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Troubling extent of trauma and PTSD in young people

New research from King’s College London suggests one in 13 young people in the UK have had post-traumatic stress disorder (PTSD) before reaching age 18.

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The first UK-based study of its kind, published in The Lancet Psychiatry, found 31% of young people had a traumatic experience during childhood, and those who were exposed to trauma were twice as likely as their peers to have a range of mental health disorders.

Relatively little is known about the extent of trauma and its effects on mental health in young people. The researchers looked at participants in the E-Risk Study, funded by the Medical Research Council, which includes 2,232 children born in England and Wales in 1994-1995.

Trauma exposure and PTSD were assessed at age 18 by structured interviews. One in four young people exposed to trauma met the criteria for PTSD. People with PTSD suffer from a range of symptoms including: re-living traumatic events through distressing memories or nightmares; avoidance of anything reminding them of their trauma; feelings of guilt, isolation or detachment; and irritability, impulsivity or difficulty concentrating.

Concerningly, only a minority of young people who had developed PTSD received help from health professionals – one in three talked to their GP about their mental health in the last year, and one in five saw a mental health professional. Therefore, only a small proportion of young people with PTSD in the study could have received effective treatments. A substantial proportion of young people with PTSD do not recover without treatment and symptoms can last many years.

Senior researcher Professor Andrea Danese from the Institute of Psychiatry, Psychology & Neuroscience (IoPPN) says: ‘Our findings should serve as a wake-up call – childhood trauma is a public health concern yet trauma-related disorders often go unnoticed. Young people with PTSD are falling through the gaps in care and there is a pressing need for better access to mental health services. Child and adolescent mental health services (CAMHS) need to make more resources available to address the needs of traumatised young people.’

In his clinical role Professor Danese is a Consultant Child & Adolescent Psychiatrist at the National & Specialist CAMHS Trauma, Anxiety, and Depression Clinic at South London and Maudsley NHS Foundation Trust.

Young people in the study who developed PTSD had high rates of a range of other mental health disorders – three in four had another mental health condition at age 18. They were also at high risk of harm to themselves - half had self-harmed and one in five attempted suicide since age 12. One in four were also not in education, employment, or training (NEET) at age 18, and half experienced social isolation or loneliness.

Lead researcher Dr Stephanie Lewis,MRC Clinical Research Training Fellow at the IoPPN, says: ‘Young people who have been exposed to trauma often have complex problems, which become increasingly difficult to assess and treat. Providing effective treatments early on could prevent mental health problems continuing into adulthood. We encourage parents and carers to seek support from health professionals if their children are exposed to trauma and are suffering from distressing psychological symptoms.’

Young people in the study were exposed to a wide range of traumas, from directly experiencing assault, injury or sexual violation to ‘network trauma’ - a traumatic event affecting someone the young person knew, which they learned about but did not directly witness. The risk of developing PTSD was greatest after a direct interpersonal assault or threat, with sexual assault being particularly high risk – 74% of young people experiencing sexual assault developed PTSD.

Dr Rachael Panizzo, who leads on mental health at the Medical Research Council – part funders of the study – says: ‘Better identification of young people at risk of developing PTSD is needed as intervening early to treat mental health conditions can help minimise the wide range of negative impacts on young people’s lives. This study highlights a gap in treatment for young people with PTSD and takes steps to improve our understanding of which individuals might be most susceptible.’

The full paper is available online.