Child trauma exposure and subsequent emotional functioning in El Salvador.

Abstract

This study examined the incidence of exposure to potentially traumatic life events and subsequent emotional functioning in Salvadorian children. Participants were 269 parents of youth aged 4 -17 who completed measures of child trauma exposure, posttraumatic stress disorder (PTSD) symptoms, emotional functioning, peer functioning, impairment, need for treatment, treatment preferences, and barriers to accessing treatment. More than half of Salvadorian children (57%) had been exposed to at least one potentially traumatic event, one third (32%) had been exposed to Ն2, one fifth (19%) had exposure to Ն3, and 10.4% to Ն4 traumatic events. Despite this, less than 4% of children who experienced a trauma fulfilled PTSD criteria, with 11-19% meeting partial PTSD criteria. Greater trauma exposure was associated with higher PTSD symptom severity and impairment, but not with emotional and peer functioning. Higher frequency of trauma exposure was associated with greater perceived need for treatment. Parents preferred to handle their child's emotional problems themselves or seek help from nonpharmacological mental health services. Parents reported low levels of barriers to accessing treatment, with the greatest barriers relating to cost and accessibility. Overall, youth trauma exposure was high, although did not necessarily correlate with poor emotional functioning. If children displayed emotional distress, parents were motivated to seek help, and reported preferences to handle the problem themselves or seek appropriate mental health treatment.

A Pilot Trial of Universal School‐Based Mental Health Screening in El Salvador: Traumatic Stress in an Underresourced School Environment

“…Researchers have postulated that culturally, it is more acceptable for women and girls to express their emotions and endorse mental health difficulties than men and boys, and relatedly, that males have a higher likelihood of engaging in externalizing rather than internalizing behaviors following trauma exposure (Tolin & Foa, 2006). The finding that adolescents in the present study reported exposure to a higher number of traumatic event types and were more likely to have elevated scores on measures of PTSD, anxiety, and depression than children is also consistent with previous studies that have suggested older children are more likely to have a history of trauma exposure (Copeland et al., 2007; Johnco et al., 2020). Finally, consistent with other studies (Copeland et al., 2007; Johnco et al., 2020), we found evidence of a cumulative impact of trauma such that youth with higher levels of exposure to potentially traumatic events endorsed more severe symptoms of posttraumatic stress, anxiety, and depression.…”

“…The finding that adolescents in the present study reported exposure to a higher number of traumatic event types and were more likely to have elevated scores on measures of PTSD, anxiety, and depression than children is also consistent with previous studies that have suggested older children are more likely to have a history of trauma exposure (Copeland et al., 2007; Johnco et al., 2020). Finally, consistent with other studies (Copeland et al., 2007; Johnco et al., 2020), we found evidence of a cumulative impact of trauma such that youth with higher levels of exposure to potentially traumatic events endorsed more severe symptoms of posttraumatic stress, anxiety, and depression.…”

“…The present results indicate that trauma exposure among youth in El Salvador is quite high, with almost 94% of youth endorsing exposure to at least one potentially traumatic event and the overall sample reporting exposure to an average of more than three lifetime traumatic events. These rates exceed those observed in other studies of the prevalence of trauma exposure among youth in LMICs (Le et al, 2018), youth in Latin America (Johnco et al, 2020;Speizer et al, 2008), and Latinx youth living in the United States (Bridges et al, 2010;López et al, 2017). Similarly, the proportion of youth in the present sample with probable PTSD (i.e., 34.5%) is much higher than rates of PTSD observed in other community samples of youth in Latin America (e.g., 3.9%; Johnco et al, 2020) and Latinx youth in the United States (e.g., 9.5%; López et al, 2017), and is more than double the rate of PTSD observed among trauma-exposed youth worldwide (i.e., 15.9%; Alisic et al, 2014).…”

“…This fact is particularly troublesome as these youth are at an increased risk of being recruited for or forced to join gangs. More than half (i.e., 57%) of Salvadoran youth have been exposed to at least one traumatic event, with many reporting having experienced up to four traumatic events (Johnco et al., 2020). These circumstances suggest that youth residing in El Salvador face disproportionate levels of adversity compared to youth in other parts of the world, significantly increasing their risk for mental health disorders.…”

“…These circumstances suggest that youth residing in El Salvador face disproportionate levels of adversity compared to youth in other parts of the world, significantly increasing their risk for mental health disorders. Among the 269 parents of Salvadoran youth surveyed by Johnco and colleagues (2020), 11%–19% reported that their child was experiencing clinically elevated symptoms of posttraumatic stress, with higher levels of trauma exposure associated with more severe posttraumatic stress disorder (PTSD) and impairment. Aside from this recent work, however, studies few studies have examined the prevalence rates of trauma exposure and subsequent mental health symptoms among children in El Salvador.…”