Medical Trauma

What is medical trauma?

  • Medical trauma is a “set of psychological and physiological responses of patients and their families to pain, injury, serious illness, medical procedures, and invasive or frightening treatment experiences” [2].
  • Responses to medical trauma may include any of the symptoms of posttraumatic stress disorder (PTSD). Responses may vary in intensity and can become disruptive to functioning.

Impacts of medical trauma on mental health: [1] [3]

Evidence shows that traumatic stress responses are relatively common to a wide variety of medical diagnoses and treatments:

  • Heart attacks and strokes: Following a heart attack or myocardial infarction (MI), most studies of PTSD found prevalence rates ranging from 16%  to 10.8-18% following cardiac surgery.
  • Childbirth and gynecological trauma: Normal childbirth may be traumatic for some women, with up to 1.7-3% of individuals meeting the criteria for PTSD between 1-13 months post-partum.
    • The prevalence of PTSD increases exponentially to 77% when a woman loses her child in childbirth.
  • Stays in the intensive care unit (ICU): Studies of patients in the ICU have yielded prevalence rates of PTSD ranging from 18.5% to 59%. Research suggests a relationship between ICU admission and the later development of PTSD, irrespective of the events preceding ICU admission.
  • Human Immunodeficiency Virus (HIV): Multiple studies have examined the psychological and emotional impact of an HIV diagnosis.
    • For example, a study of 61 homosexual or bisexual men found that 30% had developed PTSD within 4 years of learning of their HIV status.
    • Another study of 67 African American women found rates of 35.3% for PTSD between 12-14 months following their first positive HIV test.
  • Depression: Multiple studies have also examined the relationship between medical trauma and depression and anxiety.
    • In a study of 51 ICU survivors, 31% showed evidence of anxiety and depression 9 months later.
    • In a study of 80 adults treated and discharged from ICU, 47% reported clinically significant anxiety and depression on the Hospital Anxiety and Depression Scale (HADS), with 15% meeting full criteria for PTSD.
    • In another study of 157 adult patients discharged from the ICU, 46.3% exhibited depression and 44.4% exhibited anxiety.
    • In a meta-analysis of 14 studies using the HADS, the mean prevalence of clinically significant depression was 28%.
  • Grief: Researchers have found common psychological effects associated with a cancer diagnosis, including the loss of self, independence, decreased cognitive and physical functioning, role in the family, and anticipatory grief.

Risk factors: [1] [3]

  • Age
  • Socioeconomic status
  • Quality of social relationships
  • Pre-existing mental health diagnoses
  • Memories of the event
  • Length of stay (specifically related to the ICU)
  • Perception of the quality of care
  • Relationship with medical staff
  • Prior interpersonal trauma and childhood sexual and emotional abuse
  • Patient’s mood
  • Other factors related to treatment (e.g., length of sedation, medications used, sleep disturbances)

Prevention and intervention: [2]

  • Arrange psychosocial and mental health support.
  • Provide information regarding common reactions.
  • Develop strong alliances with health care providers.
  • Increase social support and coping skills.

Helpful websites:

  • Health Care Tool Box: Provides resources and guidance on adopting a trauma-informed perspective on care. The site explains the impact of traumatic stress reactions in children coping with illness, injury, and medical procedures; provides tools that can help health care professionals enhance their skills; and includes patient education materials that can be downloaded and shared with clients.
  • American Trauma Society: The American Trauma Society serves as an advocate for the trauma care system, trauma prevention programs, and the victims of trauma and their families throughout the United States.

[1] Hall, M. F. & Hall, S. E. (2013, March). When treatment becomes trauma: Defining, preventing, and transforming medical trauma. Paper based on a program presented at the 2013 American Counseling Association Conference, Cincinnati, OH.

[2] The National Child Traumatic Stress Network. (2015). Medical trauma. Retrieved from http://www.nctsn.org/trauma-types/medical-trauma

[3] Hall, M. F. & Hall, S. E. (2016). Managing the psychological impact of medical trauma: A guide for mental health and health care professionals. New York, NY: Springer Publishing Company.