General risk or individual vulnerability? Individual differences in young adults' health risk behaviour after childhood trauma
Introduction
Psychological trauma is defined by exposure to an event in which someone experienced, witnessed or was confronted by an event that involved actual threatened death, serious injury, or a threat to the physical integrity of the self or others (American Psychiatric Association, 2013). Whereas there is a great deal of uncertainty with regard to the frequency with which traumatic events occur during childhood (e.g., prevalence rates of childhood sexual abuse range from 2% to 62%; Andrews, Corry, Slade, Issakidis, & Swanston, 2004), the impact of childhood trauma has been increasingly investigated and acknowledged (Norman et al., 2012). Studies on childhood trauma have traditionally focused on, and found substantial support for, effects of trauma on post-traumatic stress symptoms (PTSS), problems in the internalizing domain and life satisfaction (Alisic et al., 2014; Ozer, Best, Lipsey, & Weiss, 2008; Whitelock, Lamb, & Rentfrow, 2013). Additionally, there is increasing support that childhood trauma may also place individuals at risk for problems in the externalizing domain (Fergusson, McLeod, & Horwood, 2013; Gabert-Quillen, Selya, & Delahanty, 2015). This seems particularly true with regard to risk behaviours during young adulthood. Whereas mild risky behaviours are quite common during adolescence but are often limited to the adolescent and young adult years (Bradley & Wildman, 2002), risk behaviour that develop in the context of trauma might be more persistent and set the stage for further adult functioning. So far, child and adolescent trauma appear to be related to a range of young adult risk behaviours (for a review see: Ben-Zur & Zeidner, 2009; for a meta-analysis see: Norman et al., 2012). For example, individuals exposed to childhood trauma reported more smoking (Gabert-Quillen et al., 2015; Roberts, Fuemmeler, McClernon, & Beckham, 2008), sexual risk, alcohol-dependence and illicit drug use (Fergusson et al., 2013).
Combining the findings from studies, links between childhood trauma and young adult health-risk behaviours seem highly consistent, regardless of the nature of childhood trauma or type of health risk behaviour under study. However, these studies have generally examined only one type of trauma and a limited range of risk behaviours (mostly smoking). Nonetheless, there is increasing evidence for the relative impact of multiple traumatic experiences and on the potentially domain specific effects of trauma on specific risk behaviours. Specifically, childhood traumatic experiences showed stronger linked to first-onset mental disorders (including substance abuse disorders) than non-family-related events (Kessler et al., 2010). So far, it is unknown whether these findings generalize to other health risk behaviours.
Additionally, whereas research has generally focused on the unique effects of specific types of trauma, there is some evidence for cumulative effects. Although some studies have found relatively strong effects (e.g., Kessler et al., 2010), small effects of individual stressful or traumatic events are quite common (e.g., Laceulle et al., 2014; Suldo & Huebner, 2004). However, these may accumulate if individuals are exposed to multiple events (Forehand, Biggar, & Kotchick, 1998). Indeed, in a nationally representative sample of children aged 2–17 it was found that cumulative exposure to multiple forms of victimization over a child's life-course represents a substantial source of mental health risk (Turner, Finkelhor, & Ormrod, 2006). Findings like these underscore the importance of taking into account potential cumulative effects.
Importantly, not everyone exposed to traumatic experiences during childhood may be at risk for adverse outcomes. However, because most studies on trauma and specific risk behaviours have involved small samples, statistical power has often been insufficient to detect subtle individual differences. Nevertheless, studies of risk factors associated with PTSS, distress, and depression after trauma suggested a range of factors which may explain individual differences in sensitivity to trauma (Alisic et al., 2014; Tolin & Foa, 2006). For example, women may be more sensitive than men may to trauma (Breslau, 2009; Tolin & Foa, 2006) although men engage in more risky behaviours than women (Bradley & Wildman, 2002). Also, SES (low) and current age (younger) may enhance the adverse effects of trauma exposure (Cohen, Doyle, & Baum, 2006). In addition to these demographic characteristics, individual trait characteristics may also play a role. High neuroticism was found to place individuals at risk for PTSS and internalizing problems after trauma (Deković, Koning, Stams, & Buist, 2008; Ickovics et al., 2006). Additionally, extraversion and lack of conscientiousness may account for individual differences because these traits have repeatedly been linked health risk behaviours (Atherton, Robins, Rentfrow, & Lamb, 2014). Moreover, individuals high on extraversion engaged more in frequent substance use and those high on neuroticism reported poorer health than individuals who were low on extraversion and neuroticism (Atherton et al., 2014). Despite these associations with health outcomes, however, the role of personality and individual differences in the link between childhood trauma (both individual traumatic events and cumulative trauma) and young adult health risk outcomes has not been empirically tested.
In this study we aimed to replicate earlier findings on the link between childhood trauma and young adults' health risk behaviours by studying childhood trauma (i.e., death of a loved one, violence and sexual abuse) and a range of health-related risk behaviours (i.e., smoking, drinking, illicit drug use, risky sexual behaviour, severe accident/injury). The inclusion of both multiple traumatic experiences and a range of health-risk behaviours within the context of a single study is new to the literature. Strongest effects were expected for sexual abuse and violence. Cumulative effects were hypothesized, with exposure to multiple events being related to more health-risk behaviours. Differential effects in the five risk domains were explored. Subsequently, individual differences were hypothesized both with regard to demographic (gender, age, SES) and individual trait (neuroticism, extraversion and conscientiousness) characteristics. Strongest links between childhood trauma and risk behaviours were expected in women and young adults high on neuroticism. By examining the moderating effects of demographic and trait characteristics the current study enables to disentangle individual differences in response to trauma and separate the effect of trauma on health risk behaviours from possible confounders known to be associated with health risk behaviours.
Section snippets
Design
A subsample of cases was drawn from a dataset collected as part of an online survey advertised and hosted by the British Broadcasting Corporation (BBC) on its “Lab UK” Web site (https://ssl.bbc.co.uk/labuk/experiments/personality/). The survey, called “The Big Personality Test,” contained items pertaining to demographic and life histories, personality and well-being, among other topics (Atherton et al., 2014; Jokela, Bleidorn, Lamb, Gosling, & Rentfrow, 2015; Whitelock et al., 2013).
Participants and sampling
A total of
Descriptive statistics
Frequencies of the traumatic experiences are reported in Table 1. Descriptive statistics are reported in Table 2. Correlation coefficients between all study variables are provided in Table 3a. Partial correlations between the trauma and health risk variables, after correcting for all demographic and trait characteristics are provided in Table 3b. Findings indicate that the associations between trauma and health risk are only slightly affected by the possible confounders. This suggests 1) that
Discussion
Using a large sample of young adults, the current study examined the links between childhood trauma and a range of health-related risk behaviours, as well as inter-individual differences in these associations. Three types of childhood trauma were distinguished: death of a loved one, sexual abuse and violence. Although all three types were related to more risk behaviours, our findings suggest somewhat stronger and more consistent effects for interpersonal trauma (sexual abuse, violence) than for
Acknowledgement
This study was financially supported by Kone Foundation Grant 31-225 and the Academy of Finland Grant 268388. The authors would like to thank BBC Lab UK and in particular Richard Cable, Joseph Coulson, and Michael Orwell for the support in developing the Big Personality Test. http://www.bbc.co.uk/labuk/.
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