The Impact of Lifetime Potentially Traumatic Event Exposure and Social Support on Anxiety during a Public Health Crisis

Background and Purpose: In their lifetime, most people are exposed to an event that poses actual or extreme potential threat of physical, psychological, or emotional harm, known as potentially traumatic events (PTE). Risk of exposure to different forms of PTE is not distributed equally, as exposure is associated with different social identities and positions, such as race, ethnicity, gender identity, sexual orientation, and socioeconomic status. More research is needed that examines the role of exposure to lifetime PTE and protective factors in impacting mental health during distressing public health crises, such as the COVID-19 pandemic. Informed by structural violence theory, a social drivers of health framework, and the stress sensitization model, this study examined relationships among lifetime PTE exposure, perceived social support, and anxiety during the first year of the COVID-19 public health crisis.

Methods: The sample included 246 adults sampled from a longitudinal panel study who completed questionnaires on demographic factors, PTE, perceived social support, and anxiety symptoms. Latent class analysis (LCA) was utilized to determine if there were meaningful groups sharing similar patterns of trauma exposure. To estimate trauma exposure class associations with anxiety, the BCH method of modeling with covariates was used, which maintains class membership based on weights. Overall and within-class linear regression of anxiety on perceived social support were specified to examine potential class-specific perceived social support relationships.

Results: Latent class analysis identified four distinct classes based on patterns of potentially traumatic event exposure: Low Exposure, Moderate-Low Exposure, Moderate Exposure, and High Exposure. The Low Exposure class was characterized by a very low probability of experiencing any form of PTE. The other three latent classes were characterized by a variety of PTE exposures, and the High Exposure class stood out as having a moderate probability of endorsing of all potentially traumatic event exposures, including a very high probability of accident/injury, a relatively high probability of experiencing physical abuse, as well as a moderate probability of endorsing a number of other exposures. The High Exposure class demonstrated significantly higher anxiety than all other classes. Perceived social support buffered anxiety symptoms for the Low Exposure and Moderate-Low Exposure classes such that higher support was related to lower anxiety.

Conclusions and Implications: This study highlights how lifetime exposure to PTE impacts mental health during a public health crisis and underscores the role of perceived social support as a protective factor, with implications for trauma-informed mental health planning and programming to address disparities in the context of public health crises. Findings suggest that targeting social support interventions is important for buffering anxiety in the context of public health crises, especially among those who may be more vulnerable to negative mental health symptoms due to complex trauma histories. Continued examination of factors contributing to inequitable potentially traumatic event exposure can help address health disparities through trauma-informed policy and healing-centered practice interventions.