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Abstract Adolescents who have multiple traumatic experiences may suffer from Post-traumatic Stress Disorder (PTSD) or other mental health problems later in life. Study of trauma exposure and PTSD among adolescents is very limited in Malaysia. This study explored the prevalence of lifetime trauma, demographic risk factors, and PTSD symptoms among Malaysian adolescents. This cross-sectional study recruited 1016 adolescents aged 13 to 17 (Mage= 14.9 years). Results showed that 83% participants had at least one traumatic exposure (TE), while prevalence of PTSD symptoms was 10.2%. Adolescents with multiple TEs and those with violent and self-inflicted TE were at significantly higher risk to develop PTSD symptoms. Findings suggest that a large proportion of Malaysian adolescents are exposed to a variety of traumatic events since childhood. Trauma exposure should be included as an important component in our adolescent mental health assessment, allowing early psychological intervention to be provided to those affected. Key words: PTSD, adolescents, gender, lifetime trauma, prevalence, Malaysia
Lifetime Trauma Exposure, Gender, and DSM–5 PTSD
Symptoms Among Adolescents in Malaysia
Siti Raudzah Ghazali, Ask Elklit, M. Ameenudeen Sultan, Rekaya Vincent Balang, and Yoke Yong
Online First Publication, September 29, 2016.
Ghazali, S. R., Elklit, A., Sultan, M. A., Balang, R. V., & Chen, Y. Y. (2016, September 29). Lifetime
Trauma Exposure, Gender, and DSM–5 PTSD Symptoms Among Adolescents in Malaysia.
Traumatology. Advance online publication.
Lifetime Trauma Exposure, Gender, and DSM–5 PTSD Symptoms Among
Adolescents in Malaysia
Siti Raudzah Ghazali
Universiti Malaysia Sarawak
Ask Elklit
University of Southern Denmark
M. Ameenudeen Sultan, Rekaya Vincent Balang, and Yoke Yong Chen
Universiti Malaysia Sarawak
Adolescents who have multiple traumatic experiences may suffer from posttraumatic stress disorder
(PTSD) or other mental health problems later in life. Study of trauma exposure and PTSD among
adolescents is very limited in Malaysia. This study explored the prevalence of lifetime trauma, demo-
graphic risk factors, and PTSD symptoms among Malaysian adolescents. This cross-sectional study
recruited 1,016 adolescents aged 13 to 17 (M
14.9 years). Results showed that 83% participants had
at least 1 traumatic exposure (TE), whereas prevalence of PTSD symptoms was 11.7%. Adolescents with
multiple TEs and those with violent and self-inflicted TE were at significantly higher risk to develop
PTSD symptoms. Findings suggest that a large proportion of Malaysian adolescents are exposed to a
variety of traumatic events since childhood. Trauma exposure should be included as an important
component in our adolescent mental health assessment, allowing early psychological intervention to be
provided to those affected.
Keywords: PTSD, adolescents, lifetime trauma, Malaysia
In the past decades, several studies have been carried out to
investigate the lifetime prevalence of victimization and trauma
among adolescents (Elklit, 2002; Finkelhor, Turner, Ormrod, &
Hamby, 2009; Rasmussen, Karsberg, Karstoft, & Elklit, 2013).
Results have corroborated one another on multiple points, but
lifetime prevalence of traumatic exposure (TE), PTSD, and types
of TE have ranged widely. Approximately 40 –90% of the adoles-
cent population in United States and Denmark has experienced a
potentially traumatic exposure (Breslau, 2009; Elklit, 2002; Kes-
sler, Sonnega, Bromet, Hughes, & Nelson, 1995).
Children and adolescents who experience multiple TEs are very
likely to develop PTSD and other psychosocial impairments later
in life (Trickey, Siddaway, Meiser-Stedman, Serpell, & Field,
2012). Lifetime prevalence of PTSD was found to be around 7.8%
in United States (Kessler et al., 1995), 9% in Denmark (Elklit,
2002), and 10% in India (Rasmussen et al., 2013). Briere, Kalt-
man, and Green (2008) showed that adults who experienced two or
more TEs in childhood had greater vulnerability to PTSD effects
when compared with those who had no previous history of TE.
Ogle, Rubin, Berntsen, and Siegler (2013) found among older
adults in United States that events that occurred with greater
frequency early in life were associated with more severe PTSD
symptoms than events that occurred with greater frequency during
later decades.
In a community setting, the most commonly reported TE in
Denmark was the death of a family member, followed by a threat
of being beaten, humiliation, near drowning, and traffic accident
(Elklit, 2002). In India, the most common TE, as in Denmark, was
the death of a family member, but followed by traffic accident,
serious illness, witnessing an injury, and coming close to being
injured or killed (Rasmussen et al., 2013).
Previous studies consistently found that female adolescents have
higher risks for PTSD than male adolescents (Elklit, 2002; Bre-
slau, 2009; Elklit & Petersen, 2008; Kessler et al., 1995). Simi-
larly, significant gender differences have been found in types of
TE. For example, Elklit (2002) reported that female adolescents
were more likely to have family related TEs such as domestic
violence and sexual abuse while male adolescents were more
likely to experience violent TEs such as physical assaults and
threats of injury (Elklit, 2002).
