Trauma: A Silent War
Traumatic events come in every shape and form. Some are a one-time occurrence, like for example, an isolated accident or a natural disaster; or they can be complex, like growing up in a war zone or being repeatedly abused and neglected.
What all traumatic events have in common is their ability to suddenly change life from good to unbearable. They have the power to brutally disrupt all synchronicities we need to live a healthy life: our connection with ourselves, with our bodies, with others, and with society at large. Trauma is so difficult to overcome because, beyond the event, it is also the disregulation of psychological and biological processes that may unfold after exposure.
Responses to traumatic events fall on a spectrum. While many are able to cope and continue life as normal after the initial shock, others struggle their full lives. Treating traumatic stress does not mean that what happened will no longer hurt. It means gaining back control over the body, brain and mind. It is teaching the nervous system to discern past and present, sleeping well at night, socializing again and being a contributing member of society, despite the pain.
The need for scaling trauma care in low-resource settings has never been this urgent:
There are 300 million estimated vulnerable persons worldwide in 2024
According to the World Health Organization, 300 million vulnerable persons will need humanitarian assistance and protection in 2024 due to conflicts, climate emergencies and other drivers.
Over a third of these vulnerable persons, as of end-2023, have been forcibly displaced, which is the highest number recorded in history.
75% of displaced persons are in low- and middle-income countries
Majority of refugees and internally-displaced persons seek protection in low- and middle-income countries, potentially impacting socio-economic development.
As research shows, mental disorders can hinder a person’s ability to contribute to society and the broader economy.
There are only 2 mental health workers estimated per 100,000 population
The estimated rate of mental health workers in the poorest countries are extremely low to attend to the needs of local and displaced populations, averaging 2 workers per 100,000 persons, compared to more than 70 workers in high-income countries.
PTSD can be up to 10 times higher in low-resource settings.
Epidemiological studies examining the prevalence of posttraumatic stress disorder (PTSD) among emergency-impacted populations in low- and middle-income countries estimate that it may be up to 10x higher when compared to PTSD prevalence in high-income countries (e.g. USA, 6%).
The Impact of Trauma
is Not Limited to PTSD.
TRANSDIAGNOSTIC ASSESSMENT AND TREATMENT APPROACHES ARE NEEDED.
Individuals with PTSD have at least one, and on average 3 other co-occurring psychiatric diagnoses, including:
• Major depressive disorder
• Generalized anxiety disorder
• Substance use disorder
• Complex PTSD
They may also suffer with other significant problems, such as:
• Sleep abnormalities
• Substance addiction and misuse
• Dissociation
• Physical symptoms
• Self-harm
• Medical conditions
The Good News:
Trauma is Treatable.
Over the past 3 decades, significant progress has been made in the development of treatments for traumatic stress, and many modalities are now backed by rigorous scientific evidence.
Core Challenges
There is no “one size fits all” intervention for traumatic stress.
Given the complexity of trauma, different people respond to different types of treatment. This brings significant challenges for developing a standardized program that can be scaled and measured.
Evidence-based treatments are primarily administered by highly trained psychologists.
The scarcity of qualified trauma psychologists in resource-poor locations have led most humanitarian mental health initiatives to heavily rely on lay community health workers, limiting trauma care to low-impact psychological first aid.
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