Stellenbosch University, Cape Town, South Africa.
J Interpers Violence. 2019 Nov;34(21-22):4357-4383. doi: 10.1177/0886260516674944. Epub 2016 Oct 24.
South African adolescents are exposed to high levels of violence and trauma, including community violence, abuse, and neglect. Violence and trauma are associated with negative mental health outcomes, including posttraumatic stress disorder (PTSD) and depression. Demographic characteristics, additional exposure to trauma, community violence, and types of childhood abuse and neglect may place adolescents at greater risk of developing PTSD. This study aimed to first assess the weighted contribution of demographic factors, trauma load, community violence, and types of abuse and neglect in predicting PTSD symptom severity. Second, we aimed to determine group differences in demographic factors, trauma load, community violence, and types of abuse and neglect among participants with no disorder, PTSD only, PTSD and depression, and depression only. Participants were 215 adolescents identified with emotional and/or behavioral problems and referred to an adolescent trauma clinic from schools in the Western Cape region of South Africa. Clinical assessments were undertaken to assess community violence exposure; physical, sexual, and emotional abuse; physical and emotional neglect; and a clinical diagnosis of PTSD and comorbidity. Trauma-exposed adolescents with PTSD and depression reported significantly higher levels of emotional abuse and community violence exposure in comparison with trauma-exposed adolescents without a disorder. Emotional abuse, community violence exposure, and female gender were significant predictors of PTSD in regression analysis. These findings underscore the contribution of different types of trauma in the development of PTSD. Interventions focused on preventing trauma, PTSD, and depression should be multifaceted and be targeted at various levels, for example, individual/interpersonal level (reduce abuse in the household and immediate environment) and community/societal level (reduce crime rates in communities and strengthen conviction policies). Traumatized youth should routinely be screened for a history of abuse and particularly exposure to community violence, given their strong association with PTSD.
南非青少年面临着高水平的暴力和创伤，包括社区暴力、虐待和忽视。暴力和创伤与负面心理健康结果相关，包括创伤后应激障碍（PTSD）和抑郁。人口统计学特征、额外的创伤暴露、社区暴力以及虐待和忽视的类型可能使青少年面临更大的 PTSD 发病风险。本研究旨在首先评估人口统计学因素、创伤负荷、社区暴力和虐待与忽视的类型对 PTSD 症状严重程度的加权贡献。其次，我们旨在确定在无障碍、仅 PTSD、PTSD 和抑郁以及仅抑郁的参与者中，人口统计学因素、创伤负荷、社区暴力和虐待与忽视的类型方面的组间差异。参与者为 215 名被确定有情绪和/或行为问题的青少年，他们来自南非西开普省的学校，被转介到青少年创伤诊所。进行临床评估以评估社区暴力暴露；身体、性和情感虐待；身体和情感忽视；以及 PTSD 和共病的临床诊断。患有 PTSD 和抑郁的创伤后青少年与无障碍的创伤后青少年相比，报告了更高水平的情感虐待和社区暴力暴露。情感虐待、社区暴力暴露和女性性别是回归分析中 PTSD 的显著预测因素。这些发现强调了不同类型的创伤在 PTSD 发展中的贡献。预防创伤、PTSD 和抑郁的干预措施应该是多方面的，并针对各个层面，例如个人/人际关系层面（减少家庭和直接环境中的虐待）和社区/社会层面（降低社区的犯罪率和加强定罪政策）。应定期对受创伤的青少年进行虐待史，特别是社区暴力暴露的筛查，因为它们与 PTSD 密切相关。
