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In recent years, numbers of unaccompanied children (UC) migrating to the U.S. have increased substantially, particularly from Central American countries. Research indicates exposure to violence, child maltreatment, and poverty promote migration. Although UC are exposed to high rates of trauma, little is known about how many UC meet diagnostic criteria for trauma-related disorders, including posttraumatic stress disorder (PTSD) or how well diagnostic frameworks capture PTSD symptoms for this population. This exploratory study addresses the following research questions in a sample of UC living in the United States: (1) What are the rates of PTSD as measured in a sample of UC living in the US? (2) What are the psychometric properties of a standardized trauma measure? and (3) How well does the instrument capture symptoms of PTSD?
Methods
The sample includes 163 UC (52.8% male) receiving post release services in the US in 2018, using administrative data collected by Lutheran Immigration and Refugee Service. Seven countries are represented, 96.9% from El Salvador, Guatemala, or Honduras. The dependent variable is measured using the Child PTSD Symptom Scale (CPSS-V). The CPSS-V is comprised of 20 items that are scored on a 5-point Likert-style scale ranging from 0 (not at all) to 4 (6 or more times a week/almost always). Symptom severity is calculated by summing items and producing a total score, with higher values indicating greater PTSD symptom severity. CPSS-V scores range from 0-80; the clinical cut point of 31 indicates a probable diagnosis of PTSD. Rates of PTSD were calculated using univariate statistics. Reliability was assessed by calculating the Cronbach’s alpha and found to be α=.92. A confirmatory factor analysis was used to test the theoretical model of the CPSS-V, which corresponds with the diagnostic criteria in the DSM-5.
Results
The rate of PTSD in the overall sample is 7.4%. Rates of PTSD vary for UC depending on country of origin: Six UC from El Salvador (9.4%) exhibit a likely diagnosis of PTSD, as did four UC from Guatemala (8.9%) and two UC from Honduras (4.1%). Differences in rates of PTSD by country of origin were not statistically significant. CFA was conducted with modification indices to identify correlated items to improve model fit. Five item correlations were used in the final model, which exhibited reasonably acceptable fit (X2=359.84,df=159, p<.00; RMSEA=0.08; CFI=0.86).
Conclusions & Implications
Results indicate slight differences in rates of PTSD among Northern Triangle countries, all of which are higher than the general population but lower than other refugee populations. The theoretical model of PTSD, as defined by the DSM-5, exhibits reasonably acceptable fit in assessing symptoms in a sample of UC. Three of the five item correlations used to improve CFA fit are on different PTSD subscales, suggesting unique presentation of PTSD symptoms for this population. Results highlight nuances in PTSD symptoms experienced by UC, and can inform existing assessments used by clinicians. Future research using qualitative designs should examine how PTSD symptoms present in different contexts such as school, home, and the community.