Trauma Exposure and PTSD among Older Adolescents in Foster Care

Purpose: To document trauma exposure and PTSD prevalence among adolescents in foster care, focusing on various trauma types beyond maltreatment.
Method: Analyzed data from 732 foster care adolescents aged 17–18 using Composite International Diagnostic Interview for PTSD assessment; logistic regression for statistical comparisons.
Results: Most respondents experienced at least one trauma; males faced more interpersonal and environmental traumas, females faced more sexual traumas; PTSD diagnoses tied to rape, torture, and molestation.
Conclusions: High rates of PTSD in this group indicate a need for trauma-informed services as they transition to independence.

Context: Youth entering foster care often face physical abuse, sexual abuse, or neglect, indicating potential vulnerability to trauma.
Prior Research:
- 30% of foster care alumni met lifetime PTSD criteria, compared to 7.6% in general population.
- In two studies, lifetime PTSD prevalence in older youth (17–18) was noted at 14% and 16%, versus 6-7% in their general counterparts.

Research on trauma in foster youth often focuses narrowly on maltreatment.
Over 30% of older adolescents in foster care reported experiencing trauma outside abuse.
Studies found a variety of traumas, such as witnessing violence, which may contribute to a comparative risk for PTSD.
Notable Findings:
- Girls experience higher rates of sexual trauma.
- Certain traumas (e.g., rape, sexual assault) significantly correlate to PTSD diagnostic criteria.

Sample: 732 adolescents (51.5% female, 48.5% male) aged 17 (59.0%) or 18 (41.0%).
Recruitment: Youth in out-of-home care for at least one year, excluding those unable to participate due to developmental issues or incarceration.
Assessment Tool: Composite International Diagnostic Interview (CIDI) for trauma and PTSD diagnosis.

Overall: 80.3% experienced at least one DSM-qualifying trauma; 61.7% experienced two or more.
Types of Trauma Reported:
- Indirect traumas (54.5%) and interpersonal violence (50.1%) most prevalent.
- Common traumas include:
- Witnessing injury or death (40.4%)
- Physical attacks (30.3%)
- Victims of molestation (27.2%)
- Kidnappings or threats with weapons (26.5%)

Findings:
- Trauma prevalence similar across genders, but with significant type differences:
- Males (1.4 times more) faced interpersonal violence and environmental trauma.
- Females (3.2 times more) experienced sexual trauma.

Findings:
- Caucasians had higher overall trauma exposure (85% vs. 76.5% of African-Americans).
- Higher trauma categories for Caucasians included sexual trauma whereas African-Americans reported higher instances of sub-DSM trauma.

Trauma and PTSD Association: Rape had the strongest correlation with lifetime PTSD diagnosis (39.7%). Other notable associations:
- Torture/victimization (45.2%)
- Molestation (32.8%)
- Overall, experiencing multiple traumatic events (22.5%) significantly raises the likelihood of PTSD compared to experiencing one event (6.7%).

Findings Summary: Higher trauma exposure in foster youth compared to peers and higher PTSD prevalence (18.8% vs. 8.8% in urban youth).
Gender Implications: Notable difference in types of trauma adds to the understanding of mental health needs; females disproportionately affected by sexual trauma.
Racial Implications: Differential exposure patterns suggest deeper socio-economic issues impacting African-American youth.
Study Limitations: Retrospective assessment introduces potential inaccuracies in reporting trauma and PTSD; sample may not represent all youths impacted by the child welfare system.

Policies should address the specialized needs for trauma-related services for youth aging out of foster care, ensuring access to mental health care to help during their transition.

Study supported by various stakeholders including the Illinois, Wisconsin, and Iowa Departments of Human Services, and a grant from the National Institute of Mental Health.