It remains unclear whether certain types of TE are more likely
to lead to PTSD. Ford, Chapman, Connor, and Cruise (2012) found
in a sample of delinquent adolescents that traumatic exposure to
sexual abuse and physical assault were important risk factors in
predicting adolescent mental health without specifically investi-
gating PTSD. A study by Ariga et al. (2008) on TE type as a
predictor for PTSD among delinquent female adolescents did not
find a significant result. Haller and Chassin (2012) showed that
Siti Raudzah Ghazali, Faculty of Medicine and Health Science, Univer-
siti Malaysia Sarawak; Ask Elklit, National Centre for Psychotraumatol-
ogy, University of Southern Denmark; M. Ameenudeen Sultan, Rekaya
Vincent Balang, and Yoke Yong Chen, Faculty of Medicine and Health
Science, Universiti Malaysia Sarawak.
This study was funded by the National Centre for Psychotraumatology,
University of Southern Denmark, Grant UNIMAS L18403 F05 00 PTSD.
Correspondence concerning this article should be addressed to Siti Raudzah
Ghazali, Department of Psychological Medicine, Faculty of Medicine and
Health Science, Universiti Malaysia Sarawak, 94300 Kota Samarahan, Sara-
wak, Malaysia. E-mail:
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Traumatology © 2016 American Psychological Association 1085-9373/16/$12.00
assaultive violence yielded on odd ratio of 2.28 in predicting
PTSD, but the association did not reach the level of significance.
Therefore, the present study will further investigate the association
of different trauma types with higher risk of PTSD symptoms.
As community studies among national populations have exhib-
ited a wide range of results, it is appropriate to ask what the
prevalence is for understudied regions such as Southeast Asia.
Studies on exposure to a variety of trauma at the community level
among adolescents in Malaysia have yet to be conducted. The
incidence and seriousness of TEs experienced by Malaysian ado-
lescents remains unknown. Considering the impact of exposure to
traumatic events early in life can be devastating, baseline data
should be established. Thus the objectives of this study were (a) to
estimate prevalence of lifetime trauma exposure, (b) to determine
if multiple trauma exposure is related to PTSD symptoms, and (c)
to assess if gender and types of trauma were risk factors in
developing PTSD symptoms among Malaysian adolescents.
Data were collected from a total population of 1,016 adolescents
aged 13 to 17 (Mage 14.9, SD 1.4; 638 female adolescents,
378 male adolescents) attending government secondary school
(Grade 7 to Grade 11). A minimum sample size of 331 was
determined using Epi Info 6 based on an estimated prevalence of
14.6% (Elklit & Petersen, 2008), precision rate of 5% and confi-
dence interval of 99%.
Following ethical approval from the Faculty of Medicine and
Health Sciences, the University Malaysia Sarawak Ethics Com-
mittee, the Malaysian Ministry of Education, and the Sarawak
Education Department, 35 schools were randomly selected from
the 11 divisions of the state and 56.7% (n17) agreed to take part
in the study. Parent and adolescent written consent was a prereq-
uisite for participating, after which a date for data collection was
set. During data collection, both parents and adolescents were
briefed on issues related to confidentiality and questionnaire col-
lection procedures.
Demographic questionnaire. A one-page survey design was
used to solicit information regarding participant age, gender, eth-
nicity, parental education, and living arrangements.
Traumatic Events Checklist. This questionnaire contains a
list of 20 traumatic and negative life events in the first column with
direct exposure and indirect exposure (i.e., witnessing or experi-
encing an event themselves or having a person close to them
experience an event) in the other two columns. The list of trau-
matic events was selected from the literature and clinical experi-
ence, covering traffic accident, other serious accident, physical
assault, abuse, rape, coming close to being injured or killed,
near-drowning, attempted suicide, robbery, severe childhood ne-
glect, humiliation or persecution by others, and other trauma. The
validity of this checklist is supported by previous research (Elklit,
PTSD symptoms. Symptoms of PTSD were measured by
Harvard Trauma Questionnaire (HTQ; Mollica et al., 1992), a
cross-cultural instrument to measure traumatic symptoms associ-
ated with diagnostic criteria for PTSD. It consists of 16 items on
a 4-point Likert scale ranging from 1 (not at all)to4(extremely)
corresponding to the three major symptoms cluster of PTSD in
DSM–IV, avoidance (seven items), re-experiencing (four items),
and hypervigilance (five items). In DSM–5, additional symptoms
cluster is included, namely cognitive and mood symptoms. Cog-
nitive and mood symptoms essentially report feeling of detach-
ment, diminished interest in daily life, inability to recall the key
feature of the traumatic event, persistently having negative beliefs
about oneself or the world, persistently blaming self or others
regarding the incident of trauma, and persistently unable to have
positive emotion. In HTQ, there are additional eight items can be
classified as cognitive and mood symptoms (e.g., Item 4: “Feeling
detached or withdrawn from people,” Item 5: “Unable to show
positive emotion,” Item 13: “Less interest in daily activities”).
