Does prior exposure to interpersonal violence increase risk of PTSD following subsequent exposure?☆

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Abstract

Research has generally found a “dose relationship” between potentially traumatic events (PTEs) and the likelihood of developing PTSD, with greater number of events associated with greater likelihood. Most of these studies have been cross-sectional, however. A recent prospective study (Breslau, Peterson, & Schultz, 2008) found that PTSD response to prior potentially traumatic event (PTE) exposure, rather than prior exposure itself, acts as a risk factor for PTSD in response to subsequent PTE; however, this analysis combined many different types of events, and the unique contribution of specific events (e.g., assault) that may be associated with differential risk of PTSD was indeterminable. The present study examined the effects of cumulative PTE exposure prospectively using a two-wave design in the National Survey of Adolescents (N = 1703). History of assault and witnessing serious violence were the focal PTEs examined. Wave I assault without PTSD was found to predict PTSD at Wave II following exposure to new assault or witnessed violence; however, among those without prior PTSD, Wave I witnessed violence did not increase risk of subsequent PTSD following exposure.

Section snippets

Participants

Schulman, Ronca and Bucavala, Inc. (SRBI; a New York-based national survey research firm) conducted follow-up interviews with a national probability sample of 3161 adolescents and a central city oversample of 862 adolescents who had completed Wave I interviews as part of the National Survey of Adolescents (NSA) approximately 7–8 years before. A more detailed description of the sample and methodology for the original NSA is provided in Kilpatrick et al. (2000). The data presented here are drawn

Statistical analyses

In order to prospectively test predictors of PTSD following exposure to subsequent violence only participants reporting exposure to new assault or witnessed serious violence at Wave II (Weighted N = 733) were used. Wave I MDD and SUD and relevant demographic variables, including gender, ethnicity, and Wave II education status and age, were included as covariates in each multivariate regression analysis.

Participants were categorized for analyses based on their status at Wave I. In order to

Results

Unless otherwise noted, results reflect weighting of sample data on the basis of age, gender, and race estimates for the adolescent population of the United States in 1995 as previously described. Logistic regression analyses were conducted using the Statistical Analysis Software (SAS) version 9.1 statistical software package.

Discussion

The findings of the present study suggest that prior exposure to assault increases the risk of PTSD following subsequent exposure. After entering a range of covariates, including demographic variables, prior substance use disorder, and depression, we found prior assault to be predictive of PTSD following exposure to interpersonal violence. Further, the experience of prior witnessed violence was not found to predict PTSD following new interpersonal violence exposure within a sample of

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    ☆

    This research was supported by NIJ Grant No. 93-IJ-CX-0023 and CDC Grant No. R49-CCR-419810. The preparation of this paper was also partially supported by NIMH Grant No. MH18869-20, Dean G. Kilpatrick, Principal Investigator. Correspondence concerning the manuscript may be addressed to Jesse R. Cougle, Department of Psychology, Florida State University, P.O. Box 3064301, Tallahassee, FL 32306, or Dean G. Kilpatrick, National Crime Victims Research and Treatment Center, Medical University of South Carolina, P.O. Box 250 852, 165 Cannon Street, Charleston, SC 29425.

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