Trauma-related mental health in the context of the COVID-19 pandemic: mental health consequences of potentially traumatic events during the pandemic

This dissertation examines the impact of the COVID-19 pandemic on trauma-related mental health in the Dutch population, focusing on how exposure to potentially traumatic events (PTEs) interacts with individual and contextual vulnerability. The pandemic was a unique global crisis, characterized by its prolonged duration, gradual onset, and widespread impact. In addition to experiences such as severe illness, hospitalization, and bereavement, people faced social isolation, financial uncertainty, disrupted routines, and reduced social support.

The central aim was to understand how these different forms of exposure and vulnerability contributed to trauma-related psychological problems, particularly PTSD, and how they interacted over time. Using large-scale longitudinal data from the Integrated Health Monitor COVID-19, the dissertation examines trauma-related symptoms, vulnerability, changes in mental health over time, coping processes, and healthcare use.

Overall, the findings indicate that the pandemic can be an important context for trauma-related mental health problems, but that exposure alone does not determine psychological outcomes. Rather, psychological responses emerge from the interplay between adverse experiences and pre-existing or contextual vulnerabilities. Factors such as loneliness, limited social support, financial difficulties, and repeated exposure may increase susceptibility to persistent distress.

These findings support the concept of a vulnerability vortex in which vulnerabilities, new stressors, and emerging psychological symptoms can interact and reinforce one another over time. At the same time, many people remain resilient despite exposure to adversity.

Although the prevalence of psychopathology after experiencing a PTE was relatively low, the scale of the pandemic resulted in a substantial societal and healthcare burden. The findings highlight the importance of integrating mental health, social cohesion, and equity into preparedness, response, and recovery strategies for future large-scale crises.