Temporal consistency in the traumatic events and stress inventory in a sample of vulnerable adolescents: yes or no?

Universidade do Minho Escola de Psicologia Marta Magalhães Caçador Temporal Consistency in the Traumatic Events and Stress Inventory in a Sample of Vulnerable Adolescents: Yes or No? outubro de 2023 UMinho | 2023 Marta Caçador Temporal Consistency in the Traumatic Events and Stress Inventory in a Sample of Vulnerable Adolescents: Yes or No? Universidade do Minho Escola de Psicologia Marta Magalhães Caçador Temporal Consistency in the Traumatic Events and Stress Inventory in a Sample of Vulnerable Adolescents: Yes or No? Dissertação de Mestrado Mestrado em Psicologia da Justiça Trabalho efetuado sob a orientação da Professora Doutora Ângela Rosa Pinho da Costa Maia outubro de 2023 e da Doutora Vanessa Mourão Ferreira Sampaio Azevedo ii DIREITOS DE AUTOR E CONDIÇÕES DE UTILIZAÇÃO DO TRABALHO POR TERCEIROS Este é um trabalho académico que pode ser utilizado por terceiros desde que respeitadas as regras e boas práticas internacionalmente aceites, no que concerne aos direitos de autor e direitos conexos. Assim, o presente trabalho pode ser utilizado nos termos previstos na licença abaixo indicada. Caso o utilizador necessite de permissão para poder fazer um uso do trabalho em condições não previstas no licenciamento indicado, deverá contactar o autor, através do RepositóriUM da Universidade do Minho. Licença concedida aos utilizadores deste trabalho Atribuição-NãoComercial-SemDerivações CC BY-NC-ND https://creativecommons.org/licenses/by-nc-nd/4.0/ Universidade do Minho, 16 de outubro de 2023, (Marta Magalhães Caçador) iii Agradecimentos Às minhas orientadoras, Professora Doutora Ângela Maia e Doutora Vanessa Azevedo, obrigada por me acompanharem nesta última fase do meu percurso académico. À Professora Doutora Ângela Maia agradeço as aprendizagens fornecidas, sugestões de melhoria e motivação. Agradeço à Dra Patrícia Correia Santos todo a disponibilidade no esclarecimento de dúvidas, apoio e dedicação. Também a toda a equipa de investigação pelo feedback fornecido, obrigada! Aos meus pais por serem a minha rede de segurança, por se sacrificarem para que eu tenha as melhores oportunidades e por sempre depositarem confiança em mim. É um prazer ter-vos como pais e um orgulho ser vossa filha, obrigada. À minha irmã, Matilde, por ter a paciência de aturar todos os meus humores, as minhas indecisões de hora em hora, os meus planos questionáveis e por nunca me deixar sozinha. Aos meus padrinhos, Joana e Nuno, que como a função pretende são uns segundos pais para mim. À minha família, que por vezes longe, está sempre disponível para me ajudar, para me apoiar e acarinhar. Às minhas companheiras de todas as horas, Maria, Sofia, Sara e Rafaela, que conseguem sempre uma gargalhada nas horas mais difíceis e que incansavelmente acompanham os meus altos e baixos. À Juliana e Manuela, por tornarem quatros horas em quatro minutos. E por fim ao Diogo, a quem infelizmente não consigo por palavras o que fez e continua a fazer por mim, agradeço por tudo. A todos os que marcaram e continuam a marcar esta jornada, um eterno obrigada. iv DECLARAÇÃO DE INTEGRIDADE Declaro ter atuado com integridade na elaboração do presente trabalho académico e confirmo que não recorri à prática de plágio nem a qualquer forma de utilização indevida ou falsificação de informações ou resultados em nenhuma das etapas conducente à sua elaboração. Mais declaro que conheço e que respeitei o Código de Conduta Ética da Universidade do Minho. Universidade do Minho, 16 de outubro de 2023, (Marta Magalhães Caçador) v Temporal Consistency in the Traumatic Events and Stress Inventory in a Sample of Vulnerable Adolescents: Yes or No? Abstract In a lifetime every human experiences moments that alters their perception and comprehension of the environment that surrounds them. There are some events that can altercate a life´s course, especially if they are adverse events that can be potentially traumatic to a person. The consistency of the reports related to these experiences is based on its stability, by analyzing if the same subject recounts the same report on two (or more) time moments without significant changes. The fact that consistency may impact studies that involve reports of adverse events, makes it imperative to comprehend and clarify this phenomenon. As such the focus of this investigation is to analyze the temporal consistency of self-reports, given by a vulnerable sample of adolescents from North Portugal, on the Traumatic Events and Stress Inventory, thus comparing if the reports given in a first moment of evaluation will be consistent with a second moment. Through the analysis of the reports provided by the participants, it was possible to verify temporal consistency, ICC=0.757, 95% CI [0.659-0.830], p = 0.00, and