Trauma
Trauma is a harmful or life-threatening experience. It affects people as a physical, cognitive, or emotional response to an isolated or ongoing event.
Sometimes traumatic events just happen—things like natural disasters or car accidents. Other types of trauma are deeply connected with social determinants of health. These include adverse childhood experiences (ACEs) and intimate partner violence (IPV).
For example, risk factors for both ACEs and IPV include unemployment, housing instability, low education, and poor mental health. Conversely, positive factors in the social determinants of health can prevent ACEs and IPV.
ACEs and IPV can lead to long-term adverse outcomes that touch many aspects of life. When we understand and address people’s needs, we can prevent trauma or lessen its negative effects.
Here’s what you’ll learn:
How Social and Community Context Impacts Olivia
Meet Olivia—a young artist who has found community through volunteering, joining LGBTQ+ support groups, and sharing her experiences with homelessness on a youth advisory board. After law enforcement encounters and overcoming addiction, Olivia is working on building deeper connections with others and embracing her identity within her chosen family.
Get to Know OliviaHow Social and Community Context Impacts The Jackson Family
Meet Nichelle—a devoted wife and mother who balances caregiving for her mom with her own family responsibilities. Living near a Haitian community helps Nichelle feel connected to her culture. With her sister far away, she leans on her best friend and creative hobbies to find joy in daily life.
Get to Know The Jackson FamilyHow Social and Community Context Impacts The Garcia Family
Meet Elena—certified nurse assistant, National Guard veteran, and single mom. Living far from her support network, she is navigating grief, PTSD, and an invisible disability while raising her two children. Elena is trying to build community and find her way again.
Get to Know The Garcia FamilyHow Social and Community Context Impacts Chris
Meet Chris, a teacher who is blind and who has built a strong community through friends, family, and shared interests. Between hosting karaoke nights, playing Dungeons & Dragons, and spending time with his girlfriend’s family, Chris works to overcome stereotypes while nurturing his social connections.
Get to Know Chris
Terms to Know
- ACEs are traumatic events that happen in childhood, such as experiencing violence, abuse, or neglect. The child might witness or be aware of the trauma, or they might be the target.[1]
- Other ACEs include experiencing homelessness, discrimination, food insecurity, and more.
- Toxic stress is prolonged exposure to stress from ACEs. It harms brain development, immune systems, and stress response. It can impact a child’s learning, attention, and decision-making skills.
- IPV is abuse, aggression, or violence caused by a current or former intimate partner.[1]
- IPV can include physical or sexual violence, stalking, or psychological aggression.
- PTSD is a mental health disorder that can develop after a person experiences a traumatic event such as an accident, disaster, assault, combat, or other violence.
- PTSD causes a person to re-experience the trauma through flashbacks, recurring memories or dreams, distressing thoughts, or physical distress.[1]
- While about half of all U.S. adults experience a traumatic event in their lifetimes, only about 6.8% develop PTSD in their lives.
- Protective factors are characteristics that reduce the impact of risk factors and lower the chance of negative outcomes.[1]
- For example, protective factors that reduce the risk of ACEs include families with caregivers who can meet their children’s basic needs and caregivers who work through conflicts peacefully.
[1] Substance Abuse and Mental Health Services Administration (SAMHSA)
- Risk factors are characteristics associated with a higher likelihood of negative outcomes. They can be at the biological, psychological, community, cultural, or family levels.[1]
- For example, risk factors that increase the likelihood of ACEs include families with caregivers who were abused or neglected as children, low income, low education, and high parenting or economic stress.[2]
[1] Substance Abuse and Mental Health Services Administration (SAMHSA)
- Individual trauma is an event or circumstance that results in physical, emotional, or life-threatening harm.[1]
- Psychological trauma happens when an intense, recurring, or prolonged event threatens or harms a person’s emotional or physical well-being.[2]
- Physical trauma is a sudden, severe injury that requires immediate medical care.
