Childhood Trauma: The Next Public Health Crisis?

Should childhood trauma be treated like a public health crisis? When public health officials get wind of an outbreak of Hepatitis A or influenza, they spring into action with public awareness campaigns, monitoring and outreach. A new study published in the Journal of the American Medical Association suggests the response to childhood trauma should be similar. It shows how the effects of childhood trauma persist and are linked to mental illness and addiction in adulthood. And, researchers say, it suggests that it might be more effective to approach trauma as a public health crisis than to limit treatment to individuals.

The study drew on the experiences of participants from the Great Smoky Mountains Study, which followed 1,420 children from mostly rural parts of western South Carolina, over a period of 22 years. They were interviewed annually during their childhood, then four additional times during adulthood. This study has something other similar studies don’t. Instead of relying on adult reports of childhood trauma, the researchers analyzed data collected while the participants were kids and their experiences were fresh. Even when the team accounted for other adversities aside from trauma (such as low income, family hardships, and adult traumas), the associations between childhood trauma and adult hardships remained clear.

This study is probably the most rigorous test scientists have to date of the hypothesis that early childhood trauma has these strong, independent effects on adult outcomes. The wide-ranging impacts of trauma may call for broad-based policy solutions in addition to individual interventions. Nearly 31% of the children told researchers they had experienced 1 traumatic event, like a life-threatening injury, sexual or physical abuse, or witnessing/hearing about a loved one’s traumatic experience. 22.5% of participants had experienced 2 traumas, while 14.8% experienced 3 or more. The childhoods of participants who went through traumatic events and those who didn’t were markedly different. Participants with trauma histories were 1.5 times as likely to have psychiatric problems and experience family instability and dysfunction than those without, and 1.4 times as likely to be bullied. They were also 1.3 times more likely to be poor than participants who didn’t experience trauma.

When these children grew up, psychiatric problems and other issues persisted. Even after researchers adjusted for factors like recall bias, race, and sex, the impact of those childhood psychiatric problems and hardships remained. Participants who experienced childhood trauma were 1.3 times more likely to develop psychiatric disorders than adults than those who did not experience trauma, and 1.2 times more likely to develop depression or substance abuse disorder. Participants with histories of trauma were also more likely to experience health problems, participate in risky behavior, struggle financially, and have violent relationships or problems making friends. And the more childhood trauma a person experienced, the more likely they were to have those problems in adulthood.

Though this link has been shown in earlier research, the new study can help direct future research and policy. It is time to think about prevention. Trauma is a public health problem, and should be met with a public health approach, says psychologist Marc Gelkopf. In an editorial published along with the study, he writes: “If the ills of our societies, including trauma, are to be tackled seriously, then injustice must be held accountable.” Policymakers can create coalitions around issues like mental health and trauma-informed approaches in contexts like education and healthcare, he says.

One step in that direction comes with the SUPPORT for Patients and Communities Act, a bipartisan bill to address the opioid crisis that was signed into law October 24. The law recognizes links between early childhood trauma and substance abuse. It includes grants to improve trauma support services in schools, created a task force to provide recommendations on how the federal government can help families whose lives have been impacted by trauma and substance abuse, and requires the Department of Health and Human Services to help early childhood and education providers spot and address trauma.

Bills like the SUPPORT Act enjoy bipartisan and are a promising start, says Gelkopf, but they don’t go far enough. To really reduce trauma and mitigate its effects, he says, policymakers must pursue community investment and policies like minimum wage laws that reduce economic pressure on people who are struggling. “It’s more than just ‘toughen up and deal with it,’ ” he says. “A lot of it comes down to people not having to live their lives in a state of chronic and constant stress.”

Allison Green
Boston Tutoring Services