identify which types of trauma (associated with TESI) exhibited more temporal consistency (for example, Traumatic Separation of Primary Caregiver(s) – k = .59, SE = .08, 80.6% agreement). Keywords: adverse events, retrospective design, Traumatic Events and Stress Inventory, (in)consistency. vi Temporal Consistency in the Traumatic Events and Stress Inventory in a Sample of Vulnerable Adolescents: Yes or No? Resumo No decorrer de uma vida, o ser humano vivencia momentos que alteram a sua perceção e compreensão do ambiente que o rodeia. Existem eventos que podem modificar o curso da sua vida, especialmente se esses eventos forem adversos, visto que estes podem ser potencialmente traumáticos para essa pessoa. O estudo da consistência dos relatos dos indivíduos que experienciaram tais eventos é baseado na sua estabilidade, analisando se um indivíduo relata, mais do que uma vez, o acontecimento da mesma forma sem grandes alterações. O facto de a consistência poder impactar nas conclusões dos estudos que envolvem relatos de experiências adversas, torna imperativo compreender e clarificar este fenómeno. Assim, o objetivo deste estudo é, numa amostra de adolescentes vulneráveis do Norte de Portugal, analisar a consistência temporal dos seus autorrelatos no instrumento Traumatic Events and Stress Inventory, comparando se os relatos fornecidos em dois momentos diferentes são consistentes entre si. Através da análise dos relatos dados pelos participantes, foi possível verificar consistência temporal, ICC=0.757, 95% CI [0.659-0.830], p = 0.00, e distinguir quais os tipos de trauma (associados à TESI) com mais consistência temporal (p.e. e.g., Traumatic Separation of Primary Caregiver(s) – k = .59, SE = .08, 80.6% agreement). Palavras-chave: experiências adversas, design retrospetivo, Traumatic Events and Stress Inventory, (in)consistência. vii Contents Temporal Consistency in the Traumatic Events and Stress Inventory in a Sample of Vulnerable Adolescents: Yes or No? ............................................................................................ 8 Adverse and Potentially Traumatic Experiences ............................................................................... 8 The Weakness of a Retrospective Design ......................................................................................... 9 The Importance of Consistency ..................................................................................................... 10 The present study ......................................................................................................................... 11 Method ......................................................................................................................................... 11 Participants .................................................................................................................................. 11 Procedure .................................................................................................................................... 13 Measures ..................................................................................................................................... 14 Data Analysis ............................................................................................................................... 15 Results .......................................................................................................................................... 15 Discussion .................................................................................................................................... 18 References ................................................................................................................................... 23 Tables Table 1. Participants Social Demographic ……………………………………………………………………………..12 Table 2. Intraclass Correlation Coefficients for Total Number of Trauma Types ……………………………15 Table 3. Temporal Reliability for Individual Items …………………………………………………………………..16 Table 4. Temporal Reliability for Types of Trauma ………………………………………………………………….17 14 Measures Socio-Demographic Questionnaire. The questionnaire allowed us to know and classify the participants by age, sex, education, occupation, living arrangements, household income, and if they have ever been identified to Child Protective Services. Traumatic Events and Stress Inventory – TESI (TESI-C/SR; Portuguese version: CorreiaSantos et al., 2021). This instrument enables the assessment of the presence or absence of 24 potentially traumatic events in the lives of adolescents aged 11 to 18 years. The measure comprises questions that explore both interpersonal and non-interpersonal experiences, spanning a wide array of themes including physical and emotional abuse, sexual abuse (whether experienced, witnessed, or learned