Participants who rated 2, 3, or 4 for at least two symptoms in
avoidance, one symptom in re-experiencing, three symptoms in
hyper vigilance, and two symptoms in mood and cognitive cluster
would be considered to have PTSD symptoms. Thus, we analyzed
the data using DSM–5 algorithm, which in our analyses we ana-
lyzed a total number of 24 items. The internal consistency of this
questionnaire in the present study was high (␣⫽.94).
All instruments were translated into the Malay language (Ba-
hasa Malaysia) and were back-translated by two academicians who
are experts in both English and Malay languages.
Eighty-three percent of the participants reported having at least
one direct or indirect TE. Out of this population, 527 (63%) were
female and 313 (37%) were male. The five most prevalent TEs
overall were death of someone close (15.4%), traffic accident
(14.5%), near-drowning (9.2%), serious illness (9.0%), and humil-
iation/bullying (6.1%). The five most common direct TEs were
death of someone close (21%), near drowning (16%), traffic ac-
cident (15%), serious illness (9%), and humiliation/bullying (8%;
Table 1). Least prevalent were rape (0.6%), sexual abuse (0.6%),
and pregnancy/abortion (0.3%). The five most common indirect
TEs were traffic accident (14%), death of someone close (12%),
serious illness (9%), other serious accidents (8%), and divorce
Most of the adolescents (52.1%) reported both direct and indi-
rect TE, 19.2% reported only experienced direct TE, and 11.4%
reported only experience indirect trauma among the total cases
reported. For direct TE, 28.7% reported no TE, 28.8% experienced
one TE, 17.9% had two, 9.7% had three, 5.5% had four, 3.8% had
five, and 5.4% reported experiencing more than five TEs. For
indirect TE, 36.5% reported having no TE, 17.2% had one, 11.4%
had two, 8.6% had three, 7.3% had four, 5.2% had five, and 13.8%
had more than five indirect TEs.
HTQ analysis of Pearson’s chi-square showed significant dif-
ference between those who reported PTSD symptoms and those
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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
who did not,
(1, N1,016) 22.93, p.001. Adolescents
with TE (11.1%) were 5.59 times more likely to report PTSD
symptoms than those who had one or no TE (2.2%) with a 95% CI
of 2.5512.26. There was a significant correlation between the
total number of TEs and PTSD symptoms. Bivariate correlation
showed that the total number of TEs correlated significantly with
HTQ score, r.43, p.001, indicated that the more number of
TEs reported the higher the HTQ score.
Pearson’s chi square showed significant gender differences for
several TEs in both direct and indirect exposure (see Table 1).
Male adolescents had significantly more direct exposure to traffic
accident, other serious accidents, physical assault, witnessing other
people injured or killed, nearly being injured or killed, threats of
beating, serious illness, physical abuse, and humiliation or bully-
ing. On the other hand, female adolescents had significantly more
direct exposure to death of someone close. With regard to indirect
exposure, male adolescents witnessed or knew others who had
experienced physical assault, robbery/theft, sexual abuse, nearly
being injured or killed and threats of beating significantly more
often than female adolescents.
Of 1,016 adolescents, 11.7% (n119; 81 female and 38 male)
reported PTSD symptoms with DSM–5 algorithm on the HTQ. A
significant number of them (6.3%) had both direct and indirect TE
compared to those who had only direct TE (1%),
(1, N724)
7.54, p.006, odds ratio (OR)2.55, or only indirect TE (0.8%),
(1, N645) 2.60, p.107, OR 1.86. The ttest analysis
showed no significant difference in PTSD symptoms between
genders among those with TE except for avoidance symptom
cluster in which showed merely significant result with more fe-
males reported more avoidance symptoms than the males.
Logistic regression results indicated that age (OR 1.33, 95%
CI [1.143–1.530]), and father with higher secondary school edu-
cation (OR 3.42, 95% CI [1.046 –11.211]) were significant
demographic variables in the model,
(18) 39.21, p.003, in
assessing the risk of PTSD, which explained 10% of the total
variance. The overall predictive accuracy was 88.3%.
The next model adjusted for the demographic and TEs signifi-
cantly predict PTSD symptoms,
(38) 126.94, p.001.
Logistic regression results indicated that male (OR 1.84, 95% CI
[1.120 –3.024]), age (OR 1.32, 95% CI [1.120 –1.557]), history
of violent attack (OR 1.91, 95% CI [1.018 –3.585]), threats of
beating (OR 2.20, 95% CI [1.240 –3.917]), attempted suicide
(OR 2.19, 95% CI [1.158 –4.150]), and humiliation (OR 2.03,
95% CI [1.207–3.414]) were significant trauma variables in the
model for assessing the risk of PTSD, which explained 23% of the
total variance. The overall predictive accuracy was 90%.
