• Posted October 4, 2024

Trauma at Life's Beginning Can Mar Its End, Study Finds

Whether abusive parents, drug addiction or gun violence are to blame, the fallout from childhood traumas can reverberate until a person's final days of life, new research shows.

"We found that early-life trauma in particular, especially physical abuse by parents, was strongly related to end-of-life pain, loneliness and depressive symptoms," said senior study author Dr. Ashwin Kotwal, of the University of California, San Francisco's division of geriatrics and the San Francisco VA Medical Center. 

Traumatic events in childhood may lead to poor health habits, social and emotional isolation and an increased risk of subsequent trauma, he explained in a UCSF news release.

His team looked at data from a study that followed about 6,500 Americans over age 50 who died between 2006 and 2020. Their average age at death: 78.

Study participants completed questionnaires about their experiences with 11 traumatic events and their psychosocial well-being and were interviewed every other year until they died. A final interview with a family member or friend with power of attorney provided insights about their final year of life.

In all, 2 in 5 participants had experienced traumas during childhood, including exposure to relatives' drug or alcohol abuse or getting into trouble with the law.

The most common potential source of childhood trauma was being held back a grade in school.

Life-threatening illness or having a spouse or child with one was the most common cause of trauma in adulthood. Less common sources of trauma were a child's death, a partner's drug addiction, surviving a natural disaster or engaging in armed combat.

Over the lifespan, more than 8 in 10 participants experienced at least one trauma, while 1 in 3 experienced at least three.

Trauma "gets under the skin," said first study author Kate Duchowny, of the University of Michigan Institute for Social Research. 

"We know that trauma is associated with depression and anxiety, which may promote a pro-inflammatory environment that is associated with chronic conditions," she said. "If stress is persistent, it can lead to inflammation and adverse health consequences later in life."

Indeed, study participants who reported no traumas had an easier time as their lives drew to a close. 

Their likelihood for end-of-life depression was 24%, compared to 40% for those who had experienced five or more traumatic events. 

The trauma-free group was also less likely to be lonely or in pain as they died -- they had a 12% likelihood of loneliness and 46% likelihood of moderate-to-severe pain, compared to 22% and 60% for those who had been through five or more traumatic events.

The findings were published Oct. 1 in the Journal of the American Geriatrics Society.

"What this tells us as providers is that we should view a patient's needs through a trauma lens," said Kotwal, who is board-certified in palliative and geriatric care. "Near the end of their lives, people may experience 'total pain' -- pain that may be spiritual and psychological, as well as pain from physical sources. Lifetime trauma may shape that total experience of pain."

A psychologist, chaplain or social worker may help alleviate it, he added.

"We may learn that what underlies a patient's suffering is not only disease-related symptoms, but the ongoing anxiety and distress that comes with experiencing a loss of control over one's body," said study co-author Chelsea Brown, a former social worker at UCSF Division of Palliative Medicine.

"For a person who has experienced trauma, this loss of control may serve as a reminder of previous harmful experiences, and this is painful to relive in so many ways," she said in a UCSF news release.

More information

The National Child Traumatic Stress Network has more about the fallout from early childhood trauma.

SOURCE: University of California, San Francisco, news release, Oct. 1, 2024