about), serious accidents, natural disasters, domestic violence, community violence, and death. Responses were recorded as either 'yes,' 'no,' or 'pass.' Subsequently, if the response was 'yes,' a series of additional items would appear. These additional items sought information regarding the participant's age at the time of the first/last experience of the event, the age at which the most severe event occurred, and details about those involved, whether as victims or perpetrators. The original instrument has shown test-retest reliability (Daviss et al., 2000; Ford et al., 2000). The reliability of the present measure is the purpose of this study. For this study, we will analyze the main questions from the TESI questionnaire, omitting specific queries related to event details, the participant’s age of onset or last report, and the parties involved. Some examples items are: “Have you ever been in a really bad accident where someone could have been (or actually was) badly injured or killed?” “Have you ever been in a natural disaster (like a tornado, hurricane, flood, fire, earthquake) where someone could have been (or actually was) badly hurt or killed, or where your family had to leave their home?”; “Has someone close to you ever died, not counting someone who was old and died naturally?”; “Have you ever been so sick that you or the doctor thought you might die?” “Have you ever been separated from someone who you depend on for love or security for more than a few days? “Has someone close to you ever tried to kill or hurt himself/herself really badly on purpose?”; “Has someone ever physically (bodily) attacked you, like hitting, pushing, choking, shaking, biting, or burning you?”. The 24 main questions were grouped into categories, resulting in 14 trauma types. These types of trauma are Severe Accidents; Illness; Non-Interpersonal Violence; Traumatic Loss of Primary Caregiver(s); Traumatic Loss of Significant Others; Traumatic Separation of Primary Caregiver(s); Traumatic Separation of Significant Others; Primary Caregiver(s) Impairment due to Behavioral Problems; Peer-Related Adversity; Physical Abuse or Assault; Sexual Abuse or Assault; Community Violence; Family Violence and Severe Neglect. 15 Data Analysis Data analysis was conducted using IBM Statistical Package for Social Sciences (IBM SPSS; version 28 for Windows). Initially, a descriptive analysis was performed on all variables relevant to the study. Subsequently, the Intraclass Correlation Coefficient (ICC) was computed to assess the agreement between responses at T1 and T2, employing a continuous outcome measure. ICC values indicate agreement levels, ranging from poor to fair (≤ .40), moderate (.41–.60), good (.61–.80), to excellent (.81–1.00). Single Measures ICC assesses the reliability of ratings provided by a typical single rater for the subject or item, it helps us understand how consistent one specific rater is in their assessments. On the other hand, Average Measures ICC examines the reliability of ratings when multiple raters are involved, and their ratings are averaged together, this provides an indication of the overall consistency across different raters' assessments. Furthermore, Cohen’s Kappa was computed to evaluate the agreement between T1 and T2 responses for the categorical data, considering the types of potential traumatic exposure assessed by the TESI. Following the guidelines established by Landis and Koch (1977), the values obtained from this test are categorized as poor if <.00, slight if .00-.20, fair if .21-.40, moderate if .41-.60, substantial if .61-.80 and almost perfect if .81-1.00. Results Regarding the temporal reliability for the total number of traumatic events, as can be seen in Table 2, there is a moderate agreement in the participants' reports (ICC=0.757, 95% CI [0.659-0.830], p = 0.00). Note . ICC = Intraclass Correlation Coefficient. CI = Confidence Intervals Considering the item’s agreement from T1 to T2, the consistency ranged from slight (e.g., "Has anyone ever abducted you or someone close to you? - k = .16, SE = 0.17; 98.1% agreement) to substantial Table 2 . Intraclass Correlation Coefficients for Total Number of Trauma Types ICC 95% CI F Test with True Value 0 Lower Bound Upper Bound Value df1 df2 Sig Single Measures 0.757 0.659 0.830 7.289 97 97 <0.001 Average Measures 0.862 0.794 0.907 7.289 97 97 <0.001 16 (e.g., "Have you ever been separated from a loved one for more than a few days?" - k = .77, SE = .07, 88.8% agreement). Reliability and agreement information for all the items can be seen in Table 3. Table 3. Temporal Reliability for Individual Items Items Temporal reliability parameters N %Agre K SE 1. Have you ever been in a really bad accident? 94 79.6 .397 .110 2. Have you ever seen a really bad accident (that didn't happen to you)? 96 63.3 .254 .098 3. Have you ever been in a natural disaster? 