Background

Youth in foster care are more likely than non-foster care youth to experience posttraumatic stress disorder (PTSD). While research has identified maltreatment as a risk factor for PTSD, this research remains limited because it tends to only (a) examine a single type or dimension of maltreatment and ignore the polyvictimization and heterogeneity in exposure, and (b) study this relation across a short period time or retrospectively at the end of care.

Objective

The current study used survival analysis to simultaneously examine the influence of maltreatment characteristics on the risk of receiving a PTSD diagnosis at any time in care following entry into care.

Participants/Setting

: 291 youth (Mean age at entry = 9.71; 53 % female; 49 % Black) in foster care and their primary caregivers from a large, Midwestern county.

Methods

Information on PTSD diagnosis was extracted from Medicaid records, and information on maltreatment and time in care was extracted from case files. Survival analysis was then used to determine the association between maltreatment and risk of PTSD diagnosis.

Results

When examined independently, each dimension (frequency, severity) of the four maltreatment types was significantly associated with PTSD diagnosis risk (all hazard ratio’s [HR] > 1.00), except sexual abuse frequency. In the comprehensive model with all dimensions examined simultaneously, only neglect frequency for youth entering care in adolescence (HR: 1.13[1.03−1.23]), and neglect severity (HR: 1.27[1.05−1.52]) and emotional abuse frequency (HR: 1.24[1.00−1.53]) for youth entering care pre-adolescence, were associated with PTSD diagnosis risk. Additionally, age of entry into care was associated with PTSD diagnosis risk (HR: 2.34[1.88−2.92]), as adolescents tended to spend fewer days in care before receiving a diagnosis.

Conclusions

Results suggest that researchers who study PTSD in youth in foster care should consider the entirety of youth’s maltreatment exposure and the context of care to more accurately determine what aspects of youth’s history contributes to receiving a PTSD diagnosis.

中文翻译：

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寄养青少年的创伤后应激障碍 (PTSD) 轨迹：一项生存分析，检查进入寄养机构之前的虐待经历

 背景

寄养青少年比非寄养青少年更有可能经历创伤后应激障碍 (PTSD)。虽然研究已将虐待确定为 PTSD 的危险因素，但这项研究仍然有限，因为它往往只 (a) 检查单一类型或维度的虐待，而忽略了多重受害和暴露的异质性，以及 (b) 研究跨群体的这种关系。短期或在护理结束时回顾。

 客观的

目前的研究使用生存分析来同时检查虐待特征对进入护理后任何时间接受 PTSD 诊断的风险的影响。

 参与者/设置

： 291 名接受寄养的青少年（入学平均年龄 = 9.71； 53%为女性； 49%为黑人）及其主要照顾者来自中西部的一个大县。

 方法

有关 PTSD 诊断的信息是从医疗补助记录中提取的，有关虐待和护理时间的信息是从病例档案中提取的。然后使用生存分析来确定虐待与 PTSD 诊断风险之间的关联。

 结果

独立检查时，除性虐待频率外，四种虐待类型的每个维度（频率、严重程度）均与 PTSD 诊断风险显着相关（所有风险比 [HR]> 1.00）。在同时检查所有维度的综合模型中，只有青少年在青春期进入护理的忽视频率（HR：1.13[1.03−1.23]）、忽视严重程度（HR：1.27[1.05−1.52]）和情感虐待频率（HR： 1.24[1.00−1.53]）对于青春期前进入护理的青少年来说，与 PTSD 诊断风险相关。此外，进入护理的年龄与 PTSD 诊断风险相关（HR：2.34[1.88−2.92]），因为青少年在接受诊断之前往往花更少的时间在护理中。

 结论

结果表明，研究寄养青少年 PTSD 的研究人员应该考虑青少年遭受虐待的全部经历和护理背景，以更准确地确定青少年历史的哪些方面有助于接受 PTSD 诊断。