- Complex trauma refers to exposure to multiple traumatic events and the long-term effects of it.[3] Examples include child abuse or profound neglect, which harms a child’s physical and mental development.
[1] Substance Abuse and Mental Health Services Administration (SAMHSA)
- Trauma-informed care recognizes that to provide effective care, the providers at the organizational and clinical levels need to understand a patient’s life experiences.[1]
- Trauma-informed care involves safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice, and choice; and addressing cultural, historical, and gender issues.[2]
- This approach can improve patients’ engagement with treatment, compliance with treatment plans, health outcomes, and the well-being of everyone — patient and provider.
[1] Substance Abuse and Mental Health Services Administration (SAMHSA)
Adverse Childhood Experiences
Adverse childhood experiences (ACEs) are trauma or negative factors in a child’s environment that can harm their health and well-being. ACEs can include abuse or household dysfunction.
Key
Facts
- You or someone you know has likely been affected by ACEs. About 61% of Hoosier adults reported experiencing at least one type of ACE before age 18.
- In Indiana, 17.5% of children have experienced two or more ACEs.
- ACEs are linked with five of the top 10 causes of death — heart disease, cancer, respiratory disease, diabetes, and suicide.
Types of ACEs
ACEs can be one-time events, such as the sudden death of a parent, or ongoing situations, like living in an unsafe environment. When a child’s sense of safety is threatened by housing instability, violence, or food insecurity, it can have lasting effects on health and well-being.
Most common
- Parental separation or divorce
- Emotional abuse
- Substance abuse in the household
Other types
- Being a victim or witness to neighborhood violence
- Living with someone with a mental illness
- Witnessing domestic violence
- Having a parent serving jail time
- Experiencing discrimination due to race, ethnicity, sexual orientation, or gender identity
- The death of a parent
- Other traumatic experiences that impact a child’s well-being and health
Who is Most Vulnerable?
While ACEs can affect any child, some groups are more vulnerable. Women and minoritized racial groups are at the greatest risk of experiencing four or more ACEs.
Other at-risk groups include young adults, non-Hispanic multiracial individuals, and people with disabilities or low income.
[1] Indiana State Department of Health
[2] America’s Health Rankings UnitedHealth Foundation
[3] U.S. Centers for Disease Control and Prevention
Consequences
Children
Youth with four or more ACEs have the greatest risk of depression, anxiety, behavior problems, ADHD, and substance use disorders.[1]
Additional studies have linked ACEs with early alcohol use, smoking, and substance use disorders in young adults.[2]
Adults
Adults who experience ACEs are more likely to face physical and mental health problems. They are more likely to struggle with education, employment, and relationships. These challenges can create cycles of adversity for future generations.
Adults with the highest level of ACEs are more likely to have chronic health conditions and depression.[1] They’re also more likely to smoke and be heavy drinkers.
Key
Takeaways
- Many of the ACE risk factors are associated with social determinants of health. Addressing these risk factors, such as a parent’s employment stability, mental health needs, and education, helps support healthier families.
- Preventing and addressing ACEs stops the generational cycle of abuse and trauma. We can prevent ACEs by boosting protective factors within the social determinants of health.
- Families with strong social support networks, those who create safe relationships and environments, and those who work at places with family-friendly policies are all ways to help protect against ACEs.
Intimate Partner Violence
Note: To get help, visit the National Domestic Violence Hotline at TheHotline.org, call 1-800-799-SAFE (7233), or text “START” to 88788.
Intimate partner violence (IPV) or domestic violence is abuse or aggression that occurs in a current or former romantic relationship.[1] It can include physical or sexual violence, stalking, and psychological aggression.
Some experience IPV as a single episode, while others endure a chronic pattern of abuse that spans many years.
Key
Facts
- IPV is common. 1 in 3 women and 1 in 4 men have experienced some form of physical violence by an intimate partner.
- About 41% of women and 26% of men have experienced any form of IPV in their lifetime.
- 15% of all violent crimes are intimate partner violence.
