Trauma exposure, posttraumatic stress, and comorbidities in female adolescent offenders: findings and implications from recent studies

Figures & data

Table 1. Studies of Traumatic Exposure (TE) and PTSD in female juvenile offenders

Study	Research	Sample (N)	Measurement	Major findings
Abram et al. ( 2007)	Prevalence of PTSD and co-morbid psychiatric disorders among incarcerated juveniles	USA, IllinoisSample (360)Age: M=14.8,SD = 1.4	DISC-IV	Reported PTSD prevalence: 14.7%; among those females diagnosed with PTSD, 82% had at least one comorbid disorder; most commonly reported comorbidity: SUD (63%)
Abrantes, Hoffmann, and Anton (2005)	Prevalence and severity of co-occurring disorders in two juvenile detention centers	USA, MaineSample (34)Age: M=16.3,SD = 1.1	PADDI	In the sample TE i.e., abuse, was reported by >70% of females: emotional—50%, sexual—44%. Reported prevalence: PTSD—35% (subclinical—23%), SUD—72%, MDD—65%. Assessed suicidal ideation among participants—58%; attempts—38%
Ariga et al. ( 2008)	Extent of TE, prevalence of PTSD, and comorbidity in the sample of incarcerated juvenile females	JapanSample (64)Age: M=17.2,SD = 1.0	CAPS; DSD; IES-R; MINI-KID	TE found in 76.5% of females; most participants described poly-traumatization: sexual abuse—54.7%, maltreatment—32.8%, victim of violence—45.3%, exposure to traumatic news—32.8%, PTSD prevalence—32.8%. Found high comorbidity: mood disorders, anxiety, anorexia, bulimia, SUD, etc.
Barnett ( 2004)	Prevalence of PTSD symptomatology in incarcerated adolescent females vs. high school students	USA, CaliforniaSample/Control (65 + 47)Age M=16.8SD = 1.6	ATS; IES-R	Repeated TE to more violent poly-victimization may be a factor in higher IES scores in incarcerated females. Common PTSD precipitating events: threatened with a weapon, seeing a loved one die, being physically abused, being raped, being robbed
Cauffman, Feldman, Waterman, and Steiner (1998)	PTSD among incarcerated juvenile females	USA, CaliforniaSample (96)Age M=17.2SD = 1.8	PDI-R; WAI	Reported PTSD prevalence—48.9%, subclinical—11.7%. Assessed lifetime PTSD symptomatology in >65% of females. Poly-TE included: witnessing severe injury, or someone being killed—76%, badly hurt, or in danger—74%, raped, or in danger—60%
Cernkovich et al. ( 2008)	Predicting adolescent and adult antisocial behavior among high-risk delinquent females; longitudinal study	USA, OhioSample (109)Age M 1=16.7Age M 2=29.7	CTS-R	Serious adult criminology correlates with sexual and physical abuse during childhood and adolescence: TE to sexual abuse increased the likelihood of serious adult offending by 264–344%, whereas TE to physical abuse: between 579 and 605%
Chapman and Ford ( 2008)	Suicidal ideation in incarcerated youth: relation to substance use and TE	USA, ConnecticutSample (235)Age M=14.3SD = 1.1	MAYSI-2; SIQ	Endorsed TE in the sample: 2.92 types per participant (e.g., something terrible happened, severe injury, rape, or witnessing violence). Traumatic stress significantly increased risk of suicide: reports of posttraumatic intrusive re-experiencing, inter-personal sensitivity, etc. correlated with suicidality
Chauhan and Reppucci ( 2009)	Racial differences in the impact of neighborhood disadvantage, exposure to violence and criminal recidivism	USA, VirginiaSample (122)Age M=16.8SD = 1.3	CVM; CTS	African American females were more likely than Caucasians to live in impoverished areas, but both races reported similar levels of TE (e.g., parental and peer abuse, witnessing violence, etc.). Established associations with recidivism: community TE for African American participants and parental physical abuse for Caucasians
Chitsabesan et al. ( 2006)	Effectiveness of mental screening of female juvenile offenders	England and WalesSample (69)Age M=15.7SD = 1.3	SNASA; WASI; WORD	Reported prevalence: PTSD—19%, self-harm—17%, depression—35%. In the sample, various mental health needs were unmet. Educational, social (peer and family) and substance abuse are lowered during incarceration, re-emerging upon release
