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expert reaction to prevalence of PTSD in young people in England and Wales

Reactions to a report on the prevalence of PTSD among young people in England and Wales as published in Lancet Psychiatry. 

Dr James Thompson, Honorary Senior Lecturer in Psychology, UCL, said:

“Excellent researchers, working carefully with a good epidemiological sample. However, they cannot get around the problems of psychiatric diagnoses. They report that 45% of this sample of normal teenagers have at least one psychiatric disorder: 20% with a major depressive disorder, 15% with conduct disorders, 13% with alcohol dependence, 9% with nicotine dependence, 8% with attention deficit hyperactivity disorder, 8% with PTSD and 6% with generalised anxiety.  If this is true, this generation is going to hell in a handcart. More likely, this is over-diagnosis disorder.  Even adjusting for that, the usual risk factors apply: female sex, racial minority, low intelligence and vulnerable families. The overall attempted suicide rate of 3.8% is alarming.

“31% say they had a traumatic event. This figure sounds comparable to something like we might expect to see in a war zone*. Perhaps something important to consider here is self-perception of stress and general over-diagnosis. We also need to understand why some families have more traumatic events than others, and how many arise from family life as opposed to extraneous factors. It would have been interesting to test for PTSD symptoms in the un-exposed population, thus evaluating whether events were causal for this diagnosis.”

Prof Peter Kinderman, Professor of Clinical Psychology, University of Liverpool, said:

“This is interesting, important and worrying research, which should give us cause for concern. The facts that so many young people – perhaps as many as a third of young people –  report traumatic experiences, and that these experiences so clearly affect our mental health, clearly demonstrates that we need to do much more to protect our young people.

“It is also worrying that, in this sample, only a minority of the young people distressed by their experiences had received help from their general practitioner or mental health professionals. This clearly points to a substantial failure to meet the needs of our young people, and could go some way to explain the worrying levels of problems observed.

“This research also, of course, indicates how our mental health is affected by the things that happen to us and how we make sense of them.  But that also suggests that we need to evolve the way we think about these issues.

“The findings of this research are worrying and clear, but it’s not really accurate to say that the young people have a ‘disorder’; ‘PTSD’. There’s nothing ‘disordered’ about being affected by traumatic events, it’s normal and understandable (as Prince Harry recently pointed out). We need to protect young people from trauma and abuse, help them when they’re affected, but not label them with ‘disorders’.”

Dr Tim Dalgleish, Clinical Psychologist and Programme Leader at the MRC Cognition and Brain Sciences Unit, University of Cambridge, said:

“This is a landmark study in understanding the frequency of exposure to psychological trauma in children and young people and its impact on their subsequent mental health. The use of multiple time points, in depth interviews and validated assessments ensure the study provides the best estimates of the nature and extent of trauma-related mental health and risk problems in British youth that we have to date. The findings are very sobering. One in three young people reported exposure to trauma before 18, one in four of those exposed go on to develop posttraumatic stress disorder (PTSD), and the majority of those with PTSD also present with other mental health problems including depression, conduct difficulties and risk behaviours such as self-harm and suicidal behaviour. Of particular concern is the relatively small proportion of effected youth who go on to access formal support or mental health services and the findings are a further wake-up call that service provision in the UK for children and adolescents dealing with the aftermath of trauma is woefully inadequate. We have the clinical knowledge to help, with NICE recommending a range of evidence-based interventions for PTSD in youth only last year (2018), but we simply don’t have the funding structure, trained staff and services to deliver this help where it is needed.

“The lifetime estimated prevalence of PTSD before age 18 in the current study is the first in a modern European sample using current diagnostic classifications. Rates of PTSD in previous studies vary enormously from country to country but the rate of PTSD reported here is probably higher than we would expect. Interestingly, the rates of trauma exposure in the current data are lower than in many other studies in high income countries; for example a recent study in around 6000 US Adolescents± reported trauma exposure rates of around 62% , but the rates of PTSD prevalence before 18 were lower overall – around 4.7% of the total sample. ”

‘The epidemiology of trauma and post-traumatic stress disorder in a representative cohort of young people in England and Wales’ by Stephanie Lewis et al. was published in Lancet Psychiatry at 23:30 UK time on Tuesday 21st February.

All our previous output on this subject can be seen at this weblink:

Declared interests

Prof Peter Kinderman: No conflicts of interest relevant to this review.

Professor Kinderman reports receiving research grants from the National Institute of Health Research and the Economic and Social Research Council, and personal fees from legal counsel, the BBC, Smoking Gun Media, GLG Group, True North Productions and Compass Pathways Ltd. He has also received royalties on published work in the field of mental health from Palgrave Macmillan, and Little, Brown Book Company, and travel and hospitality from a variety of organisations in relation to speaking and other professional activity outside the submitted work. Professor Kinderman reports that he is a Member of the Council for Evidence Based Psychiatry and a former President of the British Psychological Society.

Dr Tim Dalgleish: No declarations of interest

None other received.

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