A meta-analysis of risk factors for post-traumatic stress disorder in children and adolescents
Highlights
► Demographic and pre-event factors are only weakly associated with development of PTSD. ► Fear and perceived life threat have stronger correlation to PTSD than trauma severity. ► Post-event factors have stronger correlation to PTSD than pre-event factors. ► Thought suppression, blaming others and distraction are stronger predictors of PTSD. ► Female sex became a stronger risk factor as age increased.
Section snippets
Rationale for the present study
Knowing reliably which factors make a child more likely to develop traumatic distress (whether that is measured by a diagnosis of PTSD, or by severity of PTSD symptoms) is of both academic and clinical interest. Firstly if clinicians know which children and adolescents are most likely to be adversely affected following exposure to events, then those children and adolescents can be most closely monitored with a view to providing treatment as necessary before difficulties become chronic (Pine &
Existing reviews of research
There are a number of reviews of the literature that have attempted to increase our understanding of the development of child PTSD (Foy et al., 1996, Pine and Cohen, 2002). Pine and Cohen's review identified two factors consistently related to adverse outcome: trauma exposure and disrupted social support. Foy also argued that parental distress might act as a powerful mediating factor in the development of the child's symptoms. Whilst such reviews are helpful, a more systematic review and
Other meta-analyses of risk factors for PTSD
There are two meta-analyses of studies examining risk factors for PTSD in adults (Brewin et al., 2000 and Ozer, Best, Lipsey, & Weis, 2003). Brewin and colleagues conducted meta-analyses of 14 risk factors and analysed moderating effects of various sample and study characteristics. The effect size of all the risk factors was modest; but factors operating during or after the trauma, such as trauma severity, lack of social support, and additional life stress, had larger effect sizes (r = 0.23 to
Selection of studies for the meta-analysis
English-language articles published in peer-reviewed journals between 1980 (the first DSM definition of PTSD) and May 2009 were considered for inclusion. Various psychological and medical literature databases were searched, including the PILOTS database managed by the National Center for PTSD, Medline, PsychInfo, Embase and Web of Science. In addition, each issue of the Journal of Traumatic Stress was examined for relevant research. Secondary sources such as review articles, book chapters and
Characteristics of studies
The method described earlier generated 25 risk factors that were explored by two or more studies, which could then be entered into the meta-analysis. Sample sizes from individual studies ranged from 20 to 5687. Characteristics of the studies included in the meta-analysis (trauma type, sample size, measure of PTSD, whether the measure was an interview or questionnaire, age range, mean age, percentage of sample that were female, and location of study) are contained in Table 2.
Risk factor estimates
The main results of
Discussion
This meta-analysis involved investigating 25 risk factors for PTSD in children and adolescents aged 6–18 years, across 64 studies published between 1980 and May 2009. The combined sample size for the studies considered was very large (32,238). A small effect size was observed for race and younger age as risk factors for PTSD; a small to medium-sized effect was observed for female gender, low intelligence, low SES, pre- and post-trauma life events, pre-trauma psychological problems in the
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References marked with an asterisk indicate studies included in the meta-analysis.