Rates of trauma exposure and posttraumatic stress in a pediatric digital mental health intervention: associations with anxiety and depressive symptom improvement over time (Preprint)

Abstract

More than two out three children and adolescents in the U.S. experience trauma by age 16. Exposure to trauma in early life is linked to a range of negative mental health outcomes throughout the lifespan, particularly co-occurring symptoms of posttraumatic stress (PTS), anxiety, and depression. There has been increasing uptake of digital mental health interventions (DMHIs) among youth, particularly for anxiety and depression. However, little is known regarding the incidence of trauma exposure and PTS symptoms among youth participating in DMHIs, and whether PTS symptoms impact anxiety and depressive symptom treatment response. Moreover, it is unclear whether participation in a DMHI for anxiety and depressive symptoms is associated with secondary effects on PTS symptoms among trauma-exposed youth.

The current study aims to utilize retrospective data from youth participating in a DMHI to 1) characterize rates of trauma, PTS, and comorbid anxiety and depressive symptoms, 2) determine whether trauma exposure and elevated PTS symptoms impact improvement of comorbid anxiety and depressive symptoms throughout participation in care, and 3) determine whether participation in a non-posttraumatic DMHI is linked to reductions in PTS symptoms.

This study was conducted using retrospective data from members (children and adolescents) involved in a pediatric collaborative care DMHI. Participating caregivers reported their children’s trauma exposure. PTS, anxiety, and depressive symptom severity were measured monthly using validated assessments.

Among eligible participants (n = 966), 30.2% (n = 292) reported at least one traumatic event. Of those with trauma exposure and elevated symptoms of PTS (n = 119), 73% exhibited elevated anxiety symptoms and 50% exhibited elevated depressive symptoms. Compared to children with no trauma, children with elevated PTS symptoms showed smaller reductions per month in anxiety, but not depressive, symptoms (F = 26.11, P < .001). PTS symptoms also decreased significantly throughout care, with 96% of participants showing symptom reductions.

This study provides preliminary evidence for the frequency of trauma exposure and comorbid psychiatric symptoms, as well as variations in treatment response between trauma-exposed and non-trauma exposed youth, among participants in a pediatric collaborative care DMHI. Youth with traumatic experiences may show increased psychiatric comorbidities and slower treatment responses than their peers with no history of trauma. These findings deliver compelling evidence that collaborative care DMHIs may be well-suited to address mental health symptoms in children with a history of trauma, while also highlighting the critical need to assess symptoms of PTS in children seeking treatment.