Victoria C. Lucia

Trauma exposure and posttraumatic stress disorder: A study of youths in urban America

We estimate the cumulative occurrence of traumatic events and posttraumatic stress disorder (PTSD), using Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) criteria, in a high-risk sample of young people in urban United States. The epidemiological sample (n=2,311) was recruited in 1985–1986 at entry into first grade of a public school system of a large mid-Atlantic city. Participants were interviewed about history of trauma and PTSD in 2000–2002 when their mean age was 21 years (n=1,698). We found that the lifetime occurrence of assaultive violence was 62.6% in males and 33.7% in females. The risk of assaultive violence in males (but not females) varied by childhood area of residence within the city; the occurrence of other traumas did not vary by area of childhood residence. Females had a higher risk of PTSD than males following assaultive violence (odds ratio=4.0, 95% confidence interval 2.0–8.3), but not following other traumas. A comparison of the results from this largely inner-city sample with the results from a recent study of a largely suburban sample in another region of the United States in which the same criteria and measures of trauma and PTSD were used suggested the possibility that males’ risk for assaultive violence and females’ risk for PTSD following exposure to assaultive violence might vary by characteristics of the social environment.

Partial PTSD versus full PTSD: an empirical examination of associated impairment.

BACKGROUND Partial PTSD, employed initially in relation to Vietnam veterans, has been recently extended to civilian victims of trauma. We examined the extent to which partial PTSD is distinguishable from full DSM-PTSD with respect to level of impairment. METHOD A representative sample of 2181 persons was interviewed by telephone to record lifetime traumatic events and to assess DSM-IV PTSD criteria. Partial PTSD was defined as > or = 1 symptom in each of three symptom groups (criteria B, C and D) and duration of > or = 1 month. Impairment in persons with PTSD and partial PTSD was measured by number of work-related and personal disability days during the 30-day period when the respondent was most upset by the trauma. RESULTS Compared to exposed persons with neither PTSD nor partial PTSD, increment in work-loss days associated with PTSD was 11.4 (S.E. =0.6) days and with partial PTSD, 3.3 (S.E. =0.4) days (adjusted for sex, education and employment). Similar disparities were found across other impairment indicators. Persons who fell short of PTSD criteria by one symptom of avoidance and numbing reported an increment of 5.0 (S.E. =0.7) work-loss days, 6.0 fewer than full PTSD. PTSD was associated with excess impairment, controlling for number of symptoms. A significantly lower proportion of persons with partial PTSD than full PTSD experienced symptoms for more than 2 years. A lower proportion of persons with partial PTSD than full PTSD had an etiologic event of high magnitude. CONCLUSIONS PTSD identifies the most severe trauma victims, who are markedly distinguishable from victims with subthreshold PTSD.

The impact of early behavior disturbances on academic achievement in high school

BACKGROUND. Previous research has indicated that childhood behavioral disturbances predict lower scores on academic tests and curtail educational attainment. It is unknown which types of childhood behavioral problems are most likely to predict these outcomes. METHODS. An ethnically diverse cohort was assessed at 6 years of age for behavioral problems and IQ and at 17 years of age for academic achievement in math and reading. Of the original cohort of 823 children, 693 (84%) had complete data. Multiple regressions were used to estimate associations of attention and internalizing and externalizing problems at age 6 and with math and reading achievement at age 17, adjusting for IQ and indicators of family socioeconomic status. RESULTS. Adjusting for IQ, inner-city community, and maternal education and marital status, teacher ratings of attention, internalizing behavior, and externalizing problems at age 6 significantly predict math and reading achievement at age 17. When types of problems are examined simultaneously, attention problems predict math and reading achievement with little attenuation, whereas the influence of externalizing and internalizing problems is materially reduced and not significant. CONCLUSIONS. Interventions that target attention problems at school entry should be tested as a potential avenue for improving educational achievement.

The Lingering Academic Deficits of Low Birth Weight Children

Objective. To estimate the influence of low birth weight (LBW; ≤2500 g) on academic achievement in reading and mathematics in 12th grade in 2 socioeconomically and racially disparate, geographically defined communities. Methods. Representative samples of LBW and normal birth weight (NBW) children who were born in 1983–1985 and were from the inner city of Detroit and nearby middle class suburbs were assessed longitudinally. Woodcock-Johnson Psycho-Educational Battery-Revised standardized tests of reading and mathematics were used at ages 11 and 17 (n = 773). Multiple regression analysis applying generalized estimating equations was used to assess the independent effects of LBW on test scores. Results. Compared with NBW children, LBW children manifested deficits of 3 to 5 points in age-standardized tests of academic achievement at age 17 that had persisted with little change from age 11. LBW-related deficits were similar in urban and suburban communities and were independent of family factors. At age 17, LBW children were ∼50% more likely than NBW children to score below the standardized population mean in both reading and mathematics. The LBW-related deficits in academic achievement in adolescence were largely accounted for by LBW-related deficits in general cognitive abilities, measured by IQ tests at age 6. Conclusions. Interventions to address the lingering effects of LBW on the acquisition of core academic skills during the school years should focus on preschool LBW children in both inner city and suburban communities.