Unrecognized Trauma and PTSD among Public Mental Health Consumers with Chronic and Severe Mental Illness

Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Martin Luther King, Chapel Hill, NC 27599-7590, USA.
Community Mental Health Journal (Impact Factor: 1.03). 11/2006; 42(5):487-500. DOI: 10.1007/s10597-006-9049-4
Source: PubMed


Lifetime prevalence of traumatic events and current PTSD was assessed among 142 mental health consumers with serious mental illness served by a psychosocial rehabilitation day program. Lifetime exposure to trauma was high (87%). The rate of PTSD based on the PTSD Checklist (PCL) was also high (19-30% depending on different scoring criteria). Overall, the PCL had strong internal reliability for this sample. Documentation of trauma and PTSD was exceptionally low in medical records. Results suggest that trauma and PTSD are significantly overlooked in the public mental health system. Improved recognition of trauma and PTSD are needed in order to provide meaningful services to this highly vulnerable population.

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    • "For example, Alvarez et al. (2011) collected data on about 100 individuals diagnosed with a severe mental health problem and found that just under half (47.5%) suffered from some form of child abuse, and that those who reported such abuse had an earlier diagnosis and more hospitalizations compared to those without a history of abuse. Likewise, Cusack et al. (2006) found an 87% lifetime exposure to child and adult trauma in a community sample of 142 mental health consumers with a severe mental illness (See also Carmen et al., 1984; Edward et al., 2003; Bendall et al., 2008). "
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    ABSTRACT: Trauma during childhood and adolescence is a common event among people with a serious psychological disorder. Few studies assess a wide range of stressors for this population. This is surprising given that these stressful events are implicated in poorer outcomes related to course and treatment of mental health problems. This study of 214 people with serious mental illness examines the prevalence of childhood traumas, perceived neighborhood problems, discrimination, chronic strains, negative life events, and daily hassles. We use regression analyses to determine if these stressors are associated with quality of life. Results show that 95% of the sample report at least one childhood adversity. Perceived neighborhood problems, experiences of discrimination, chronic strains, life events, and daily hassles were also common. Examining the relationship between demographic factors and stressors suggests that older respondents, Whites, those who have never been married, and people diagnosed with Schizophrenia reported fewer stressors compared to those who are older, non-White, ever married, or suffering from other types of mental health problems. Finally, three of the six types of stressors were related to lower quality of life and depression. We discuss the implications of these findings for the treatment of severe psychological problems.
    10/2015; 230(2). DOI:10.1016/j.psychres.2015.10.012
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    • "In clinical practice, assessing interpersonal trauma exposure and trauma-related disorders in SMI can reduce current underreporting and lack of treatment. Trauma history can be assessed without further impairment of the patient (Cusack et al., 2006; Griffin et al., 2003; Tucker, 2002). Patient reports of trauma have also been shown to be reliable (Goodman et al., 1999; Mueser et al., 2004). "
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    ABSTRACT: Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness (SMI) are often not recognized in clinical practice. To substantiate the prevalence of interpersonal trauma exposure and trauma-related disorders in people with SMI. We conducted a systematic review of four databases (1980-2010) and then described and analysed 33 studies in terms of primary diagnosis and instruments used to measure trauma exposure and trauma-related disorders. Population-weighted mean prevalence rates in SMI were physical abuse 47% (range 25-72%), sexual abuse 37% (range 24-49%), and posttraumatic stress disorder (PTSD) 30% (range 20-47%). Compared to men, women showed a higher prevalence of sexual abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI. Prevalence rates of interpersonal trauma and trauma-related disorders were significantly higher in SMI than in the general population. Emotional abuse and neglect, physical neglect, complex PTSD, and dissociative disorders have been scarcely examined in SMI.
    European Journal of Psychotraumatology 04/2013; 4(4):19985. DOI:10.3402/ejpt.v4i0.19985 · 2.40 Impact Factor
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    • "rauma and posttraumatic stress disorder (PTSD) are major health problems (Brunet et al., 2007). Previous research supports that individuals with psychiatric disorders are at an increased risk of later exposure to traumatic events (Picken et al., 2010) and the development of PTSD (Cusack et al., 2006). It has further been reported that inpatients on psychiatric units may be exposed to potentially traumatizing experiences during their stay, with patients reporting high rates of potentially harmful and traumatic experiences such as physical assaults (31%), seclusions (59%), or handcuffed transports (65%) within psychiatric settings (Frueh et al., 2005). "
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    ABSTRACT: The present study aimed to explore exposure to stressful events during a psychiatric admission and the predictive power of peritraumatic distress and dissociation in the development of posttraumatic stress disorder (PTSD) symptoms after exposure to such events. Psychiatric inpatients (N = 239) were asked to report exposure to stressful events during their admission within 48 hours of being admitted. Individuals reporting at least one stressful event during admission (n = 70, 29%) were assessed for peritraumatic dissociation and distress in relation to this event and, 5 weeks later, were reassessed for PTSD symptoms. Eight participants (12.3%) scored above the cutoff for probable PTSD. Multiple regression analyses revealed that peritraumatic distress was a significant predictor of 5-week PTSD symptoms. Our findings suggest that individuals experiencing increased peritraumatic distress in relation to a stressful event experienced during a psychiatric admission might be at risk of PTSD symptoms and might benefit from increased attention.
    The Journal of nervous and mental disease 01/2012; 200(1):88-90. DOI:10.1097/NMD.0b013e31823fafb9 · 1.69 Impact Factor
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