Correlates of post-traumatic stress disorder symptoms among high-risk adolescents presenting to the emergency department

Background: Post-traumatic stress disorder (PTSD) is associated with long-term morbidity, but is rarely identified or treated in high-risk adolescents. Rates and correlates of PTSD symptoms among adolescents seen in the emergency department (ED) are unknown.

Method: A consecutive sample of adolescents (ages 13-17) presenting to the ED were recruited. Eligible participants completed a screening survey using validated measures on: demographics; past 2-week PTSD and depressive symptoms; past-year peer violence, cyberbullying, community violence, and stressful events. Descriptive, bivariate [odds ratios, 95% confidence intervals], and logistic regression were performed to identify correlates of PTSD symptoms.

Results: Among 386 eligible adolescents, 258 (67%) participated. Mean age=15, 50% male, 37% low socioeconomic status. Fifty participants (19%) screened positive for PTSD symptoms. These adolescents were more likely to report depressive symptoms, peer/community violence, cyberbullying, and stressful events. Few currently used mental health services (26%). In Model 1 (including depressive symptoms): PTSD symptoms were positively associated with depressive symptoms (AOR 41.0, CI 11.9-141.0) and relationship stressful events (AOR 5.0, CI 1.2-20.3). In Model 2 (excluding depressive symptoms): cyberbullying (AOR 2.4, CI 1.0-5.6), relationship stressful events (AOR 5.3, CI 1.7-16.9), and illness/death of others stressful events (AOR 3.1, CI 1.1-8.5) were positively associated. Both models had acceptable goodness-of-fit.

Conclusions: High percent of adolescents presenting to the ED for any chief complaint have PTSD symptoms. On logistic regression, violence was minimally associated with PTSD symptoms, yet non-injury stress was associated; further investigation should explore the reasons to develop interventions. Depression may moderate relationships between violence and PTSD.