Timing of Trauma Exposure and Criminal Involvement on PTSD and Mediation by Emotion Dysregulation Público

Abstract

Identifying sensitive periods in development and the timing of trauma and criminal involvement are critical in understanding the biological etiology of post-traumatic stress disorder (PTSD). In defining sensitive periods and mechanistic pathways, emotion dysregulation (ED) may be a potential trans-diagnostic risk factor for PTSD.  We conducted secondary analyses of a cross-sectional study of highly trauma-exposed, civilian adults in Atlanta, GA (n=10,503). The current study investigated whether developmentally sensitive timing of trauma and justice system involvement are associated with PTSD diagnosis as well as PTSD severity among non-Hispanic, AA adults (n=4,000). In addition, ED was examined as a potential mediator of the relationship between both age of onset of trauma and PTSD symptom severity and age of onset of justice system involvement and PTSD severity. All analyses adjusted for sociodemographic characteristics, depressive symptoms, and frequency of exposure to trauma. Participants exposed to trauma in early childhood had greater odds of a PTSD diagnoses compared to those not exposed to trauma (aOR=1.5, 95% CI=0.5, 4.3). Participants exposed to trauma in middle childhood had greater PTSD symptom severity than those exposed during later developmental stages and to those not exposed (adjusted beta=0.7, 95% CI=-2.9, 4.3). Participants with juvenile age of onset of justice system involvement had greater odds (arrest: aOR=1.3, 95% CI=1.0, 1.7; jail: aOR=1.3, 95% CI=1.0, 1.8) and greater symptom severity than those whose age of onset of justice system involvement were in adulthood (arrest: adjusted beta=1.5, 95% CI=0.7, 2.3; jail: adjusted beta=1.5, 95% CI=0.5, 2.5). ED mediated the relationship between age of onset of trauma in middle childhood and PTSD symptom severity, and between juvenile age of onset of justice system involvement and PTSD symptom severity, but not for adulthood age of onset of justice system involvement. The current study findings provide new information that may guide further research in identifying critical developmental periods where trauma exposures and involvement with the justice systems may have detrimental effects in mental health of an already highly vulnerable populations.    

Table of Contents

Table of Contents 

1. Background ....................................................................................................................... 1 

1.1 Introduction ........................................................................................................... 1 

1.2 Criminal involvement, overall mental health, and PTSD ..................................... 2 

1.3 Interpersonal trauma, non-interpersonal trauma, and PTSD ................................. 4 

1.4 Developmental timing of trauma and criminal justice system involvement

      exposure on PTSD ................................................................................................. 4 

1.5 Emotion dysregulation as a mediator of trauma, incarceration, and PTSD .......... 6 

1.6 Current study ......................................................................................................... 8 

2. Methods.............................................................................................................................. 9 

2.1 Procedure ............................................................................................................... 9 

2.2 Participants ............................................................................................................ 9 

2.3 Measures .............................................................................................................. 11 

2.4 Statistical analysis ............................................................................................... 13 

3. Results ............................................................................................................................. 16 

3.1 Sample.................................................................................................................. 16 

3.2 Prevalence of trauma exposure and trauma timing ............................................. 16 

3.3 Prevalence of criminal involvement exposure and criminal involvement timing        

      .............................................................................................................................. 17 

3.4 Relationship between age of onset of trauma exposure and age of onset of

      criminal involvement with PTSD diagnosis ........................................................ 17 

3.5 Relationship between age of onset of trauma and age of onset of criminal

      involvement with PTSD symptom severity ......................................................... 18 

3.6 Mediation by emotion dysregulation ................................................................... 19 

4. Discussion ........................................................................................................................ 21 

4.1 Strengths and Limitations .................................................................................... 24 

4.2 Future Directions and Conclusion ....................................................................... 26 

5. References ....................................................................................................................... 28 

6. Tables ............................................................................................................................... 41 

Table 1. ....................................................................................................................... 41 

Table 2. ....................................................................................................................... 42 

Table 3. ....................................................................................................................... 43 

7. Figures............................................................................................................................... 44 

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Epidemiology - MPH & MSPH
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Mental Health Health Sciences, Epidemiology
Palavra-chave	Childhood trauma; interpersonal trauma; PTSD; justice system involvement; incarceration
Committee Chair / Thesis Advisor	Spaulding, Anne, Emory University
Committee Members	Jovanovic, Tanja, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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