Ableist microaggressions are brief or covert insults that are targeted towards individuals based on their disability status (Keller & Galgay, 2010; Sue et al., 2007). Qualitative studies of people with disabilities reveal that anger, embarrassment, and frustration are commonly experienced in relation to ableist microaggressions, suggesting that psychological outcomes could be impacted (Keller & Galgay, 2010). However, more quantitative studies are required to examine this relationship. Studies of racial microaggressions have found that these experiences are related to poorer academic performance, lower self-esteem, and poorer mental health outcomes (Ikram et

Objective: Prior research suggests that there is a relationship between traumatic experiences and poor health. When considered through the lens of betrayal trauma (i.e., the perpetrator and the victim have a close interpersonal relationship), traumatic experiences predict greater posttraumatic difficulty and higher levels of depression. Betrayal trauma has been associated with poorer interpersonal relationships and less trust in individuals and systems that may be important for a person’s wellbeing, such as health care systems. In turn, trauma survivors are less likely to adhere to medical treatment, which may ultimately affect their overall health. The current study examined the complex relationship between experiences of betrayal trauma and poor health, while accounting for demographics, mental health symptoms, trust in physicians and the medical system, attachment style, and nonadherence to medical treatment. Method: A demographically representative sample of 312 Canadian participants was surveyed online. Participants completed measures that assessed symptoms of mental health (PTSD, depression), trauma, attachment style, trust, and nonadherence to medical treatment. Results: Hierarchical regression models were used to examine the relationship between betrayal trauma and health. Betrayal trauma significantly predicted nonadherence to treatment, while trust in physicians was explained by trauma, attachment style, and mental health symptoms. All of these factors significantly explained poor health status. Conclusions: Results suggest the importance of implementing trauma-informed care in health care systems.

In this commentary, researchers, health care consumers, and medical providers reflect on institutional betrayal during the COVID-19 pandemic in American and Canadian health care systems. Examples of institutional betrayal experienced by patients and their family members, as well as medical providers, are described. Although such examples may be more evident to the general public during the current pandemic, they do not represent new problems.

Individuals who struggle with chronic medical conditions frequently use medical services and may depend on the medical system to ensure their overall well-being. As a result, they may be at a greater risk of feeling betrayed by the medical system when their needs are not being met. The current study aimed to qualitatively assess patients' negative experiences with the medical system that may lead to feelings of institutional betrayal. A total of 14 Canadian adults struggling with various chronic conditions completed an online open-ended questionnaire. Results indicated that institutional betrayal is composed of doctor-level betrayal (inadequate medical care and lack of psychological support) as well as system-level betrayal. The findings are discussed in the context of betrayal trauma theory; specifically, patients' appraisals of their negative health care experiences may play a vital role when one is considering the impact of institutional betrayal on an individual's overall well-being.

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