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Home > Public Resources > Trauma Blog > 2023 - December > Exposure to potentially traumatic experiences and mental health care use in adolescents

Exposure to potentially traumatic experiences and mental health care use in adolescents

Annika Skandsen, Tormod Bøe, Mari Hysing, Martin H. Teicher, Kristin Gärtner Askeland, and Liv Sand

December 8, 2023

Woman-illustration.pngExposure to Potentially Traumatic Experiences during Development

Children and adolescents subjected to potentially traumatic experiences (PTEs) are at an elevated risk of developing psychopathology during their adolescent years compared to their unexposed counterparts (Lewis et al., 2019). Although exposure to PTEs is part of the diagnostic criteria for acute and posttraumatic stress disorders, numerous studies have linked PTEs to other psychiatric conditions during adolescence (i.e. Gradus et al., 2022; Tiet et al., 2001).

PTEs and Risk for Mental Health Problems ​

A critical question is whether PTE exposure represents a transdiagnostic risk factor for mental health problems in general or if PTEs selectively increase the risk for a circumscribed set of disorders. Another important question is whether the driving risk factor linking PTEs to psychopathology is the cumulative burden of exposure to multiple different types of PTEs or whether exposure to specific PTE types selectively enhances the risk for particular disorders. 

Studies examining early experiences as potential risk factors for psychopathology are remarkably heterogeneous, differing in types of exposure (e.g., PTEs, maltreatment, poverty discrimination), the gamut of psychiatric disorders investigated, age range, the nature of the sample (e.g., convenience, representative, population), and outcome measures (e.g., prevalence, odds ratios, severity scores).

New Research

The present study was designed to address a significant gap in understanding in several ways. First, we focused on adolescence, which is both the developmental period that confers the highest risk for exposure to many types of PTEs and the peak or median period of the onset of psychopathology (McLaughlin et al., 2013; Solmi et al., 2022). Hence, a detailed understanding of the association between adversity and the onset of psychopathology during adolescence may be most germane to efforts aimed at prevention or preemption. Second, to better understand the interrelationship from a cumulative burden perspective, we selected as our outcome measure the mean number of different types of PTEs observed across a broad array of diagnostic categories. Although many studies have examined the number of different types of PTEs as a risk factor, we are unaware of any studies that have compared trauma load between diagnostic groups using the mean number of different types of PTEs as the outcome measure.

This association was explored through the collection of PTE exposure in a large population-based survey (8845 participants) that was linked to Norwegian National Patient Registry (NPR) data to compare participants who did or did not receive help within Child and Adolescent Mental Health Services (CAMHS). Diagnoses within the registry were formulated by clinicians providing standard clinical care, which increases the generalizability of the findings.

The present study revealed that having contact with Child and Adolescent Mental Health Services (CAMHS) predicted more PTEs and exposure to two or more PTEs compared to having no CAMHS contact after adjusting for age, ethnicity, sex, and parental education. Adolescents diagnosed with attention-deficit/hyperactivity disorder, depression, trauma-related disorders, conduct disorder, and anxiety experienced significantly more PTEs than those with no CAMHS contact. All diagnostic categories except psychosis, autism spectrum disorders, and eating disorders had a significantly higher rate of PTEs compared with adolescents with no CAMHS contact. The study highlights the potential role of exposure to multiple PTEs as a transdiagnostic risk factor, although the level of risk varies between diagnoses.

Key Takeaway

Clinicians may find it useful to screen for PTEs in adolescents who have had contact with CAMHS or similar services. Clinicians are advised to pay particular attention to those diagnosed with trauma-related disorders, conduct disorders, depression, and ADHD, both with the aim of addressing unresolved trauma and stopping any ongoing trauma in the adolescent’s life. Clinicians are also encouraged to monitor adolescents who have been exposed to more than one PTE, as this might be a distinct transdiagnostic vulnerability factor.
 
Read the full article here.
Skandsen, A., Hysing, M., Askeland, K. G., Teicher, M. H., Sand, L., & Bøe, T. (2023). Using Norwegian National Patient Registry data to understand associations between potentially traumatic life experiences and mental health care use in adolescence. Journal of Traumatic Stress.

Discussion Questions

  1. How does level of trauma exposure differ between adolescents in contact with CAMHS compared to those with no CAMHS contact?
  2. How does the current study extend our knowledge of PTE exposure and mental health care use in adolescence?
  3. Based on our research findings how can future studies further our knowledge of PTE exposure and mental health care use in adolescence?

About the Authors

Annika Skandsen, PhD, is a licensed clinical psychologist and PhD fellow at the Faculty of Psychology, University of Bergen, Norway. She also works as a clinical psychologist at Stavanger University Hospital. Skandsens´s research areas focus on trauma and psychopathology. She can be contacted at [email protected] or [email protected]. Follow Dr. Skandsen on LinkedIn and Twitter/X
 
Tormod Bøe is a Professor and licensed Clinical Psychologist at the Faculty of Psychology, University of Bergen, Norway.
 
Mari Hysing is a  Professor and licensed Clinical Psychologist at the Faculty of Psychology, University of Bergen, Norway.

Martin H. Teicher, MD, is an Associate Professor at the Department of Psychiatry, Harvard Medical School, Boston MA, USA. Dr. Teicher is the Director of the Developmental Biopsychiatry Research Program, McLean Hospital, Belmont MA, USA.

Kristin Gärtner Askeland is an Associate Professor and licensed Clinical Psychologist at Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE, Norwegian Research Centre, Bergen, Norway.

Liv Sand is a Postdoctoral Research Fellow and licensed Clinical Psychologist at Stavanger University Hospital, Stavanger, Norway.
 

References

Gradus, J. L., Rosellini, A. J., Szentkúti, P., Horváth-Puhó, E., Smith, M. L., Galatzer-Levy, I., Lash, T. L., Galea, S., Schnurr, P. P., & Sørensen, H. T. (2022). Using Danish national registry data to understand psychopathology following potentially traumatic experiencesJournal of Traumatic Stress, 35(2), 619-630.

Lewis, S. J., Arseneault, L., Caspi, A., Fisher, H. L., Matthews, T., Moffitt, T. E., Odgers, C. L., Stahl, D., Teng, J. Y., & Danese, A. (2019). The epidemiology of trauma and post-traumatic stress disorder in a representative cohort of young people in England and WalesThe Lancet Psychiatry, 6(3), 247-256.

McLaughlin, K. A., Koenen, K. C., Hill, E. D., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Trauma exposure and posttraumatic stress disorder in a national sample of adolescentsJ Am Acad Child Adolesc Psychiatry, 52(8), 815-830.e814. 

Solmi, M., Radua, J., Olivola, M., Croce, E., Soardo, L., Salazar de Pablo, G., Il Shin, J., Kirkbride, J. B., Jones, P., Kim, J. H., Kim, J. Y., Carvalho, A. F., Seeman, M. V., Correll, C. U., & Fusar-Poli, P. (2022). Age at onset of mental disorders worldwide: large-scale meta-analysis of 192 epidemiological studiesMolecular Psychiatry, 27(1), 281-295. 

Tiet, Q. Q., Bird, H. R., Hoven, C. W., Moore, R., Wu, P., Wicks, J., Jensen, P. S., Goodman, S., & Cohen, P. (2001). Relationship between specific adverse life events and psychiatric disorders. J Abnorm Child Psychol, 29(2), 153-164. doi:https://10.1023/a:1005288130494