Trauma Type, Comorbidity, and Treatment Response in Youth PTSD: A Clinical Study and Systematic Review with Meta‑Analysis of Post-traumatic Stress Disorder and Major Depressive Disorder After Intrafamilial Abuse

Ngan, Sze Ting Joanna (2026) Trauma Type, Comorbidity, and Treatment Response in Youth PTSD: A Clinical Study and Systematic Review with Meta‑Analysis of Post-traumatic Stress Disorder and Major Depressive Disorder After Intrafamilial Abuse. Doctoral thesis, University of East Anglia.

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Abstract

Post-traumatic stress disorder (PTSD) in young people is often more severe after multiple traumatic stressors, especially interpersonal violence such as sexual assault, and physical abuse by caregivers. PTSD prevalence in children and adolescence is estimated at 4.7%, with higher rates in females (7.3%) than males (2.2%). Evidence on PTSD and major depressive disorder (MDD) following intrafamilial abuse remains limited. Psychological therapies such as trauma-focused cognitive behavioural therapy are effective for PTSD in trauma-exposed youth, but the generalisability of these effects is less clear.

This thesis portfolio comprises a systematic review and meta-analysis of PTSD and MDD prevalence in children and adolescents exposed to intrafamilial abuse, followed by an empirical study of treatment response and moderators in youth with multiple traumas. Across 15 studies (n = 2,677), the pooled PTSD prevalence was 18.6%, lower than for all interpersonal traumas (25.2%–32.1%) but higher than for non-interpersonal trauma (9.7%– 11.8%). Eight studies (n = 1,529) yielded a pooled MDD prevalence of 20.1%, lower than estimates for trauma-exposed youth (24.2%) and interpersonal violence (28.7%). This suggests that intrafamilial abuse may carry greater risk than non-interpersonal trauma, but not necessarily greater risk of PTSD or MDD than other abuse or violence types, though estimates were highly heterogeneous.

The empirical study used secondary DECRYPT data from 120 children and adolescents with multiple traumas receiving either cognitive therapy for PTSD (CT-PTSD) or treatment as usual (TAU). After controlling for baseline post-traumatic stress symptoms (PTSS), being female and experiencing intrafamilial abuse predicted higher PTSS at 11 months, and higher baseline dissociation moderated baseline and 11-month PTSS. After adjusting for treatment arm, disturbances in self-organisation, depression, generalised anxiety, panic symptoms, and voice hearing predicted higher PTSS at 11 months. Intrafamilial abuse moderated treatment effects, with CT-PTSD more beneficial than TAU. However, most other potential moderators were non-significant. Overall, the findings suggest that youth with multiple traumas respond well to CT-PTSD, with some tentative evidence that treatment effects vary by demographic factors, trauma characteristics, and baseline comorbidity. These findings require cautious interpretation due to modest sample and limited power, highlighting the need for larger longitudinal studies on how clinical presentation shapes treatment response and supports more tailored interventions.

Item Type:	Thesis (Doctoral)
Faculty \ School:	Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User:	Amy Millward-Doherty
Date Deposited:	13 Nov 2026 16:47
Last Modified:	13 Nov 2026 16:47
URI:	https://ueaeprints.uea.ac.uk/id/eprint/105122
DOI:

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