Buckley, L., Turiano, N., Sesker, A., Butler, M., & O'Súilleabháin, P. S. (2024). Lifetime trauma and mortality risk: A systematic review. Health Psychology, 43(4), 280–288. https://doi.org/10.1037/hea0001343
Key Points
- The systematic review found inconclusive evidence of the relationship between lifetime trauma and mortality risk in adulthood, with three larger sample studies suggesting a positive association and two smaller, male-only studies finding no relationship.
- Factors like inconsistent terminology, lack of standardized measures for lifetime trauma, and limited diversity in sample populations significantly affect the comparability and generalizability of the studies.
- The research, while enlightening, has certain limitations, such as the heterogeneity of the studies, preventing a meta-analysis, and the lack of representation of early and late adulthood in the samples.
- Understanding the impact of lifetime trauma on mortality risk has significant implications for health policy and interventions aimed at reducing traumatic experiences across the lifespan.
Rationale
The relationship between exposure to traumatic events and adverse health outcomes has been well-established in the literature (D’Arcy-Bewick et al., 2022; Do et al., 2019; Hendrickson et al., 2013; López-Martínez et al., 2018).
While much research has focused on the impact of childhood trauma (Austin, 2018; D’Arcy-Bewick et al., 2023; De Bellis & Zisk, 2014) and specific types of traumatic events (Neria et al., 2008), less is known about the cumulative effect of trauma experienced throughout one’s lifetime on mortality risk in adulthood.
Given that people often experience more than one traumatic event in their lives (Breslau et al., 1999; Krause et al., 2004), it is crucial to examine the impact of lifetime trauma on longevity. T
his systematic review aimed to determine the state of the literature examining lifetime trauma and mortality risk during adulthood, building upon previous research on the accumulative effects of adverse childhood experiences (D’Arcy-Bewick et al., 2023; Felitti et al., 1998).
Method
The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines (Page et al., 2021).
The protocol was pre-registered on PROSPERO (CRD42022333432).
Six databases (Scopus, Web of Science, CINAHL, PsycInfo, Embase, and Medline) were searched for studies published up to April 2023 that reported adult mortality outcomes associated with lifetime traumatic events.
The search terms included variations of “adult,” “trauma,” “abuse,” “neglect,” “stressful life events,” and “mortality.”
Studies were included if they had a measure of lifetime trauma (defined as cumulative trauma and stressful life events meeting DSM-5 criteria) and reported mortality data for participants aged 18 or older.
Studies focusing solely on childhood trauma or a single type of trauma were excluded.
Inclusion and exclusion criteria
Studies were included if they were peer-reviewed, investigated lifetime trauma and mortality in adults, and had a measure of lifetime trauma exposure and mortality as an outcome.
Studies were excluded if they did not meet these criteria, focused solely on childhood trauma, measured only one type of trauma, or were systematic reviews or meta-analyses.
Statistical measures
Due to the heterogeneity of the five included studies, a meta-analysis was not conducted. Instead, a narrative synthesis of the data was performed.
Results
The search yielded 2,607 articles, of which five met the inclusion criteria (0.19% of the initial pool). The studies were conducted in the United States (K = 4) and Canada (K = 1), with sample sizes ranging from 90 to 3,809 participants (total n = 5,506).
Three studies found a positive relationship between lifetime trauma and mortality risk, while two men/male-only studies found no relationship.
The most common childhood traumas examined were psychological and physical abuse, while the most common adult traumas were the death of a loved one and life-threatening illness of self or family member.
Insight
This systematic review provides valuable insights into the complex relationship between lifetime trauma and mortality risk in adulthood.
The findings suggest that exposure to multiple traumatic events throughout one’s life may increase the risk of premature death, although the evidence is inconclusive.
The review highlights the need for more longitudinal research using standardized measures of lifetime trauma and diverse sample populations to better understand this relationship.
Future studies should also explore potential mechanisms underlying the association between lifetime trauma and mortality, such as physiological and behavioral pathways.
Understanding the impact of lifetime trauma on longevity can inform the development of targeted interventions and health policies aimed at reducing the occurrence and consequences of traumatic experiences across the lifespan.
Strengths
The study had many methodological strengths, including:
- Adherence to PRISMA guidelines and pre-registration of the protocol on PROSPERO
- Comprehensive search of six databases using a broad range of search terms
- Clear inclusion and exclusion criteria
- Quality assessment of included studies using the Newcastle-Ottawa Scale
Limitations
The review has several limitations that should be considered when interpreting the findings:
- Heterogeneity of the included studies prevented a meta-analysis
- Lack of consensus on the definition and measurement of lifetime trauma
- Limited representation of early and late adulthood in the sample populations
- Predominantly Western samples, limiting generalizability to other cultures
- Potential for recall bias in studies using self-report measures of trauma
These limitations highlight the need for more standardized approaches to defining and measuring lifetime trauma, as well as the importance of conducting research with diverse populations across the lifespan.
Clinical Implications
The findings of this systematic review have significant implications for public health and clinical practice.
