Trauma related mental health problems a public health priority

MeNtal health is a state of well-being in which an individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a meaningful contribution to their community.

Mental health is a critical component of individual, family, community and national wellbeing and prosperity.

Physical and psychological trauma is a major cause of mental ill health.

trauma related mental health problems affect an individual’s quality of life as well as their ability to function in their family, decreasing their productivity and ability to contribute meaningfully to their community.

trauma, therefore, increases the burden on the medical system and the economy of a community and a nation.

What is psychological trauma and what can cause it?

experiencing a direct or indirect exposure to a stressful or life threatening event can result in significant emotional distress and psychological trauma.

the experience may happen to us or we may witness someone else experience a fatal or life threatening event.

Sometimes hearing that someone close to us has faced something life threatening or has died in a traumatic manner can also cause psychological trauma.

Severe traumatic events that can cause severe trauma related mental health problems, particularly acute stress disorder and post traumatic stress disorder (PtSD) include:

Rape: Sexual assault or rape is n the most common trauma that results in PtSD in non-war settings. Studies have shown that up to 50% of women who are sexually assaulted can develop PtSD. Child sexual abuse is also a common cause of psychological trauma with one in four girls in Zimbabwe experiencing some form of sexual abuse before the age of 12 and 1 in 10 young men reporting having experienced sexual abuse in childhood.

Assault and Domestic Violence: n Physical attacks, being robbed, being threatened with a weapon can all result in psychological trauma. Domestic violence and intimate partner violence are also a major cause of trauma, affecting 35% of women worldwide, with 38% of murders of women being committed by an intimate partner.

Road traffic accidents: Road traffic n accidents are a leading cause of disability in low and middle income countries. In africa 26% of road traffic accident survivors develop PtSD and this risk can be there even in ‘near miss’ situations.

Combat exposure/War: there are n high levels of PtSD and other trauma related mental health problems in populations that have survived war situations. this risk is there for both soldiers and civilians.

Natural disasters: Hurricanes, n floods, earthquakes and other natural disasters can result in psychological distress. loss of loved ones, property and homes as well as displacement can cause much grief and challenges adjusting long after the relief efforts have stopped.

Child neglect, physical and emotional n abuse: apart from child sexual abuse, physical and emotional abuse including severe neglect can result in trauma related mental health problems in childhood and even into adulthood. Rejection and abandonment can severely affect a child’s physical and emotional wellbeing.

Imprisonment: the social upheaval n that comes with imprisonment and on release from imprisonment can have a negative impact on mental health.

Sudden unexpected death of a n loved one: traumatic or sudden, unexpected death of a loved one can trigger grief that is complicated by trauma. the impact of deaths that occurred due to Covid-19 is still being seen in some of us who lost loved ones during the pandemic. less severe situations that can also cause milder forms of trauma related mental health challenges include:

• Relationship/marriage termination

• Financial difficulties

• Getting married

• Becoming a parent

• Failing examinations/assessments

• Death of a close family member

• Changes in work/school environment (starting a job/losing, a job/starting at a new school/changing schools) Types of trauma related mental health problems

trauma related mental health problems range from milder problems like stress and adjustment disorder to more severe challenges like acute stress disorder and PtSD.

adjustment disorder: this is a maladaptive n response to a stressful event. this can result in sadness, tearfulness, hopelessness, excessive worry and nervousness and in some cases suicidal thoughts. Physically one may struggle to sleep and may experience fatigue and muscle pain.

acute stress disorder: this is an initial n reaction to a severe, life threatening traumatic event and occurs within the first month of the trauma. It is characterised by five types of experiences including re-experiencing of the trauma (through flashbacks and nightmares); avoiding anything that would remind you of the traumatic event; feeling numb and emotionally detached and even struggling to recall certain aspects of the trauma; feeling irritable, jittery and getting easily startled; struggling to experience any positive emotion.

Post traumatic stress disorder: this n is a chronic reaction to a severe, life threatening traumatic event and has similar experiences as seen in acute Stress Disorder but these have persisted beyond one month and can last for months or even years if not managed.

What can we do as a society and as a nation to prevent and address trauma related mental health problems?

as individuals, we can increase our n emotional awareness as well as improve our understanding about mental health and wellbeing. this will help us identify when we are struggling emotionally and if needed seek help early.

In our relationships and families, n we can strive to meet the physical and emotional needs of children and prevent all forms of child abuse. Child abuse is both a cause and a risk factor for trauma related mental health problems. at risk families may need parental/ caregiver training support. Families or other organizations involved in caring for children who have already experienced trauma may need training in how to provide trauma informed care to help these children heal and reducing the risk of further challenges in adulthood. Within our families it is also imperative to report child abuse when it is discovered, particularly sexual abuse, which is often perpetrated by an adulated related to or known well by the child. Families should avoid protecting perpetrators, perceived family harmony is not worth the mental wellbeing of the affected child.

In our communities, we can strive n to create a culture of watching out for each other and creating safe communities. Strong community connections and cooperation can help in crime prevention as already seen in many neighbourhood watch initiatives. Communities can safeguard against genderbased and domestic violence as well as other forms of assault. Within our communities, safe schools free of bullying and harassment can also help reduce risks of trauma related mental health challenges

as a society, we can invest in the n mental health system, ensuring provision of quality mental health care including care for trauma related mental health problems for all.

If you think that you or someone that you know may be struggling with a trauma related mental health problem, please contact your nearest health care provider and get help.

* Dr. Chido Rwafa-Madzvamutse is a consultant psychiatrist. Feedback: Whatsapp: +263714987729