When someone experiences a traumatic event, such as a serious car accident or injury, recovery isn't just physical. Emotional healing can take time, too. A new study published in JAMA Psychiatry suggests that experiences from years earlier may play an important role in that recovery.
Researchers found that people with a history of sexual violence experienced more severe symptoms of post-traumatic stress disorder (PTSD) and recovered more slowly after a later traumatic event, even when that new trauma was unrelated to the earlier experience.
The findings help explain one way that the impact of trauma can compound over time and reinforce the importance of trauma-informed care across all healthcare settings.
"Trauma often isn’t a one-time thing," says Emily Mellen, PhD, first author of the study, clinical psychologist at Tufts Medical Center and assistant professor at Tufts University School of Medicine. "Many survivors of sexual violence do not tell anyone about their trauma for years, if ever, due to the stigma they experience after their assault(s). For those who go on to experience subsequent trauma, even non-sexual traumas, those subsequent experiences can re-aggravate old wounds and create new or additional risk for worse mental health.
Looking at recovery over time
The study followed 2,423 adults who were treated in emergency departments across the United States after a traumatic injury, most commonly a motor vehicle crash. Participants were followed for a full year, with researchers measuring PTSD symptoms two weeks, eight weeks, three months, six months and 12 months after their injury. Just over half of participants reported a previous history of sexual violence.
While previous research has shown that sexual violence increases the risk of developing PTSD, this study is among the first to follow people over time after a new, unrelated traumatic event. That allowed researchers to better understand not only who developed PTSD symptoms, but also how those symptoms changed during recovery.
What researchers found
At every point during the year-long study, people with a history of sexual violence reported significantly higher PTSD symptoms than those without that history, even after researchers accounted for other types of previous trauma. They were also more likely to have symptom scores consistent with probable PTSD.
Recovery also followed a different pattern. Participants with a history of sexual violence showed the greatest improvement during the first three months after their injury, but their recovery slowed after that. Participants without a history of sexual violence continued to improve throughout the year.
The findings don't mean that everyone who has experienced sexual violence will develop PTSD after another traumatic event. Rather, they suggest that a history of sexual violence may increase someone's risk and influence how they recover.
Researchers also found that certain PTSD symptoms lingered longer than others. Feelings of hypervigilance—or being constantly alert, watchful or on edge—remained the most persistent throughout the year, while negative changes in mood and thinking were the slowest symptoms to improve.
Why trauma-informed care matters
The findings have important implications for clinicians across every specialty—not just mental health.
Many survivors of sexual violence never disclose their experiences, yet that history may still affect how they respond to medical care, stressful situations or future trauma. The researchers say trauma-informed care can help patients feel safer and more supported by incorporating practices such as explaining procedures before they begin, asking permission before touching a patient and offering choices whenever possible.
Ultimately, the study reinforces a simple but important message: recovery is shaped by more than the injury or traumatic event itself. A person's past experiences can influence how they heal, and recognizing that can help healthcare teams provide more compassionate, personalized care.
At Tufts Medicine, our researchers are advancing the understanding of trauma, PTSD and other mental health conditions to improve care for patients everywhere.
