Evidence for a public health impact of trauma

Background/Purpose

Exposure to trauma is pervasive in societies worldwide and does not occur at random, but can be influenced by individual characteristics, peer group relationships, community characteristics, and socio-political factors.  Using the public health framework as an organizing principle, we provide data on trauma exposure and impact at each of these levels.

Methods

Within a public health framework, we conducted a selected literature review on trauma occurrence and impact and prevention.

Findings

Trauma is not random.  Its occurrence varies as a function of characteristics of the individual (e.g., racial/ethnic minority or LGBT status), peer relationships (e.g., intimate partner violence), community characteristics (e.g., poor neighborhoods), and socio-political factors (e.g., terrorism, war, and civil unrest).  Additionally, these characteristics influence trauma type (e.g., women are more likely than men to be victims of intimate partner violence and unwanted sex).  Outcomes of trauma are also not random, and are highly related to characteristics of the individual, peer group support, community, and socio-political factors. 

Implications

A public health framework is critical in approaching trauma and its aftermath and targeting opportunities for prevention at multiple levels.  Primary prevention efforts should be aimed at preventing exposure to trauma itself.  Secondary prevention should be directed at the prevention of trauma-related sequelae, in particular post-traumatic stress disorder.  Tertiary prevention should slow the progression of trauma-related illness and disability.  Examples at the individual, relationship, community, and socio-political levels are provided, indicating that a public health approach can have a significant positive impact on trauma and its aftermath.