Medical trauma (a brief review)

The following guide will address the issue of medical trauma, its characteristics and some elements related to the psychological impact.

Medical trauma

Medical trauma refers to a series or group of responses that can be psychological and physiological, presented by patients and their families as a reaction to pain or injury, serious illness, medical procedures, as well as invasive or perceived threatening treatment experiences. 

In the area of Health Psychology, it is common to address all of these types of consequences that may result from the treatments indicated for some disease, which is usually medical. It is known that, in addition to the disease itself, patients are exposed to a number of stressors that can generate psychological symptoms.

What is the response to medical trauma?

Different responses to medical trauma may include any of the symptoms of post-traumatic stress disorder (PTSD). These responses can vary in intensity and can become disruptive to functioning, preventing the person from continuing to live a normal life. 

As is well known, the symptoms of PTSD are closely related to experience, in some way, the highly stressful or traumatic event being relived. This can occur through flashbacks, vivid memories of the scene in which you were involved, nightmares, and intense difficulty sleeping, among others. 

All of the above can occur because, as has been defined when talking about stress-related disorders or alterations, the person may perceive some event that is typical of medical treatment as very threatening. It is well known in medical trauma and in life in general that medical treatments are sometimes very aggressive and generate pain in people. 

On the other hand, medical trauma also takes into account that the recovery from a medical or surgical procedure plays a crucial role in the treatment, and in this phase of the process symptomatic responses to the stress generated can also be generated. After surgery performed in a hospital, it is possible that the recovery will be very long and generate a lot of stress in the patient. 

When we talk about major trauma, for example, it is even more serious since the physical integrity of the person has been put at risk in many ways, and the expectations of recovery are more reserved for the patient. In these cases, the possibility of symptoms arising in response to stress is also quite high. 

Pediatric trauma 

As a subcategory of medical trauma, we found pediatric trauma. This refers to the same thing that we mentioned in the previous sections, with the difference that the consequences of the stressful event are suffered or experienced by a child. Although the definition is the same, given the stage of development and the characteristic vulnerability of the first years of life, children are especially vulnerable to these situations. 

It is common that the services offered in hospitals present special features to the medical trauma when it comes to children since they require special care and need different measures to be implemented that favor them in a differential way. 

Medical trauma: what impact can it have on mental health?

Depending on the specific illness or situation, the consequences of mental health can vary. Among the diagnoses and treatment that usually generate a symptomatic stress response are the following: 

Staying in an Intensive Care Unit (ICU) has been identified as one of the events that can be highly stressful. According to Techtrauma, the prevalence figures for post-traumatic stress disorder (PTSD) symptoms in Intensive Care Units are quite high and can vary between 18:% and 59%. 

The above figures are so high that some research has associated admission to the intensive care service with the subsequent development of PTSD symptoms, regardless of the events prior to admission to the unit. In other words, you only need to spend some time and undergo treatment in the unit to be at risk of developing such symptoms in the future. 

Being exposed to grief has also been pointed out as a potentially stressful event. It’s clear that everyone, at some point in their lives, will be in the midst of grief, whether it’s the loss of a close family member or a friend, it just happens. Grief can also be caused by a diagnosis of cancer, where it has been found that people may exhibit signs such as loss of identity, independence, a decline in cognitive as well as physical functioning, and changes in family roles. 

Another element that has been identified as causing intense stress and medical trauma is the diagnosis of Human Immunodeficiency Virus (HIV). It has been shown that after diagnosis, 30% of gay or bisexual men (out of a sample of 61 people) developed symptoms of PTSD within four years of the HIV diagnosis. As you can see, this is a high proportion of people, so we understand that receiving such a diagnosis can have a great impact on mental health, since post-traumatic stress symptoms, in and of themselves, can become quite problematic.

The relationship between medical trauma and depression and anxiety has also been examined in different ways. It has been found, for example, that in 51 ICU survivors, 31% of them exhibited anxiety and depression in the nine months following hospitalization. On the other hand, using a measurement instrument to assess symptoms of anxiety and depression in the hospital setting, a meta-analysis of 14 studies found that the average prevalence of clinically significant depression was 28%. 

