Abstract

Background
Despite the emphasis placed on childhood trauma in psychiatry, comparatively little is known about the epidemiology of trauma and trauma-related psychopathology in young people. To inform clinical assessment and treatment, we undertook a comprehensive epidemiological study of the prevalence, clinical features, and risk factors associated with trauma exposure and post-traumatic stress disorder (PTSD) in young people.

Methods
Participants were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a population-representative birth-cohort of 2,232 children born in England and Wales in 1994-1995. At the age-18 follow-up (93% participation), participants were assessed with structured interviews for trauma exposure, PTSD, other psychopathology, risk events, functional impairment, and service use. Risk factors for PTSD were measured prospectively over four previous assessments.

Outcomes
We found that 642 (31·1%) of 2,064 participants reported trauma exposure and 160 (7·8%) experienced PTSD by age 18 years. Trauma-exposed participants, and particularly those with PTSD, had high rates of psychopathology, risk events, and functional impairment. However, only 33 (20·6%) participants with PTSD received help from mental health professionals. To inform screening development, we reported initial, proof-of-principle evidence that psychosocial and clinical risk factors can be used to build an individualized PTSD risk calculator for trauma-exposed participants with adequate internally validated prediction performance (AUC=0·74).


Interpretation
Trauma exposure and PTSD are associated with complex psychiatric presentations, high risk, and significant impairment in young people. Improved screening, reduced barriers to care provision, and comprehensive clinical assessment are needed to ensure that trauma-exposed young people and those with PTSD receive appropriate treatment.

Funding
The Medical Research Council, the National Institute of Child Health and Development, the Jacobs Foundation, the Nuffield Foundation, the National Society for Prevention of Cruelty to Children, the Economic and Social Research Council, the National Institute for Health Research, MQ, and Canadian Institutes for Advanced Research.
Original languageEnglish
JournalThe Lancet Psychiatry
Publication statusAccepted/In press - 21 Dec 2018

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