The Predictive Utility of Trauma Subtypes in the Assessment of Mental Health Outcomes for Persons Resettled as Refugees

What happened matters: Trauma type and cumulative trauma exposure in refugee youth psychopathology.

“…The results of the PTSD models are consistent with recent evidence supporting the predictive utility of trauma subtypes as compared to cumulative trauma models in both refugee (Arnetz et al, 2014; Hinchey, Grasser, et al, 2023) and nonrefugee populations (Raudales et al, 2019; Reiland & Clark, 2017). Notably, while all youth in this sample were of refugee status and experienced forced migration due to war, of the three subtypes only death threat traumas were associated with PTSD symptom severity.…”

“…While the efficacy of trauma subtypes in predicting posttraumatic stress symptoms is in line with findings from adult refugee cohorts (Arnetz et al, 2014; Hinchey, Grasser, et al, 2023), the type of trauma associated with PTSD symptomatology, as well as the present anxiety findings, differ from dynamics observed in these adult groups (despite similar prevalence of trauma subtypes reported; Hinchey, Grasser, et al, 2023). Specifically, in adult refugees victimization has been associated with posttraumatic stress, depression, and anxiety symptom severity, and trauma subtype models have been shown to better predict both anxiety and PTSD-related outcomes.…”

“…Cumulative scores alone, however, may mask important predictive information. A significant body of findings, including those from our group, indicates that organizing assessments by specific type of trauma (i.e., trauma subtype) improves predictive utility for psychological outcomes (Arnetz et al, 2014; Contractor et al, 2020; Hinchey, Grasser, et al, 2023). For instance, sexual assault and other interpersonal traumas have been associated with more severe emotion dysregulation (Raudales et al, 2019) and posttraumatic stress symptoms (Reiland & Clark, 2017) in adults when compared to combat-related and noninterpersonal traumas.…”

“…Compared to other migrant groups and general populations in their host countries, refugees consistently report high incidence and severity of mental health symptoms, including posttraumatic stress and anxiety (Fazel et al, 2005; Javanbakht et al, 2019). Trauma exposure is a key determinant in these outcomes and may be predictive of greater symptom severity—even years after resettlement (Bogic et al, 2015; Fazel et al, 2005; Hinchey, Grasser, et al, 2023). With up to 96% of displaced persons reporting multiple trauma exposures (Fino et al, 2020), and prevalence rates of posttraumatic stress disorder (PTSD) in refugee youth typically ranging from 7% to 17% (though rates as high as 42% have been recorded) these dynamics warrant thorough investigation (Fazel et al, 2005; Jensen et al, 2019).…”

“…In a general population sample, three trauma subtypes were defined within the measure: (a) accidental/injury traumas (e.g., life-threatening illness, transportation accident, fire, or explosion); (b) victimization traumas (i.e., physical or sexual assault); and (c) predominant death threat traumas (e.g., being threatened with a weapon, exposure to combat or war-zone, captivity; see Table 1 for a complete list of events included in each subtype). Applying this improved classification method in a cohort of Syrian and Iraqi adults resettled in the United States, a recent study found that while cumulative trauma scores predicted PTSD symptom severity, victimization traumas explained significantly more variance (21%, compared to 12.5%) in PTSD outcome and predicted anxiety- and depression-related symptoms in addition to PTSD scores (Hinchey, Grasser, et al, 2023).…”