The present study found that a large proportion of Malaysian
adolescents (83%) are directly and indirectly exposed to one or
more traumatic events since childhood. This finding is high but
within the range reported in other community based studies (Elklit
& Petersen, 2008; Rasmussen et al., 2013). The five most preva-
lent TEs reported were death of someone close, traffic accidents,
near-drowning, serious illness, and humiliation or bullying. Al-
though similar to findings from Denmark (Elklit & Petersen, 2008)
and India (Rasmussen et al., 2013), in this study, traffic accidents
were ranked higher, as the second most prevalent TE. Death
caused by road traffic accidents in Malaysia has reached 7.85% of
total deaths, making it the 4th leading cause of death nationwide
(World Health Organization, 2011). An average of 18 people is
killed on Malaysian roads daily, with the number expected to rise
to 29 by 2020 (Malaysian Institution of Road Safety Research,
Table 1
Trauma and Negative Life Events Based on Type of Exposure and Gender, Statistical Gender Differences Based on Pearson
Chi-Square Analyses (N 1,016)
Direct exposure Indirect exposure
(n638) (%)
(n378) (%)
(n638) (%)
(n378) (%)
Traffic accident 21 34.9 23.79
37.1 35.4 .30
Other serious accidents 3.4 7.4 7.95
18.2 22.5 2.77
Physical assault/violent attack 2.5 6.3 9.26
7.4 16.4 20.23
Rape .9 1.3 .32 4.2 5 .35
Witnessed other people injured/killed 4.9 10.1 10.12
9.7 13.5 3.42
Come close to being injured/killed 2.8 7.1 10.47
5.3 10.3 8.86
Threatened to be beaten 3.3 14.3 41.96
10.3 15.3 5.54
Near-drowning 26.8 29.1 .62 11.9 12.4 .06
Attempted suicide 5.3 3.7 1.39 6.1 8.2 1.61
Robbery/theft 2.7 4.5 2.47 11.4 16.4 5.07
Pregnancy/abortion .9 0 3.58, p.059 7.7 8.2 .089
Serious illness 12.4 21.2 13.87
23.5 23.3 .01
Death of someone close 39.8
31.5 7.09 32.1 26.5 3.64
Divorce 4.1 3.2 .54 16.3 15.1 .27
Sexual abuse .9 1.1 .03 2.8 5.3
Physical abuse 2.8 5.8
6.6 8.5 1.25
Severe childhood neglect 3.6 3.2 .13 6.3 7.9 1.03
Humiliation (bullying) 11.3 17.2
11.8 14.8 1.98
Absence of a parent 7.5 5.8 1.07 10.3 12.4 1.05
Other trauma 1.7 3.2 2.26 .3 2.4
Note. Total percentage is not 100 because the percentage presented in each cell is the percentage within participant’s gender.
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2012). Other recent reports show that Malaysia ranks 8th in road
fatalities worldwide (Sivak & Schoettle, 2014). The high fre-
quency of road accidents in Malaysia would appear to explain why
adolescents report this TE more widely than their global peers.
Total number of TEs was significantly correlated with PTSD
symptoms, corroborating previous studies among adolescents
(Elklit, 2002; Elklit & Petersen, 2008; Kessler et al., 1995). Fre-
quency of trauma serves as a major risk factor for PTSD, regard-
less of the type of TE. This finding indicates the need for imme-
diate intervention programs among those with multiple TEs, even
if the types of TE may individually seem less significant. From
researchers’ clinical experience and field study, many of our
surveyed adolescents did not recognize the impact of trauma
experience on their mental health.
Significant gender differences in types of TE were found, with
male adolescents having significantly more TE to violence, acci-
dents, and humiliation, and female adolescents having signifi-
cantly higher rates of experiencing death of someone close. Pre-
vious studies found similar results. Breslau and Anthony (2007)
reported that men experienced more assaultive violence than
women. Elklit and Petersen (2008) found female adolescents more
likely to report family-related events such as death of someone and
absence of a parent, and male adolescents more likely to be
exposed to traffic accidents, threats, and coming close to being
injured or killed (Elklit & Petersen, 2008). However, humiliation
is a TE that has not been significantly gendered in previous studies
and deserves further attention in the Malaysian context.
There were no significant gender differences in PTSD symp-
toms among adolescents in the present study. The apparent dis-
crepancy may be explained in part by a study conducted by Benoit,
Lacourse, and Claes (2013), describing the onset of psychological
disorder among genders as based on level of puberty status and
timing, especially in late adolescence. In the present study, nearly
half (49.1%) of the participants were in early adolescence (aged
13–14) and another half was in mid-adolescence (aged 15–17).
Further investigation on the influence of trajectories of puberty
over time with PTSD symptoms may be appropriate here.
The present study found that certain TEs, namely violent attack,
beating, attempted suicide, and humiliation, were associated with
significantly greater risk for PTSD symptoms. Previous studies
have linked violent attack and self-inflicted TE (e.g., attempted
suicide) to greater likelihood of exhibiting PTSD symptoms
(Elklit, 2002; Petersen, Elklit, & Olesen, 2009). The risk from
traumatic exposure to humiliation may be explained by a study
showing overwhelming feelings of shame serve as a moderator for
PTSD onset and its persistence into adulthood (Andrews, Brewin,
Rose, & Kirk, 2000).
