Risk factors for depression in trauma-exposed children and adolescents: A systematic review and meta-analysis

Abstract

Abstract Background: While Post Traumatic Stress Disorder (PTSD) has been the most frequently studied sequela in the aftermath of trauma, post-traumatic depression is at least as prevalent, if not more so. The impacts of depression are wide-ranging, deleterious and potentially long-term. Understanding the risk factors for post-traumatic depression in children and adolescents is therefore critical. The present systematic review and meta-analysis considered this question. Method: Three databases (Medline, PsycINFO, and Published International Literature on Traumatic Stress [PILOTS]) were searched for pertinent studies. Results: Fifty-seven studies (N=45,981) allowed for the derivation of pooled effect sizes for 12 risk factors, contributing 145 effect sizes. All effect sizes were statistically significant. Negligible to small effect sizes were largely found for pre-trauma variables (age [r=.09], gender [r=.16], low family income [r=.16] and prior trauma exposure [r=.16) and trauma-related risk factors (trauma severity [r=.20], peri-traumatic distress [r=.24] and direct exposure [r=.07]). Small to large effect sizes were found for post-trauma variables (comorbid PTSD symptoms [r=.58], avoidant coping [r=.26], low social support [r=.29] and maternal depression [r=.20]) and bereavement (r=.29). Limitations: Risk factor effect size estimates were characterised by significant heterogeneity, and several effect sizes were based on only a few studies (e.g. income, maternal depression). Conclusions: These findings suggest that the post-traumatic responses and environments of children and adolescents may be prominent risk factors for the emergence or maintenance of post-traumatic depression in children and adolescents. This highlights potential targets for assessment and monitoring those most at risk and may also inform treatment.