The United States is in the middle of a mental health crisis marked by surging rates of depression, anxiety, and suicidal ideation. A recent JAMA study revealed that pediatric primary care visits for anxiety climbed to more than three times their previous rate since 2016, and one in five adolescents report significant mental health challenges. This childhood distress routinely follows patients into adulthood, with children facing these struggles being six times more likely to experience mental health conditions later in life. Today, nearly one in four U.S. adults carry a mental health diagnosis. Beyond the immense human toll on individuals and families, the crisis carries an unprecedented economic burden, costing an estimated $282 billion annually — roughly 1.7% of the nation’s GDP.
Expanding access to quality clinical care is an essential response to this emergency, but treating symptoms after they appear isn’t enough. We must address the upstream factors driving this spike.
Emotional distress and trauma, whether experienced in childhood or adulthood, directly dictate health outcomes across a person’s life course. Right now, Americans are facing widespread exposure to chronic stress. Political polarization, economic uncertainty, community violence, discrimination, social media conflict, and deep anxieties over everything from healthcare and education to immigration and civil rights have created a toxic baseline. As a result, many report feeling completely overwhelmed by the relentless pace of social change, divisive public discourse, and a profound uncertainty about the future.
A core principle of trauma-informed care is understanding that past and ongoing exposure to stress and trauma can directly shape health outcomes. Yet, despite decades of evidence, healthcare providers still routinely fail to ask patients about these experiences during visits. By remaining blind to these histories, the medical community severely limits its ability to address the very drivers of the diseases it is trying to cure.
The evolution of ACEs
For decades, the framework of Adverse Childhood Experiences (ACEs) has given us a clear picture of how childhood trauma can alter the course of a life. The foundational CDC-Kaiser Permanente ACE study from the 1990s established a dose-response relationship between childhood adversity (i.e., physical, sexual, or psychological abuse, neglect, or household stressors) and adult disease. Thus, childhood exposure to stress has the potential to shift a child’s physiological and behavioral trajectories across the life course.
ACE study researchers found the more ACEs an adult reported, the greater their probability of developing behavioral health challenges like depression, anxiety, and post-traumatic stress disorder (PTSD). But the data didn’t stop at mental health. The study demonstrated that this same dose-response relationship extends to physical health conditions, including cardiovascular disease, stroke, heart attacks, diabetes, and obesity. In its most extreme expressions, reporting six or more of these exposures was associated with a reduction in life expectancy by as much as 20 years.
The traditional ACE framework did have its blind spots, focusing almost entirely on stressors occurring within the walls of the home. In 2012, researchers in Philadelphia replicated the study but expanded the metrics to include community-level stressors. When tracking outside childhood exposures, such as racial discrimination and direct or witnessed violence, they found the exact same dose-response effects on lifelong health. These “expanded ACEs” prove that the trauma reshaping a child’s biology is also driven by external forces, neighborhood environments, and structural inequities.
A cracked foundation: Why childhood matters differently
To grasp why a more than three times increase in pediatric anxiety visits must be viewed as a looming public health emergency, we must first understand the unique biology of child development within the broader context of adversity. When traumatic experiences occur while a child’s brain is still developing, the trajectory of their neurological, endocrine, and immune systems can be fundamentally altered.
Childhood trauma essentially cracks the foundation, magnifying susceptibility to stress later in life. If someone has a stable childhood and then experiences traumatic events as an adult – known as Adverse Adult Experiences (AAEs) – these events are less likely to create the same long-term systemic damage than in individuals who have been exposed to ACEs. A solid foundation promotes resilience to future adversity, giving an individual the physiological and psychological groundwork to self-correct and return to a healthy baseline. Conversely, when a person with a cracked foundation encounters stressors as an adult, those same disruptions can push them further off the track.
This vulnerability manifests through two pathways: physical wear-and-tear and coping mechanisms. On a cellular level, chronic trauma disrupts the hypothalamic-pituitary-adrenal (HPA) axis, keeping the body in a prolonged state of fight-or-flight that causes systemic damage over time. Behaviorally, people who experience trauma without adequate emotional support naturally seek ways to manage their internalized distress. This frequently leads to health risks like smoking, substance use, or overeating – behaviors that serve as immediate coping mechanisms but directly accelerate physical disease later in life.
Because exposure to ACEs during critical developmental windows disrupts brain architecture and alters stress-response systems, affected children face an increased risk of mental health disorders and maladaptive health behaviors across their lifespan. Against this backdrop, the surge in pediatric anxiety visits likely represents only the tip of the iceberg. When considered alongside growing evidence of increasing exposure to stress, trauma, and adversity among both children and adults, this trend signals the emergence of a broader public health crisis with far-reaching consequences for population health and well-being.
The disconnect in adult medicine
Importantly, the aforementioned pathways are not deterministic. A growing body of evidence shows that trauma-informed services and supportive interventions actively promote resilience and mitigate the adverse effects of ACE exposure. Practitioners play a critical role in this process by identifying individuals affected by adversity, fostering safe relationships, and connecting patients to evidence-based resources that can interrupt negative developmental trajectories.
