Cultural and intergenerational pathways between family alcohol use, trauma exposure, and probable PTSD in Taiwanese adolescents.

BACKGROUND

Posttraumatic stress disorder (PTSD) and alcohol use (AU) frequently co-occur, yet little is known about how family drinking patterns shape trauma exposure and PTSD risk in non-Western and Indigenous adolescent populations. Taiwan's multi-ethnic eastern region-home to Amis and Atayal Indigenous groups-provides a unique context for examining culturally specific trauma pathways.

OBJECTIVE

To examine how caregiver and adolescent alcohol use relate to exposure to traumatic events (TEs) and probable PTSD likelihood among Han Chinese and two Indigenous groups, Amis and Atayal, in eastern Taiwan.

METHODS

A cross-sectional survey was conducted among 751 junior-high students (Han, Amis, Atayal) in rural eastern Taiwan. Adolescents completed the Chinese UCLA PTSD Reaction Index and a trauma-exposure checklist. Caregiver and adolescent AU were assessed via self-report. Logistic regression tested associations among caregiver and adolescent AU, trauma exposure, and probable PTSD likelihood, adjusting for demographic factors.

RESULTS

Caregiver AU was significantly associated with both trauma exposure and probable PTSD across all ethnic groups. While adolescent AU was associated with trauma exposure among Han and Amis youth, no such link was found for Atayal adolescents. Furthermore, exploratory testing rejected the self-medication hypothesis, lending support to the high-risk environmental framework. Trauma types most strongly associated with probable PTSD differed by ethnicity: sexual trauma and painful medical procedures among Han youth; bereavement among Amis adolescents; and witnessing community violence among Atayal adolescents. Indigenous participants showed consistently higher trauma exposure than Han peers.

CONCLUSIONS

Family drinking patterns exert strong intergenerational effects on adolescent trauma exposure and probable PTSD risk. The culturally distinct trauma profiles across Han, Amis, and Atayal adolescents highlight the need for trauma-informed, culturally grounded, and family-centered mental-health interventions. Reducing caregiver AU and addressing structural inequities affecting Indigenous communities may offer critical leverage points for preventing PTSD among youth in Taiwan and comparable multi-ethnic settings.