Cruise, Marsee, Dandreaux, and DePrato (2007)	Prevalence and severity of co-occurring disorders in two juvenile detention centers	USA, LouisianaSample (145)Age M=15.3SD = 1.7	MAYSI-2; TSCC	Undiagnosed females scored lower on anger, suicidality, and TE than those with high mental health symptoms (33.8%) and comorbidity (19.3%). Diagnosed females were seven times more likely to report physical abuse, and twice as likely sexual
DeLisi et al. (2010)	Link between early life exposure to violence and victimization in regards to the cycle of violence in incarcerated youth	USA, CaliforniaSample (153)Age M=16.9SD = 1.1	MAYSI-2	Incarcerated females exhibited similar levels and types of psychopathology and TE, as males. Once incarcerated, youth with greater exposure to early trauma evinced more sexual and total misconduct, with females showing greater levels of suicidality
Dembo and Schmeider (2003)	Classification of incarcerated youth based on personal characteristics, TE, substance use, and mental health	USA, FloridaSample (142)Age M=14.5SD = 1.6	CTS-R, adapted; SCL-90-Revised	High-level delinquency correlated to elevated TE (i.e., physical abuse). Every 3rd female was a sexual victim. Self-reported drug users experienced more family and mental health problems than low-level delinquents/drug users, high-level delinquents, and hair-test identified marijuana/cocaine users
Dixon, Howie, and Starling (2004)	Psychopathology in incarcerated adolescent females in relationship to SES, mental health status, family, and trauma variables	Australia, SydneySample/Control (100 + 100)Age M=16.5SD = 1.2	FACES-II; K-SADS-PL	Incarcerated sample exhibited high prevalence of disorders (PTSD—20%, past—17%, SUD—85%, depression—33%, CD—91%) and comorbidity of 3 or more diagnoses in 78%. Results: higher TE in incarcerated females than in the control group (e.g., witnessing a violent crime—70 vs. 30%)
Goldstein et al. ( 2003)	Comorbidity of psychiatric disorders in incarcerated adolescent females	USA, MassachusettsSample (232)Age M=16.1	MACI; MAYSI-2; CBCL-YSR	Reported prevalence in the sample: anxiety disorder—56.3%, depression—63%, SU—71.7%, suicidal ideation—36.6%. Characteristic TE: rape—44%, and witnessing someone being killed—52%
Gore-Felton, Koopman, McGarvey, Hernandez, and Canterbury (2001)	Relationship between abuse, emotional (internalizing), and behavioral (externalization) problems in incarcerated youth	USA, Southern StateSample (133)Age M=15.8SD = 1.3	YSR	Females were likely to internalize their problems and emotional abuse, reporting withdrawal, somatization, anxiety, and depression. Externalization (e.g., substance use, delinquency, aggression) was correlated with physical (e.g., excessive hitting with objects) and sexual abuse
Gover ( 2004)	Assessment of childhood sexual trauma among incarcerated youth, in regards to gender and depression	USA, NationalSample (206)Age: 15.7SD = 1.4	JI, integrated in a survey	Females were significantly more likely than males to have a history of childhood sexual abuse (t = –7.96, p < 0.01), with reported prevalence of 37.5% in females vs. 8.4% in males. Females were significantly more depressed than males: depression recorded at 3.4 in females vs. 3.08 for males
Jaycox, Ebener, Damesek, and Becker (2004)	PTSD, TE, and psycho-social functioning in youth referred from the juvenile justice system to drug treatment centers	USA, NationalSample (42)Age M=16.5SD = 1.6	CPTSD-I; PYLS; TEQ; YSR	Reported TE in females: overall—68%, sexual, i.e., touched sexually without consent—35.7%, sexually attacked—33.3%, natural disasters—19%. More than 1/3 of the females have had both TE and PTSD vs. 18% of males in the sample
Karnik et al. ( 2009)	Prevalence of mental disorders in juvenile offenders after 9 months of incarceration	USA, CaliforniaSample (140)Age M=16.8SD = 1.2	SCID-IV; DICA	Excluding CD and ODD, 92% of females met criteria for at least one psychiatric disorder, including: PTSD—13%, SUD—84%, anxiety—55%, mood—32%, etc. Comorbidity of 3 or more diagnoses was established in 86% of the sample
