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Looking Beyond Posttraumatic Stress Disorder in Children: Posttraumatic Stress Reactions, Posttraumatic Growth, and Quality of Life in a General Population Sample

Eva Alisic, M.A., M.Sc.; Tom A. W. van der Schoot, Ph.D.; Joost R. van Ginkel, Ph.D.; and Rolf J. Kleber, Ph.D.

Objective: In order to broaden the view beyond posttraumatic stress disorder (PTSD) in children, we examined to what extent posttraumatic stress reactions, posttraumatic growth, and quality of life were related to each other and to traumatic exposure in the general population.

Method: 1770 children of 36 randomly selected primary schools (mean age = 10.24 years, 50% boys) reported in October/November 2006 on their worst experience (traumatic exposure was considered present when the described event fulfilled the A1 criterion for PTSD of the DSM-IV-TR) and filled out the Children's Responses to Trauma Inventory, the Posttraumatic Growth Inventory for Children, and the KIDSCREEN-27. Correlational and hierarchical linear regression analyses were carried out in a multiple imputation format.

Results: Posttraumatic stress reactions were strongly related to posttraumatic growth (r = 0.41, p < .01) and quality of life (r = -0.47, p < .01). The latter 2 variables were weakly related; positively when controlling for posttraumatic stress reactions (r = 0.09, p < .01), negatively when not (r = -0.12, p < .01). Children who were exposed to trauma reported more posttraumatic stress reactions (beta = .12, p < .01), more posttraumatic growth (beta = .09, p < .01), and less quality of life (beta = -.08, p < .01) than nonexposed children (effect sizes were small).

Conclusions: Negative and positive psychological sequelae of trauma can coexist in children, and extend to broader areas of life than specific symptoms only. Clinicians should look further than PTSD alone and pay attention to the broad range of posttraumatic stress reactions that children show, their experience of posttraumatic growth, and their quality of life.


(J Clin Psychiatry 2008;69:1455-1461. Online Ahead of Print August 26, 2008.)

Received Dec. 4, 2007; accepted April 1, 2008. From the Psychotrauma Center for Children and Youth, University Medical Center Utrecht (Ms. Alisic and Dr. van der Schoot); Data Theory Group, Faculty of Social and Behavioral Sciences, Leiden University, Leiden (Dr. van Ginkel); and the Department of Clinical and Health Psychology, Utrecht University, Utrecht, and the Institute for Psychotrauma, Zaltbommel (Dr. Kleber), the Netherlands.

This study was supported by grants from 4 Dutch foundations: Prof. H. A. Wijerstichting (Utrecht), Madurodamfonds (The Hague), Fonds Slachtofferhulp (The Hague), and Stichting Achmea Slachtoffer en Samenleving (Zeist).

Acknowledgments are listed at the end of this article.

The authors report no additional financial affiliations or other relationships relevant to the subject of this article.

Corresponding author and reprints: Eva Alisic, Psychotrauma Center for Children and Youth, University Medical Center Utrecht, KA.00.004.0, P.O. Box 85090, 3508 AB Utrecht, the Netherlands (e-mail: