Unravelling the contribution of complex trauma to psychopathology and cognitive deficits: a cohort study

Abstract

Background Complex traumas are traumatic experiences that involve multiple interpersonal threats during childhood or adolescence, such as repeated abuse. These traumas are hypothesised to cause more severe psychopathology and poorer cognitive function than other non-complex traumas. However, empirical testing has been limited to clinical/convenience samples and cross-sectional designs. Aims To investigate psychopathology and cognitive function in young people exposed to complex, non-complex or no trauma, from a population-representative longitudinal cohort, and to consider the role of pre-existing vulnerabilities. Method Participants were from the Environmental Risk Longitudinal Twin Study, a population-representative birth cohort of 2232 British children. At age 18 years (93% participation), we assessed lifetime exposure to complex and non-complex trauma, past-year psychopathology and current cognitive function. We also prospectively assessed early childhood vulnerabilities: internalising and externalising symptoms at 5 years of age, IQ at 5 years of age, family history of mental illness, family socioeconomic status and sex. Results Participants exposed to complex trauma had more severe psychopathology and poorer cognitive function at 18 years of age, compared with both trauma-unexposed participants and those exposed to non-complex trauma. Early childhood vulnerabilities predicted risk of later complex trauma exposure, and largely explained associations of complex trauma with cognitive deficits, but not with psychopathology. Conclusions By conflating complex and non-complex traumas, current research and clinical practice underestimate the severity of psychopathology, cognitive deficits and pre-existing vulnerabilities linked with complex trauma. A better understanding of the mental health needs of people exposed to complex trauma could inform the development of new, more effective interventions.

Associations Between Complex Trauma Exposure in Childhood/Adolescence and Psychopathology in Older Age: The Role of Stress Coping and Coping Self-Perception

“…In contrast to previous findings (e.g., Cook et al, 2005;Spinazzola et al, 2005), individuals with a history of complex trauma exposure presented with comparably low prevalence rates for substance abuse, such as alcohol abuse (lifetime: 1.9%; current: 0% in the present study vs. 18% at the age of 18 years as reported in the study by Lewis et al, 2021). Potential explanations for these differences may be that the older generation tends to under-report alcohol consumption due to fear of social stigmatization or that former high users have been affected by premature death due to alcohol-related illness (e.g., Blow & Barry, 2012).…”

“…With regard to current mental health, significantly higher prevalence rates for various anxiety and depressive disorders, PTSD, and smoking were found for individuals with a history of complex trauma exposure. These findings were expected on the basis of previous studies with younger samples (e.g., Greeson et al, 2011;Lewis et al, 2021;Rapsey et al, 2019) and further corroborate the notion that complex trauma exposure in childhood and/ or adolescence can depict a lifelong burden that can reach into later life. Regarding the related study by Thoma et al (2021) on mental health disparities in survivors of CSMP and controls, the groups from these two studies partially overlap and the results go into the same direction in the understanding of child maltreatment.…”

“…This was indicated by meaningfully high(er) prevalence rates for a broad range of current and lifetime mental health disorders, as well as a significantly higher psychopathology index score, corroborating findings on the detrimental long-term correlates of child maltreatment (see, e.g., review by Bellis et al, 2019). The higher lifetime prevalence rates for various anxiety and depressive disorders and for PTSD align with previous findings derived from younger samples (e.g., Greeson et al, 2011;Kisiel et al, 2009;Lewis et al, 2021;Rapsey et al, 2019). With regard to current mental health, significantly higher prevalence rates for various anxiety and depressive disorders, PTSD, and smoking were found for individuals with a history of complex trauma exposure.…”

“…Complex trauma exposure in childhood and/or adolescence has previously been linked to an increased risk for the development of mental health disorders across the lifespan (e.g., Cook et al, 2005;Kisiel et al, 2009). In the short-term (i.e., up to adolescence), children and adolescents affected by complex trauma exposure have been shown to present with significantly high(er) rates of a diverse range of mental ill-health outcomes (e.g., Ford et al, 2009;Haahr-Pedersen et al, 2020;Lewis et al, 2021). For example, according to a foster care study by Greeson et al (2011), a history of complex trauma exposure increased the odds of having at least one clinical mental health diagnosis in youth by 21.3% compared to those who experienced other types of trauma.…”

“…Such knowledge would be relevant for stress coping interventions. Finally, although complex trauma exposure is typically associated with more complex and long-lasting impacts than non-complex trauma constellations (e.g., Cook et al, 2005;Spinazzola et al, 2005), only a few comparative studies exist (e.g., Lewis et al, 2021;Rapsey et al, 2019). Further comparative evidence is needed on the potential lasting detrimental impact of complex trauma exposure, particularly in older age, as this may help to create better tailored mental health services and interventions for this cohort of particularly vulnerable individuals.…”