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The Contribution of Trauma to Women’s Ill Health: GP Perspectives

Published: 21/06/2024

Women’s health has often been overlooked and stigmatised. The complex relationship between mind and body in health and well-being is well-recognised, and trauma can significantly impact a woman’s health experience However, the role of trauma in illness is frequently underappreciated in healthcare settings.

The authors of a recent study note that “negotiating effective and acceptable trauma-informed conversations can be difficult for clinicians and patients.” They therefore aimed to explore the experience of primary care practitioners caring for women through a trauma-informed lens.

What is Trauma?

Understanding Trauma

Trauma results from extremely stressful, frightening, or distressing events. This can include past care experiences, adverse childhood events (ACEs), and other adult experiences. Trauma can lead to post-traumatic stress disorder (PTSD) and other physical and mental health issues.

Research shows that more frequent episodes of ACEs are linked to poorer health outcomes, including cardiovascular, respiratory, gastrointestinal disorders, and mental health issues. In the UK, women are disproportionately affected by violence, trauma, and ill health, adding complexity to their health presentations.

Trauma-Informed Care

Trauma-informed care is a framework founded on five core practices: safety, trustworthiness, choice, collaboration, and empowerment. It aims to address the impact of trauma on patients and healthcare professionals and prevent re-traumatisation in healthcare services.
Design and Methods of the Study

The study conducted a secondary analysis of qualitative interviews data designed to explore primary care practitioners’ experiences of supporting women’s health needs. The study, commissioned by the National Institute of Health Research (NIHR) Policy Research Program, involved 46 primary care practitioners across England. This included general practitioners (GPs), nurses, and other professionals, with an average of 12 years of experience.

Key Findings

The study identified four main themes from the interviews:

Prioritising physical symptoms

Practitioners often prioritise physical symptoms to avoid missing serious conditions. Women’s health consultations are complex and difficult to manage within limited time slots. This focus on excluding serious conditions like cancer often pushes the consideration of trauma’s contribution to physical symptoms down the list.

Avoiding alienation

Practitioners are cautious about discussing trauma to avoid alienating patients. There is a need for a cultural shift in healthcare to acknowledge the mind-body connection as a legitimate aspect of distress. However, some patients may not be receptive to recognising the emotional or past experiences contributing to their physical symptoms, fearing it might devalue their experiences.

Systemic support for trauma-informed care

Systemic challenges hinder the provision of trauma-informed care, including inadequate appointment times, long waiting times for specialist reviews, and limited access to services due to local funding models. However, some structural supports, like support networks and social prescribers, were noted to be effective.

Impact on healthcare professionals

Providing trauma-informed care is demanding and impacts practitioners’ workloads. When practitioners can navigate these challenges, they report job satisfaction. Conversely, when unable to deliver the desired care, it negatively affects them. The stress of managing patients’ distress without adequate system support adds to the challenge.

Conclusions

The study suggests that a trauma-informed systems-level approach would better integrate psychological support within multiple care pathways. This approach should support an integrated and holistic model rather than separating physical and psychological services. More research is needed to understand how to implement and support equitable trauma-informed care in practice.

By adopting a trauma-informed approach, healthcare systems can better address the complex needs of women affected by trauma, ultimately improving health outcomes and practitioner well-being.

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