Cumulative Effect of Multiple Trauma on Symptoms of Posttraumatic Stress Disorder, Anxiety, and Depression in Adolescents

Compr Psychiatry. Mar-Apr 2009;50(2):121-7. doi: 10.1016/j.comppsych.2008.06.006. Epub 2008 Aug 23.


Background: Recent literature has indicated that exposure to multiple traumatic events in adults is associated with high levels of posttraumatic stress disorder (PTSD), anxiety, and depression. Against the backdrop of stressful life events and childhood abuse and neglect, we investigated the cumulative effect of multiple trauma exposure on PTSD, anxiety, and depression in an adolescent sample.

Method: One thousand one hundred forty 10th-grade learners from 9 Cape Town (South Africa) schools completed questionnaires on stressful life experiences; trauma exposure; and symptoms of anxiety, depression, and PTSD. Our population of interest for this study was adolescents between the ages of 14 and 18 years who had been exposed to serious, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, qualifying traumatic events. The final sample size was thus 922.

Results: Rates of trauma exposure, PTSD, depression, and anxiety were high. Controlling for sex, stressful life experiences in the past year, and childhood adversity, we found an effect of cumulative trauma exposure effect on PTSD and depression, with an increase in the number of traumas linearly associated with an increase in symptoms of PTSD (F((4,912)) = 7.60, P < .001) and depression (F((4,912)) = 2.77, P < .05). We did not find a cumulative effect on anxiety.

Conclusion: Our findings indicate that adolescents exposed to multiple traumas are more likely to experience more severe symptoms of PTSD and depression than those who experience a single event, with this effect independent of childhood adversity and everyday stressful life experiences. Exposure to multiple trauma, however, does not seem to be associated with more severe anxiety symptoms.

MeSH terms

  • Adolescent
  • Anxiety / epidemiology*
  • Anxiety / psychology
  • Child
  • Child Abuse / psychology
  • Child Abuse / statistics & numerical data
  • Crime / psychology
  • Crime / statistics & numerical data
  • Depression / epidemiology*
  • Depression / psychology
  • Female
  • Humans
  • Life Change Events*
  • Linear Models
  • Male
  • Psychiatric Status Rating Scales
  • Sex Factors
  • South Africa / epidemiology
  • Stress Disorders, Post-Traumatic / epidemiology*
  • Stress Disorders, Post-Traumatic / psychology
  • Stress, Psychological / epidemiology
  • Stress, Psychological / psychology
  • Surveys and Questionnaires
  • Wounds and Injuries / epidemiology
  • Wounds and Injuries / psychology