Stress and trauma

Stress and trauma affect the physical and emotional wellbeing of millions of Australians. As the COVID-19 pandemic continues to unfold and there is a significant amount of uncertainty, it is normal for people to experience symptoms of emotional distress. From an analysis perspective, 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.

What is stress?

Stress is a common and normal physical response to challenging or new situations. Stress has both mental and physical aspects and can be triggered by different life experiences. Stressors can be external (from environment, psychological or social situations) or internal (for example, illness). Stress can initiate the ‘fight or flight’ response, a complex reaction of the neurologic and endocrine 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 and 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. The trauma experienced can be physical and/or mental and not everyone will respond in the same way. A well-known trauma-related mental illness is post-traumatic stress disorder (PTSD). PTSD is a chronic condition that can be diagnosed when fear, anxiety and memories of a traumatic event persist. The feelings last for a long time and interfere with how people cope with everyday life.

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).

Traumatic injury survivors often suffer from physical, emotional, cognitive, and financial consequences that can affect their lives, their families, and society for prolonged periods of time (Herra-Escobar 2021).

Exceptional situations, such as the COVID-19 pandemic can lead to trauma. Emerging research propose that individuals affected are likely to experience traumatic stress reactions related to worry about the future, exposure to the virus and stressful events (for example, unemployment, isolation, non-sudden illness/death) (Bridgland et al. 2021).

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. See Mental health.

How common is stress?

Measuring stress is a challenge as people have varied stress responses when exposed to variants of stressors and health researchers across disciplines have varied practices for measuring stress.

The Australian Bureau of Statistics (ABS) measures stress in several of its national surveys: the National Health Survey (NHS) and the General Social Survey (GSS) and in 2020 began surveying stress in the Household Impacts of COVID-19 Survey.

In 2020, the ABS GSS was conducted over a 4 month period from 15 June to 5 September 2020. It is estimated that more than half of Australians (59%) experienced at least one personal stressor in the last 12 months. This was similar to the findings from 2019 (56%) and a decrease compared with 2014 (63%). (ABS 2014, 2020).

The GSS found that during 2020, people with a mental health condition were more likely to have experienced at least one personal stressor compared to those who do not have a mental health condition (83% and 56% respectively). People with a long-term health condition were also more likely to have experienced at least one personal stressor compared to those who did not (68% and 52% respectively) (ABS 2020).

Psychological distress

The Australian National University (ANU) Centre for Social Research and Methods COVID-19 Impact Monitoring Survey program has been monitoring psychological distress levels in Australia since the beginning of the COVID-19 pandemic and comparing the results to baseline data pre the pandemic in February 2017. This has been measured using the Kessler 6 (K6) measure of psychological distress.

Emerging research from the ANU Centre for Social Research and Methods, (Biddle and Gray 2022) state in February 2017, 8.4% of Australians were estimated to be experiencing severe psychological distress while in the initial stages of the COVID-19 pandemic (April 2020), this had increased to 10.6%. There was some fluctuation around this level between April 2020 and August 2021. Between August and October 2021, however, there was another large increase to 12.5% of Australians experiencing severe psychological distress. This increase was not only statistically significant, it represented the highest level of severe psychological distress observed since the start of start of the pandemic period. There appears to have been a slight reduction in severe psychological distress between October 2021 and January 2022 (to 11.0%), though this difference is not statistically significant and the January 2022 value is still above pre-pandemic levels (Nicholas and Gray 2022).

The ABS has also reported on psychological distress in the 2020–2021 Household Impacts of COVID-19 Survey and 2017–18 NHS. This is measured using the Kessler 10 (K10) psychological distress scale and not is directly comparable with the ANU study. Further information can be found by visiting the ABS National Health Survey.

While there has been a rise in the use of mental health services and an increase in psychological distress during the pandemic, COVID-19 has not been associated with a rise in the number of suspected deaths by suicide. Further information can be found by visiting Suicide and self-harm monitoring.

For more information on Australians’ experience of psychological distress during the pandemic see ‘Chapter 2 Changes in the health of Australians during the COVID-19 period’ in Australia’s health 2022: data insights.

How common is trauma?

It is estimated that 75% of Australian adults have experienced a traumatic event at some point in their life (Productivity Commission estimates using ABS 2009).

International studies estimate that 62–68% of young people will have been exposed to at least one 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, an estimated 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 2008). According to the 2017–18 National Health Survey, an estimated 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 estimate) (ABS 2019).

Exposure to trauma 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, people experiencing family and domestic violence, LGBTIQ+ people and certain occupation groups such as emergency services, armed forces and veterans (Bendall et al. 2018; Phoenix Australia 2013).

Cumulative exposure to work-related traumatic events is associated with increased risk of PTSD. This is particularly the case for first responders, such as emergency service workers, where the rates of the disorder may be more likely among long-term employees than new recruits (Phoenix Australia 2013). This finding 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 (AIHW 2018; Bendall et al. 2018). For further information, see Indigenous health and wellbeing.

The long-term effects of the COVID-19 pandemic are still unknown and there could be longer-term negative impacts. Health care workers are vulnerable to developing trauma or stress-related disorders as a result of work-related stress during the pandemic due to the higher risk of infection and workload.

What is the cost of stress and trauma?

Stress and trauma impose considerable costs 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).

Psychological distress increases absenteeism (unexpectedly absent) and presenteeism (present at work but not working) in the workplace (Holden et al. 2011). The 2020 Productivity Commission Inquiry on Mental Health estimated mental ill-health cost Australia from $13 billion to $17 billion per year. The typical compensation payment per claim for a mental condition was reported to be $25,650 (compared with $10,600 for all other claims) while the typical time off work was 16.2 weeks (compared with 5.7 weeks for all other claims) (Productivity Commission 2020).

Prevention and management

According to Howlett and Stein (2016), '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 and Stein 2016). The recommendations made in the Australian Guidelines for the Treatment of Acute Stress Disorder and Post-traumatic Stress Disorder (Phoenix Australia 2013) remain the recommended practice for Australian health providers; however, beyond PTSD, evidence for treatment of trauma is scarce (Bendall et al. 2018).

Stress management is recognised as an effective treatment modality and may include pharmaceuticals as well as non-pharmaceutical interventions such as psychological and relaxation methods including meditation, progressive muscle relaxation, yoga, and adopting a healthy lifestyle (Chen and Kottler 2012).

Where do I go for more information?

For more information on stress and trauma visit:

• Australian Bureau of Statistics (ABS) National Health Survey: first results, 2017–18
• ABS National Survey of Mental Health and Wellbeing: summary of results, 2007
• Orygen 2008 Trauma and young people: moving toward trauma-informed services and systems
• Phoenix Australia