95 80.6 .232 .126 4. Has someone close to you been so injured or sick that he/she almost died or had to go to the hospital? 94 65.3 .282 .098 5. Has someone close to you ever died (not counting natural causes)? 94 70.4 .405 .090 6.Have you ever been so sick that you or doctor thought you could die? 95 77.6 .375 .109 7. Have you ever been separated from a loved more than a few days? 95 88.8 .770 .065 8. Has someone close to you tried to kill or hurt himself/herself on purpose? 96 75.5 .373 .104 9. Has someone ever physically attacked you? 94 84.7 .673 .075 10. Has someone ever said/acted like they were going to hurt you or kill you? 95 80.6 .540 .093 11. Has someone ever mugged you or someone close to you? 94 79.6 .372 .114 12. Has anyone ever kidnapped you or someone close to you? 95 91.8 .159 .174 13. Have you ever been attacked by a dog or other animal? 96 82.7 .609 .085 14. Have you ever witnessed violent physical altercations within your family? 94 79.6 .561 .087 15. Have you ever saw or heard people in your family act like they were going to kill or hurt each other? 93 86.7 .584 .103 16. Have you ever had a family member who was arrested or put in jail/prison? 96 88.7 .700 .084 17 17. Have you ever seen or heard people outside your family fighting/shooting or attacking each other in your school or neighborhood? 96 69.4 .389 .092 18. Have you ever been in a war or terrorist attack? 94 100 ª ª 19. Have you ever seen real wars or terrorist attacks on the TV? 91 69.4 .325 .099 20. Have you ever had a time in your life when you did not have the right care? 93 86.7 .474 .125 21. Has someone ever made you see or do something sexual? 94 93.9 .467 .185 22. Have you ever seen or heard someone else being forced to sex acts? 96 87.8 .193 .146 23. Have you ever been told repeatedly that you were no good? 94 81.6 .455 .109 24. Have you ever watched people using drugs, like smoking drugs or using needles? 96 54.1 .551 .086 Note . % Agre = percentage of agreement. к = Cohen’s kappa. SE = standard error. ª No statistics were computed because the variable was a constant or the crosstabs were empty Table 4 described that various types of trauma exhibit varying levels of agreement. The reliability of the traumatic types also ranges from slight (e.g., Illness – k =.26, SE = .10, 67.3% agreement) to substantial (e.g., Traumatic Separation of Primary Caregiver(s) – k = .59, SE = .08, 80.6% agreement). Table 4. Temporal Reliability for Types of Trauma Items Temporal N %Agre k SE Severe Accidents 98 68.4 .359 .095 Illnesses 98 67.3 .258 .102 Non-Interpersonal Violence 98 84.7 .314 .135 Traumatic Loss of Primary Caregiver(s) 98 94.9 .709 .122 Traumatic Loss of Significant Oher(s) 98 76.5 .446 .097 Traumatic Separation of Primary Caregiver(s) 98 80.6 .594 .083 18 Traumatic Separation of Significant Oher(s) 98 84.7 .612 .090 Primary Caregiver(s) Impairment due to Behavioral Problems 98 92.9 .629 .127 Peer Related Adversity 98 62.2 .246 .098 Physical Abuse or Assault 98 81.6 .632 .078 Sexual Abuse or Assault 98 84.7 .314 .135 Community Violence 98 71.4 .392 .093 Family Violence 98 79.6 .578 .084 Severe Neglect 98 86.7 .474 .125 Note . % Agre = percentage of agreement. к = Cohen’s kappa. SE = standard error. Discussion The exposure to potentially traumatic events and its impact on an individual's life have been extensively studied, especially when these events occur during childhood and adolescence, often resulting in significant and long-lasting effects (Monnat & Chandler, 2015). This study represents a pioneering effort, being part of an ongoing longitudinal investigation that focuses on examining the repercussions of complex trauma using the TESI questionnaire. Given the relatively recent introduction of the TESI questionnaire, it becomes even more critical to explore questions related to its use and applicability in various contexts. To address these questions, this study is based on a social-demographic characterization and the administration of the TESI questionnaire to a vulnerable sample of adolescents in North Portugal. The primary objective is to investigate whether the time elapsed between reports has an impact on consistency of their responses. In the examination of results, it can be seen that the temporal reliability for the total number of traumatic events reported by participants, the Intraclass Correlation Coefficient (ICC) proved to be a valuable metric. Our analysis revealed a moderate agreement in the participants' reports. This finding suggests that, overall, participants' responses to questions about traumatic events exhibited a moderate level of consistency over time (De Vet et al., 2006). However, delving deeper into the assessment of individual traumatic events over time, a nuanced picture emerges. The reliability of these events ranged from slight to