 for major depressive episode, 146 [22·9%] of 638 for conduct disorder, and 102 [15·9%] of 641 for alcohol dependence), risk events (160 [25·0%] of 641 for self-harm, 53 [8·3%] of 640 for suicide attempt, and 42 [6·6%] of 640 for violent offence), and functional impairment. Participants with lifetime PTSD had even higher rates of psychopathology (87 [54·7%] of 159 for major depressive episode, 43 [27·0%] of 159 for conduct disorder, and 41 [25·6%] of 160 for alcohol dependence), risk events (78 [48·8%] of 160 for self-harm, 32 [20·1%] of 159 for suicide attempt, and 19 [11·9%] of 159 for violent offence), and functional impairment. However, only 33 (20·6%) of 160 participants with PTSD received help from mental health professionals. The PTSD risk calculator had an internally validated area under the receiver operating characteristic curve of 0·74, indicating adequate discrimination of trauma-exposed participants with and without PTSD, and internally validated calibration-in-the-large of -0·10 and calibration slope of 0·90, indicating adequate calibration.

INTERPRETATION: Trauma exposure and PTSD are associated with complex psychiatric presentations, high risk, and significant impairment in young people. Improved screening, reduced barriers to care provision, and comprehensive clinical assessment are needed to ensure that trauma-exposed young people and those with PTSD receive appropriate treatment.


Item Type:Evidence resource
Drug Type:Alcohol or other drugs in general
Intervention Type:AOD disorder harm reduction
Date:March 2019
Page Range:pp. 247-256
Volume:6
Number:3
EndNote:View
Subjects:F Concepts in psychology > Psychological stress
G Health and disease > State of health > Mental health
G Health and disease > Substance related disorder > Substance related mental disorder
J Health care, prevention and rehabilitation > Care by type of problem > Mental health care
T Demographic characteristics > Adolescent / youth (teenager / young person)
VA Geographic area > Europe > United Kingdom > Wales
VA Geographic area > Europe > United Kingdom > England

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