Jessica Memarzia1, Jack Walker2, Richard Meiser-Stedman3. 1. Peterborough Integrated Neurodevelopmental Service, Child and Adolescent Mental Health Service, Cambridgeshire and Peterborough Foundation NHS Trust, Winchester Place, 80 Thorpe Road, Peterborough, PE3 6AP, Canada; Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, NR4 7TJ. 2. Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, NR4 7TJ. 3. Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, NR4 7TJ. Electronic address: r.meiser-stedman@uea.ac.uk.
Abstract
BACKGROUND: Meta-analytic reviews concerning predictors of PTSD in children and adolescents have predominantly identified evidence relating to pre- and post-trauma risk factors; however, there is little evidence regarding peritraumatic risk factors. This paper comprised a systematic review and meta-analysis of studies exploring psychological peritraumatic risk factors for PTSD in youth. METHODS: Thirty-two studies were identified. Random effects meta-analyses were undertaken, with meta-regressions to explore the moderating role of study characteristics (gender, sex, timing of assessment after trauma, study quality, design and trauma type) on the size of effect of predictive factors. RESULTS: Peritraumatic subjective threat (k = 28; r = 0.37, 95% CI=0.31-0.42) yielded a medium effect size estimate, while dissociation (k = 5; r = 0.17, 95% CI=0.03-0.29) and data-driven processing (feeling muddled or confused during the trauma) (k = 2; r = 0.29, 95% CI=0.14-0.43) yielded smaller population effect size estimates for the relationship with PTSD symptoms. Perceived life threat yielded a medium sized effect (k = 12; r = 0.37, 95% CI=0.32-0.41). The relationship between subjective threat and PTSD symptoms was moderated by the percentage of female participants. Estimates of heterogeneity were high in studies assessing perceived threat and fear (I2 = 95%), but moderate and low within studies assessing dissociation and data-driven processing (I2 = 57% and 0%, respectively). LIMITATIONS: Peritraumatic psychological processes were commonly assessed using single-item measures. Studies primarily concerned single-incident traumas, limiting generalisability. CONCLUSIONS: Peritraumatic experiences, particularly relating to subjective threat, are important correlates of subsequent PTSD, which implicates timely assessment of these experiences in youth to inform identification of at-risk groups and implementation and design of intervention.
BACKGROUND: Meta-analytic reviews concerning predictors of PTSD in children and adolescents have predominantly identified evidence relating to pre- and post-trauma risk factors; however, there is little evidence regarding peritraumatic risk factors. This paper comprised a systematic review and meta-analysis of studies exploring psychological peritraumatic risk factors for PTSD in youth. METHODS: Thirty-two studies were identified. Random effects meta-analyses were undertaken, with meta-regressions to explore the moderating role of study characteristics (gender, sex, timing of assessment after trauma, study quality, design and trauma type) on the size of effect of predictive factors. RESULTS: Peritraumatic subjective threat (k = 28; r = 0.37, 95% CI=0.31-0.42) yielded a medium effect size estimate, while dissociation (k = 5; r = 0.17, 95% CI=0.03-0.29) and data-driven processing (feeling muddled or confused during the trauma) (k = 2; r = 0.29, 95% CI=0.14-0.43) yielded smaller population effect size estimates for the relationship with PTSD symptoms. Perceived life threat yielded a medium sized effect (k = 12; r = 0.37, 95% CI=0.32-0.41). The relationship between subjective threat and PTSD symptoms was moderated by the percentage of female participants. Estimates of heterogeneity were high in studies assessing perceived threat and fear (I2 = 95%), but moderate and low within studies assessing dissociation and data-driven processing (I2 = 57% and 0%, respectively). LIMITATIONS: Peritraumatic psychological processes were commonly assessed using single-item measures. Studies primarily concerned single-incident traumas, limiting generalisability. CONCLUSIONS: Peritraumatic experiences, particularly relating to subjective threat, are important correlates of subsequent PTSD, which implicates timely assessment of these experiences in youth to inform identification of at-risk groups and implementation and design of intervention.