A systematic review of 14 meta-analyses found strong evidence that psychological trauma increases one’s risk of mental disorder by nearly three-fold. The findings were published in the European Archives of Psychiatry and Clinical Neuroscience.
Psychological trauma is when a harmful event provokes long-term negative consequences on a person’s mental, physical, social, emotional, or spiritual health. Such trauma can result from adverse life events like witnessing a natural disaster or losing a loved one, or from suffering physical, psychological, emotional, or sexual abuse.
While 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 might 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.
“Back in 2016, I founded in our university hospital, Parc de Salut Mar in Barcelona, Spain, the Centro Fòrum Research Unit with a focus on psychological trauma in a normal psychiatric hospital, as I realized that there is an enormous need of psychiatric patients to revise in detail their biographical line, identify childhood and adulthood traumatic events and offer a trauma-focused approach,” Amann told PsyPost.
“There was already convincing scientific evidence of a negative impact of childhood trauma on mental health, but nobody summarized this in form of an umbrella meta-analysis to confirm that psychological trauma is a transdiagnostic risk factor to suffer from a mental disorder in adulthood. My fantastic team and myself had this idea back in 2019 and together with support from the Hospital Clínic in Barcelona and the Laboratory of Molecular Psychiatry, Hospital de Clínicas de Porto Alegre, Brazil, we were able to publish this work finally in 2022.”
Amann and his colleagues conducted an umbrella review analysis which 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, involving 16,277 psychiatric cases and 77,586 control subjects.
The researchers classified the associations as convincing (the highest level of confidence), highly 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 suggested that experiencing psychological trauma increased a person’s risk of mental disorder by almost three-fold.
“A main message for everybody is that psychological trauma across age, but especially in childhood, triples the risk of suffering a variety of mental disorders in later life,” Amann explained. “Obviously, the etiology of why we are suffering from mental disorders is multifactorial with a genetic predisposition and further environmental variables, but our work underlines that psychological trauma is one of the most robust and preventable risk factors for suffering a mental disorder later on.”
“In other words, if everybody would act as caring and protective parents, external violence could be avoided, if school would target bullying, if economic adversities and social problems could be significantly decreased, we would reduce approximately 30% of psychiatric diagnoses. This seems very relevant to me, but needs economic inversion in social and health politics across the globe.”
When considering specific types of childhood trauma, five of the six types of trauma were associated with the development of any mental disorder. For physical abuse, this was convincing evidence, and for sexual abuse, emotional abuse, and non-specific trauma this was highly suggestive evidence.
Certain types of abuse were also 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 prevalent, but understudied childhood trauma, was clearly associated with anxiety disorders, the most prevalent mental disorder,” Amann told PsyPost. “Another interesting finding was that the risk was 16 times higher compared to the general population to suffer a borderline personality disorder in case of a childhood trauma, which is remarkable and should help to decrease the therapeutic stigma towards people with this diagnosis by including a trauma-focused 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 may have unique effects on the brain. With future studies, it may be possible to pinpoint the specific processes linked to each type of trauma and use these findings to inform treatment.
The researchers note a few limitations to the study. For one, a variety of approaches were used to assess trauma in the included studies. Many of them used retrospective reporting, which can be affected by recall bias.
“The majority of studies included are of retrospective nature, which means that the trauma history was taken retrospectively, which might carry the 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 Psychiatry, contradicts this concern and confirms our results.”
“Our clients in general terms do not invent adverse events in their biography. However, more prospective large trials in the future would be helpful to further emphasize the negative neurobiological impact of childhood trauma on the brains of the most vulnerable members of our society, the children.”
The findings also highlight 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 in the individual treatment plan of clients with the diagnosis of a psychiatric disorder a trauma-focused intervention, as 1) a PTSD comorbidity is usually high (around 15-20% pending on the primary diagnosis) but untreated, 2) the same is true for complex PTSD (cPTSD) (around 50% of clients in psychiatric services suffer from cPTSD) and 3) the course of the psychiatric disease is worse in case of a history of psychological trauma,” Amann explained.
“On the other hand and as mentioned before, our results should waken up politicians to invest in the prevention of psychological trauma in order 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.
