Pediatric Traumatic Stress in Primary Care

OBJECTIVE Trauma exposure and traumatic stress are common drivers of mental health morbidities. However, trauma screening has not been widely adopted. The goal of this study was to describe rates of trauma exposure and traumatic stress symptoms, as well as clinical associations of trauma with depression, anxiety, and suicidality among youth at well-child visits. METHOD Youth aged 11 to 19 years presenting to primary care clinics for well-child visits between July 2022 and June 2024 were included for this analysis. As part of routine care, youth completed the “Triple Screen” including the Pediatric Traumatic Stress Screening Tool, the Patient Health Questionnaire – Adolescent version, and the Generalized Anxiety Disorder 7. When indicated, the Columbia Suicide Severity Rating Scale (C-SSRS) was completed. RESULTS Of 24 675 youth, 15.5% (3832) reported trauma exposure, and 7.5% reported moderate or high symptoms of traumatic stress. Female and Hispanic (all P .001) youth were more likely to report a traumatic experience. Only half of youth with high traumatic stress symptoms had high anxiety and/or depression symptom scores. High traumatic stress symptoms were more common among older, female, and Hispanic individuals and those with prior mental health diagnoses (all P .001). Adolescents with trauma and high traumatic stress were 10 times more likely to be at high risk for suicide relative to those with low or moderate traumatic stress, representing 48% of all youth at high risk for suicide. CONCLUSION Trauma exposure and traumatic stress are prevalent among youth in primary care. Trauma screening in primary care can help identify youth at risk of mental health morbidities.