Stress and trauma affect the physical and emotional wellbeing of millions of Australians. It is difficult to get accurate information about the prevalence of stress and trauma and associated impacts because of the complex events and variation in individual responses.

Difference between stress and trauma   

According to Gomes 2014, ‘Trauma is an experience of extreme stress or shock that is/or was, at some point, part of life’. Traumatic events are often life-threatening and include events such as natural disasters, motor vehicle accidents, the illness of a close friend or family member, sexual assault or difficult child birth experiences. Stress is a reaction to less dramatic and actual life events such as a job loss, exams, deadlines, finances, or divorcing a spouse. While stress is not always harmful, trauma nearly always is.

What is stress?

According to the website MedicineNet, ‘Stress is a physical, mental, or emotional factor that causes bodily or mental tension’. Stresses can be external (from the environment, psychological, or social situations) or internal (illness, or from a medical procedure). Stress can initiate the ‘fight or flight’ response, a complex reaction of the neurologic and endocrinologic systems. Continuous stress without relief can result in a condition called distress—a negative stress reaction that can lead to physical symptoms such as headaches, loss of appetite, increased blood pressure, chest pain, sexual dysfunction, and problems sleeping. Stress can also cause or influence a broad range of physical health conditions such as heart disease, diabetes, poor healing, irritable bowel syndrome, and mental disorders such as depression or anxiety (Gouin & Kiecolt-Glaser 2011; NIMH 2019; Stöppler 2018).

What is trauma?

Any event that involves exposure to actual or threatened death, serious injury, or sexual violence has the potential to be traumatic. Most people will go through at least 1 traumatic event in their lives, but not everyone will respond in the same way. Australian research suggests that the most common traumatic events experienced by Australians are:

  • experiencing an unexpected death of a close loved one
  • witnessing a person critically injured or killed, or finding a body
  • being in a life-threatening car accident (Phoenix Australia 2019).

Post-traumatic stress disorder (PTSD)

Following a traumatic event, many people develop post-traumatic symptoms, and a minority develop post-traumatic stress disorder (PTSD), which is a severe reaction to an extreme and frightening traumatic event (Phoenix Australia 2019). PTSD is typically characterised by all of the following:

  • re-experiencing the traumatic event or events in vivid intrusive memories, flashbacks, or nightmares, typically accompanied by strong or overwhelming emotions, particularly fear or horror, and strong physical sensations
  • avoiding thoughts and memories of the event or events, or avoidance of activities, situations, or people reminiscent of the event or events
  • persistent perceptions of a heightened current threat, which, for example, might lead to hypervigilance, or reacting beyond what would normally be expected to something like an unexpected noise.

The symptoms persist for at least several weeks and cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning (WHO 2019). In some cases, individuals remain symptomatic for 3 years or longer and may develop secondary problems such as substance misuse (National Collaborating Centre for Mental Health 2005). 

Trauma and mental illness

Experience of trauma can contribute to development of many different forms of mental illness such as psychosis, schizophrenia, eating disorders, personality disorders, depressive and anxiety disorders, alcohol and substance use disorders, and self-harm and suicide-related behaviours (Heim et al. 2010; Phoenix Australia 2019). Childhood trauma experiences not only increase the risk of onset of mental illness but also affect clinical course and responses to treatment. Previous research has shown that 90% of public mental health clients have been exposed to (and most have actually experienced) multiple experiences of trauma (Jennings 2004). See Mental health.

How common is stress?

The Australian Bureau of Statistics (ABS) measures stress in 2 of its surveys: the National Health Survey (NHS) and the General Social Survey (GSS). It uses 2 methods to quantify a respondent’s level of stress:

  • the Kessler 10 (K10) psychological distress scale measuring non-specific psychological distress, based on questions about negative emotional states experienced in the past 30 days (ABS 2012)
  • asking respondents whether they experienced 1 or more specific personal stressors.  

Psychological distress

According to the 2017–18 ABS NHS, there were an estimated 13% or 2.4 million Australians aged 18 and over reported high or very high levels of psychological distress, a 12% increase from 2014–15 (11.7% or 2.1 million Australians). High or very high levels of psychological distress were more often reported by women than men in 2017–18 (15% and 11% respectively) (ABS 2019).

In 2017–18, adults living in the most disadvantaged areas (the first quintile) across Australia were more than twice as likely to report high or very high levels of psychological distress as adults living in the least disadvantaged areas (the fifth quintile) (18% and 9% respectively), similar to the pattern seen in 2014–15 (18% and 7% respectively) (ABS 2019).

Personal stressors

The ABS defines personal stressors as ‘events or conditions that occur in a person's life that may adversely impact on the individual's or their family's health or wellbeing. A stressor may occur directly, such as personally experiencing a serious illness, or indirectly, such as having a family member with a serious illness. In some instances, personal stressors may have an ongoing impact or limit the capacity of a person, or family, to live a satisfying and productive life’. (ABS 2011).

