From the Guidelines
Trauma, stress, and social determinants of health have a profound impact on disease and healthcare outcomes. The evidence suggests that adverse childhood experiences (ACEs) and trauma can lead to changes in the brain, immune system, and other physiological systems, increasing the risk of chronic diseases such as cardiovascular disease, mental health conditions, and substance abuse 1.
Key Factors Influencing Health Outcomes
- Adverse Childhood Experiences (ACEs): ACEs, including physical and emotional abuse, neglect, and household dysfunction, can have a lasting impact on physical and mental health 1.
- Trauma-Informed Care (TIC): TIC is an approach to healthcare that recognizes the impact of trauma on patients and provides a safe and supportive environment for care 1.
- Social Determinants of Health: Social determinants, such as poverty, housing instability, and lack of access to healthcare, can exacerbate the effects of trauma and ACEs on health outcomes 1.
- Stress Responses: The body's stress response, including the hypothalamic-pituitary-adrenal (HPA) axis, can be altered by trauma and ACEs, leading to changes in inflammation, immune function, and other physiological processes 1.
Implications for Healthcare
- Screening for ACEs and Trauma: Healthcare providers should screen patients for ACEs and trauma to provide targeted interventions and support 1.
- Trauma-Informed Care: Healthcare providers should adopt a trauma-informed approach to care, recognizing the impact of trauma on patients and providing a safe and supportive environment 1.
- Addressing Social Determinants of Health: Healthcare providers should address social determinants of health, such as poverty and housing instability, to reduce the impact of trauma and ACEs on health outcomes 1.
From the Research
Impact of Trauma, Stress, and Social Determinants of Health
- The provided studies do not directly address the impact of trauma, stress, and social determinants of health on disease and healthcare outcomes according to the principles of Evidence-Based Medicine (EBM) 2, 3, 4, 5, 6.
- However, the principles of EBM emphasize the importance of considering patient expectations and individual clinical situations when making medical decisions 2, 3, 4.
- EBM also involves the judicious use of current best evidence in the care of individual patients, which may include considering the social determinants of health and the impact of trauma and stress on patient outcomes 3, 4.
- The use of evidence-based medicine requires a rigorous process to remove bias in medical decision-making, which may involve considering the complex interplay between trauma, stress, and social determinants of health 5.
Evidence-Based Medicine Principles
- The principles of EBM involve formulating answerable questions, gathering evidence, appraising the evidence, implementing the valid evidence, and evaluating the process 3.
- EBM requires the use of current best evidence, as well as clinical experience and patient preferences, to make medical decisions 2, 3, 4.
- The application of EBM principles can help to address complex medical issues, such as patient blood management, and can inform decisions about diagnosis, prognosis, and treatment 5.
Limitations of Evidence-Based Medicine
- The provided studies highlight the limitations of EBM, including the difficulty of applying evidence to individual patients and the potential for bias in medical decision-making 2, 3, 4, 5, 6.
- EBM requires a systematic approach to evaluating evidence and making medical decisions, which can be challenging in complex clinical situations 3, 6.