- Anyone can be a victim—no matter their age, community, education, ethnicity, religion, or lifestyle. Victims are at risk for severe injuries, mental health problems, and death.
Dynamics of Abuse
Domestic violence happens when a partner feels entitled to power and control over their partner. They may use physical, sexual, emotional, financial, or psychological tactics to maintain power.[1] Even the threat of violence is abuse.
The abuser might blame the victim or try to convince them that they brought violence upon themselves. It’s not true. Even if the victim fights back, the abuser is the primary source of control and abuse within the relationship.
Power and Control
One way to explain the dynamics in IPV is with the power and control wheel.[2] The spokes of the wheel describe ways the abuser might intimidate, emotionally abuse, isolate, and blame their victim.
In male-female partnerships where the abuser is a male, he might use male privilege as justification for abuse. He might involve the victim’s children and make threats.
Additionally, the abuser might economically abuse and make various threats to maintain power.
Abuse is Cyclical
IPV usually follows a cycle: calmness, tension and abuse, peak abuse, apologies, and a brief honeymoon period before the cycle repeats.
Even during calm phases, abusers often use psychological tactics to control and instill fear in the victim.
Barriers to Leaving
Leaving an abusive relationship is profoundly complex and difficult. Abusers often isolate their partners from family and friends, leaving them with no one to turn to for help.
Victims often have concerns about child custody or fears that the abuser will harm the children if they leave. Financial abuse can prevent the victim from having access to bank accounts or the ability to support themselves.
Leaving can be the most dangerous time for a victim. Abusers might escalate violence and threaten to hurt or kill the victim, their child, or another family member or threaten they will die by suicide. Data show that 72% of all murder-suicides involve an intimate partner.[3]
[1] National Domestic Violence Hotline
Physical and Mental Health Impact
Victims of IPV often suffer long-lasting impacts to their overall health, even after leaving the abuser. This includes:
- Mental health problems such as depression, PTSD, Dependent Personality Disorder, and substance use disorder[1]
- Unintended pregnancy, miscarriage, and stillbirth[2]
- Gastrointestinal problems, neurological disorders, chronic pain, and disability
- Hypertension, cardiovascular disease, and cancer
Economic Impact
IPV makes it harder for victims to keep a job or support themselves if they can leave the relationship.
An estimated 21 – 60% of victims lose their jobs due to IPV.[1]
Nationwide, the economic cost of intimate partner violence is about $8.3 billion annually.[2] This figure includes medical services to treat IPV-related injuries, criminal justice costs, and lost productivity for paid work.
Key
Takeaways
- Some social determinants of health, such as health care, education, stable jobs, and community support, can be protective factors to prevent ACEs and IPV. But when these factors are negative—unemployment, poor health care access, low education, and low community support, to name a few—people are at greater risk for ACEs and IPV.
Other Social & Community Topics
Community and Social Supports
Isolation and loneliness harm well-being, while strong social ties help individuals and communities thrive.
Criminal Justice Involvement
Addressing education, economic stability, and community support reduces crime and improves outcomes for those who have interacted with the criminal justice system.
Social Identity
Social identities like race, disability, and age shape experiences in daily life. Marginalized groups often face discrimination that contributes to poorer health outcomes.
ACEs
IPV
[1] Adverse childhood experiences and life opportunities: Shifting the narrative. Children and Youth Services Review.
[2] Adverse childhood experiences and life opportunities: Shifting the narrative. Children and Youth Services Review.
[3] U.S. Centers for Disease Control and Prevention
ACEs
IPV
[1] Child maltreatment
ACEs
IPV
[1] Journal of health care for the poor and underserved
[2] IUPUI Center for Health Policy
[3] United Way of Central Carolina
[4] U.S. Centers for Disease Control and Prevention
Both ACEs and IPV
IPV
[1] National Coalition Against Domestic Violence
ACEs
IPV
[1] National Coalition Against Domestic Violence
[2] National Coalition Against Domestic Violence
[3] National Coalition Against Domestic Violence