Epidemiological studies on a broad range of potentially traumatic events and posttraumatic stress disorder-like states (PTSD) in adolescents that build on national probability samples are quite rare in contrast to the considerable number of convenience sampling studies focusing on children and adolescents exposed to specific events. In a national probability sample, Elklit [2] studied 390 Danish 8th graders age 12–15 (Mean = 14.0 years, SD .37); and found that 78 percent of the males and 87 percent of the females had been exposed to at least one potentially traumatic event. The estimated lifetime prevalence of PTSD (measured by the HTQ-IV – see below) in the sample was 9.0 percent, whereas another 14.1 percent reached a sub-clinical level of PTSD. Following exposure, females suffered from PTSD twice as often as males. The most common events were the death of a family member, threat of violence, and serious accidents. The most distressing subjective events were rape, suicide attempts, death in the family, serious illness, and childhood abuse. Gender, parents' education, and living with a single parent were associated with specific events. Being exposed to multiple potentially traumatic events was associated with an increase in PTSD.
Domainskaite-Gota & Elklit: (Victimization and PTSD in a Lithuanian national youth probability sample, submitted) studied a national probability sample of 183 9th grade Lithuanian adolescents (M = 15.1 years; SD .61; range 13–17 years) and found that 81 percent of the males and 80 percent of the females had been exposed to at least one potentially traumatic event. Most frequent events were threats of physical assault, near-drowning experiences, death of someone close, and robbery/theft. Estimated lifetime prevalence of PTSD (measured by the HTQ-IV – see below) was 6.1% with 12.2% reaching a sub-clinical level of PTSD. Female gender, living with a single parent, direct and indirect exposure to potentially traumatic events, number of events, and more recent exposure (< 1 year) predicted higher PTSD levels.
In an Israeli convenience youth sample of 494 9th and 10th grade students (M = 15.6 years; SD .72; range 14–18). Andersen, Elklit & Lasgaard: (The prevalence and impact of traumatic events in Israeli youth, submitted) studied 20 potentially traumatizing events along with their psychological impact on the Trauma Symptom Checklist (TSC). Eighty-five percent of the students had been exposed to at least one potentially traumatic event. The most common events recorded were almost being injured or killed, war, and violent assault. Socio-demographic variables were found to be associated with specific events. The total number of events was associated with symptomatology, and the presence of recent exposure was associated with somatization and total symptom score. The events most strongly associated with symptom level were humiliation or persecution, attempted suicide, and childhood neglect.
As part of a general population study Costello et al. [3] interviewed 1420 children and adolescents aged 9–13, living in a poor rural part of North Carolina, about 30 potentially traumatic events. By age 16 one quarter had experienced at least one high magnitude event, with 6% experiencing a high magnitude event within 3 months prior to the study. One third experienced a low magnitude event within 3 months prior to the study.
In a longitudinal study of 384 18-year-old working-class US adolescents, Giaconia et al. [4] found that 43% had experienced at least one traumatic event (as defined by the DSM-III-R [5]) out of a list of 11 stressful events. Fifteen percent of the exposed youths or 6 percent of the total sample developed PTSD assessed by means of a structured clinical interview. Youths who had experienced potentially traumatic events demonstrated behavioural emotional problems, interpersonal problems, academic failure, suicidal behaviour, and physical health problems by the age of 18 – regardless of whether or not they developed PTSD. Eighty percent of the adolescents with PTSD met criteria for at least one additional disorder, and 40 percent had two or more lifetime disorders. Giaconia et al. [4] stressed that those who work with adolescents should not underestimate the potential of a wide range of stressful events to provoke PTSD symptoms and associated problems later in the adolescents' lives – including events that do not involve direct violence or physical harm. They also emphasize the importance of investigating other factors such as sample characteristics and family environment.
Joseph et al. [6] examined the prevalence of 12 negative life events in a convenience sample of 427 English adolescents aged 11 to 16 (Mean age for boys = 13.7, SD = 1.5; mean age for girls = 13.8, SD = 1.3) and found that 84% endorsed at least one event, the most common being a threat to the life of a family member or friend (accident, injury or illness). The impact of the aversive events was measured by the Impact of Event Scale.
A criminological study [7] of 1,270 Danish 8th-grade students from three different regions of the country found that 44 percent had experienced a theft, 16 percent had been beaten, and 36 percent had been threatened with violence within a period of 12 months. Twenty-six percent of the students in the Balvig study came from a split home. A Swedish study [8] of a national sample of 17-year-old adolescents found that 2.3 percent of the boys and 7.1 percent of the girls had experienced sexual abuse. The corresponding data for abusive intercourse were 1.2 percent for boys and 3.1 percent for girls, and for suicide attempts (and self-mutilating acts), were 5.9 percent for boys and 11.4 percent for girls.
All the reviewed studies (but the Giaconia et al. study that used structured clinical interviews) assessed the events retrospectively by self-report. The reviewed studies give ample evidence that youth in several countries are exposed to a considerable amount of potentially traumatic and distressing life events and that the PTSD-like state prevalences are comparable to what is found in adult studies. National probability studies provide authorities with reliable estimates of service needs that are missing in mental health planning.
Hill and Jones [9] examined children's and parents' perceptions of children's exposure to community violence and found a remarkable discrepancy between the two groups. The children reported exposure to much more violence than their parents were aware of. The parents' lack of awareness may increase the risk of inadequate guidance of the young in situations where they might need the most guidance. The same could be said about professional guidance of children and adolescents. To meet the requirement of optimal professional guidance, it is important to examine the prevalence of different types of victimization and distressing living conditions. The current study was designed to provide epidemiological information about exposure to potentially traumatic events and life events together with PTSD-like states in an Icelandic national probability study. The purpose was threefold: 1) to examine the relationship among the experiences of potemtial traumatic events, life events, socio-demographic variables, and PTSD-like states; 2) to estimate the lifetime prevalence of potentially traumatic events, life events, and PTSD-like states, overall, and according to gender; and 3) to assess the subjective distress of a number of potentially traumatic events and life events.