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. 2025 Dec;16(1):2486902.
doi: 10.1080/20008066.2025.2486902. Epub 2025 May 28.

Potentially traumatising events and post-traumatic stress symptoms of adolescents in out-of-home care

Carolin Hummel  1   2 , Steffen Schepp  1   2 , Miriam Rassenhofer  1   2 , Andreas Witt  3 , Jörg Fegert  1   2 , Elisa Pfeiffer  1   2   4
Affiliations

Potentially traumatising events and post-traumatic stress symptoms of adolescents in out-of-home care

Carolin Hummel et al. Eur J Psychotraumatol. 2025 Dec.

Abstract
in English, Spanish

Background: Children and adolescents in out-of-home care are particularly vulnerable to potentially traumatising events (PTEs) and trauma-related mental health disorders. In Germany, there is limited evidence on trauma exposure and posttraumatic stress symptoms (PTSS) among youth in child welfare facilities. Better understanding their psychopathology could support the development of tailored trauma-focused interventions.Objective: This study investigates PTEs and PTSS (DSM-5 criteria) in adolescents living in residential care. It also examines risk factors for PTSS and compares self-reports with proxy-reports from institutional staff.Method: A total of N = 126 adolescents (mean age = 14.98 years, SD = 1.62, range = 11-19) from 17 residential care facilities in southern Germany and their institutional caregivers completed questionnaires assessing demographics, PTEs, and PTSS.Results: Participants reported an average of M = 4.51 PTEs (SD = 3.08, range = 0-12). High rates of online victimisation were found, with 19.8% reporting cyberbullying and 22.2% reporting being coerced online into sexual acts - the latter showing a strong correlation with PTSS (r = 0.33). Adolescents scored an average of M = 21.24 (SD = 11.01, range = 2-50) on the CATS-2, with scores above the clinical cut-off (≥21) indicating high symptom burden. Significant predictors of PTSS included the number of PTEs (β = .55, p < .001), female gender (β = .27, p < .01), and interpersonal trauma (β = .55, p < .001). Correlations between self- and staff-reports were low (r = .06-.19), with staff reporting fewer symptoms.Conclusion: The findings underline the high vulnerability of youth in care to trauma and stress-related symptoms and support the need for trauma-sensitive care. The prominence of online victimisation highlights the need for routine clinical screening. Low agreement between self- and caregiver reports reinforces the importance of directly assessing adolescents' experiences.

Antecedentes: Los niños en casas de acogida constituyen una población especialmente vulnerable no solo por experimentar eventos potencialmente traumáticos (PTEs), sino también por el desarrollo de trastornos de salud mental relacionados con el trauma como consecuencia del trauma y otros estresores. Actualmente, existe una importante falta de evidencia sobre el trauma y síntomas de estrés postraumático (PTSS por sus siglas en ingles) en niños que viven en centros de protección infantil en Alemania. Una mejor comprensión de su psicopatología podría facilitar el desarrollo de intervenciones centradas en trauma adaptadas a esta población para abordar sus necesidades específicas.

Objetivo: Este estudio tiene como objetivo investigar los PTEs y PTSS según los criterios DSM-5 en una población de adolescentes en centros de acogida. Adicionalmente, se analizaron los factores de riesgo asociados con el desarrollo de PTSS.

Método: N = 126 adolescentes con una edad media de 14.98 años (DE = 1.62, rango = 11–19), que vivían en 17 residencias de acogida diferentes en el sur de Alemania, y el personal institucional que cuidaba a estos adolescentes, completaron cuestionarios sobre datos demográficos, PTEs y PTSS.

Resultados: En promedio, los participantes del estudio reportaron M = 4.51 PTEs (DE = 3.08, rango = 0–12). Los adolescentes en casa de acogida reportaron M = 21.24 (DE = 11.01, rango = 2–50) de PTSS en el CATS-2 (punto de corte clínico ≥21). Los factores de riesgo significativos para PTSS incluyeron el número de PTEs (β = .55, p < .001), sexo femenino (β = .27, p < .01), y los PTEs interpersonales (β = .55, p < .001).

Conclusión: Los resultados confirmaron hallazgos previos de la mayor vulnerabilidad para PTEs y de desarrollar secuelas de trauma en la población examinada, lo que refuerza la importancia de establecer cuidados sensibles al trauma en las casas de acogida para jóvenes.

Keywords: PTSD; TEPT; Trauma; centros de acogida; child; child welfare; factores de riesgo; niño; out-of-home care; protección infantil; risk factor.

Plain language summary

On average, adolescents in out-of-home care reported M = 4.51 potentially traumatising events, alongside significantly elevated rates of post-traumatic stress symptoms (PTSS).The most commonly reported interpersonal potentially traumatising events was bullying (n = 62, 49.2%), while 19.8% (n = 25) specifically reported experiencing cyber-bullying.As rates of online victimisation were high in this population, these experiences should be assessed with each patient in clinical practice.We found low consistency between self-report and child welfare staff report indicating the importance of self-reported data.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

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