Trauma, Protection, and Distress in Late Adolescence: A Multi-Determinant Approach

Article excerpt

Psychological distress (symptoms of anger, anxiety and depression) is surprisingly common among adolescents. For example, approximately one-quarter of adolescents experience a major depressive disorder (Lewinsohn, Rohde, & Seeley, 1998) and approximately one-half of older adolescents report moderate or high levels of depressive symptoms (Rosenthal & Schreiner, 2000). Depression and anxiety are highly co-morbid and may represent a single dysfunctional psychological state (Cf., Briere 1995; Olino et al., 2008), which is often described as "psychological distress." Many studies have attempted to identify the causes of psychological distress, and several types of traumatic events have been found to be correlated with it.

Unfortunately, the correlations between various specific types of traumatic experiences and psychological distress are rather small. Quantitative reviews of the literature estimate the correlations of psychological distress with selected traumas to be: for community violence r = .25 (Wilson & Rosenthal, 2003); for childhood sexual abuse r = .13 (Rind, Tromovitch, & Bauserman, 1998) to r = .21 (Paolucci, Genuis, & Violato, 2001); for domestic violence r =. 15 (Kitzman, Gaylord, Holt, & Kenny, 2003) to r = .28 (Wolfe, Crooks, Lee, McIntyre-Smith, & Jaffe, 2003); for disasters r = .17 (Rubonis & Bickman, 1991); for accidents r = .25 (Ozer, Best, Lipsey & Weiss, 2003); and for interpersonal loss r = .25 (Lazarus, 1990).

These small correlations at first were interpreted optimistically as indicating that not everyone who was exposed to trauma developed psychological distress. This realization resulted in a search for resiliency and protective factors--characteristics and conditions that, when they co-occur with trauma, tend to diminish the ensuing level of psychopathology. However, the research on resiliency and protective factors has not been very productive (Buckner, Beardslee, & Bassuk, 2004; Gorman-Smith & Tolan, 2003). A number of potential protective factors have been identified, but the empirical evidence for any of them is quite scarce (Luthar, 2006), and the correlations between protective factors and psychological distress is typically rather small between .10 and .30 (see above).

The level of understanding of the origins of psychological distress seems to be not very high; research has identified a number of potentially traumatic events and a number of potential protective factors, but has not been able to account for substantial amounts of the variance in the distribution of psychological distress in community populations. The low empirical correlations between psychological distress and trauma and protective variables, however, may be an artifact of a "single-determinant of behavior" orientation in the research. When a behavior actually has multiple determinants, this fact in itself places constraints on the size of the correlation between the behavior and any one of the determinants (Ahadi & Diener, 1989; Strube, 1991). Research based on a single-determinant strategy is doomed to find small relationships when a behavior has multiple determinants.

The possibility and desirability of using a multiple-determinant framework in the investigation of the trauma-distress relationship has been implied in the literature: Sameroff and Seifer (1995) discussed "accumulation of environmental risk"; Brewin and colleagues (2000) suggested "aggregating risk factors"; Rutter (2000) suggested the "simultaneous consideration of multiple stressors"; and Garbarino (2001) raised the possibility of "multiple protective variables operating in concert," However, these ideas have not been implemented, and there have been almost no empirical studies of the cumulative effects of sets of multiple traumatic events or of the cumulative effects of sets of multiple protective factors.

The present paper presents a multivariate study of the combined effect of exposure to several types of potentially traumatic experiences during high school and the presence of several protective factors during the high school years on the level of manifesting psychological distress in late adolescence. …