substantial, indicating variations in 19 the degree of agreement. Observing the data, it becomes evident that the majority of the items exhibited either moderate or fair agreement levels, with fewer items showing slight or substantial agreement. Out of the 24 items assessed, 8 displayed moderate agreement values, 9 exhibited fair agreement values, 2 demonstrated slight agreement values, and the remaining 4 items fell into the substantial agreement values. Notably, one item ("Have you ever been in a war or terrorist attack?") did not yield any values due to non-responses from all participants. Upon analyzing each questionnaire item, it becomes apparent that some questions are more likely to apply to a person's life experiences. For instance, questions like "Have you ever been in a severe accident?" and "Has someone close to you been so seriously injured or ill that they nearly died or required hospitalization?" are more commonly affirmed when compared to other items such as "Have you ever experienced a natural disaster?" or "Have you ever witnessed or heard individuals outside your family engage in fights, shootings, or attacks within your school or neighborhood?". Therefore, it’s essential to consider the characteristics of the participant sample, particularly given that many adolescents from North Portugal, for example, may not have experienced natural disasters or a high level of community violence. Some items in the questionnaire appear to have the potential to evoke more traumatic experiences, especially those where the events involve either the participant themselves or someone else. This distinction is, for example, noticeable in the items 'Have you ever been in a severe accident?' and 'Have you ever witnessed a severe accident (not involving yourself)?', being that the sole difference between these questions lies in the individual to whom the accident occurs, and as a result, the values of kappa increase when the question pertains to the person directly involved. Specifically, for the question directed at the person themselves, the kappa value is k =0.397 ( SE =0.110, 79.6% agreement), whereas for the question regarding witnessing the accident, the kappa value is k =0.254 ( SE =0.098, 63.3% agreement). Nevertheless, the fact that some of these items are more directly involved does not imply that experiences that happened to someone close or not to the participant do not exhibit good kappa values. For instance, 'Have you ever had a family member who was arrested or put in jail/prison?' presents substantial agreement levels ( k =0.700, SE = 0.084, 88.7% agreement) and it is not an event that occurred directly with the participant but rather involved a person from his/her family. To further enhance the completeness of these results, the results illustrate that most types of trauma exhibit fair levels of kappa, aligning with the individual item findings. Out of the 14 types of trauma assessed using TESI, 6 items showed a fair level of agreement, 4 items exhibited moderate agreement, 20 and 4 displayed substantial agreement. In contrast to the outcomes of individual items, no types of trauma demonstrated slight results, indicating that despite some individual items showing low kappa values, the types of trauma maintain good consistency across reports. To gain a deeper understanding of why certain types of trauma show higher levels of agreement, it is essential to consider that some types of trauma have a more profound impact on a person's life than others. Additionally, various factors associated with the event can influence the degree of exposure to trauma. For instance, severe accidents can be potentially traumatic experiences, but their impact can vary significantly depending on several factors, such as the accident's severity, whether anyone was injured or lost their life, and whether the accident occurred recently or in the more distant past (Schnyder et. al (2001). These factors can also exert a similar influence on other types of trauma, such as illness. The impact of illness depends on various variables, including the severity of the illness, whether the affected individual is the person themselves or someone close to them, whether the disease is terminal, the duration and frequency of illness episodes, and whether hospitalization was necessary, along with the length of hospital stays (Tedstone & Tarrier,2003). Considering that non-intentional violence can encompass accidents, natural disasters, animal attacks, and other incidents, there are also factors that can influence the exposure to trauma. For instance, in the case of a natural disaster, the impact depends on the specific type of disaster, its duration, the extent of damage, the number of casualties, and whether the individual or someone close to them suffered severe injuries or even loss of life (Arnberg et al., 