A systematic review of 14 meta-analyses found strong evidence that psychological trauma nearly triples the risk of mental disorders. The findings were published in the European Archives of Psychiatry and Clinical Neurosciences.
Psychological trauma is when a harmful event causes long-term negative consequences on a person’s mental, physical, social, emotional or spiritual health. Such trauma can result from negative life events, such as witnessing a natural disaster or losing a loved one, or from experiencing physical, psychological, emotional, or sexual abuse.
Although psychological trauma is a well-studied precursor to post-traumatic stress disorder (PTSD), it is also associated with other mental health diagnoses like depression and anxiety. Some researchers have proposed that psychological trauma may help explain why mental disorders often coexist.
Study author Benedikt Amann and his team conducted the first review to systematically test whether psychological trauma is a risk factor for a range of mental disorders. If so, this would suggest that trauma can be considered a transdiagnostic construct.
“In 2016, I founded in our university hospital, Parc de Salut Mar in Barcelona, Spain, the Centro Fòrum research unit focusing on psychological trauma in a normal psychiatric hospital, because I realized that there is had a huge need for psychiatric patients to thoroughly revise their biographical line, identify traumatic events in childhood and adulthood, and provide a trauma-focused approach,” Amann told PsyPost.
“There was already compelling scientific evidence of a negative impact of childhood trauma on mental health, but no one has summarized this in the form of an umbrella meta-analysis to confirm that psychological trauma is a factor. transdiagnostic risk of suffering from a mental disorder in adulthood. My fantastic team and I came up with this idea in 2019 and with the support of Hospital Clínic de Barcelona and the Laboratory of Molecular Psychiatry of Hospital de Clínicas de Porto Alegre, Brazil, we were finally able to publish this work. in 2022.”
Amann and colleagues conducted a review analysis that included 14 meta-analyses and reviews reporting associations between psychological trauma and at least one diagnosed mental disorder. The reviews included a total of 106 studies, involving 16,277 psychiatric cases and 77,586 control subjects.
The researchers categorized the associations as convincing (the highest level of confidence), very suggestive, suggestive, or weak (the lowest level of confidence). First, they found a highly suggestive association between any type of trauma and any type of mental disorder. In fact, the results suggest that experiencing psychological trauma increases a person’s risk of mental disorders nearly threefold.
“A main message for everyone is that psychological trauma through age, but especially during childhood, triples the risk of suffering from various mental disorders later in life,” Amann explained. “Clearly, the etiology of why we suffer from mental disorders is multifactorial with genetic predisposition and other environmental variables, but our work highlights that psychological trauma is one of the most robust risk factors. and the most preventable to suffer from a mental disorder later on.”
“In other words, if everyone acted like caring and protective parents, external violence could be avoided, if the school targeted bullying, if economic adversities and social problems could be greatly reduced, we would reduce about 30% of psychiatric diagnoses. This seems very relevant to me, but requires an economic inversion in social and health policies around the world.
When examining specific types of childhood trauma, five of the six types of trauma were associated with the development of any mental disorder. For physical abuse, it was compelling evidence, and for sexual abuse, emotional abuse, and nonspecific trauma, it was highly suggestive evidence.
Certain types of abuse have also been found to increase the risk of specific disorders. Physical abuse increased the risk of anxiety disorders, bipolar disorder (BD) and obsessive-compulsive disorder (OCD). Sexual abuse increased the risk of anxiety disorders, borderline personality disorder (BPD) and psychosis.
“Emotional abuse, the most common but understudied childhood trauma, was clearly associated with anxiety disorders, the most common mental disorder,” Amann told PsyPost. “Another interesting finding was that the risk was 16 times higher compared to the general population to suffer from a borderline personality disorder in the event of childhood trauma, which is remarkable and should help to reduce the stigma therapy for people with this diagnosis including trauma-targeted intervention.
“My experience with EMDR, a recognized and evidence-based trauma-focused intervention, in patients with borderline personality disorder is very positive. We are also currently conducting a randomized controlled trial of EMDR in this population.
According to the study authors, various mechanisms may play a role in how trauma contributes to mental health disorders. Neuroimaging studies show that psychological trauma can impact brain development and that different types of trauma can have unique effects on the brain. With future studies, it may be possible to identify specific processes related to each type of trauma and use these findings to inform treatment.
The researchers note a few limitations to the study. For one thing, a variety of approaches were used to assess trauma in the included studies. Many of them used retrospective reports, which may be affected by recall bias.
“The majority of included studies are retrospective in nature, meaning that the history of trauma was taken retrospectively, which could carry a risk of false memory or bias,” Amann explained. “My daily clinical experience with traumatized clients and prospective studies, such as a very recent Brazilian work published by Bauer et al (2022) in the Lancet of Psychiatrycontradicts this concern and confirms our results.
“Our clients in general terms do not invent adverse events in their biographies. However, larger, prospective trials in the future would be helpful in further highlighting the negative neurobiological impact of childhood trauma on the brains of our society’s most vulnerable members, children.
The findings also underscore the importance of prevention and early intervention programs as well as trauma-informed care.
“Our results demonstrate two major needs: on the one hand, we need to add a trauma-focused intervention to the individual treatment plan of clients diagnosed with a psychiatric disorder, because 1) a comorbidity of PTSD is generally high (approximately 15 – 20% awaiting main diagnosis) but not treated, 2) the same is true for complex PTSD (cPTSD) (about 50% of clients of psychiatric services suffer from PTSDc) and 3) the course of the psychiatric illness is worse if there is a history of psychological trauma,” Amann explained.
“On the other hand and as mentioned earlier, our findings should prompt policy makers to invest in psychological trauma prevention to reduce mental and somatic suffering and costs in the future.”
The study, “Psychological trauma as a transdiagnostic risk factor for mental disorder: an umbrella meta-analysis,” was authored by Bridget Hogg, Itxaso Gardoki-Souto, Alicia Valiente-Gómez, Adriane Ribeiro Rosa, Lydia Fortea, Joaquim Radua, Benedikt L Amann and Ana Moreno-Alcázar.