According to the ABS General Social Survey, the proportion of Australians reporting at least 1 personal stressor did not change significantly between 2010 and 2014. In the survey, people were asked whether selected issues such as serious illness, death of a family member or difficulty getting a job had been a problem for them or their family or close friends in the last 12 months. Men were less likely than women to report a stressor.

In 2014, about 2 in 3 (63%) Australians aged 15 and over reported experiencing at least 1 personal stressor in the previous 12 months, with people in 1-parent families with children being more likely to experience personal stressors (ABS 2014).

How common is trauma and PTSD?

While there is limited data on the prevalence of trauma in Australia, 2 studies suggest that 57–75% of Australians will experience a potentially traumatic event at some point in their lives (Mills et al. 2011; Rosenman 2002). International studies estimate that 62–68% of young people will have been exposed to at least 1 traumatic event by the age of 17 (Copeland et al. 2007; McLaughlin et al. 2013).

According to the 2007 National Survey of Mental Health and Wellbeing, 12% of Australians experience PTSD in their life (lifetime prevalence), with women being at almost twice the risk of men (15.8% and 8.6% respectively) (ABS 2007). According to the 2017–18 National Health Survey, 1.7% of women and 1.3% of men reported that they had been told by a doctor, nurse, or health professional that they have PTSD (point prevalence) (ABS 2019).

Trauma exposure is more common among specific groups such as people who experience homelessness, young people in out-of-home care or under youth justice supervision, refugees, women and children experiencing family and domestic violence, LGBTIQ people and certain occupation groups (for example emergency services, armed forces and veterans) (Bendall et al. 2018; Phoenix Australia 2013). As cumulative exposure to work-related traumatic events is associated with increased risk of PTSD, the rates of the disorder may be more likely among long-term emergency services employees than new recruits (Phoenix Australia, 2013). This is also supported by a study of the mental health of current and retired Australian firefighters, where prevalence of PTSD was more than two times higher in retired than current firefighters (18% and 7.7%, respectively) (Harvey et al. 2016). Historical and current trauma experienced as a result of separation from family, land, and cultural identity has also had a serious impact on the social and emotional wellbeing of Aboriginal and Torres Strait Islander people (Bendall et al. 2018; AIHW 2018). See Indigenous health and wellbeing.

What is the cost of stress and trauma?

Stress and trauma have a considerable economic impact on society. The Economic Cost of the Social Impact of Natural Disasters study reviewed some of the intangible costs: the 2010–11 Queensland floods and the 2009 Black Saturday bushfires in Victoria. Queensland residents affected by floods were 5.3 times more likely to report poorer health than those not affected, and 2.3 times more likely to develop PTSD (Alderman et al. 2013). Mental health issues represented the largest financial impact of the floods, with a lifetime cost estimated at $5.9 billion. In addition to more than 170 deaths and 400 injuries caused by bushfires in Victoria, the lifetime cost of the mental health issues was estimated to be more than $1 billion (Deloitte Access Economics 2016).

Prevention and management

According to Howlett & Stein, ‘Public policy and public health interventions to reduce violence, traumatic injuries, and other traumatic events have a major role to play in the primary prevention of acute stress disorders and PTSD’. Secondary prevention includes targeted interventions for individuals at the highest risk of developing PTSD after trauma, including those with pre-existing psychiatric disorders, a family history of disorders and/or childhood trauma, and psychosocial and somatic approaches such as cognitive behavioural therapy (Breslau 2002; Howlett & Stein 2016). The recommendations made in the Australian Guidelines for the Treatment of Acute Stress Disorder and Posttraumatic Stress Disorder (Phoenix Australia 2013) remain the recommended practice for Australian health providers; however, beyond PTSDs, evidence for treatment of trauma is scarce (Bendall et al. 2018).

Primary prevention—intervening before health effects occur, through measures such as vaccinations, altering risky behaviours (poor eating habits, tobacco use), and banning substances known to be associated with a disease or health condition.

Secondary prevention—screening to identify diseases in the earliest stages, before the onset of signs and symptoms, through measures such as mammography and regular blood pressure testing (CDC 2017).

People are negatively affected by stress when they have not developed a stable set of strategies for coping with stressors. Stress management is recognised as an effective treatment modality and may include drugs as well as non-drug components such as psychological and relaxation methods including meditation, progressive muscle relaxation, and yoga, and adopting a healthy lifestyle (Chen & Kottler 2012).

Where do I go for more information?

For more information on stress and trauma, see:

References

ABS (Australian Bureau of Statistics) 2007. National Survey of Mental Health and Wellbeing: summary of results, 2007. ABS cat. no. 4326.0. Canberra: ABS.