2013). Similar factors come into play in the context of animal attacks, including the type of animal involved, the duration and intensity of the attack, the presence of injuries, and related aspects (Ji et al., 2010). Similar factors can be anticipated in the context of community violence trauma. Depending on the nature of the violence, its frequency, duration, the presence of firearms, and whether the individual or someone close to them is injured or killed by the violence (Aisenberg et al., 2008), various factors can influence the type and extent of trauma experienced. Then, there's interpersonal violence, which, for example, can be attributed to peer-related adversity. The impact of such violence may depend on factors like who the perpetrators are, the number of individuals exerting peer pressure, the frequency of these incidents, when they first began, and the nature of the pressure applied (Murphy et al., 2014). The experience of physical or sexual abuse and assault can also depend on various factors. These factors include whether the abuse occurred personally or to someone close or known to the individual, the identity of the perpetrator, the duration and frequency of the assault, whether it was spontaneous or ongoing, and whether it resulted in serious injuries, among other considerations (Dunmore et al., 2001). It is essential to note that the closer the relationship 21 between the victim and the perpetrator, the higher the likelihood of trauma exposure. The traumatic loss or separation from primary caregivers or significant others already highlights one of the factors that depend on the relationship between the person experiencing the trauma and the one who is lost or separated. It is important to note that the closer the relationship, the greater the probability of becoming a traumatic experience. Additionally, it is worth noting that loss generally results in more significant exposure than separation (Atwoli et al., 2017). For these types of trauma, other factors come into play, such as when the loss or separation occurred, whether it was planned or spontaneous, in the case of separation, whether it was initiated by others, and in case of loss, the type of death of the person lost, among other considerations (Atwoli et.al, 2017, Hibberd et al., 2010). Moreover, there are various factors that can significantly influence trauma exposure, especially when examining family violence. These factors encompass the nature of the violence, the identity of the perpetrator(s), whether the violence was spontaneous or continuous, the duration over which it occurred, the living situation (including whether the person resides with the perpetrator), and many other relevant considerations (Becker & Freyd, 2005). Finally, in the case of Primary Caregiver(s) Impairment due to Behavioral Problems, several factors come into play. These factors include whether the perpetrator is affected by substance or alcohol abuse or has a mental or physical disability. Such impairments can lead to neglect, resulting in another type of trauma known as Severe Neglect. The extent of trauma related to Severe Neglect depends on various factors, such as the type and severity of neglect, the presence of significant physical or psychological effects, the duration over which the neglect occurred, the identity of the perpetrator, and the relationship between the perpetrator and the individual experiencing neglect, among other factors (DeBellis et al., 2009). Taking into account all the factors that can influence trauma exposure, it can be concluded that the participants in this study exhibit good consistency in their reports regarding trauma related to Traumatic Separation of Significant Others (k=0.612, SE=0.090, 84.7% agreement), Impairment of Primary Caregiver(s) due to Behavioral Problems ( k =0.629, SE =0.127, 92.9% agreement), Physical Abuse or Assault (k=0.632, SE=0.078, 81.6% agreement), and Traumatic Loss of Primary Caregiver(s) (k=0.709, SE=0.122, 94.9% agreement). According to the existing literature, these types of trauma are among those most likely to lead to the development of trauma-related symptoms or disorders, such as PTSD (Atwoli et.al, 2017; Dunmore et al., 2001; Hibberd et al., 2010). However, there are other types of trauma that also carry a risk of developing such symptoms and disorders, with Sexual Abuse or Assault being one of the highest-risk categories (Dunmore et al.2001). It is noteworthy from the results that there is a lower kappa value associated with this type of trauma. This can be attributed to the lack of positive responses from the participants, as many either answered 'no' or did not respond at all to items related 22 to sexual acts. Additionally, some types of trauma may present low values of kappa due to the unlikelihood of their occurrence in Portugal, such as natural disasters that translate into Non-Interpersonal Violence (k=0.314, SE=0.135, 84.7% agreement). In summary, all the results obtained in this study have shown highly favorable outcomes that support the research hypothesis. Therefore, it can be reasonably assumed that there is demonstrated consistency across two separate assessment points in the reports provided by a vulnerable sample of adolescents using the TESI questionnaire. This achievement allows us to fulfill the primary objective of the study and provides an answer to the central research question: 'Is there temporal consistency in the TESI questionnaire in a sample of vulnerable adolescents?'