The relationship between age of first exposure and posttraumatic symptoms: results from the global psychotrauma screen

Background: Early trauma exposure is widely associated with increased psychological distress, but less is known about how the timing and type of trauma interact to influence outcomes across diverse cultural settings.Objectives: This study tested three hypotheses: (1) that younger age of first trauma exposure predicts more severe post-traumatic sequelae; (2) that this effect persists across trauma types; and (3) that patterns are consistent across countries.Methods: Data were drawn from the Global Psychotrauma Screen (GPS), a validated self-report tool assessing trauma-related symptoms and risk/protective factors. The final sample included 8,831 adults (aged 16–85) from 38 countries. Outcomes included overall symptom burden, post-traumatic stress disorder (PTSD), depression, complex-PTSD (C-PTSD), anxiety levels, depression, insomnia, dissociation, substance use and self-harm. Cumulative link mixed models were fitted for each outcome, with self-identified gender, trauma type, and developmental stage as predictors, and random slopes and intercepts for country.Results: Compared to adulthood, trauma exposure in early childhood predicted significantly greater symptom burden, particularly for C-PTSD, dissociation, self-organisation disturbances, depression and self-harm. Middle childhood and adolescent exposure also increased risk, but effects were more variable. Sexual violence in early and middle childhood was especially detrimental across outcomes. Emotional abuse consistently predicted elevated symptoms regardless of timing. Interaction models revealed that trauma type moderated the effect of age at exposure on symptoms, with serious injury and causing harm to others associated with fewer symptoms when experienced early. Substantial cross-country variation emerged in both symptom severity and the strength of age-related effects, especially for early childhood exposure.Conclusions: Early trauma exposure, particularly sexual and emotional abuse, has a disproportionate and enduring impact on mental health across cultures. These findings underscore the need for developmentally informed, trauma-specific interventions and highlight the importance of considering age and trauma type in global mental health research and practice.