Complex Childhood Trauma As a Life Course Indicator of Potentially Traumatic Experiences in Adolescence

Background: Complex trauma is a concept that is often employed when attempting to explain adverse outcomes associated with chronic and multi-type child maltreatment. The existing research literature indicates that adverse consequences are broadly linked to all abuse types and can affect all domains of development, leading to interpersonal relationship problems, poor mental health, and early death. However, in light of research limitations such as problems with definitions (for example, type or severity of abuse), recruiting a representative sample, and obtaining accurate recollections of past events by participants, associations between complex trauma in early life and a range of potentially traumatic events (PTEs) in adolescence has been understudied.

Methods: Data from the Adolescent Supplement of the National Comorbidity Survey (NCS-A) replication study were used to estimate the prevalence of a range of potentially traumatic events experienced among adolescents in the United States who also reported maltreatment and neglect during childhood. The outcomes of interest included: physical violence, vicarious exposure to a potentially traumatic event, accident or serious physical injury, natural disaster, and medical illness. Data were analyzed from adolescents age 13-18 (N=9,956) to estimate the risk ratios resulting from Log-Poisson regression and prevalence differences for each of four child maltreatment categories (physical abuse only, neglect only, physical abuse or neglect, and physical abuse and neglect). The adjusted estimates in which each model controlled for the key demographic covariates were examined in comparison to respondents who reported no child maltreatment.

Results: Adolescents who reported physical abuse only had a higher prevalence of experiencing non-caregiver physical violence (PR = 1.92), vicarious trauma exposure (PR = 1.36), accident or serious injury (PR = 1.48), natural disaster (PR = 1.34), and serious medical illness (PR = 1.76). Adolescents who reported neglect only had a higher prevalence of experiencing non-caregiver physical violence (PR = 1.56), vicarious trauma exposure (PR = 1.18), accident or serious injury (PR = 1.29), natural disaster (PR = 1.33), and serious medical illness (PR = 1.34). Adolescents who reported both physical abuse and neglect had a higher prevalence of experiencing non-caregiver physical violence (PR = 2.79), vicarious trauma exposure (PR = 1.66), accident or serious injury (PR = 1.82), natural disaster (PR = 1.41), and serious medical illness (PR = 1.44).

Conclusions: Adolescent PTEs are prevalent among victims of child maltreatment, indicating that adolescents with complex trauma histories may benefit from trauma-focused prevention efforts that specifically address this relationship.