The Impact of Trauma

What is the impact of trauma?

Trauma can impact individuals in many ways, including socially, psychologically, academically, neurophysiologically, and socioeconomically, and can impair physical health as well [1].

Traumatized individuals, particularly those who are traumatized in childhood and adolescence, are at increased risk for:

  • Social and behavioral problems, including, but not limited to: relationship difficulties, risky sexual behavior, aggression and criminal behaviors [2] [3] [4] [5].
  • Impaired psychological health throughout the lifespan, including, but not limited to: PTSD, depression, substance use/abuse, and suicide attempts [3] [5] [6] [7] [8] [9] [10] [11].
    • Adverse childhood experiences are related to the onset of a range psychological disorders as well [12].
    • Additionally, adults who had four or more adverse childhood experiences were 7.3 times more likely to have at least one diagnosis from each of the following four types of disorders: mood, anxiety, impulse control, and substance abuse disorders [13].
  • Cognitive and academic problems, including, but not limited to: low IQ and reading scores, delayed language and cognitive development, and poor academic performance [14] [15] [16].
  • Neuropsychological alterations involving areas of the brain that regulate emotion, control of emotions, judgment, and problem solving [17] [18] [19], in addition to the stress response system [17] [18] [20].
  • Impaired physical health that can endure for decades, such as increased risk of cancer, heart disease, liver disease, pulmonary disease, auto-immune disease, and obesity [9] [21] [22].
  • Higher use of mental health and medical services [3] [5] [6] [22].
  • Increased rates of unemployment, poverty, and Medicaid usage [29].
  • Childhood mortality or early death [9] [23].

In addition to causing suffering for traumatized individuals, trauma has a negative effect on society and the economy:

For every three additional types of trauma a child experiences, the child is:

  • 53% more likely to be involved in the juvenile justice system,
  • 204% more likely to receive mental health services,
  • 216% more likely to receive child welfare services,
  • and 25% more likely to receive health services [6].

The economic cost:

  • Child abuse survivors access the healthcare system 2-2.5 times more often than non-abused people [24].
  • 16.7-37.5% of United States healthcare dollar is spent on abuse-related mental and medical costs [25].
  • Estimates of the annual cost of child abuse and neglect in the United States range $24 to $124 billion, depending which direct (e.g., child welfare, health care, mental health care, maltreatment-related law enforcement and legal services) and indirect costs (e.g., increased spending due to long-term problems including impaired mental and physical health, criminality, incarceration, special education, teenage pregnancy, unemployment, and reduced opportunity costs) are included [26] [27].
  • The lifetime cost of a single case of child abuse and neglect in the United States was estimated to be $6.1 million (where lost opportunity costs contribute the highest expense) [28].

[1] Fairbank, J. A., Putnam, F. W., & Harris, W. W. (2014). Child traumatic stress: Prevalence, trends, risk and impact. In M. J. Friedman, T. M. Keane, P. A. Resick (Eds.), Handbook of PTSD: Science and practice (pp. 121-145). New York, NY, US: Guilford Press.

[2] Cloitre, M., Miranda, R., Stovall-McClough, K. C., & Han, H. (2005). Beyond PTSD: Emotion regulation and interpersonal problems as predictors of functional impairment in survivors of childhood abuse. Behavior Therapy36(2), 119-124.

[3] Jonson-Reid, M., Kohl, P. L., & Drake, B. (2012). Child and adult outcomes of chronic child maltreatment. Pediatrics, 129(5), 839-845.

[4] Manly, J. T., Cicchetti, D., & Barnett, D. (1994). The impact of subtype, frequency, chronicity, and severity of child maltreatment on social competence and behavior problems. Development and Psychopathology, 6(01), 121-143.

[5] Millett, L. S., Kohl, P. L., Jonson-Reid, M., Drake, B., & Petra, M. (2013). Child maltreatment victimization and subsequent perpetration of young adult intimate partner violence: An exploration of mediating factors. Child Maltreatment, 18(2), 71-84.

[6] Briggs, E. C., Fairbank, J. A., Greeson, J. K., Layne, C. M., Steinberg, A. M., Amaya-Jackson, L. M., … & Pynoos, R. S. (2013). Links between child and adolescent trauma exposure and service use histories in a national clinic-referred sample. Psychological Trauma: Theory, Research, Practice, and Policy, 5(2), 101.

[7] Dube, S. R., Anda, R. F., Felitti, V. J., Chapman, D. P., Williamson, D. F., & Giles, W. H. (2001). Childhood abuse, household dysfunction, and the risk of attempted suicide throughout the life span: Findings from the Adverse Childhood Experiences Study. Jama, 286(24), 3089-3096.

