Outlook: Newsletter of the Society of Behavorial Medicine

Fall 2018

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Trauma, violence, and health: Why We Formed the Violence and Trauma SIG

Sheela Raja, PhD; Elissa Lee, OTS; Pamela Behrman, PhD; and Rose Constantino, PhD, MN, JD

Violence, Trauma, and Toxic Stress are Common. As illustrated by the following statistics, violence and trauma are extremely prevalent in the United States. Approximately one in five women report a history of adult sexual trauma.1 One in four girls and one in twenty boys experience childhood sexual abuse2 and five children die from child abuse-related injuries every day.3 One of four women and one in seven men have experienced severe physical violence in an intimate relationship.4 Approximately one in ten seniors report elder abuse in the form of sexual, emotional, or physical abuse, or financial control.5 Seven percent of the population has been exposed to combat in a war zone, either as a part of military service or as a refugee/immigrant.6 Finally, the Centers for Disease Control estimate that approximately 12,000 Americans die by firearm related homicides a year, and an additional 24,000 die from firearm related suicides. From the epidemic gun violence (e.g., mass shootings, daily community violence, and police-involved shootings), the #MeToo movement, and the forced separation of refugee families seeking asylum, trauma is in our news and in our culture.

Trauma Influences Mental Health, Physiology, and Behavioral Coping. Because many traumatic events involve violation of a person’s bodily integrity, they often have adverse influences on physical and mental health7,8 and attitudes toward medical care.9,10,11,12 The Adverse Childhood Events (ACE) study was a landmark project in trauma-informed care that documented the relationship between self-reported childhood trauma (e.g., child abuse, neglect, parental separation, and parental mental illness and substance abuse) and adult health.13 In addition to mental health and substance use, ACEs are related to our physical health. For example, people who experience more ACEs are at an increased risk of heart disease and liver disease. Further, six or more ACEs are related to up to twenty-year reductions in life expectancy.14 This may be due in part to the fact that repeated trauma and violence can change our physiology and influence the way we cope (e.g., smoking, overeating, substance use, or sexual risk taking). Compared to non-traumatized individuals, trauma survivors may report more sick and emergency room visits, but they may actually avoid seeking preventive medical care such as mammograms, cervical cancer screenings, and even dental cleanings.15,16,17,18 Survivors may feel anxious or “re-triggered” during these appointments.

Behavioral Interventions Need to Address Trauma and Support Resilience. The good news is that many people are able to live healthy, fulfilling lives, even after experiencing very difficult life events. One key finding is that social networks play a key role in healing—these networks can be a combination of friends, family, and professionals. No one heals alone. Behavioral interventions need to be designed to assess trauma, violence, and toxic stress. In addition, patients who do not respond to simple interventions may need more tailored, intensive interventions, where their trauma history is addressed. Trauma informed interventions can help people live healthy and meaningful lives.  

The Violence and Trauma SIG has been active in many aspects of SBM. SIG members have contributed to SBM position statements opposing the forced separation of families at the US border and urging the restoration of CDC funding to study gun violence prevention. The SIG has also presented several sessions at SBM meetings on trauma-informed health, the neurobiology of stress, and the role of adverse childhood experiences on health. SIG members are actively collaborating on papers and projects focused on several topics, including how trauma influences opioid addiction, how racism and toxic stress influence health, how healthcare providers can accurately assess for a history of violence and trauma, and how behavioral medicine interventions can become more trauma-informed. The Violence and Trauma SIG welcomes your ideas!

