Traumatic Life Events
Traumatic life events are events that are particularly severe in that they involve threat to life of physical integrity of the self or others such as experiencing or witnessing violence, death of a loved one, experiencing abuse, or natural disasters.
Experiencing a greater number of traumatic events across the lifespan is associated with worse self-reported health, greater health care utilization, functional disability, arthritis, greater number of acute and chronic illnesses, and mortality (Gawronski, Kim, & Miller, 2014; Keyes et al., 2013; Krause, Shaw, & Cairney, 2004; Rosengren, Wilhelmsen, & Orth-Gomér, 2004).
Experiencing trauma in childhood is particularly deleterious for health; there is strong evidence that early childhood adversity is associated with higher rates of illness in adulthood including cancer, depression, cognitive decline, and premature mortality (Brown, Harris, & Hepworth, 1995; Kelly-Irving et al., 2013; Barnes et al., 2012; Montez & Hayward, 2014).
Common trauma exposure measures are described on the US Department of Veteran's Affairs website, here. These instruments are used both to measure trauma exposure as an independent risk factor for psychiatric and medical morbidities, as well as indexing the exposure component for making the diagnosis of Posttraumatic Stress Disorder (PTSD). Regarding the latter, the Life Events Checklist for DSM-5 (LEC-5) is a commonly used self-report measure prior to the administration of the Clinician Administered PTSD Scale-5 (CAPS-5) interview. The LEC-5 lists 16 potential traumatic events in addition to one open-ended item for other unlisted events.
The Trauma History Questionnaire (THQ) assesses lifetime exposure to traumatic stressors (Green, 1996). Designed primarily as a method for assessing PTSD-related events, the instrument consists of 24 yes or no questions that address different traumatic events of three primary types: (a) crime-related events (e.g., robbery, mugging), (b) general disaster and trauma (e.g., injury, disaster, witnessing death), and (c) unwanted physical and sexual experiences. For each item that is endorsed, participants indicate whether they have experienced the stressor and, if so, the number of times it was experienced and the age of the exposure(s), which is important for determining childhood trauma exposure. For the six sexual and physical trauma questions, participants are asked whether the experience was repeated and, if so, approximately how often and at what age. Consequently, the THQ is best used to assess lifetime exposure to situations specifically involving a threat to life, such as those involving assaults to physical integrity, tragic accidental loss of loved ones, and witnessing death or violence (Green, 1993).
The THQ can be self-administered (approximately 10-15 minutes) or interviewer-administered (15-20 minutes), with administration times varying based on the number of stressors experienced. Based on the information collected, investigators can, in turn, obtain a total score representing the frequency and types of stressors endorsed, as well as subscale scores that are calculated by summing items associated with crime-related events (4 items), general disaster and traumatic experiences (13 items), and physical and sexual experiences (6 items). The system has acceptable reliability, with stability coefficients for specific life events ranging from .51 - .91 (Hooper, Stockton, Krupnick, & Green, 2011). In addition, the instruments validity has been examined in several different contexts and in relation to different mental and physical health problems (Hooper et al., 2011).
Another self-report measure that assesses lifetime exposure to traumatic events is the 13-item Stressful Life Events Screening Questionnaire (SLESQ; Goodman, Corcoran, Turner, Yuan, & Green, 1998). It assesses life-threatening accidents, physical and sexual abuse, and witness to another person being killed or assaulted. Respondents indicate whether the event happened, their age at the time of the event, and other questions about the event (e.g., duration). It is recommended for research and general screening purposes in non-clinical samples.
Of note, these measures assess both stress exposure as well as subjective responses. One example of scale that measures subjective distress caused by traumatic events is the Impact of Event Scale - Revised (IES-R). At this point, it is not clear how important subjective response is, but they may be more accurate and meaningful for recent events than assessing perceptions from events from years earlier.
The most commonly used self-report measure of posttraumatic stress symptoms is the PTSD Checklist-5. The gold-standard measure for diagnosing PTSD is the Clinician Administered PTSD Scale for DSM-V (CAPS-5), which is administered in the form of a structured clinical interview that addresses the nature of the traumatic event and the occurrence of any PTSD symptoms.
Authors and Reviewers: Prepared by Stefanie Mayer and Alexandra Crosswell. Reviewed by Thomas Neylan and Aoife O’Donovan. If you have questions or comments about this entry, please email Stefanie.Mayer@ucsf.edu.
Version date: September 2023.
Barnes, L. L., Wilson, R. S., Everson-Rose, S. A., Hayward, M. D., Evans, D. A., & Leon, C. F. M. de. (2012). Effects of early-life adversity on cognitive decline in older African Americans and whites. Neurology, 79(24), 2321–2327.
Brown, G. W., Harris, T. O., & Hepworth, C. (1995). Loss, humiliation and entrapment among women developing depression: a patient and non-patient comparison. Psychological Medicine, 25(1), 7–21.
Gawronski, K. A., Kim, E. S., & Miller, L. E. (2014). Potentially traumatic events and serious life stressors are prospectively associated with frequency of doctor visits and overnight hospital visits. Journal of Psychosomatic Research, 77(2), 90–96.
Green, B. L. (1993). Identifying survivors at risk: Trauma and stressors across events. In J. P. Wilson & B. Raphael (Eds.), International handbook of traumatic stress syndromes (pp. 135-144). New York, NY: Plenum.
Green, B. L. (1996). Trauma History Questionnaire. In B. H. Stamm (Ed.), Measurement of stress, trauma, and adaptation (pp. 366-369 ). Lutherville, MD: Sidran Press.
Goodman, L. A., Corcoran, C., Turner, K., Yuan, N., & Green, B. L. (1998). Assessing traumatic event exposure: General issues and preliminary findings for the Stressful Life Events Screening Questionnaire. Journal of traumatic stress, 11(3), 521-542.
Hooper, L., M., Stockton, P., Krupnick, J. L., & Green, B. L. (2011). Development, use, and psychometric properties of the Trauma History Questionnaire. Journal of Loss and Trauma, 16, 258-283.
Kelly-Irving, M., Lepage, B., Dedieu, D., Lacey, R., Cable, N., Bartley, M., … Delpierre, C. (2013). Childhood adversity as a risk for cancer: Findings from the 1958 British birth cohort study. BMC Public Health, 13, 767.
Keyes, K. M., McLaughlin, K. A., Demmer, R. T., Cerdá, M., Koenen, K. C., Uddin, M., & Galea, S. (2013). Potentially traumatic events and the risk of six physical health conditions in a population-based sample. Depression and Anxiety, 30(5), 451–460. https://doi.org/10.1002/da.22090
Krause, N., Shaw, B. A., & Cairney, J. (2004). A descriptive epidemiology of lifetime trauma and the physical health status of older adults. Psychology and Aging, 19(4), 637–648.
Montez, J. K., & Hayward, M. D. (2014). Cumulative childhood adversity, educational attainment, and active life expectancy among US adults. Demography, 51(2), 413–435.
Rosengren, A., Wilhelmsen, L., & Orth-Gomér, K. (2004). Coronary disease in relation to social support and social class in Swedish menA 15 year follow-up in the study of men born in 1933. European Heart Journal, 25(1), 56–63.