Kenny and Nelson ( 2008)	Examination of health, welfare, and criminogenic needs in young offenders on community-based orders	Australia, South WhalesSample (120)Age M=16.8SD = 1.3	APS-SF; K-10; CTQ	Reported PTSD prevalence—45% (moderate—28%, mild—17%). Moderate TE was found in 45% of the sample, while severe TE in 28%: sexual abuse—22%, emotional—11%, physical—11%. SUD was frequent: severe—44%, mild to moderate—33%
Kerig, Ward, Vanderzee, and Moeddel (2009)	Interrelationship between TE, PTSD, and mental health in juvenile delinquents	USA, MidwestSample (90)Age: 11–18	PTSD-I, CAPS-CA; MAYSI-2	In the female sample, reported PTSD prevalence—45% (clinical) and 21% (subclinical). Key finding—PTSD mediates the relationship between interpersonal trauma & mental health problems, with higher correlation for females than males
Krischer and Sevecke ( 2008)	Early traumatization, violence, and neglect as a significant impact on psychopathology in incarcerated juveniles	GermanySample/Control (89 + 45)Age M=17.3SD = 1.4	CTQ; PCL-YV	The sample of incarcerated adolescent females had elevated scores on all abuse scales, compared to the control group and incarcerated males. Parental criminality and familial breakdown showed highest correlation with psychopathology, whereas emotional neglect was related to antisocial tendencies
Lederman, Dakof, Larrea, and Li (2004)	Characteristics of incarcerated adolescent females	USA, NationalSample (493)Age M=15.2SD = 1.5	DISC; TEQ	TE found in 84% of the participants, who disclosed three types of TE on average, with half of the sample recently witnessing a violent attack. Every fourth female reported sexual abuse. Mental disorders co-morbidity was at 78% (anxiety—59%, SUD—61%)
Leve and Chamberlain ( 2004)	Defining early age-onset pathway of delinquency in serious female juvenile offenders	USA, OregonSample (62)Age M=15.3SD = 1.1	AES-III; CES-D; CSEQ	Familial environment (transitions; injurious punishment, e.g., burns, cuts, broken bones, bruises; sexual abuse), personal characteristics (IQ) and parental criminality were significantly correlated to the first arrest (e.g., biological parent criminality increased the odds of an early arrest from 15 to 283 times)
McReynolds et al. ( 2008)	Assessment of mental disorders in adolescent offenders during an intake at a juvenile detention center prior to adjudicatory incarceration	USA, CaliforniaSample (248)Age: 15.4SD = 1.6	V-DISC	Reported prevalence: anxiety disorders—25.8% (panic—5%, agoraphobia—10.5%, specific phobia—12.9%), separation anxiety—22.8%, MDD—9.4%, PTSD—5.1% (vs. 2.4% in males). Results: higher rates on nearly all components of anxiety and affective disorders in the sample, compared to incarcerated young males, or general population
Mueser and Taub ( 2008)	Correlates and prevalence of PTSD in adolescents with severe psychopathology involved in the multiple service system, including detention	USA, New HampshireSample/Control (26 + 48)Age M=14.1SD = 1.9	CBCL-YSR; ChiPS	Prevalence of PTSD in the incarcerated females sample—42%. Sexual abuse was described as the most distressing event, and was correlated with higher rates of PTSD. Reported TE: sexual abuse—50%, sexual victimization—54%, death of the loved one—50%, witnessed domestic violence—42%
Odgers, Reppucci, and Moretti (2005)	Victimization in the sample of incarcerated adolescent females and investigation of utility of the PCCL-YV	USA, South-EastSample (125)Age M=16.2SD = 1.3	CTS-R; DICA; PCL-YV; YSR	The sample exhibited high comorbidity: >50% met criteria for two or more disorders (PTSD—25%, ADHD—17%, MDD—27%, GAD—25%). Majority of participants reported familial victimization: psychological abuse—88%, physical abuse—53%, domestic violence—36%
