Posttraumatic stress symptoms in trauma-exposed plateau children and adolescents: associations with resilience and prosocial behaviour

This study assessed posttraumatic stress symptom (PTSS) severity and associated factors among trauma-exposed children and adolescents on the Qinghai–Tibet Plateau, focusing on prosocial behaviour and resilience and examining the association of prosocial behaviour with PTSS via resilience. A cross-sectional study involved 2,322 trauma-exposed children and adolescents aged 10–19 years, with boys comprising 49.1%. PTSS, prosocial behaviour, and resilience were measured via three self-report questionnaires: the Child Post-Traumatic Stress Symptom Scale (CPSS), the Prosocial Behaviour Subscale of the Strengths and Difficulties Questionnaire (SDQ), and the short version of the Connor–Davidson Resilience Scale (CD-RISC), respectively. Descriptive statistics and correlation analyses were used to summarise participants’ characteristics and the bivariate associations between variables, and a mediation model with bootstrapped confidence intervals was estimated to test the indirect association of prosocial behaviour with PTSS via resilience. Overall, 40.4% of trauma-exposed children and adolescents scored at or above the CPSS cut-off (≥ 16) and thus screened positive for probable posttraumatic stress disorder (PTSD; 95% CI [38.4%, 42.4%]). Prosocial behaviour was positively associated with resilience and negatively associated with PTSS, whereas resilience was negatively associated with PTSS (r = 0.53, − 0.30, and − 0.50, respectively, all p < 0.001). In the mediation model, prosocial behaviour was positively related to resilience (β = 0.52, SE = 0.02, 95% CI [0.48, 0.55]), and resilience was negatively associated with PTSS (β = − 0.50, SE = 0.02, 95% CI [− 0.55, − 0.46]), while the direct path from prosocial behaviour to PTSS was close to zero (β = − 0.02, SE = 0.02, 95% CI [− 0.07, 0.02]). The indirect effect of prosocial behaviour on PTSS via resilience was statistically significant (β = − 0.26, SE = 0.02, 95% CI [− 0.29, − 0.23]), accounting for most of the total association (β = − 0.28, SE = 0.02, 95% CI [− 0.32, − 0.24]). The results highlight the high burden of PTSS among trauma-exposed children and adolescents in high plateau areas. Prosocial behaviour was associated with lower PTSS, with most of this association statistically accounted for by resilience. These findings are hypothesis-generating and suggest that prosocial behaviour and resilience may represent plausible targets for future longitudinal or experimental research, with practical implications requiring prospective confirmation.