Beyond survival The impact of interpersonal trauma on youth, barriers to mental healthcare, and treatment opportunities

This dissertation examines several interconnected aspects of trauma-informed youth mental healthcare, ranging from the identification of childhood adversity to the organisation, delivery, and accessibility of trauma-focused treatment. The studies collectively show that adverse childhood experiences are common among adolescents referred to mental health services and are associated with greater symptom severity, psychiatric comorbidity, and diagnostic complexity. These findings support the systematic assessment of trauma exposure as part of clinical evaluation.
The dissertation also addresses the sequencing of trauma-focused treatment for adolescents with PTSD following multiple interpersonal traumatic experiences. A randomised controlled trial showed that both a phase-based approach, consisting of preparatory skills training (STAIR-A) followed by EMDR, and immediate EMDR resulted in substantial reductions in PTSD symptoms.
In addition, the dissertation considers factors that may hinder access to effective care. Online sexual abuse illustrates how emerging forms of adversity may require coordinated psychological, medical, forensic, and technical responses. Trauma-related shame and guilt may further inhibit disclosure and help-seeking, which motivated the development of a brief psychoeducational intervention targeting self-blame related to involuntary trauma responses.
Taken together, the dissertation supports a model of trauma-informed care in which adversity is systematically identified, trauma-focused treatment is offered without unnecessary delay, and additional interventions are tailored to barriers that may affect disclosure, engagement, or recovery.