Plattner et al. ( 2009)	Gender-specific predictors of re-offending and psychopathology in detained juveniles	Austria, ViennaSample (56)Age M=17.8SD = 1.7	MINI-KID	The sample exhibited high comorbidity of disorders: PTSD—51.8%, SUD—75%, MDD—23.2%, etc. GAD, found in every fourth participant was a predictor for re-offending, whereas dysthymia (16.1%) appeared to serve as a protection
Robertson, Dill, Husain, and Undesser (2004)	Prevalence of psychiatric disorders among incarcerated juvenile offenders in training schools and detention centers	USA, MississippiSample (161)Age M=15.3SD = 1.4	APS	The sample was characterized by high comorbidity and prevalence of disorders: PTSD—41% (mid-to-severe symptomatology), separation anxiety—51.9%, MDD—31%, schizophrenia—30.6%, bulimia—28%, anorexia—17.8%
Ruffalo, Sarri, and Goodkind (2004)	Risks and protective factors for delinquent, diverted, and high-risk adolescent females in home-based, open, and closed residential settings	USA, urban sampleSample/Control1/Control2 (44 + 68 + 47)Age M 1=15.5Age M 2=15.3Age M 3=17.3	CES-D; CTQ; LE/SC	Compared to females in diversion and less restrictive programs, incarcerated females had upsurge in TE and risk factors: lower SES, parental criminality, substance use, familial and school disruptions, sexual abuse, etc. Prevalence in the incarcerated sample: suicidal ideation—31%, depression—80%
Smith, Leve, and Chamberlain (2006)	TE and health-risking sexual behaviors in adolescent females, mandated to out-of-home care by court	USA, OregonSample (88)Age M=15.3SD = 1.1	DISC; CSEQ; TSS	Prevalence of PTSD: full—16%, partial—46%. TE in the sample was 200–300 higher than in general population: sexual or physical—93%, both sexual & physical—63%, sexual abuse before 13 years of age—76%
Suk et al. (2009)	Suicidal ideation and psychopathology in incarcerated youth compared to a general population sample	Belgium, FlandersSample (62)Age M=15.7SD = 1.2	CES-D; CPTS-RI; SRSA, adapted	Suicidal ideation in incarcerated females was at 58.1 vs. 14.4%, recorded in the general population. In the incarcerated sample, the suicidal group scored higher on depression, anxiety and post-traumatic stress than the non-suicidal group
Wood et al. ( 2002)	Prevalence of TE and PTSD in an incarcerated juvenile females sample, compared to a sample of high school students	USA, CASample/Control (100 + 100)Age M=15.8SD = 1.6	AEIII; CES-D; CTS; FES; GII; LASC-RA; PSS-F; SAEQ; SCECV	Nearly as 3X more incarcerated females reported sexual assault or molestation compared to high schoolers. Physical, sexual abuse, and community violence were significant predictors of PTSD in incarcerated females. Prevalence of PTSD: incarcerated—52%; control sample—30%
Yoshinaga, Kadomoto, Otani, Sasaki, and Kato (2004)	Prevalence of PTSD and TE in incarcerated adolescent females	Japan, TokyoSample (45)Age M=17.0SD = 1.5	CAPS, adapted	Prevalence of PTSD (past and current): full—18%, partial—27%. Most of the sample (81%) reported more than one type of TE, describing physical assault, physical abuse, sexual assault, unwilling sexual experience, witness of death, injury, etc.

Notes: ATS, Adolescent Trauma Scale (Berton & Stabb, 1996); CAPS, Clinically Administered PTSD Scale (Blake et al., 1995); DISC, Diagnostic Interview Schedule for Children (Shaffer, Fisher, & Lucas, 2003); DSD, DSM Scale for Depression (Roberts, Roberts, & Chen, 1995); IES, Impact of Event Scale (Horowitz, Wilner, & Alvarez, 1979; Weiss & Marmar, 1997); MINI-KID, Mini-International Neuropsychiatric Interview for Children and Adolescents (Sheehan et al., 1998); PADDI, Practical Adolescent Diagnostic Interview (Estroff & Hoffmann, 2001); PDI-R, Psychiatric Diagnostic Interview—Revised (Othmer, Penick, Powell, Read, & Othmer, 1981); WAI, Weinberger Adjustment Inventory (Weinberger & Schwartz, 1990); CTS-R, Conflict Tactic Scale (Straus, 1979), CTS-R, CTS—revised (Straus & Gelles, 1990); CVM, Community Violence measures (Chauhan & Reppucci, 2009); MAYSI-2, Massachusetts Youth Screening Instrument (Grisso & Barnum, 2000); SIQ, Suicide Ideation Questionnaire (Reynolds, 1987); SNASA, Salford Needs Assessment Schedule