Longitudinal Examination of PTSD Symptoms and Problematic Alcohol Use as Risk Factors for Adolescent Victimization

Abstract

The current study examined associations between posttraumatic stress disorder (PTSD) symptoms and future interpersonal victimization among adolescents, after accounting for the impact of early victimization exposure, gender, ethnicity, and household income. In addition, problematic alcohol use was tested as a mediator of the relation between PTSD symptoms and subsequent victimization. Participants included a national longitudinal sample of adolescents (N = 3,604) who were ages 12 to 17 at the initial assessment: 50% were male, and 67% were White, 16% African American, and 12% Hispanic. Cohort-sequential latent growth curve modeling was used to examine associations among the study variables. Baseline PTSD symptoms significantly predicted age-related increases in interpersonal victimization, even after accounting for the effects of earlier victimization experiences. In addition, alcohol problems emerged as a partial mediator of this relation, such that one fourth to one third of the effect of PTSD symptoms on future victimization was attributable to the impact of PTSD symptoms on alcohol problems (which, in turn, predicted additional victimization risk). Collectively, the full model accounted for more than half of the variance in age-related increases in interpersonal victimization among youth. Results indicate that PTSD symptoms serve as a risk factor for subsequent victimization among adolescents, over and above the risk conferred by prior victimization. This increased risk occurred both independently and through the impact of PTSD symptoms on problematic alcohol use. Based on these findings, it is hypothesized that the likelihood of repeated victimization among youth might be reduced through early detection and treatment of these clinical problems.

Notes

¹A few studies have reported positive associations between general measures of distress (e.g., global anxiety, depression) and future victimization among youth (Cuevas, Finkelhor, Clifford, Ormrod, & Turner, 2010; Lindhorst, Beadnell, Jackson, Fieland, & Lee, 2009). In addition, one study examined PTSD symptoms as a risk factor for assault in a mixed group of adults and adolescents (Noll, Trickett, Susman, & Putnam, 2006). However, studies have not yet examined the association between PTSD and revictimization in an exclusively adolescent sample.

Note: Demographic variables were assessed using standard questions employed by the U.S. Bureau of the Census (1988). Age was measured as the current age in years at the time of the Wave 1 interview (range = 12–17 years). No significant differences in gender, ethnicity, or income were found across cohorts (all chi-square p values > .10).

^a National estimates reflect U.S. Census estimates of the adolescent population in 2005.

²Allowing these slope weights to be estimated freely resulted in significantly improved model fit relative to forcing a linear or quadratic solution for all models tested (all chi-square difference tests p < .0005). Thus, positive slope values reflect a general increase in symptom reporting with increasing age, rather than a strictly linear increase (see Figure 3).

³Community type was also tested as an ordered categorical variable based on distance from urban areas (0 = urban, 1 = suburban, 2 = rural). Results were unchanged when this variable was substituted for the dichotomous categorical variable described earlier.

Note: The percentage values represent the percentage of youth who endorsed at least one victimization event.

Note: For the PTSD variable, values represent the percentage of youth who met DSM–IV symptom criteria for PTSD. For the Alcohol Problems variable, values represent the percentage of youth who endorsed at least one alcohol use problem.

⁴ER are computed as the indirect effect divided by the total effect (direct effect + indirect effect). For example, the indirect effect of PTSD intercept on victimization slope just reported (β = .13) was divided by the sum of the PTSD intercept to victimization slope direct effect shown in Figure 2b (β = .27) and the indirect effect just reported to calculate the percentage of the total effect of PTSD intercept on victimization slope attributable to the indirect effect of PTSD intercept through alcohol problems [.13/(.27 + .13) = .33].