A model exploring the relationship between betrayal trauma and health: The roles of mental health, attachment, trust in healthcare systems, and nonadherence to treatment.

Abstract

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.

Nonlinear Associations between Medical Expenditure, Perceived Medical Attitude, and Sociodemographics, and Older Adults’ Self-Rated Health in China: Applying the Extreme Gradient Boosting Model

“…In addition, other studies found a mixed association between trust in individuals and healthcare systems. One study, for example, indicates a significant association between trust in physicians and health symptoms [ 12 ]; another found a linear and curvilinear association between trust in doctors and anxiety [ 13 ]. This trust-based association is developed through physicians’ execution of “medical expertise” [ 14 ], something considered a major source of anxiety that warrants further investigation [ 15 ].…”

Gender differences in a wide range of trauma symptoms after victimization and accidental traumas: a cross-sectional study in a clinical setting

“…A meta-analysis of PTSD and intimate relationship problems also found more issues in men (Taft, Watkins, Stafford, Street, & Monson, 2011 ). Two studies indicate that betrayal trauma may cause more trust issues in women, however, but the effect was small (Klest, Tamaian, & Boughner, 2019 ; Tang & Freyd, 2012 ).…”

BITTEN at the Bedside: An Application Guide for Nurse Practitioners

“…The BITTEN theoretical framework is expected to be particularly useful for the NP when treating a patient from a group with a high likelihood of having experienced institutional betrayal, trauma (especially medical trauma), and/or a trust rupture with one or more providers. 7 These groups might include those with frequent interactions with the health care system (ie, high utilizers), those with multiple chronic health conditions, 8 those with an intensive care unit or critical care experience, 9 those with autoimmune diseases, 8 or those from traditionally disenfranchised social groups who are likely to have encountered structural discrimination and racism. For example, posttraumatic stress disorder symptoms have been linked to autoimmune disorders such as rheumatoid arthritis 10,11 and fibromyalgia.…”

“…Further, noting the presence of a betrayal and/or trauma history may help explain the patient's current interpersonal behavior with health care providers, lack of medication adherence, and other barriers to treatment. 7 Recognizing that a history of trauma may contribute to a patient's current presentation can help providers approach a potentially difficult encounter in a patient-centered way rather than in a reactive or defensive manner. This recognition, in and of itself, can be healing and improve the encounter experience for both the patient and the provider.…”