. Furthermore, this success encourages the continuation of the ongoing longitudinal investigation, which aims to explore the consequences of complex trauma using the TESI questionnaire. This research contributes valuable insights into the applicability of the TESI instrument. However, the study has some limitations that should be carefully considered. First, it relies on self-reports to measure each construct, which could be supplemented with additional information obtained from parents or legal guardians or through the use of clinical interviews. It's also crucial to acknowledge the potential for reporting bias, particularly given that the study's sample consists of vulnerable adolescents (Pinto & Maia, 2014). Furthermore, there is the possibility that some participants may respond to the questionnaire arbitrarily, as the level of traumatic exposure can strain their attention span (Dixit et al., 2019). Lastly, the study faced challenges related to the timing of data collection, as it did not occur as originally planned by the researchers. This discrepancy in the timing of data collection may have influenced the accuracy of the reported consistency. In future studies, it would be essential to apply this research to a more diverse and heterogeneous sample, including participants from various geographical locations and individuals with different cultural backgrounds. Additionally, it would be intriguing to shift the focus beyond the general questions in the TESI and delve into more detailed inquiries regarding event specifics, the participant's age at the time of onset or last report, and the parties involved. Conducting a more comprehensive study of this nature could shed light on factors that can influence trauma reporting. By examining aspects such as the identity of those perpetrating the event, the participant's age, or the event-related details, we can gain a deeper understanding of the complexities of trauma exposure. 23 References Aisenberg, E., Ayón, C., & Orozco-Figueroa, A. (2008). The Role of Young Adolescents’ Perception in Understanding the Severity of Exposure to Community Violence and PTSD. Journal of Interpersonal Violence, 23 (11), 1555-1578. Anda, R.F., Croft, J.B., Felitti, V.J., Nordenberg, D., Giles, W.H., Williamson, D.F., Giovino, G.A. (1999). Adverse childhood experiences and smoking during adolescence and adulthood, 282 (17), 1652– 1658. https://doi.org/10.1001/jama.282.17.1652 Arnber, F.K., Johannesson, K.B. & Michel, P. (2013) Prevalence and duration of PTSD in survivors 6 years after a natural disaster. Journal of Anxiety Disorders , 27 (3), 347-352. https://doi.org/10.1016/j.janxdis.2013.03.011 Atwoli, L., Stein, D.J., King, A., Petukhova, M., Aguilar-Gaxiola, S., Alonso, J., Bromet, E.J., de Girolamo, G., Demyttenaere, K., Florescu, S., Maria Haro, J., Karam, E.G., Kawakami, N., Lee, S., Lepine, J.- P., Navarro-Mateu, F., O'Neill, S., Pennell, B.-E., Piazza, M., Posada-Villa, J., Sampson, N.A., ten Have, M., Zaslavsky, A.M., Kessler, R.C. (2017), Posttraumatic stress disorder associated with unexpected death of a loved one: Cross-national findings from the world mental health surveys. Depression & Anxiety, 34 , 315-326. https://doi.org/10.1002/da.22579 Azevedo, V. (2016) Experiências de vida e sintomatologia psicopatológica (re)contadas na vida adulta: O que se conta? O que vale o que se conta? E o que conta para se contar? [Tese de Doutoramento, Universidade do Minho]. Becker-Blease, K. A., & Freyd, J. J. (2005). Beyond PTSD: An Evolving Relationship Between Trauma Theory and Family Violence Research. Journal of Interpersonal Violence, 20 (4), 403411. https://doi.org/10.1177/0886260504269485. Browne, A. e Finkelhor, D. (1986). The impact of child sexual abuse: A review of research. Psychological Bulletin, 99 (1), 66–77.https://doi.org/10.1037/0033-2909.99.1.66. Carvalho, M. M. T. (2015). Perceções e motivos das inconsistências no autorrelato de experiências de vida. [Dissertação de Mestrado, Universidade do Minho]. Daviss, W. B., Mooney, D., Racusin, R., Ford, J., Fleischer, A., & McHugo, G. J. (2000). Predicting posttraumatic stress after hospitalization for pediatric injury. Journal of the American Academy of