Limitations and Future Study
One caveat of this study is the potential for response bias. The
results in the study were all based on adolescent self-reports. It is
unavoidable that there might be some memory bias and lack of
willingness to share traumatic experiences. The ability to express
and recognize one’s own feelings while recalling an awful expe-
rience, and the stability of the adolescent emotional state in gen-
eral, were some uncertain factors in this study. However, some
participants reported that this study provided them the opportunity
to express and understand their emotions, facilitating their mental
well-being. Furthermore, Hulme (2004) argued that self-reported
retrospective data were applicable and comparable with the cor-
roborating data of victimization and etiology of PTSD.
Although the instruments used in this study have not yet been
validated in Malaysia, the HTQ was originally designed to mea-
sure refugees in South-East Asia and has been validated with other
South-East Asian populations (Mollica et al., 1992; Smith Fawzi et
al., 1997). The scoring of HTQ in the present data was calculated
manually depending on DSM–5 algorithm. Given the broad cul-
tural similarities in the Association of Southeast Asian Nations
(ASEAN) region, the authors are optimistic about their use in
Malaysia. A pilot study with a smaller sample of adolescent
participants has been conducted and showed that the instruments
used in the present study were appropriate (Ghazali, Elklit, Balang,
Sultan, & Kana, 2014).
In summary, this study supports previous studies and fills a void
in evidence on the prevalence of TE and PTSD symptoms among
Malaysian adolescents and the ASEAN region by extension. The
findings highlight the importance of assessing trauma exposure
and PTSD symptoms during routine mental health screening of
adolescents. It is strongly hoped this data will allow federal mental
health promotion and intervention programs to focus more re-
sources on the adolescents who need it most.
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Received February 19, 2016
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Accepted August 12, 2016
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... Walaupun program seumpama itu turut menunjukkan keberkesanan yang signifikan namun, adalah lebih baik jika intervensi yang diberi mempunyai fokus dan objektif kepada mangsa buli supaya kaunselor tidak terlepas pandang akan isu-isu kesihatan mental khususnya masalah kesihatan mental PTSD di kalangan mereka.Di samping itu, pengkaji percaya ketidakpastian responden berkaitan isu kesihatan mental PTSD yang berisiko dialami oleh mangsa buli ini berkemungkinan berlaku kerana kurangnya pendedahan berkenaan PTSD mangsa buli baik dari segi pelaksanaannya di peringkat sekolah mahupun bersifat global di Malaysia. Bahkan di luar negara kajian tentang buli di persekitaran sekolah dan PTSD masih baru dan kurang dikaji(Idsoe et al., 2012).Di Malaysia, kajian PTSD ada dilakukan namun ruang lingkup kajian masih terhad(Siti Raudzah, Elklit, Sultan, Balang & Chen, 2017). Kebanyakan objektif kajian lebih memfokus kepada situasi traumatik lain yang boleh memberi impak PTSD seperti kanser, kematian mengejut, penderaan seksual dan AIDS (Geshina Ayu & Nadiah Syariani, 2015), lemas, kematian ahli keluarga dan kemalangan kereta (Siti Raudzah, Elklit, Balang, Sultan & Kana 2014), penganiayaan kanak-kanak, simptom PTSD dan kemurungan di kalangan remaja nakal(Siti Raudzah, Chen & Hafizah, 2018). ...
Mangsa buli di sekolah berisiko tinggi untuk mengalami isu Gangguan Stres Pasca Trauma (PTSD). Pelbagai risiko isu psikologikal mendatang seperti penyalahgunaan bahan serta kecenderungan membunuh diri boleh berlaku jika tidak ditangani. Ekoran daripada itu, penglibatan kaunselor dan guru bimbingan kaunseling diharapkan dapat membendung gejala PTSD ini dengan memberi intervensi awal kepada mangsa buli yang mengalami trauma. Justeru, satu kajian tinjauan analisis keperluan telah dilaksanakan bagi mengenal pasti persepsi kaunselor terhadap isu PTSD mangsa buli. Seramai 161 orang kaunselor dari pelbagai institusi telah terlibat dalam kajian ini melalui teknik Pensampelan Mudah. Kaedah pengumpulan data melalui borang soal selidik telah diedarkan secara atas talian menggunakan aplikasi ‘Google Form’. Data kuantitatif dianalisis menggunakan analisis deskriptif melalui analisis kekerapan dan peratusan. Dapatan kajian menunjukkan bahawa tahap kesedaran kaunselor tentang isu PTSD mangsa buli berada di tahap baik (87.6%). Namun begitu, kesedaran dan pengetahuan kaunselor kurang terhadap isu-isu psikologikal mendatang serta kurang berkemahiran dalam membina intervensi kaunseling yang sesuai. Oleh itu, satu tindakan bagi menerapkan kesedaran, pengetahuan dan kecekapan kemahiran tentang PTSD mangsa buli di kalangan kaunselor khususnya di peringkat sekolah perlu dilaksanakan supaya mangsa buli tidak dipinggirkan tetapi dibantu agar mereka dapat mencapai psikologi yang sejahtera. Victims of bullying in schools are at high risk for Post-Traumatic Stress Disorder. Various psychological issues such as substance abuse as well as suicidal tendencies can occur if left untreated. As a result, the involvement of counselors and counseling guidance teachers is seen as important to curb the symptoms of PTSD by providing early intervention to victims who are traumatized. Thus, a quantitative needs assessment survey was conducted to obtain preliminary information on counselors’ perceptions of PTSD symptoms among adolescents victims of bullying. A total of 161 counselors from various institutions were involved in this research through Convenience Sampling. Data collection methods through questionnaires have been distributed online using the Google Form application. Quantitative data were analyzed by frequency counts and percentage analysis. The findings of the study show that the level of counselor awareness on the issue of PTSD victims of bullying is at a good level (87.6%). However, their awareness and knowledge on the risk of psychological issues is lacking and they are less competent in constructing appropriate trauma counseling interventions.Thus, an action to inculcate competency skills and awareness towards PTSD of bullying victim among school counselors should be implemented upon in uplifting the victims’ psychological well being .
