Longitudinal Associations Between Posttraumatic Stress Disorder, Separation Anxiety, and Rumination Among Adolescents: Disentangling Within-Person and Between-Person Associations

Objective: Posttraumatic stress disorder (PTSD) and separation anxiety often show high comorbidity after trauma, which complicates the course of disease and treatment response. However, it is unclear how PTSD and separation anxiety comorbidity occur. According to the cognitive model of PTSD, rumination may be a key cognitive process linking the two constructs. Thus, this study aimed to examine the relation between PTSD and separation anxiety and to assess the mediating role of rumination in this relation among adolescents after trauma. Method: A follow-up survey was conducted among 204 adolescent survivors of the Ya'an earthquake, at 6 months (T1), 12 months (T2), and 18 months (T3). A random-intercept cross-lagged panel model was used for data analysis to disentangle within-person dynamics from stable between-person differences. Results: The results showed that at the within-person level, PTSD increased separation anxiety via rumination, and early PTSD further exacerbated later PTSD through increased rumination and separation anxiety. Conclusions: These findings highlight the mediating role of rumination, elucidate the relation between PTSD and separation anxiety, and provide theoretical support for the development of transdiagnostic clinical interventions and treatments. Clinical Impact Statement<br /> This study suggests that rumination is an important mechanism responsible for the comorbidity between posttraumatic stress disorder (PTSD) and separation anxiety. PTSD is the main psychological disorder that occurs in adolescents after trauma and that separation anxiety is secondary to PTSD. Thus, we should first focus on alleviating the severity of PTSD at the early stage. Moreover, focusing on rumination-based interventions could be a potential treatment approach for PTSD and separation anxiety comorbidity.