Posttraumatic Cognitions as a Mediator Between Traumatic Experiences and Posttraumatic Stress Symptoms in Children and Adolescents

Theoretical background: Dysfunctional posttraumatic cognitions refer to negative appraisals of traumatic events and their sequetae, for example, to the sense of permanent and disturbing change or of being a fragile person in a scary world. Previous research demonstrated that such dysfunctional cognitions can lead to a sense of current threat and impact the development and maintenance of posttraumatic stress disorder including symptoms of re-experiencing, avoidance, negative alterations in cognitions and mood, and hyperarousal. Furthermore, the type of traumatic events was found to be a risk factor for posttraumatic stress symptoms. White both accidental and interpersonal experiences can be potentially traumatic, there is a higher risk of developing posttraumatic stress disorder following interpersonal events. Objective: This study investigates the association between type of traumatic events (interpersonal or accidental), dysfunctional posttraumatic cognitions, and posttraumatic stress symptoms in children and adolescents. Method: The sample included N = 48 children and adolescents between 9 and 17 years (M = 14.53, SD = 1.64, 69% female). Participants were recruited through child-welfare services. All children and adolescents in the sample lived in out-of-home care. We collected data using standardized self-report measures assessing potentially traumatic experiences, posttraumatic stress symptoms, and dysfunctional posttraumatic cognitions. The data were analyzed using statistical mediation models including the index trauma type as the dichotomous independent variable (accidental or interpersonal), posttraumatic cognitions as the mediator, and posttraumatic stress symptoms as the dependent variable. Results: More than half of the children and adolescents in the sample reported interpersonal potentially traumatic experiences (70.8%; n = 34) as an index event. Screening for posttraumatic stress disorder showed that 54.2% (n = 26) had clinically relevant posttraumatic stress symptoms that might require additional diagnostics and treatment. The mediation analysis showed that dysfunctional posttraumatic cognitions explained a large part of the variance of posttraumatic stress symptoms (87.1%). Those children and adolescents who experienced interpersonal index traumatic events showed significantly higher levels of dysfunctional posttraumatic cognitions than participants who reported an accidental index trauma. Dysfunctional posttraumatic cognitions had a significant mediating role when explaining the relationship between interpersonal traumatic experiences compared to accidental events and posttraumatic stress symptoms. A closer took at Cluster D showed that the mediation effect was significant when explaining posttraumatic stress symptoms of alterations in cognitions and mood as well as just alterations in mood. Discussion and conclusion: The findings indicate that interpersonally traumatized children and adolescents are prone to develop negative cognitions about themselves and the world which could lead to posttraumatic stress symptoms. The findings emphasize the importance of cognitive elements in trauma therapy, especially for children and adolescents with interpersonal traumatic experiences.