PTSD and dissociation symptoms as mediators of the relationship between polyvictimization and psychosocial and behavioral problems among justice-involved adolescents

Abstract

Polyvictimization (PV) has been shown to be associated with psychosocial and behavioral impairment in community and high risk populations, including youth involved in juvenile justice. However, the mechanisms accounting for these adverse outcomes have not been empirically delineated. Symptoms of posttraumatic stress disorder (PTSD) and dissociation are documented sequelae of PV and are associated with a wide range of behavioral/emotional problems. This study used a cross-sectional research design and bootstrapped multiple mediation analyses with self-report measures completed by a large sample of justice-involved youth (N = 809, ages 12-19 years old, 27% female, 46.5% youth of color) to test the hypothesis that PTSD and dissociation symptoms mediate the relationship between PV and problems with anger, depression/anxiety, alcohol/drug use, and somatic complaints after controlling for the effects of exposure to violence and adversities related to juvenile justice involvement. As hypothesized, PTSD symptoms mediated the relationship of PV with all outcomes except alcohol/drug use problems (which had an unmediated direct association with PV). Partially supporting study hypotheses, dissociation symptoms mediated the relationship between PV and internalizing problems (i.e., depression anxiety; suicide ideation). Implications are discussed for prospective research demarcating the mechanisms linking PV and adverse outcomes in juvenile justice and other high risk populations.

Psychological trauma at different developmental stages and ICD-11 CPTSD: The role of dissociation

“…However, adolescent and adulthood trauma were also significantly associated with dissociation and CPTSD and so the relationship is not fully accounted for by childhood trauma. One possible factor that may confound our results is that those with early trauma may more likely experience polyvictimization in later life, which itself has been associated with dissociation (Ford et al, 2018). However, a study that used a factor analytic approach controlling for lifetime trauma exposure also identified that childhood experiences uniquely predicted PTSD, CPTSD, and dissociation (Frewen et al, 2019).…”

PTSD in prison settings: A systematic review and meta-analysis of comorbid mental disorders and problematic behaviours

“…The 36 studies [26–61] reported on a combined sample of 9594 participants, 6478 male and 2847 female prisoners. Stratified by age, identified studies reported on a combined sample of 4139 incarcerated young offenders (age range 10–19) (M = 2766; F = 1324) and 5455 adult prisoners (M = 3712; F = 1523).…”

“…Most studies were conducted in high income countries, with the majority (n = 21) conducted in the USA, four studies conducted in Europe [31, 35, 39, 55], and five studies (three reporting on the same sample) from the UK [47, 48, 50, 56, 58]. 22 studies reported on adult prisoners [39–60], while 14 reported on incarcerated youth [26–38, 61].…”

“…Of the 36 studies included in this review, 11% were considered high quality, 72% medium-quality and 17% low quality. Many studies [26, 27, 31–37, 39, 40, 43, 45–57, 61] reported associations between PTSD and other mental disorders or with problematic behaviours using simple group comparisons without further reporting analyses adjusted for potential confounding factors that may have contributed to the association.…”

“…PTSD is a common disorder within prison populations [3]. People in prison are more likely to have experienced cumulative, multiple traumas across their lifetime [65], further increasing the risk of developing mental health problems [66], a pathway that may in part be mediated by the presence of PTSD symptoms [32, 61, 67]. The presence of PTSD has been linked to poorer treatment outcomes including functional impairment and treatment adherence [68].…”