Academic journal article European Journal of Psychotraumatology

Trauma Is a Public Health Issue

Academic journal article European Journal of Psychotraumatology

Trauma Is a Public Health Issue

Article excerpt

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1. Public health impact of trauma

Exposure to trauma is pervasive in societies worldwide. Population-based data from various countries indicate that a majority of adults will experience a traumatic event at some point in their lives, despite cross-national variation in the prevalence of specific types of traumatic events (Benjet et al., 2016; Burri & Maercker, 2014). Trauma exposure is also common in children and adolescents around the world. A substantial proportion of children globally are exposed to trauma as a result of armed conflict, natural disasters, and other humanitarian emergencies (World Health Organization, 2013b). An estimated 230 million children currently live in countries impacted by armed conflicts (UNICEF, 2014), which increases risk of experiencing displacement, witnessing violence and death, and being orphaned, kidnapped, raped, or recruited as child soldiers (UNICEF, 2009).

Traumatic events do not only occur at random, but can be influenced by individual characteristics, peer group relationships, community characteristics, and socio-political factors. At the individual level, for example, the likelihood of experiencing particular types of trauma varies by sex, age, race/ethnicity, and sexual orientation (Garcia-Moreno, Jansen, Ellsberg, Heise, & Watts, 2006; Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995; McLaughlin et al., 2013; Rees et al., 2011). Community and socio-political factors also influence the likelihood of trauma occurrence across geographic locations. Certain types of traumas (e.g. violence) are more likely to occur in certain locations (e.g. metropolitan areas and conflict zones) (McLaughlin et al., 2013; Perkonigg, Kessler, Storz, & Wittchen, 2000). Moreover, different communities will have diverse trauma recovery trajectories based on their pre-trauma community characteristics (Nakagawa & Shaw, 2004). Thus, it is important not to overlook these characteristics in considering both trauma exposure and outcome.

The public health impact of trauma exposure is staggering for both communities and individuals. Catastrophic events such as natural and man-made disasters and terrorist attacks can have devastating effects on the social fabric of society and communities, not only involving injuries and loss of life, but also related to property destruction and infrastructure damage. This aftermath, coupled with high levels of resulting migration, can create prolonged disruption in the delivery of social services and the dissolution of social support networks. These community-level consequences can persist for lengthy periods, often fundamentally changing the physical and social landscape of a community (Galea et al., 2002; Hollifield et al., 2008; Rosenbaum, 2006). Low and middle income countries (LMICs) are disproportionately affected. Collective violence (e.g. war, genocide) is 10 times more common in LMICs versus high income countries (HICs) (World Health Organization, 2002), and LMICs carry the brunt of migration problems caused by disasters and violence. In 2015, 65.3 million people were forcibly displaced, the vast majority from LMICs. According to the United Nations High Commission for Refugees (UNHCR), the top hosting countries are Turkey (2.5 million), Pakistan (1.6 million), Lebanon (1.1 million), and Iran (1.0 million).

Exposure to trauma is particularly detrimental when it occurs in childhood or adolescence, disrupting numerous aspects of development in cognitive, emotional, and social domains, leading to adverse mental health and educational outcomes (Cicchetti & Toth, 1995; Koenen, Moffit, Caspi, Taylor, & Purcell, 2003) with long-term consequences for learning and memory (Teicher, Anderson, & Polcari, 2012), emotional functioning (De Bellis et al., 1994; McCrory et al., 2011; McLaughlin & Hatzenbuehler, 2009; Pollak & Sinha, 2002; Pollak, Vardi, Putzer Bechner, & Curtin, 2005), social relationships, elevated risk of re-victimization (Cole & Putnam, 1992; DiLillo, 2001; Follette, Polusney, Bechtle, & Naugle, 1996), and mental disorders (Kilpatrick et al. …

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