... NLEs such as the death of a family member, divorce, or moving to a new school or city, have the potential to substantially impact an adolescent's life because the behaviors adopted to cope with them may continue well past the actual event (Kuh, Ben-Shlomo, Lynch, Hallqvist, & Power, 2003). NLEs have been significantly associated with health risk behaviors and psychiatric symptoms in youth, particularly depression and anxiety (Call & Nonnemaker, 1999;Ge, Lorenz, Conger, Elder, & Simons, 1994;Ge, Natsuaki, & Conger, 2006;Mackin, Perlman, Davila, Kotov, & Klein, 2017;Natsuaki et al., 2007;Stikkelbroek, Bodden, Kleinjan, Reijnders, & van Barr, 2016), suicidal thoughts and behaviors (Daniel, Goldston, Erkanli, Heilbron, & Franklin, 2016;Mackin et al., 2017), smoking (Byrne, Byrne, & Reinhart, 1995;Cheney, Oman, Vesely, Aspy, & Tolma, 2014;Simantov et al., 2000;Siqueira, Diab, Bodian, & Rolnitzky, 2000), alcohol abuse (Lloyd & Turner, 2008) and use of marijuana, cocaine, nonmedical use of prescription drugs, other drugs (Carliner et al., 2016;King & Chassin, 2008;Wills, Sandy, Yeager, Cleary, & Shinar, 2001), increased risk of PTSD (Ghazali, Elklit, Sultan, Balang, & Chen, 2016) and changes in BMI (Elsenburg, Smidt, & Liefbroer, 2016). Single life events associated with health risk behaviors include moving, negative events at school, people moving in and out of the home, losing a close friend and conflict with family and peers (Booker, Gallaher, Unger, Ritt-Olson, & Johnson, 2004;Flouri & Kallas, 2007;Karcher & Finn, 2005;Kirby, 2002;Pederson, Koval, McGrady, & Tyas, 1998). ...
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The prospective associations between negative life events (NLEs) and adolescent alcohol use was examined using the Youth Asset Study Participants (n=1040 adolescents, mean age = 15.8 years) completed annual interviews which included a life events scale and alcohol use in the last 30 days. Family structure and parent education were assessed as confounders. For the youngest group, each NLE increased the odds of alcohol use the next year compared to those with no events (ORs 1.66, 2.43, 2.65). For the middle age group, one or more NLEs doubled the odds of alcohol use the next year (ORs 2.01, 2.03, 2.05). A simple life events checklist can be a useful tool to assess an increased risk of future alcohol use in adolescents. © 2018 American Alcohol and Drug Information Foundation (Lansing). All rights reserved.
Potentially traumatic events (PTEs), such as natural disasters, sexual assault, and child abuse, are frequent occurrences throughout the world and take a tremendous psychological toll on individuals and communities. In this chapter, we present the global public health burden posed by PTE exposure. To accomplish this goal, we review the global prevalence and distribution of PTEs and trauma-related disorders from epidemiologic studies. Epidemiology is the cornerstone of public health and is the study of the distribution and determinants of disease in human populations and the application of this study to control health problems. Epidemiological studies provide empirical evidence on the high prevalence of PTEs and the devastating effects of trauma-related disorders and have shown that PTEs are not equally distributed across populations. When presenting the results, we highlight methodological considerations that make cross-study comparisons difficult. Finally, we discuss public health approaches to addressing PTEs and trauma-related disorders. Trauma exposure is a major public health concern worldwide and its prevention and treatment should be prioritized.
Trauma researchers often make claims about the severity of posttraumatic stress disorder (PTSD) across populations, and yet cross-cultural measurement invariance (MI) is rarely assessed. Nine youth samples with Harvard Trauma Questionnaire (HTQ) responses were grouped based on sampling strategy used into two sets: representative (Denmark, the Faroe Islands, Iceland, and Lithuania, n = 1,457), and convenience (Greenland, India, Kenya, Malaysia, and Uganda, n = 2,036). Confirmatory factor analysis (CFA) was used to gauge whether configural, metric, scalar, and residual invariance of different models held between national samples within the two sets. Configural invariance held for most PTSD models in convenience samples, not in representative samples. Metric invariance was less common, and scalar and residual in general did not hold. Cultural similarity between samples seemed to be associated with invariance. Findings suggest that although PTSD symptoms may cluster similarly across culturally distal groups, comparisons of the severity of symptoms using the HTQ across adolescent samples are not likely valid.
