Prevalence and validity of CPTSD in a community sample of adolescents with refugee backgrounds

Abstract Objectives Research on complex posttraumatic stress disorder (CPTSD) among individuals with refugee backgrounds is limited, particularly in adolescents, and its validity in this group remains underexplored. The aim of this study was to assess the prevalence and discriminant validity of posttraumatic stress disorder (PTSD) and CPTSD, as well as the risk factors for CPTSD, in a community sample of adolescents with refugee backgrounds residing in Sweden. Methods The study included 296 adolescents with refugee backgrounds recruited nationwide in Sweden. Participants were aged 12-25 years, 45.3% were female, and 23.7% had unaccompanied status. Probable diagnoses were evaluated according to DSM-5 and ICD-11 criteria using questionnaires. Latent class analysis was employed to examine the discriminant validity of PTSD and CPTSD, while logistic regression analysis was used to explore risk factors for CPTSD. Results The findings indicated that 24.1% had a probable diagnosis of PTSD according to the DSM-5. For ICD-11, the equivalent proportions were 7.1% for PTSD and 10.8% for CPTSD. The probable diagnostic rates for DSM-5 PTSD were significantly higher than ICD-11 PTSD and CPTSD. Latent class analysis identified three distinct classes: Low symptoms (46.9%), PTSD (29.6%), and CPTSD (23.6%). Compared to the PTSD class, membership in the CPTSD class was predicted by exposure to more types of violence and child maltreatment. It was also associated with higher posttraumatic stress symptoms, worse general functioning, poorer mental well-being, increased suicidal ideation, more treatment-seeking behavior and greater comorbidity. Conclusions This study found a high prevalence of PTSD and CPTSD among adolescents with refugee backgrounds living in Sweden. Distinct classes aligned with the ICD-11 formulation of PTSD and CPTSD were identified, with exposure to more types of violence and child maltreatment emerging as key risk factors for CPTSD. Key messages • Adolescents with refugee backgrounds living in Sweden may be highly affected by PTSD and CPTSD. • The ICD-11 distinction between PTSD and CPTSD is likely valid for adolescents with refugee backgrounds. Exposure to more types of violence and child maltreatment may be risk factors for CPTSD.