This study assessed posttraumatic stress symptom (PTSS) severity and associated factors among trauma-exposed children and adolescents on the Qinghai–Tibet Plateau, focusing on prosocial behaviour and resilience and examining the association of prosocial behaviour with PTSS via resilience. A cross-sectional study involved 2,322 trauma-exposed children and adolescents aged 10–19 years, with boys comprising 49.1%. PTSS, prosocial behaviour, and resilience were measured via three self-report questionnaires: the Child Post-Traumatic Stress Symptom Scale (CPSS), the Prosocial Behaviour Subscale of the Strengths and Difficulties Questionnaire (SDQ), and the short version of the Connor–Davidson Resilience Scale (CD-RISC), respectively. Descriptive statistics and correlation analyses were used to summarise participants’ characteristics and the bivariate associations between variables, and a mediation model with bootstrapped confidence intervals was estimated to test the indirect association of prosocial behaviour with PTSS via resilience. Overall, 40.4% of trauma-exposed children and adolescents scored at or above the CPSS cut-off (≥ 16) and thus screened positive for probable posttraumatic stress disorder (PTSD; 95% CI 38.4%, 42.4%). Prosocial behaviour was positively associated with resilience and negatively associated with PTSS, whereas resilience was negatively associated with PTSS (r = 0.53, − 0.30, and − 0.50, respectively, all p < 0.001). In the mediation model, prosocial behaviour was positively related to resilience (β = 0.52, SE = 0.02, 95% CI 0.48, 0.55), and resilience was negatively associated with PTSS (β = − 0.50, SE = 0.02, 95% CI − 0.55, − 0.46), while the direct path from prosocial behaviour to PTSS was close to zero (β = − 0.02, SE = 0.02, 95% CI − 0.07, 0.02). The indirect effect of prosocial behaviour on PTSS via resilience was statistically significant (β = − 0.26, SE = 0.02, 95% CI − 0.29, − 0.23), accounting for most of the total association (β = − 0.28, SE = 0.02, 95% CI − 0.32, − 0.24). The results highlight the high burden of PTSS among trauma-exposed children and adolescents in high plateau areas. Prosocial behaviour was associated with lower PTSS, with most of this association statistically accounted for by resilience. These findings are hypothesis-generating and suggest that prosocial behaviour and resilience may represent plausible targets for future longitudinal or experimental research, with practical implications requiring prospective confirmation.
Xiao et al. (Mon,) studied this question.