[8] Edwards, V. J., Holden, G. W., Felitti, V. J., & Anda, R. F. (2003). Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: Results from the adverse childhood experiences study. American Journal of Psychiatry, 160(8), 1453-1460.

[9] Gilbert, R., Widom, C. S., Browne, K., Fergusson, D., Webb, E., & Janson, S. (2009). Burden and consequences of child maltreatment in high-income countries. The Lancet, 373(9657), 68-81.

[10] Kilpatrick, D. G., Saunders, B. E., & Smith, D. W. (2003). Youth victimization: Prevalence and implications, research in brief. Washington, DC: Office of Justice Programs, National Institute of Justice.

[11] Putnam, F. W. (2003). Ten-year research update review: Child sexual abuse. Journal of the American Academy of Child & Adolescent Psychiatry, 42(3), 269-278.

[12] McLaughlin, K. A., Green, J. G., Gruber, M. J., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2012). Childhood adversities and first onset of psychiatric disorders in a national sample of US adolescents. Archives of General Psychiatry, 69(11), 1151-1160.

[13] Putnam, K. T., Harris, W. W., & Putnam, F. W. (2013). Synergistic childhood adversities and complex adult psychopathology. Journal of Traumatic Stress26(4), 435-442.

[14] Delaney-Black, V., Covington, C., Ondersma, S. J., Nordstrom-Klee, B., Templin, T., Ager, J., … & Sokol, R. J. (2002). Violence exposure, trauma, and IQ and/or reading deficits among urban children. Archives of Pediatrics & Adolescent Medicine, 156(3), 280-285.

[15] Shonk, S. M., & Cicchetti, D. (2001). Maltreatment, competency deficits, and risk for academic and behavioral maladjustment. Developmental Psychology, 37(1), 3.

[16] Veltman, M. W., & Browne, K. D. (2001). Three decades of child maltreatment research: Implications for the school years. Trauma, Violence, &  Abuse, 2(3), 215-239.

[17] De Bellis, M. D., Baum, A. S., Birmaher, B., Keshavan, M. S., Eccard, C. H., Boring, A. M., … & Ryan, N. D. (1999). Developmental traumatology part I: Biological stress systems. Biological Psychiatry, 45(10), 1259-1270.

[18] De Bellis, M. D., Keshavan, M. S., Shifflett, H., Iyengar, S., Beers, S. R., Hall, J., & Moritz, G. (2002). Brain structures in pediatric maltreatment-related posttraumatic stress disorder: A sociodemographically matched study. Biological Psychiatry, 52(11), 1066-1078.

[19] Lanius, R. A., Vermetten, E., Loewenstein, R. J., Brand, B., Schmahl, C., Bremner, J. D., & Spiegel, D. (2010). Emotion modulation in PTSD: Clinical and neurobiological evidence for a dissociative subtype. American Journal of Psychiatry, 167(6), 640-647.

[20] De Bellis, M. D., Lefter, L., Trickett, P. K., & Putnam, F. W. (1994). Urinary catecholamine excretion in sexually abused girls. Journal of the American Academy of Child & Adolescent Psychiatry, 33(3), 320-327.

[21] Dube, S. R., Fairweather, D., Pearson, W. S., Felitti, V. J., Anda, R. F., & Croft, J. B. (2009). Cumulative childhood stress and autoimmune diseases in adults. Psychosomatic Medicine, 71(2), 243.

[22] Felitti, M. D., Vincent, J., Anda, M. D., Robert, F., Nordenberg, M. D., Williamson, M. S., … & James, S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine, 14(4), 245-258.

[23] Brown, D. W., Anda, R. F., Tiemeier, H., Felitti, V. J., Edwards, V. J., Croft, J. B., & Giles, W. H. (2009). Adverse childhood experiences and the risk of premature mortality. American Journal of Preventive Medicine, 37(5), 389-396.

[24] Koss, M. P., & Heslet, L. (1992). Somatic consequences of violence against women. Archives of Family Medicine, 1(1), 53.

[25] Dolezal, T., McCollum, D., & Callahan, M. (2009). Hidden costs in health care: The economic impact of violence and abuse.

[26] Wang, C. T., & Holton, J. (2007). Total estimated cost of child abuse and neglect in the United States. Chicago, IL: Prevent Child Abuse America.

[27] Fang, X., Brown, D. S., Florence, C. S., & Mercy, J. A. (2012). The economic burden of child maltreatment in the United States and implications for prevention. Child Abuse & Neglect, 36(2), 156-165.

[28] Conrad, C. (2006). Measuring costs of child abuse and neglect: A mathematic model of specific cost estimations. Journal of Health and Human Services Administration 29(1), 103-123.

[29] Zielinski, D. S. (2009). Child maltreatment and adult socioeconomic well-being. Child Abuse & Neglect, 33(10), 666-678.