ABS 2011. General Social Survey: summary results, Australia, 2010. ABS cat.no. 4159.0. Canberra: ABS.

ABS 2012. Information paper: Use of the Kessler Psychological Distress Scale in ABS health surveys, Australia, 2007–08. ABS cat. no. 4817.0.55. Canberra: ABS.

ABS 2014. General Social Survey: summary results, Australia, 2014. ABS cat.no. 4159.0. Canberra: ABS.

ABS 2019. National Health Survey: first results, 2017–18. ABS cat. no. 4364.0.55.001. Canberra: ABS.

Alderman K, Turner LR & Tong S 2013. Assessment of the health impacts of the 2011 summer floods in Brisbane. Disaster Medicine and Public Health Preparedness 7(4):380–6.

AIHW (Australian Institute of Health and Welfare) 2018. Aboriginal and Torres Strait Islander Stolen Generations and descendants: numbers, demographic characteristics and selected outcomes. AIHW Cat.no. IHW 195. Canberra: AIHW.

Bendall S, Phelps A, Browne V, Metcalf O, Cooper J, Rose B et al. 2018. Trauma and young people. Moving toward trauma-informed services and systems. Melbourne: Orygen, The National Centre of Excellence in Youth Mental Health.

Breslau N 2002. Epidemiologic studies of trauma, posttraumatic stress disorder, and other psychiatric disorders. The Canadian Journal of Psychiatry 47(10):923–9.

CDC (Centers for Disease Control and Prevention) 2017. Picture of America: prevention. Atlanta: United States Department of Health and Human Services. Viewed 5 February 2020.

Chen DD & Kottler JA 2012. Stress management and prevention: applications to everyday life. New York & London: Routledge.

Copeland WE, Keeler G, Angold A & Costello EJ 2007. Traumatic events and posttraumatic stress in childhood. Archives of General Psychiatry 64(5):577–84.

Deloitte Access Economics 2016. The economic cost of the social impact of natural disasters. Viewed 19 December 2019.

Gomes S 2014. Engaging touch & movement in somatic experiencing® Trauma resolution approach. New York: International University for Graduate Studies. Viewed 5 February 2020.

Gouin JP & Kiecolt-Glaser JK 2011. The impact of psychological stress on wound healing: methods and mechanisms. Immunology and allergy clinics of North America 31(1):81–93.

Harvey SB, Milligan-Saville JS, Paterson HM, Harkness EL, Marsh AM, Dobson M et al. 2016. The mental health of fire-fighters: an examination of the impact of repeated trauma exposure. Australian and New Zealand Journal of Psychiatry 50(7):649–58.

Heim C, Shugart M, Craighead WE & Nemeroff CB 2010. Neurobiological and psychiatric consequences of child abuse and neglect. Developmental Psychobiology 52(7):671–90.

Howlett JR & Stein MB 2016. Prevention of trauma and stressor-related disorders: a review. Neuropsychopharmacology 41(1):357–69.

Jennings A 2004. Models for developing trauma-informed behavioral health systems and trauma-specific services. Viewed 28 September 2019.

MedicineNet 2018. Medical definition of stress. Viewed 28 September 2018.

McLaughlin KA, Koenen KC, Hill ED, Petukhova M, Sampson NA, Zaslavsky AM & Kessler RC 2013. Trauma exposure and posttraumatic stress disorder in a national sample of adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 52(8):815–30.e14.

Mills KL, McFarlane AC, Slade T, Creamer M, Silove D, Teesson M & Bryant R 2011. Assessing the prevalence of trauma exposure in epidemiological surveys. Australian and New Zealand Journal of Psychiatry 45(5):407–15.

National Collaborating Centre for Mental Health 2005. Post-traumatic stress disorder: the management of PTSD in adults and children in primary and secondary care. Leicester, United Kingdom: Gaskell.

NIMH (National Institute of Mental Health) 2019. Fact sheet on stress. NIMH publication no. 19-MH-8109. Bethesda: NIMH. Viewed 6 February 2020.

Phoenix Australia 2013. Australian Guidelines for the Treatment of Acute Stress Disorder & Posttraumatic Stress Disorder. Melbourne: Phoenix Australia, Centre for Posttraumatic Mental Health.

Phoenix Australia 2019. What is trauma? Melbourne: Phoenix Australia. Viewed 28 September 2019.

Rosenman S 2002. Trauma and posttraumatic stress disorder in Australia: findings in the population sample of the Australian National Survey of Mental Health and Wellbeing. Australian and New Zealand Journal of Psychiatry 36(4):515–20.

Stöppler MC 2018. Stress facts. Viewed 28 September 2019.

WHO (World Health Organization) 2019. International Classification of Diseases 11th Revision: the global standard for diagnostic health information. Geneva: WHO. Viewed 10 October 2019.