Understanding the relationship between lifetime trauma and mortality risk can inform the development of targeted interventions and health policies aimed at reducing the occurrence and consequences of traumatic experiences across the lifespan.
Healthcare professionals should be aware of the potential long-term health impacts of trauma and screen for a history of traumatic experiences when assessing patient risk factors.
The review also underscores the importance of providing trauma-informed care and support services to individuals who have experienced multiple traumatic events throughout their lives.
Further research is needed to elucidate the mechanisms underlying the association between lifetime trauma and mortality risk, as well as to identify protective factors that may mitigate the adverse health consequences of trauma exposure.
References
Primary reference
Buckley, L., Turiano, N., Sesker, A., Butler, M., & O’Súilleabháin, P. S. (2024). Lifetime trauma and mortality risk: A systematic review. Health Psychology, 43(4), 280–288. https://doi.org/10.1037/hea0001343
Other references
Austin, A. (2018). Association of adverse childhood experiences with life course health and development. North Carolina Medical Journal, 79(2), 99-103. https://doi.org/10.18043/ncm.79.2.99
Breslau, N., Chilcoat, H. D., Kessler, R. C., & Davis, G. C. (1999). Previous exposure to trauma and PTSD effects of subsequent trauma: Results from the Detroit Area Survey of Trauma. American Journal of Psychiatry, 156(6), 902-907. https://doi.org/10.1176/ajp.156.6.902
D’Arcy-Bewick, S., Terracciano, A., Turiano, N., Sutin, A. R., Long, R., & O’Súilleabháin, P. S. (2022). Childhood abuse and neglect, and mortality risk in adulthood: A systematic review and meta-analysis. Child Abuse & Neglect, 134, Article 105922. https://doi.org/10.1016/j.chiabu.2022.105922
D’Arcy-Bewick, S., Turiano, N. A., Sutin, A. R., Terracciano, A., & O’Súilleabháin, P. S. (2023). Adverse childhood experiences and all-cause mortality risk in adulthood. Child Abuse & Neglect, 144, Article 106386. https://doi.org/10.1016/j.chiabu.2023.106386
De Bellis, M. D., & Zisk, A. (2014). The biological effects of childhood trauma. Child and Adolescent Psychiatric Clinics of North America, 23(2), 185-222. https://doi.org/10.1016/j.chc.2014.01.002
Do, T. T. H., Correa-Velez, I., & Dunne, M. P. (2019). Trauma exposure and mental health problems among adults in Central Vietnam: A randomized cross-sectional survey. Frontiers in Psychiatry, 10, Article 31. https://doi.org/10.3389/fpsyt.2019.00031
Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., & Marks, J. 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. https://doi.org/10.1016/S0749-3797(98)00017-8
Hendrickson, C. M., Neylan, T. C., Na, B., Regan, M., Zhang, Q., & Cohen, B. E. (2013). Lifetime trauma exposure and prospective cardiovascular events and all-cause mortality: Findings from the Heart and Soul Study. Psychosomatic Medicine, 75(9), 849-855. https://doi.org/10.1097/PSY.0b013e3182a88846
Krause, N., Shaw, B. A., & Cairney, J. (2004). A descriptive epidemiology of lifetime trauma and the physical health status of older adults. Psychology and Aging, 19(4), 637-648. https://doi.org/10.1037/0882-7974.19.4.637
López-Martínez, A. E., Serrano-Ibáñez, E. R., Ruiz-Párraga, G. T., Gómez-Pérez, L., Ramírez-Maestre, C., & Esteve, R. (2018). Physical health consequences of interpersonal trauma: A systematic review of the role of psychological variables. Trauma, Violence, & Abuse, 19(3), 305-322. https://doi.org/10.1177/1524838016659488
Neria, Y., Nandi, A., & Galea, S. (2008). Post-traumatic stress disorder following disasters: A systematic review. Psychological Medicine, 38(4), 467-480. https://doi.org/10.1017/s0033291707001353
Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., Shamseer, L., Tetzlaff, J. M., Akl, E. A., Brennan, S. E., Chou, R., Glanville, J., Grimshaw, J. M., Hróbjartsson, A., Lalu, M. M., Li, T., Loder, E. W., Mayo-Wilson, E., McDonald, S., … Moher, D. (2021). The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Systematic Reviews, 10(1), Article 89. https://doi.org/10.1186/s13643-021-01626-4
Keep Learning
- How might the inconsistencies in defining and measuring lifetime trauma contribute to the mixed findings in the literature on its relationship with mortality risk?
- What are some potential physiological and behavioral mechanisms that could explain the association between lifetime trauma and increased mortality risk?
- How can healthcare professionals and policymakers use the findings of this systematic review to improve screening, prevention, and intervention efforts related to trauma exposure?
- What are some ethical considerations researchers should keep in mind when conducting studies on lifetime trauma and mortality, particularly with vulnerable populations?
- Given the limitations of the current literature, what methodological improvements would you suggest for future studies examining the relationship between lifetime trauma and mortality risk?