This is a very high figure for such a large study, so we can understand a large number of people who may be affected by symptoms of depression and anxiety when undergoing different medical procedures. Medical trauma is an issue that cannot be dismissed, as it is very common. 

For some women, it is normal for the birth to produce some medical trauma, specifically gynecological trauma, with figures of between 1.7% and 3% of women meeting the criteria to be diagnosed with PTSD within 1 to 3 months after the procedure. On the other hand, the figure can increase incredibly, to 77%, if the mother loses her child after birth. 

Heart attacks and strokes have also been studied, and it has been found that many of those who suffer from them at some point develop symptoms of PTSD.

Again, the common factor in all of these events is that the symptoms are preceded by a traumatic or highly stressful event, something that alters the normal course of life because it is an event that has the potential to change the normal course of things in an exceptional way. 

In other cases, although the event does not have much potential to alter the future in the short or medium term, it does represent dawn that it is difficult to dismiss or assimilate in such a way that life can continue under normal conditions. Stressful or traumatic events can vary from person to person. 

In response to stress or traumatic situations, the person’s assessment of the situation and their role in it, i.e., how much control they have over the situation and what is their scope of action to alter or improve what has happened, plays a very important role. This is one of the reasons why different people react differently to the same stressful event.

However, in the case of medical trauma, it is clear that there are procedures, diagnoses, or treatments that are highly threatening to most people, which is why there is such a high prevalence and people who work in the health area must be very careful in communicating these types of situations and/or changes in their treatments to patients. 

Risk factors in medical trauma 

As mentioned previously, the person’s evaluation and/or assessment of the situation is highly relevant. On the other hand, there are other factors that can increase the probability that people will suffer some medical trauma. These factors are presented below: 

Age is one of the main risk factors. As mentioned, children are especially vulnerable, as well as older adults, to developing medical trauma in response to non-medical intervention.

Another factor is socioeconomic status, which may play a role in how people cope with medical treatment and the burden of such an event. 

The quality of social relationships is also a risk factor. To the extent that there are poor social relationships, with low support and/or emotional attachment, people are more vulnerable and may present medical trauma more easily. 

If there are previous diagnoses of mental illness there is also a greater risk of reacting symptomatically to a stressful situation. This should, therefore, be taken into account in the care provided to the person. 

Memories of the event. How the person remembers the event, and especially the information they have about it, will also play an important role in this situation. Sometimes people at a medical procedure have little awareness of the situation and do not have many memories of what happened. On the other hand, it may be the case that the person keeps highly negative memories of how the procedure was performed and this generates high stress. 

Another factor involved in prolonging the hospital stay. The longer the hospitalization, the greater the risk of PTSD symptoms developing in the context of medical trauma. 

Another very important element is the patient’s perception of the quality of care he or she is receiving, that is, how he or she perceives the people and services that are caring for him or her.

The relationship with the medical staff is also an important factor to consider. The quality of that relationship has an impact on how the person lives through the event and how they remember it later. 

The patient’s state of mind is another element that can have an important weight. If a negative or low mood prevails in the person, the chances of medical trauma developing are increased, thus becoming a risk factor for the patient. 

Conclusion 

Medical trauma is a symptomatic response to a highly stressful event, usually resulting from medical treatment, proposed treatment, pain or injury caused by one of the above. The symptoms that occur are usually the same as those that exist when post-traumatic stress disorder (PTSD) is present. 

Frequently asked questions (FAQs) about medical trauma

Recommended resources

1. Trauma Care Pre-Hospital Manual
2. The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma
3. Healing the Fragmented Selves of Trauma Survivors

References

1. When Treatment Becomes Trauma: Defining, Preventing, and Transforming Medical Trauma
2. Treating Psychological Trauma and PTSD
3. Psychological Trauma
4. Assessing Psychological Trauma and PTSD