for Adolescents (Kroll et al., 1999); WASI, Wechsler Abbreviated Schedule Interview (Psychological Corporation, 1999); WORD, Wechsler Objective Reading Dimension (Psychological Corporation, 1992); FACES-II, Family Adaptability and Cohesion Scale II (Olson, Portner, & Bell, 1982); K-SADS-PL, Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version (Kaufman, Birmaher, Brent, Rao, & Ryan, 1996); MAYSI-2, Massachusetts Youth Screening Instrument (Grisso & Barnum, 2000); SCL-90, Symptom Checklist (Derogatis, 1983); TSCC, Trauma Symptom Checklist for Children (Briere, 1996); CBCL-YSR, Child Behavioral Checklist Youth Self-Report (Achenbach, 1991); CPTSD-I, Children PTSD Inventory (Saigh et al., 2000); JI, Jesness Inventory (Jesness, 1983); MACI, Millon Adolescent Clinical Inventory (Millon, 1993); MAYSI-2, Massachusetts Youth Screening Instrument (Grisso & Barnum, 2000); PYLS, Past Year Life Stressors (Jaycox et al., 2004); TEQ, Traumatic Experience Questionnaire (Jaycox et al., 2004); YSR, Youth Self Report (Achenbach, 1991); APS-SF, Adolescent Psychopathology Scale—Short Form (Reynolds, 1998); CAPS-CA, Clinician Administered PTSD Scale for Children and Adolescents (Nader et al., 1996); CTQ, Childhood Trauma Questionnaire (Bernstein & Fink, 1998); DICA, Diagnostic Interview for Children and Adolescents (Reich, Shayka, & Taibleson, 1991); K-10, Kessler Psychological Distress Scale (Kessler et al., 2002); MAYSI- 2, Massachusetts Youth Screening Instrument (Grisso & Barnum, 2000); PCL-YV, The Psychopathy Checklist—Youth Version (Forth, Kosson, & Hare, 2003); PTSD-I- UCLA, Posttraumatic Stress Disorder Index for DSM-IV, Adolescent Version (Pynoos, Rodriguez, Steinberg, & Stuber, 1998); SCID-IV, Structured Clinical Interview for DSM-IV (Pfohl, Blum, & Zimmerman, 1997); AES-III, Assessing Environments Scale-III (Knutson, 1978); CBCL-YSR, Child Behavioral checklist Youth Self-Report (Achenbach, 1991); CES-D, Center for Epidemiological Studies- Depression Scale (Radloff, 1977); ChIPS, Children's Interview for Psychiatric Syndromes (Weller, Weller, Fristad, Rooney, & Schecter, 2000); CSEQ, Childhood Sexual Experience Questionnaire (Zaidi et al., 1991); TEQ, Trauma Experience Questionnaire (Lederman et al., 2004); V-DIC, Voice Diagnostic Interview Schedule for Children (Shaffer et al., 2003); APS, Adolescent Psychopathology Scale (Reynolds, 1998); CES-D, Center for Epidemiological Studies—Depression Scale (Eaton, 2001); CTQ, Childhood Trauma Questionnaire (Scher, Stein, Asmundson, McCreary, & Forde, 2001); CTS-R, Conflict Tactics Scale, revised (Straus & Gelles, 1990); DICA, Diagnostic Interview for Children and Adolescents (Reich et al., 1991); LE/SC, Life Events/ Stress Scale (Bynum, 1995); MINI-KID, Mini-International Neuropsychiatric Interview for Children and Adolescents (Sheehan et al., 1998); PCL-YV, Psychopathy Checklist—Youth Version (Forth et al., 2003); YSR, Youth Self Report (Achenbach, 1991); AEIII, Assessing Environments (Berger, Knutson, Mehm, & Perkins, 1988); CAPS, Clinically-Administered PTSD Scale (Blake et al., 1995); CES-D, Center for Epidemiological Studies- Depression Scale (Eaton, 2001; Radloff, 1977); CPTS-RI, Child Posttraumatic-Reaction Index (Pynoos et al., 1993); CSEQ, Childhood Sexual Experience Questionnaire (Zaidi et al., 1991); CTS, The Conflicts Tactic Scale (Straus, 1979); DISC, Diagnostic Interview Schedule for Children (Shaffer et al., 2000); FES, Family Environment Scale (Moos & Moos, 1981); GII- The Gang Involvement Index (Layne, 1996); LASC-R, Los Angeles Symptom Checklist, revised (Foy, Wood, King, King, & Resnick, 1997); PSS-F, Perceived Social Support- Family (Procidano & Heller, 1983); SAEQ, Sexual Abuse Exposure Questionnaire (Rowan, Foy, Rodriguez, & Ryan, 1994); SCECV, Survey of Children's Exposure to Community Violence (Richters & Saltzman, 1990); SRSA, Self-Reported Suicide Attempts (Safer, 1997); TSS, Trauma Stress Schedule (Norris, 1990).

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