Pandemic takes toll on mental health of older women with histories of trauma, violence
The COVID-19 pandemic may have had a greater impact on the mental health of older women with a history of childhood abuse or intimate partner violence than women without such histories, according to a study.
Presented at the North American Menopause Society Annual Meeting in Washington, D.C., the study polled 582 women (mean age, 70 years) about the prevalence of depression, anxiety, sleep problems and conflicts with members of their household and non-household family during the pandemic.
The researchers then examined how these problems were magnified in older women who had a history of childhood trauma or who had experienced intimate partner violence (IPV) at least 4 years before the pandemic.
“We knew that trauma has a really potent effect on mental health and sleep and physical health, even before the pandemic,” author Karen P. Jakubowski, PhD, assistant professor of psychiatry at the University of Pittsburgh School of Medicine, told Healio.
“So, we asked if these histories of stress and trauma from before the pandemic changed how these women are functioning or feeling during the pandemic,” Jakubowski continued.
Approximately 48% of the women surveyed reported childhood trauma, and 35% reported past IPV. Jakubowski said these numbers were in line with previous studies.
The researchers said 27% of the women surveyed reported elevated COVID-19 depression, and 32% reported anxiety symptoms. Elevated conflict with household members (29%) and non-household family (17%) were also reported.
“You’re spending more time in the household with your household members and, given social distancing guidelines, you may have less access to or different access to family outside the household,” Jakubowski said. “We wanted to just get a sense of how people’s relationships were changing, especially with the people we would expect they would be seeing or communicating with most frequently.”
Furthermore, 46% of those surveyed said they were experiencing elevated sleep symptoms. Jakubowski noted that histories of depression and anxiety can impact sleep and cardiovascular disease due to inflammation.
“Almost half of the women reported increased problems with sleep during the pandemic, and that, to me, was a very striking result,” said Jakubowski. “There’s not as much data out there right now looking at sleep problems, particularly in aging women during the pandemic.”
The elevated depressive symptoms, sleep problems and household conflict during the pandemic were related to childhood trauma and past IPV, the researchers said. Jakubowski cited the stress sensitization hypothesis, which suggests that experiences such as childhood trauma and IPV could decrease individual tolerance for stress among these women.
“When they later experience stressors such as the pandemic, they might be at risk for more distress and more difficulty,” Jakubowski said.
Childhood trauma additionally elevated anxiety symptoms and conflict with non-household family. Significant associations persisted even after adjusting for any pre-pandemic anxiety (for analyses on childhood trauma) and sleep symptoms, but not after adjusting for pre-pandemic depressive symptoms.
The survey contacted women in Boston, Pittsburgh and Newark, New Jersey, but Jakubowski said she believed women in suburban and rural areas would have similar experiences.
“I haven’t seen any data to suggest that the impacts on mental health or sleep would differ based on urban versus rural, and I don’t think I’ve seen any data to suggest that the impact of trauma on the symptoms would differ,” she said. “My hypothesis would be that it would be broadly similar.”
The study also accounted for race, ethnicity and education, and Jakubowski said that similar results persisted beyond adjusting for these demographic factors.
Overall, Jakubowski said, trauma histories and prior symptomology are critical in understanding the pandemic’s psychosocial impacts.
“These experiences of violence and trauma that were experienced before the pandemic — and in the case of childhood abuse, decades before the pandemic — impact their experience during this completely different time,” she said. “And that, to me, really just highlights what we’re learning more and more about — just the long reach of trauma on health.”
Providers in all specialties should account for mental health histories in the care they provide, Jakubowski continued, to get a complete picture of their patients and improve their care.
“Providers should really consider the importance of asking about trauma, because it may help them identify who is at a higher risk for having elevated depressive symptoms, anxiety and elevated sleep problems,” she said.
Jakubowski added that providers should also ask specific questions, such as about how relationships are faring and the patient’s ability to stay socially connected.
“During the pandemic, rightfully so, there’s a lot of focus on physical symptoms related to the virus specifically. But I think this shows that there are a lot of other things going on that providers can ask about that can help them understand the impact of the pandemic on their patients,” she said.
Jakubowski KP, et al. Abstract P-35. Presented at: North American Menopause Society Annual Meeting; Sept. 22-25, 2021; Washington, D.C.