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There are no valid and reliable cross-cultural instruments capable of measuring torture, trauma, and trauma-related symptoms associated with the DSM-III-R diagnosis of posttraumatic stress disorder (PTSD). Generating such standardized instruments for patients from non-Western cultures involves particular methodological challenges. This study describes the development and validation of three Indochinese versions of the Harvard Trauma Questionnaire (HTQ), a simple and reliable screening instrument that is well received by refugee patients and bicultural staff. It identifies for the first time trauma symptoms related to the Indochinese refugee experience that are associated with PTSD criteria. The HTQ's cultural sensitivity may make it useful for assessing other highly traumatized non-Western populations.
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Background: Indian adolescents are presumably exposed to a range of potentially traumatizing and negative life events. However, the knowledge on this area is relatively sparse. The present study aims to investigate the prevalence of exposure to potentially traumatizing and negative life events and the occurrence of Posttraumatic Stress Disorder (PTSD) among a specific sample of Indian adolescents. Method: A sample of 411 Indian 9th graders, (M = 14.15 years) from two private schools in Pune City answered a questionnaire about 1) socio-demographical background and 2) the direct or indirect exposure to 20 specific, potentially traumatizing and negative life events. Also, they filled out Part IV of the Harvard Trauma Questionnaire (HTQ-IV) to assess their level of PTSD-symptoms. Results: 70% of the females and 85% of the males had been exposed to or witnessed at least one traumatizing or negative life event. The mean number of experienced events was 2.5. The most common events were: death of someone close, traffic accidents, serious illness, witnessing the injury or killing of others, and coming close to being injured or killed. The prevalence of PTSD was 10%. Males reported higher direct as well as indirect exposure than females to all events, while no significant gender difference was found in the prevalence of PTSD. Living in a single-parent household meant increased risk of developing PTSD. Conclusion: Exposure to potentially traumatizing events was comparable to that seen in similar studies in Western European youth samples. Prevalence of PTSD was also in the same range. This may be attributable to a number of protective factors associated with the specific sample. Males were exposed to more potentially traumatizing events than females, but contradictory to most other studies, no gender difference in prevalence of PTSD was seen. These differences in comparison to earlier studies might reflect cultural and national circumstances that distinguish this Indian sample from Western European countries previously investigated.
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Youth in secure juvenile justice settings (e.g., detention, incarceration) often have histories of complex trauma: exposure to traumatic stressors including polyvictimization, life-threatening accidents or disasters, and interpersonal losses. Complex trauma adversely affects early childhood biopsychosocial development and attachment bonding, placing the youth at risk for a range of serious problems (e.g., depression, anxiety, oppositional defiance, risk taking, substance abuse) that may lead to reactive aggression. Complex trauma is associated with an extremely problematic combination of persistently diminished adaptive arousal reactions, episodic maladaptive hyperarousal, impaired information processing and impulse control, self-critical and aggression-endorsing cognitive schemas, and peer relationships that model and reinforce disinhibited reactions, maladaptive ways of thinking, and aggressive, antisocial, and delinquent behaviors. This constellation of problems poses significant challenges for management, rehabilitation, and treatment of youth in secure justice settings. Epidemiological and clinical evidence of the prevalence, impact on development and functioning, comorbidity, and adverse outcomes in adolescence of exposure to complex trauma are reviewed. Implications for milieu management, screening, assessment, and treatment of youth who have complex trauma histories and problems with aggression in secure juvenile justice settings are discussed, with directions for future research and program development.
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This longitudinal study examined personal-accentuation and contextual-amplification models of pubertal timing. In these models, individual and contextual risk factors during childhood and adolescence can magnify the effects of early or late puberty on depression symptoms that occur years later. The moderating role of prepubertal individual factors (emotional problems in late childhood) and interpersonal factors (deviant peer affiliation, early dating, perceived peer popularity, and perceived parental rejection during adolescence) were tested. A representative sample of 1,431 Canadian adolescents between 10-11 and 16-17 years of age was followed biannually. In line with the personal-accentuation model, early puberty has been shown to be a predictor for depression in both girls and boys who presented emotional problems in childhood. This effect was also noted for late maturing boys. Consistent with the contextual-amplification model, early puberty predicted later depression in youth who perceived greater parental rejection. Interpersonal experiences such as early dating in girls and deviant peer affiliation in boys predicted depression in early maturers as well. For girls, early dating was also found to be amplified by childhood emotional problems. In line with biopsychosocial models, results indicate that the effect of pubertal timing on depressive symptoms must be conceptualized through complex interactions between characteristics of adolescents' interpersonal relationships and prepubertal vulnerabilities.
