Thursday June 08, 2017
How childhood trauma can have a life-long impact on health
A history of childhood trauma can affect the mental health of adults.
But what is less well-recognized, even by doctors, is the link to physical health.
Childhood trauma raises the risk of everything from diabetes to lung cancer to heart disease. Those who endured a high level of trauma in their youth have an average life expectancy 20 years lower than those who didn't.
The risk factors are leading some doctors to suggest that, along with standard questions about medical history, health-care practitioners should routinely ask patients about what they may have lived through as children.
'It actually goes beyond abuse and neglect, to other kinds of adversity that kids experience.' - Dr. Robert Maunder, psychiatrist at Mount Sinai Hospital
Surveys have shown that nearly a third of Canadians suffered abuse or neglect in their youth.
Dr. Robert Maunder, a psychiatrist at Toronto's Mount Sinai Hospital as well as the co-author of Love, Fear, and Health: How our Attachments to Others Shape Health and Health Care, says that just scratches the surface.
"It actually goes beyond abuse and neglect to other kinds of adversity that kids experience," Dr. Maunder tells The Current's Anna Maria Tremonti.
"[It can be] having a parent with a mental illness, having a parent with addiction, witnessing violence in the family."
Dr. Maunder describes a "double whammy" in terms of the ongoing effects of trauma on health.
"On the one hand it puts you at risk of becoming ill, but once you're ill and once you're in the hospital, it complicates health care," he says.
'It has been a very important morale booster for the staff.' - Dr. Howard Ovens, chief medical strategy officer at Sinai Health System
Dr. Maunder gives an example of a woman with Crohn's disease who refuses a colonoscopy needed to develop her treatment plan. A doctor who knows her history of childhood sexual abuse would know that this type of test would be a trigger for her — and be able to suggest alternative tests. A doctor who hasn't asked about any childhood trauma might just see her as a difficult patient.
"And then the relationship becomes poisoned with mistrust," says Dr. Maunder.
Dr. Maunder has worked with Mount Sinai hospital in Toronto to incorporate this strategy into how their emergency room treats "difficult patients" — patients who are in the ER frequently and whose problems are difficult to solve.
Dr. Howard Ovens is the chief medical strategy officer for the Sinai Health System, and until April of this year, he was the chief of emergency medicine at Mount Sinai Hospital.
"People who have chaotic lives have trouble following through in maintaining relationships, keeping appointments," he explains.
"And the emergency department is open 24 hours a day every day."
Now, these patients are seen in the ER by members of the psychiatric team linked to the childhood trauma project, who then work on building a relationship with them — and building an individual comprehensive care plan for all health-care staff to use.
The new care model helps not only the patients, but the health-care practitioners at the hospital as well.
Dr. Ovens says it supports the staff who find many of these people "very upsetting, challenging."
"It's a source of burnout for a lot of our staff. But if they feel that they are supported, that we've given them some direction and will stand behind them in employing a particular approach, it really makes them feel like they're part of a team," he says.
"It has been a very important morale booster for the staff."
This segment was produced by The Current's Sujata Berry and Willow Smith.