Exposure to Lifetime Trauma, the COVID-19 Pandemic, and Mental Health: A Scoping Review

Background and Purpose: While a vast body of literature has developed since the start of the COVID-19 pandemic on the impacts of mental health during this time, less is known about the extent of research on mental health outcomes among those who have had prior exposure to traumatic events. This scoping review summarizes the existing evidence on the mental health impact of the COVID-19 pandemic on adults who have experienced traumatic events.

Methods: This scoping review was guided by a social determinants of health framework and the stress sensitization model. Six databases were searched for research literature published between March 2020 and November 2023 using relevant search terms and the following criteria for inclusion: (1) research study with at least one mental health outcome; (2) included at least one separate variable or question that examines mental health or emotional responses or reactions during the COVID-19 pandemic (i.e., COVID-19-specific distress); (3) included at least one variable that captured exposure to a traumatic event separate from the COVID-19 pandemic; (4) published in the English language; and (5) full text was available.

Results: Of the 2,446 studies screened 64 studies met criteria for inclusion. Of included studies, 55 were quantitative, 8 were mixed methods, and 1 was qualitative. Across all studies, veterans were the most frequently examined population, with two of these studies focusing specifically on female veterans. General, non-representative community samples were the next most frequently examined, followed by healthcare workers, university students, and patients with major illness. Across quantitative, mixed methods, and qualitative studies, most examined cumulative trauma exposure and adverse childhood experiences and examined anxiety, depression, post-traumatic stress, among other mental health outcomes. Studies’ findings suggest a history of trauma exposure was associated with worse mental health during the pandemic.

Conclusions and Implications: The varied trauma histories and populations identified in this scoping review underscore the pervasiveness in exposure to traumatic events in the United States, crossing lines of race, gender identity, and socioeconomic status. Notably, there were gaps in the populations examined in the body of literature, such as individuals with disabilities, and underrepresentation of studies with sexual minorities, including transgender individuals, socioeconomically disadvantaged individuals, and racial minorities. These gaps limit our comprehensive understanding of the impact of trauma and the COVID-19 pandemic on these populations, and the ways in which different social determinants of health may intersect with pandemic experiences. Overall, findings align with the stress sensitization model and previous research that demonstrates exposure to trauma lowers an individual's threshold for tolerating future stressors, making them more susceptible to psychological distress. This review highlights the need for trauma-informed mental health services for vulnerable populations during public health crises such as the COVID-19 pandemic.