Measuring Trauma Exposure: Count Versus Variety of Potentially Traumatic Events in a Binational Sample

Abstract

Traumatic event checklists typically ask respondents to indicate whether they have experienced particular types of potentially traumatic events (PTEs) and then sum these endorsements to gauge cumulative trauma exposure. However, the sum of these endorsements indicates the variety of PTEs respondents have experienced rather than the count of exposure events. The main objective of the present study was to explore the association between PTE count and variety to examine assumptions regarding the use of traumatic event checklists to measure cumulative trauma exposure. The limited empirical research suggests that count and variety are strongly associated; however, there may be variation in magnitude concerning whether participants' environments confer an increased or decreased risk of exposure. We present Life Event Checklist data from a large sample of Mexican and U.S. participants (n = 1,820), which allowed us to compare reports of count and variety. Count and variety were strongly correlated, Kendall's tau-b = .74, such that count accounted for 54.6% of the variance in variety. A negative binomial regression analysis revealed that this association was moderated by county and municipio homicide rate, used as a proxy for violent crime, but not by natural disaster history. Variety was more strongly associated with scores on the Posttraumatic Stress Checklist for DSM-5, Kendall's tau-b = .26, than was PTE count, Kendall's tau-b = .22, Fisher's z = −8.04, p < .001. Although there are challenges in estimating PTE counts, the present findings suggest that PTE variety is not a good proxy for cumulative trauma exposure.

Sex differences in post-traumatic stress disorder in a high adversity cohort of South African adolescents: an examination of depressive symptoms, age, and trauma type as explanatory factors

“…Another limitation is that the extent of trauma exposure was measured by summing the different types of events that adolescents reported, which will underestimate the number of actual events experienced for young people who experienced more than one exposure to the same type of event. A recent large, cross-national (US–Mexico) trauma study demonstrated that while the number of trauma event types typically correlates very highly with actual event counts, this association is reduced at extremely high levels of trauma exposure (Rasmussen et al, 2020 ). Nonetheless, in the same study, the different types of trauma experienced were a stronger predictor of PTSD than the overall quantity of events.…”

The Prevalence, Patterns and Correlates of Childhood Trauma Exposure in a Nationally Representative Sample of Young People in Northern Ireland

“…Cecil et al, 2017 ; Vacek & Whisman, 2020 ), or (3) a count (summed) score to represent multiple CT exposure (e.g. Cloitre et al, 2009 ; Rasmussen et al, 2020 ). These approaches are considered ‘variable-centred’, where the focus is on trauma exposure (Houston et al, 2011 ; Shevlin & Elklit, 2008 ), whereas latent class analysis (LCA) shifts the level of analysis to the individual and has been supported as the optimal method to model trauma exposure patterns (O’Donnell et al, 2017 ).…”

Polytraumatization in young male refugees from the Middle East and its association with internalizing and externalizing symptoms

“…However, as the SLESQ is a conventional traumatic event type checklist, it should be kept in mind that the total number of PTEs is not quantified by counting the occurred traumatic events per se, retrospectively recalled by the adolescents. Nevertheless, it is likely that particularly in refugee pre-migration contexts, there are risks for (a) a higher number of potentially traumatic events as well as (b) a greater variety of these events, thus leading to a strong correlation between the count and variety [ 45 ]. Especially for adolescents who have survived war and other traumatic events, the variety score appeared to have strong predictive power with respect to mental health outcomes [ 13 ].…”

“…Especially for adolescents who have survived war and other traumatic events, the variety score appeared to have strong predictive power with respect to mental health outcomes [ 13 ]. Moreover, the variety score might even be a stronger predictor when directly compared to the count, based on the possibility that a habituation effect could occur with certain—but not all—repetitive types of traumatic events (e.g., viewing corpses in war zones), attenuating the association with mental health [ 45 ]. Further, experiencing a higher variety of traumatic events can trigger a multitude of problems that need to be overcome simultaneously, which might lead to a range of deteriorated mental health outcomes [ 23 ].…”