Routineversorgung für Jugendliche und junge Erwachsene mit Posttraumatischer Belastungsstörung nach sexualisierter und physischer Gewalt in Deutschland

Abstract

Theoretischer Hintergrund: Für die Behandlung der Posttraumatischen Belastungsstörung (PTBS) im Jugend- und jungen Erwachsenenalter liegen diverse evidenzbasierte Interventionen (EBIs) vor. Fragestellung: Inwiefern sind EBIs für Jugendliche und junge Erwachsene mit PTBS nach sexualisierter und physischer Gewalt in Deutschland verfügbar? Methode: Es wurden die Daten von 39 Teilnehmenden einer multizentrischen Behandlungsstudie analysiert, die für die Diagnose einer PTBS ambulante Behandlungsempfehlungen erhalten hatten. Ergebnisse: In den folgenden sieben Monaten erhielten 21 der Teilnehmenden eine Behandlung; bei nur acht wurden in deren Rahmen die traumatischen Erfahrungen adressiert. Alle Teilnehmenden verbesserten sich hinsichtlich der PTBS-Symptomatik unabhängig von der Art der Behandlung. Diskussion und Schlussfolgerung: Die Ergebnisse weisen auf Barrieren für den Zugang zu EBIs in unserer Stichprobe hin. Künftige Forschung sollte die Hintergründe für diese Barrieren fokussieren.

Theoretical background: Numerous studies document high prevalences of child sexual and physical abuse and their severe consequences for mental health. Specifically, the diagnosis of posttraumatic stress disorder (PTSD) is associated with previous child abuse and neglect. Therefore, early and evidence-based treatments (EBTs) are crucial to ensuring and fostering the adequate development of affected individuals. To date, several EBTs have proved to be effective in the treatment of PTSD in adolescents and young adults. Objective: It is presently unclear to what extent EBTs are available for adolescents and young adults with histories of child abuse seeking treatment in Germany. Therefore, the present study wanted to gain insight into standard treatment (“treatment as usual”) as delivered for adolescents and young adults with abuse-related PTSD in three German cities. Method: We analyzed the data of 39 participants of a multicenter, randomized, and controlled trial of persons aged 14 to 21 who had received treatment recommendations for the respective region following the diagnosis of PTSD. We investigated the percentage of participants who had received treatment during the following 7-month period and whether there were any differences between participants who had or had not received treatment regarding their sociodemographic, psychopathological, or trauma-specific characteristics and treatment outcomes. Results: Of the 39 participants, 21 had received some kind of intervention during the subsequent 7-month period, but only 8 reported that the traumatic events had been addressed in treatment. Participants receiving treatment differed from participants without treatment only regarding living in out-of-home placement or institutional care and receiving psychotropic medication at baseline. All participants demonstrated significant improvements in their clinician-rated as well as self-rated posttraumatic stress symptoms, regardless of whether they had received treatment or trauma-focused treatment addressing the traumatic events at all. Discussion and conclusion: This study is the first to analyze standard treatment as delivered in Germany for adolescents and young adults suffering from abuse-related PTSD and seeking treatment. Our results indicated barriers to access to EBTs in our study population. Although indicated, only about half of the participants received treatment at all, and when participants did receive treatment, the traumatic experiences were rarely addressed, which does not correspond to the recommendations of international guidelines. However, a generalization of our results is limited because of the small sample size and the lack of information on the individual reasons of the study participants who did not initiate treatment. Future research is needed to explore whether limited access to EBTs might be due to system-level (e. g., lack of implementation of EBTs in community settings) or individual-level barriers (e. g., lack of motivation after referrals).