 

References

  1. Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J., & Stevens, M.R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
  2. Finkelhor, D., Shattuck, A., Turner, H. A., & Hamby, S. L. (2014). The Lifetime Prevalence of Child Sexual Abuse and Sexual Assault Assessed in Late Adolescence. Journal of Adolescent Health, 55(3), 329-333. doi:10.1016/j.jadohealth.2013.12.026
  3. U.S. Department of Health and Human Services, Administration for Children and Families, Administration on Children, Youth and Families, Children’s Bureau. (2011). Child maltreatment 2010. Available from http://www.acf.hhs.gov/programs/cb/stats_research/index.htm#can
  4. Black, M.C., Basile, K.C., Breiding, M.J., Smith, S.G., Walters, M.L., Merrick, M.T., Chen, J., & Stevens, M.R. (2011). The National Intimate Partner and Sexual Violence Survey (NISVS): 2010 Summary Report. Atlanta, GA: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention
  5. Hernandez, M., Acierno, R., & Muzzy, W. (2009). Race and Ethnicity Findings: The National Elder Mistreatment Study. PsycEXTRA Dataset. doi:10.1037/e517292011-482
  6. Kilpatrick, D. G., Resnick, H. S., Milanak, M. E., Miller, M. W., Keyes, K. M., & Friedman, M. J. (2013). National Estimates of Exposure to Traumatic Events and PTSD Prevalence UsingDSM-IVandDSM-5Criteria. Journal of Traumatic Stress, 26(5), 537-547. doi:10.1002/jts.21848
  7. Havig, K. (2008). The Health Care Experiences of Adult Survivors of Child Sexual Abuse. Trauma, Violence, & Abuse, 9(1), 19-33. doi:10.1177/1524838007309805
  8. Thoits, P. A. (2010). Stress and Health: Major Findings and Policy Implications. Journal of Health and Social Behavior, 51(1_suppl). doi:10.1177/0022146510383499
  9. Morse, D. S., Lafleur, R., Fogarty, C. T., Mittal, M., & Cerulli, C. (2012). "They Told Me To Leave": How Health Care Providers Address Intimate Partner Violence. The Journal of the American Board of Family Medicine, 25(3), 333-342. doi:10.3122/jabfm.2012.03.110193
  10. Ullman, S. E. (2010). Talking about sexual assault: Society’s response to survivors. Washington, DC: American Psychological Association.
  11. Spelman, J. F., Hunt, S. C., Seal, K. H., & Burgo-Black, A. L. (2012). Post Deployment Care for Returning Combat Veterans. Journal of General Internal Medicine, 27(9), 1200-1209. doi:10.1007/s11606-012-2061-1
  12. Jeffreys, M. R. (2016). Teaching cultural competence in nursing and health care: Inquiry, action, and innovation. New York: Springer Publishing Company.
  13. Felitti V.J, Anda, R.F., Nordenberg, D., Williamson, D.F., Spitz, A.M., Edwards V., Koss, M.P., et al. (1998). The Relationship of Adult Health Status to Childhood Abuse and Household Dysfunction. American Journal of Preventive Medicine, 14: 245-258.
  14. Brown, D.W., Anda, R.A., Tiemeier, H., Felitti, V.J., Edwards, V.J., Croft, J.B., Giles, W.H. (2009). Adverse Childhood Experiences and the Risk of Premature Mortality. American Journal of Preventive Medicine, 37: 389-396.
  15. Farley M., Golding J.M., Minkoff J.R. (2002). Is a history of trauma associated with a reduced likelihood of cervical cancer screening? Journal of Family Practice, 51(10):827-831.
  16. Farley, M., Minkoff, J. R., & Barkan, H. (2001). Breast Cancer Screening and Trauma History. Women & Health, 34(2), 15-27. doi:10.1300/j013v34n02_02
  17. Farley, M., & Patsalides, B. M. (2001). Physical Symptoms, Posttraumatic Stress Disorder, and Healthcare Utilization of Women with and without Childhood Physical and Sexual Abuse. Psychological Reports,89(3), 595-606. doi:10.2466/pr0.2001.89.3.595
  18. Leeners, B., Stiller, R., Block, E., Görres, G., Imthurn, B., & Rath, W. (2007). Consequences of childhood sexual abuse experiences on dental care. Journal of Psychosomatic Research, 62(5), 581-588. doi:10.1016/j.jpsychores.2006.11.009