Citation

Gradus JL, Galea S. Am. J. Epidemiol. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, Oxford University Press)

DOI

10.1093/aje/kwad126

PMID

37218615

Abstract

Trauma is defined as an event that includes "actual or threatened death, serious injury, or sexual violence." The list of traumatic events included in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, represents a long history of the field attempting to define trauma and differentiate these events from less severe stressors. In this commentary, we suggest that this strict distinction between traumatic and stressful events is not useful for public health. The current list of traumatic events may work well for identifying people with the most severe experiences and highest conditional probability of distress who need clinical care. However, public health has different priorities. If we think about posttraumatic psychological distress on a population-scale, it is not only helping those with the most severe experiences that is needed. Rather, public health requires attention to all people experiencing distressing stress and trauma reactions. We propose that context is crucial to the development of a population-relevant definition of trauma and provide examples in which stressors have resulted in posttraumatic psychological distress and traumatic event reactions have been mitigated by the context in which they occur. We discuss trauma context from an epidemiologic perspective and conclude with recommendations for the field.

Language: en

Keywords

Trauma; posttraumatic stress disorder; stress disorders