A huge review study suggests that psychological trauma almost triples the risk of mental disorders

A huge review study suggests that psychological trauma almost triples the risk of mental disorders

A huge review study suggests that psychological trauma almost triples the risk of mental disorders

A systematic review of 14 meta-analyses found strong evidence that psychological trauma increases the risk of developing mental disorders by almost three times. The results were published in European Archives of Psychiatry and Clinical Neuroscience.

Psychological trauma occurs when a harmful event causes long-term negative consequences for a person’s mental, physical, social, emotional or spiritual health. Such trauma can result from adverse life events, such as witnessing a natural disaster or the loss of a loved one, or from physical, mental, 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 such as depression and anxiety. Some researchers have suggested that psychological trauma may help explain why mental disorders often co-occur.

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 set up the Centro Fòrum research unit at our university hospital Parc de Salut Mar in Barcelona, ​​Spain, focusing on psychological trauma in a normal psychiatric hospital, because I realized that there is a huge need for psychiatric patients to revise their biographical line in detail, identify traumatic childhood and adulthood events and offer a trauma-centred approach,” Amann told PsyPost.

“There was already compelling scientific evidence of the negative impact of childhood trauma on mental health, but no one has summarized it in an aggregate meta-analysis to confirm that psychological trauma is a transdiagnostic risk factor for developing mental disorders in adulthood. My fantastic team and I came up with this idea in 2019 and with the support of the Hospital Clínic in Barcelona and the Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre in Brazil, we were finally able to publish this work in 2022.”

Amann and colleagues conducted a cumulative review analysis that included 14 meta-analyses and reviews that reported associations between psychological trauma and at least one diagnosed mental disorder. The reviews included a total of 106 studies with 16,277 psychiatric cases and 77,586 controls.

The researchers categorized the associations as persuasive (highest level of confidence), highly suggestive, suggestive, or weak (lowest level of confidence). First, they found a highly suggestive relationship between any type of trauma and any type of mental disorder. In fact, the results suggest that experiencing a psychological trauma increased a person’s risk of developing a mental disorder by almost three times.

“The main message for everyone is that psychological trauma at any age, and especially in childhood, triples the risk of developing various mental disorders later in life,” Amann explained. “Of course, 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 strongest and preventable risk factors for developing mental disorders in the future.”

“In other words, if everyone behaved like caring and protective parents, external violence could be avoided, if school focused on bullying, if economic adversity and social problems were significantly reduced, we would reduce about 30% of psychiatric diagnoses. This seems very important to me, but it requires an economic inversion of social and health policies around the world.”

When considering specific types of childhood trauma, five of the six types of trauma were associated with the development of any mental disorder. In the case of physical abuse, it was convincing evidence, and in the case of sexual abuse, emotional abuse, and non-specific trauma, it was highly suggestive evidence.

Some types of abuse have also been found to increase the risk of certain disorders. Physical violence 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 prevalent but under-researched childhood trauma, was clearly associated with anxiety disorder, the most prevalent mental disorder,” Amann told PsyPost. “Another interesting finding was that the risk of developing borderline personality disorder for childhood trauma was 16 times higher compared to the general population, which is remarkable and should help reduce therapeutic stigma towards people with this diagnosis by including a trauma-targeted intervention.” .

“My experience with EMDR, a recognized and evidence-based trauma-focused intervention, for patients with borderline personality disorder has been very positive. We are also currently conducting a randomized controlled EMDR trial in this population.”

Different mechanisms may play a role in how trauma contributes to mental health disorders, according to the authors of the study. Neuroimaging studies show that psychological trauma can affect brain development and that different types of trauma can have unique effects on the brain. With future research, it may be possible to identify the specific processes involved in each type of injury and use these findings to inform treatment.

The researchers note several limitations of the study. First, the included studies used different approaches to trauma assessment. Many of them used retrospective reports, which may be affected by the recall error.

“Most of the studies included are retrospective, meaning that the history of trauma was taken retrospectively, which may carry the risk of false memories or biases,” Amann explained. “My daily clinical experience with trauma clients and prospective studies such as the very recent Brazilian paper published by Bauer et al. (2022) in Lancet of Psychiatrycontradicts these concerns and confirms our results.”

“Our clients generally don’t make up adverse events in their biography. However, more prospective large studies 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 highlight the importance of prevention and early intervention programs as well as trauma-based care.

“Our results show two main needs: on the one hand, we need to add a trauma-focused intervention to the individual treatment plan of patients diagnosed with a mental disorder because 1) PTSD comorbidity is usually high (around 15-20% of those awaiting primary diagnosis) but untreated, 2) the same goes for complex PTSD (cPTSD) (approx. history of psychological trauma,” Amann explained.

“On the other hand, as mentioned earlier, our results should awaken politicians to invest in the prevention of psychological trauma in order to reduce mental and somatic suffering and costs in the future.”

By Bridget Hogg, Itxaso Gardoki-Souto, Alicia Valiente-Gómez, Adriane Ribeiro Rosa, Lydia Fortea, Joaquim Radua, Benedikt L. Amann, and Ana Moreno-Alcázar.

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