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Mark I. Singer, PhD; Trina Menden Anglin, MD, PhD; Li yu Song, PhD; Lisa Lunghofer, PhD

JAMA. 1995;273(6):477-482.

Abstract
Objective.
—To examine the extent to which adolescents are exposed to various types of violence as either victims or witnesses, and the association of such exposure with trauma symptoms; specifically, the hypotheses that exposure to violence will have a positive and significant association with depression, anger, anxiety, dissociation, posttraumatic stress, and total trauma symptoms.

Design and Setting.
—The study employed a survey design using an anonymous self-report questionnaire administered to students (grades 9 through 12) in six public high schools during the 1992-1993 school year.

Participants.
—Sixty-eight percent of the students attending the participating schools during the survey participated in the study (N=3735). Ages ranged from 14 to 19 years; 52% were female; and 35% were African American, 33% white, and 23% Hispanic.

Results.
—All hypotheses were supported. Multiple regression analyses of the total sample revealed that violence exposure variables (and to a lesser extent, demographic variables) explained a significant portion of variance in all trauma symptom scores, including depression (R²=.31), anger (R²=.30), anxiety (R²=.30), dissociation (R²=.23), posttraumatic stress (R²=.31), and total trauma (R²=.37).

Conclusions.
—A significant and consistent association was demonstrated linking violence exposure to trauma symptoms within a diverse sample of high school students. Our findings give evidence of the need to identify and provide trauma-related services for adolescents who have been exposed to violence.

(JAMA. 1995;273:477-482)

Author Affiliations
From the Mandel School of Applied Social Sciences, Case Western Reserve University, Cleveland, Ohio (Drs Singer, Song, and Lunghofer); and the Department of Pediatrics, University of Colorado School of Medicine, and Section on Adolescent Medicine, The Children's Hospital, Denver, Colo (Dr Anglin).

Footnotes
Reprint requests to Mandel School of Applied Social Sciences, Case Western Reserve University, 10900 Euclid Ave, Cleveland, OH 44106-7164 (Dr Singer).

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