Background: Data were obtained on the general population epidemiology of DSM-III-R posttraumatic stress disorder (PTSD), including information on estimated lifetime prevalence, the kinds of traumas most often associated with PTSD, sociodemographic correlates, the comorbidity of PTSD with other lifetime psychiatric disorders, and the duration of an index episode.Methods: Modified versions of the DSM-III-R PTSD module from the Diagnostic Interview Schedule and of the Composite International Diagnostic Interview were administered to a representative national sample of 5877 persons aged 15 to 54 years in the part II subsample of the National Comorbidity Survey.Results: The estimated lifetime prevalence of PTSD is 7.8%. Prevalence is elevated among women and the previously married. The traumas most commonly associated with PTSD are combat exposure and witnessing among men and rape and sexual molestation among women. Posttraumatic stress disorder is strongly comorbid with other lifetime DSM-III-R disorders. Survival analysis shows that more than one third of people with an index episode of PTSD fail to recover even after many years.Conclusions: Posttraumatic stress disorder is more prevalent than previously believed, and is often persistent. Progress in estimating age-at-onset distributions, cohort effects, and the conditional probabilities of PTSD from different types of trauma will require future epidemiologic studies to assess PTSD for all lifetime traumas rather than for only a small number of retrospectively reported "most serious" traumas.
Objective The objective of this study is to determine the prevalence of lifetime exposure to traumatic events and its relation to PTSD symptoms. Methods Participants were randomly selected from several schools located in the city of Kuching. There were 85 adolescents participating in this study, with ages ranging from 13 to 14 years old, of whom 31% (n = 26) were males and 69% (n = 59) females. The Child Posttraumatic Stress Index-Revised, The Harvard Trauma Questionnaire and a lifetime trauma checklist were used in this study. Results Results showed that 77.6% of participants were exposed to at least one lifetime trauma. The most frequently reported traumas were road accident (20.1%), death of a family member (19.7%), and almost drowning (10%). There was more indirect trauma than direct trauma exposure. Males were more likely to be involved in traumatic events than females. Results showed that 7.1% (6) exhibited PTSD symptoms. There was no significant difference in the mean score of CPTS-RI between genders and among ethnic groups. Total exposure to traumatic events was significantly correlated with PTSD symptoms. Conclusion Findings suggest that number of lifetime traumatic events was quite high and multiple exposures to traumatic events were significantly related to PTSD symptoms.
We examined the frequency and impact of exposure to potentially traumatic events in a nonclinical sample of older adults (N = 3,575), a population typically underrepresented in epidemiological research concerning the prevalence of traumatic events. Current posttraumatic stress disorder (PTSD) symptom severity and the centrality of events to identity were assessed for events nominated as currently most distressing. Approximately 90% of participants experienced one or more potentially traumatic events. Events that occurred with greater frequency early in the life course were associated with more severe PTSD symptoms compared to events that occurred with greater frequency during later decades. Early life traumas, however, were not more central to identity. Results underscore the differential impact of traumatic events experienced throughout the life course. We conclude with suggestions for further research concerning mechanisms that promote the persistence of posttraumatic stress related to early life traumas and empirical evaluation of psychotherapeutic treatments for older adults with PTSD.
Objective Exploring the relationship of exposure to a traumatic event and the subsequent onset of posttraumatic stress disorder (PTSD) in the population. Methods Posttraumatic stress disorder was assessed using the Impact of Event Scale (IES), Posttraumatic Diagnostic Scale (PDS) and interview data. Logistic regression analyses with sex, age, marital status, educational level and traumatic event characteristics were performed. Prevalences were standardised to the sex and age distribution of the German population. Results A total of 41 % of the subjects reported exposure to a trauma, leading to full PTSD in 1.7 % and to partial PTSD in 8.8 % of the participants. Logistic regression revealed accidents (OR 2.5, 95 % CI 1.3–4.7), nonsexual assault by known assailants (4.5, 2.1–9.8), combat/war experiences (5.9, 2.0–17.4), life-threatening illness (4.9, 2.7–8.9) and interpersonal conflicts (15.5, 2.5–96.0) as risk factors for full PTSD; risk factors for partial PTSD were accidents (3.2, 2.4–4.3), sexual (4.6, 2.2–9.6) or nonsexual (2.3, 1.4–3.8) assault by known assailants, life-threatening illness (6.2, 4.6–8.3), death of relatives (5.0, 3.2–7.8) and interpersonal conflicts (22.0, 8.3–58.1). Conclusions Of subjects exposed to traumatic events, only a minority developed PTSD indicating a relationship between characteristics of the exposure and the individual and the onset of PTSD.
The present study examined the impact of the developmental timing of trauma exposure on posttraumatic stress disorder (PTSD) symptoms and psychosocial functioning in a large sample of community-dwelling older adults (N = 1,995). Specifically, we investigated whether the negative consequences of exposure to traumatic events were greater for traumas experienced during childhood, adolescence, young adulthood, midlife, or older adulthood. Each of these developmental periods is characterized by age-related changes in cognitive and social processes that may influence psychological adjustment following trauma exposure. Results revealed that older adults who experienced their currently most distressing traumatic event during childhood exhibited more severe symptoms of PTSD and lower subjective happiness compared with older adults who experienced their most distressing trauma after the transition to adulthood. Similar findings emerged for measures of social support and coping ability. The differential effects of childhood compared with later life traumas were not fully explained by differences in cumulative trauma exposure or by differences in the objective and subjective characteristics of the events. Our findings demonstrate the enduring nature of traumatic events encountered early in the life course and underscore the importance of examining the developmental context of trauma exposure in investigations of the long-term consequences of traumatic experiences. (PsycINFO Database Record (c) 2013 APA, all rights reserved).