Unfortunately, this is where adult medicine falls short: while pediatricians are increasing screenings for anxiety and depression, adult medicine remains largely trauma-blind. There is typically almost no routine clinical conversation connecting ACEs to physical disease management. Most adult medicine clinicians know what ACEs are, but they virtually never ask their patients about them.
As clinicians, we carefully document family history, cholesterol levels, and smoking and drinking habits, but we completely ignore the childhood trauma that may be driving them in the first place. This omission severely compromises patient care. A patient whose depression is fueled by a history of trauma requires specific, trauma-focused cognitive behavioral therapy, not merely a standard prescription or generic counseling.
Ignoring a patient’s history also actively disrupts the clinician-patient relationship, because routine clinical workflows can be intensely triggering. A standard physical examination or a routine procedure like a mammogram can induce extreme distress for a person who has experienced sexual abuse or assault.
Without a trauma-informed approach, where clinicians communicate clearly, explain why exams are necessary, and actively build a safe environment, the patient may experience care as a re-traumatization. This results in becoming less trustful of medical resources and less likely to engage with health systems and adhere to prescribed treatment plans.
Implementing a trauma-informed way forward
While medicine will always need to treat acute illness, it is time for health systems to also think about upstream causes of health conditions and adopt a comprehensive framework of trauma-informed care. This requires making real changes in how clinics are run day-to-day.
This shift starts with adopting universal trauma-informed practices. Clinicians must assume any patient might have a trauma history, ensuring every step of sensitive examinations is explained clearly to prevent triggering distress.
We also need to create seamless communication channels between clinicians who provide primary care and behavioral health specialists, allowing for warm handoffs and accurate diagnostic summaries, so patients actually follow up on referrals.
Additionally, the industry should look toward leveraging advanced analytics and clinical decision support tools. While AI is traditionally feared for amplifying bias, clinical tools can be used to synthesize complex symptom presentation patterns and gently prompt clinicians to consider trauma history. This could serve as a powerful check against human cognitive shortcuts, like availability bias, where a clinician fixates on a psychiatric diagnosis and completely misses a life-threatening physical symptom.
This shift must happen across all patient demographics. While poverty and low income are heavily correlated with high exposure to adversity, trauma does not respect socioeconomic boundaries. The original CDC-Kaiser study proved that significant levels of trauma also exist within affluent, middle- to upper-class populations. If we only deploy trauma screenings in under-resourced communities, we will fail millions of patients who are suffering in silence behind veneers of financial stability.
Healing the cracked foundation
The rising tide of pediatric anxiety and the relentless stressors of our modern world are actively shaping a future epidemic of adult chronic disease. As the gatekeepers of healthcare, we cannot afford to remain isolated from the realities of our patients’ life histories. Understanding trauma is not the exclusive domain of the psychiatrist or the social worker; it’s a requirement for any clinician who wishes to be effective. Only when medicine commits to asking not just “what is wrong with the patient,” but “what happened to the patient,” can we hope to repair the foundations of human health.
Picture: torwai, Getty Images
Dr. Roy Wade is a Senior Medical Editor at DynaMed and an Assistant Professor of Pediatrics in the Division of General Pediatrics at the Children’s Hospital of Philadelphia and the University of Pennsylvania Perelman School of Medicine. A physician-scientist and nationally recognized expert on childhood trauma and health equity, his research focuses on understanding how adverse childhood experiences and toxic stress contribute to lifelong health disparities and identifying strategies to improve outcomes for children and families. Dr. Wade earned his M.D. from the Geisel School of Medicine at Dartmouth, an MPH in Health Policy and Management from the Harvard T.H. Chan School of Public Health, and a Ph.D. in Microbiology from the Georgia Institute of Technology. He has authored numerous peer-reviewed publications on childhood adversity and trauma-informed care, with research featured by outlets including NPR and The Philadelphia Inquirer. His work bridges clinical practice, research, and evidence-based medicine to improve healthcare delivery and patient outcomes.
Dr. Roy Ziegelstein, Chief Medical Officer and Editor-in- Chief, DynaMed has more than 30 years of experience in medical education and healthcare. He joined Johns Hopkins in 1986 after earning his M.D. from Boston University. He completed his internal medicine residency and chief residency on the Osler Medical Service and his cardiology fellowship at Johns Hopkins School of Medicine before joining the faculty there in 1993. He has held numerous leadership positions, including Director of the Internal Medicine Residency Program, Executive Vice Chairman, and Vice Chair for Humanism in the Department of Medicine at Johns Hopkins Bayview Medical Center, and Vice Dean for Education at Johns Hopkins University School of Medicine. A dedicated educator and co-director of the Aliki Initiative on patient-centered care, Dr. Ziegelstein has received numerous awards for teaching excellence and is an internationally recognized expert on the connection between depression and cardiovascular disease.
This post appears through the MedCity Influencers program. Anyone can publish their perspective on business and innovation in healthcare on MedCity News through MedCity Influencers. Click here to find out how.
