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How Common Is Trauma?
Trauma exposure is common in the United States. However, trauma exposure varies considerably according to different demographic characteristics and is especially high among clients receiving behavioral health services (see the discussions under the headings “Extent and Effects of Trauma and Traumatic Stress Reactions in Specific Populations” and “Other Disorders That May Be Related to Trauma” for more information on relevant rates). Although the large surveys discussed here provide data on trauma exposure for the general population, published literature often provides more specific data as well, which is one reason why differences in exposure according to gender and race/ethnicity are highlighted here.
At one time, trauma was considered an abnormal experience. Contrary to this myth, the first National Comorbidity Study (NCS), a large national survey designed to study the prevalence and effects of mental disorders in the United States, established how prevalent traumas are in the lives of the general U.S. population (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995). Presented with a list of 11 types of traumatic experiences and a 12th “other” category, 60.7 percent of men and 51.2 percent of women reported experiencing at least one trauma in their lifetime (Kessler, 2000; Kessler et al. 1995; 1999):
The NCS also found that it was not uncommon for individuals to have experienced multiple traumatic events (Kessler, 2000). Among men in the total sample, 14.5 percent reported two traumatic events, 9.5 percent reported three, 10.2 percent reported four or more, and 26.5 percent reported only one such event. Among women, 13.5 percent of the total sample reported two traumatic events, 5 percent reported three, 6.4 percent reported four or more, and 26.3 percent reported only one.
The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) is another large national survey of behavioral health, but it only assessed posttraumatic stress disorder (PTSD) and trauma exposure in its second wave of interviews, in which 34,653 of the original 43,093 respondents were reinterviewed (Pietrzak, Goldstein, Southwick, & Grant, 2011a). In the Wave 2 interview, respondents were asked about 27 different types of potentially traumatic events; the most commonly reported traumatic events were serious illness or injury to someone close (affecting 48.4 percent of those who did not have PTSD symptoms and 66.6 percent of those with PTSD), unexpected death of someone close (affecting 42.2 percent of those without PTSD and 65.9 percent of those with PTSD), and seeing someone badly injured or killed (affecting 24 percent of those without PTSD and 43.1 percent of those with PTSD; Pietrzak, Goldstein, Southwick, & Grant, 2011a). According to the same data, 71.6 percent of the sample witnessed trauma, 30.7 percent experienced a trauma that resulted in injury, and 17.3 percent experienced a trauma that was purely psychological in nature (e.g., being threatened with a weapon; El-Gabalawy, 2011).
NESARC also found that exposure to specific traumatic events varied considerably according to race, ethnicity, or cultural group. The survey found that 83.7 percent of non-Latino White Americans reported a traumatic event, compared with 76.4 percent of African Americans, 68.2 percent of Latinos, and 66.4 of percent of Asian Americans, Native Hawaiians, or Pacific Islanders (Roberts, Gilman, Breslau, Breslau, & Koenen, 2011). Exposure to specific traumas also varied considerably. White Americans were more likely to report an unexpected death of someone they knew (44.7 percent did) than were African Americans (39.9 percent), Latinos (29.6 percent), and Asian Americans, Native Hawaiians, or Pacific Islanders (25.8 percent) as well as being more likely to report having a close friend/relative who experienced a life-threatening injury. On the other hand, African Americans were the most likely to report being the victim of assaultive violence (29.7 percent), followed by White Americans (26.1 percent), Latinos (25.6 percent), and Asian Americans, Native Hawaiians, or Pacific Islanders (16.3 percent). In terms of combat trauma, White Americans and African Americans were about as likely to have been combatants (10 percent of each group reported combat trauma), and more likely than Asian Americans, Native Hawaiians, or Pacific Islanders (5.4 percent) or Latinos (4.4 percent). However, Asian Americans, Native Hawaiians, or Pacific Islanders were the most likely to have been unarmed civilians in a war zone (7.5 percent), followed by Latinos (3.8 percent), White Americans (2 percent), and African Americans (1.9 percent).
Across the world, according to data from the World Health Organization (WHO) surveys, which includes the NCS and NCS replication (NCS-R) and surveys from 20 other countries, the most commonly reported traumas are the death of a loved one (30.5 percent), witnessing violence to others (21.8 percent), and experiencing interpersonal violence (18.8 percent; Stein et al., 2010). As Kessler (2000) noted, trauma from assaultive violence in the United States is likely to be more common than in most other developed countries in general. However, trauma related to other traumatic events (e.g., automobile accidents, natural disasters) appear to be quite similar throughout developed countries.
A longitudinal survey from New Zealand also provides useful data on trauma exposure. In this survey, a cohort of subjects from a single town was interviewed at age 26 and again at age 32 in order to evaluate what constituted the worst trauma those individuals had experienced (Koenen, Moffitt et al., 2008). The types of worst experiences reported before age 26 were: