NAMICon Speaker Calls for Prevention-Based Approach

Have you ever personally experienced trauma? Think about your answer before you read on.

Now ask yourself: have you ever been in a motor vehicle crash? Ever had a bad injury or severe illness? Been a victim of sexual assault or some other form of interpersonal violence? Were you ever present at the sudden or unexpected death of a loved one? 

These – and many more not described here – are traumatic events. By definition, they cause physical, emotional and/or psychological harm or distress. They happen every day, to many people all around the world. Some of these people recover and move on with their lives. Others don’t. Figuring out why some do and others don’t is a major focus of trauma research.

Trauma Exposure Common Worldwide

While we have no problem thinking of high-profile events such as hurricanes as traumatic, “lesser” traumas can also inflict real harm. New data from a long-term study suggests more than half of Americans have experienced at least one traumatic event. Reports put the worldwide prevalence at around 5 to 6 percent of population over a lifetime, but that’s probably an underestimate. In parts of the world experiencing long-term conflict, for example, the prevalence can be much higher, 25 percent or more of the population.

“Trauma is incredibly common,” said Karestan Koenen, a research scientist at Harvard School of Public Health, who presented the new data at NAMICon, the mental health conference. “If you look at the list of traumatic events, we’re all there.”

The good news is that most people recover from trauma without treatment, she says. An Israeli study found that the majority recovered rapidly; others took longer to bounce back but eventually did. In about 10 to 20 percent of people, symptoms persist. Some of them meet the threshold of diagnosis for post-traumatic stress disorder (PTSD). Finding the keys to unlocking resilience and preventing a progression into PTSD is critical.

Heavy Toll of Chronic Post-Trauma Symptoms 

When PTSD continues, or becomes chronic, its toll on health increases.  In conjunction with the longstanding Nurses’ Health Study, Koenen investigates how violence, trauma, and PTSD alter long-term physical health and accelerate aging. Anxiety and depression commonly co-occur with PTSD, and the combination of depression and severe PTSD is particularly worrisome, nearly tripling the risk of death. But the health impact goes beyond psychological challenges. Cognitively, attention, learning and working memory may be affected. Trauma and PTSD also increase the risk of cardiovascular disease, stroke, heart attack, and type 2 diabetes. This may be due to inflammatory processes linked to PTSD. With diabetes, research shows a dose-like effect: the more severe one’s PTSD symptoms, the more likely one is to develop the condition. Diabetes itself raises the risk of stroke and heart attack. 

At a more fundamental level, chronic PTSD is associated with a particular biological marker of accelerated aging that has been the focus of much research: shorter telomeres. Telomeres are microscopic thread-like proteins that cap the ends of chromosomes and protect the twisted helixes of DNA inside. As we age, telomeres wear and physically shorten. Koenen likens the telomere to the tip of a shoelace, where each rethreading damages the shoelace a little bit until the ends are so worn they no longer perform their function. Chronic stress wears out telomeres faster, and so does PTSD. 

What Can Be Done?

Trauma disproportionately burdens women, who experience more of the kind of high-impact events that often lead to PTSD. All too commonly, this includes sexual assault. Recovery after experiencing personal violence often takes longer, sexual violence included. Half of rape survivors go on to develop PTSD symptoms, Koenen says, which can range from sporadic and manageable to debilitating. 

The classic medical model for treatment and prevention is to identify people at high risk and intervene with therapy. Effective treatments are available for PTSD, including trauma-informed cognitive-behavioral therapies that help survivors manage symptoms. But whether treating PTSD symptoms improves health outcomes is “the million-dollar question,” Koenen says. 

The bigger problem, she says, is that globally, most people with PTSD symptoms don’t get treated. Even in the U.S., only about a third do, and that drops to 5 percent or less in low-income countries, where trauma may be more widespread.. “The treatment gap is really dismal when it comes to PTSD,” she says.

Preventing Trauma is Key to Reducing PTSD

Koenen and others advocate an alternative: a population-based health approach that acknowledges the gap and focuses on prevention. “We would like to shift the entire risk distribution for PTSD by lowering the amount of trauma in the population.” Considering that physical and sexual violence account for more than of PTSD burden in the U.S., Koenen says the answer is clear. 

“The prevention of physical and sexual violence may be the most important strategy we have for reducing PTSD in the U. S. and worldwide.”

~ Karestan Koenen, Ph.D., Harvard School of Public Health

What would such a monumental endeavor entail? Koenen says it would require a multi-pronged attack on the major causes of violence in societies, which in America revolve around guns, racial tensions, domestic violence, sexual assaults, and LGBTQ+ violence. It would also require a medical system that understands trauma and its relation to health and integrates trauma-informed mental health care into every aspect of the individual’s treatment and recovery. No small task indeed, but one which urgently needs attention to reduce the societal burden of trauma and post-traumatic complications.

Blog written by Brenda Patoine on behalf of VCN/Vermont Care Partners for COVID Support Vermont, a grant funded by FEMA and the Vermont Department of Mental Health

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