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Structural PTSD-SMI Model for women. Values on paths are standardized coefficients with standard errors in parentheses.
Source publication
The literature on severe mental illness (SMI), trauma, PTSD, and substance use is expansive, yet no research exists examining the specific population served by Assertive Community Treatment (ACT) concerning these relationships and particularly the SMI-PTSD model proposed in the literature. In this paper, we employed retrospective chart reviews to e...
Contexts in source publication
Context 1
... terms of mediation, the only significant mediation present was that adult trauma mediated the relationship between childhood trauma and PTSD (β = 0.19, p < .001). The model for men is represented in Figure 2 Discussion This study evaluated gender differences in people living with SMI in ACT and evaluated the SMI-PTSD model. The results indicate that there are gender differences in the diagnosis of PTSD, experiences of trauma, substances of choice as well as problematic substance use, and the SMI-PTSD model. ...
Context 2
... were major inconsistencies in the degree of detail in charting, from person to person. Furthermore, there was only a 10% prevalence rate of PTSD diagnosis inquired about and recorded, which is not in line with research that has consistently shown very high rates of PTSD in SMI populations (Mueser et al., 2002; Note. * p <.05, **p <.001, observed followed by expected frequencies in brackets O' Hare et al., 2013;Solomon & Davidson, 1997). ...
Citations
... For providers, these results suggest that PTSD specialty clinics are an acceptable treatment site for veterans who experienced MST and have cooccurring PTSD and SMI. While future research should explore the pathways that allowed for these positive results in more detail, one explanation may be that VHA's efforts to reach and support veterans diagnosed with SMI help to provide the stability necessary for engagement in trauma-focused treatment, a method that has been used to help individuals with cooccurring SMI and PTSD in community settings (e.g., Sharif et al., 2021). VHA eligibility policies that ensure free treatment for any MST-related condition for eligible former service members who experienced MST may also contribute to increased access to care for this population. ...
It is important to ensure that veterans who have experienced military sexual trauma (MST) and have posttraumatic stress disorder (PTSD) have access to trauma-focused treatment. For veterans with serious mental illness (SMI), prior work documents decreased likelihood to receive trauma-focused care. This study focused on evaluating the engagement of Veterans Health Administration (VHA) patients diagnosed with PTSD and who have experienced MST in PTSD specialty care, as well as how this differs for veterans with SMI. Using VHA administrative data, all VHA patients who screened positive for MST prior to fiscal year 2019 (FY2019) were identified (N = 84,503). Based on information from FY2019, measures of psychiatric diagnosis status and VHA treatment participation were generated for all cohort members. Logistic regressions assessed whether there were differences in the likelihood to initiate PTSD care (1+ VHA PTSD specialty clinic encounter) or receive guideline-concordant levels of PTSD specialty care (8+ VHA PTSD specialty clinic encounter) during FY2019. Several other patient characteristics associated with decreased likelihood to receive VHA PTSD specialty servies were identified, including White race and older age. Patient SMI status was not significantly associated with likelihood to initiate or receive guideline-concordant levels of PTSD specialty care. Overall, PTSD treatment initiation was low (11% of veterans with SMI initiated PTSD specialty treatment, as opposed to 10% of veterans without SMI). Additional work is merited to identify ways that VHA is able to overcome barriers to trauma care participation experienced by persons who have experienced MST and been diagnosed with PTSD.
... For example, cumulative exposure to a potentially traumatic event has been associated with cannabis use and illicit drug use in women but not in men (Cunradi et al., 2020). Regarding patients in SUD treatment programmes, this differential profile has been studied in veterans (Livingston et al., 2021) and in persons with severe mental illness (Lipschitz et al., 2000;Sharif et al., 2020). Although little is known about gender differences in patients in treatment for SUD who have experienced physical and/or sexual abuse, Ouimette et al. (2000) recommended gender-related traumainformed practice in SUD-treatments. ...
... This study supports the existence of a differential profile between women and men in treatment for SUD who have experienced lifetime physical and/or sexual abuse, similar to previous findings (Lipschitz et al., 2000;Livingston et al., 2021;Sharif et al., 2020). Specifically, as hypothesized, women presented a more severe profile than men regarding trauma characteristics and consequences. ...
... Specifically, as hypothesized, women presented a more severe profile than men regarding trauma characteristics and consequences. This more severe profile in women who have experienced trauma has also been reported in the general population (Cunradi et al., 2020), in people who use drugs (Mitra et al., 2021) and in patients with co-occurring SUD, such as veterans or patients with severe mental illness (Lipschitz et al., 2000;Sharif et al., 2020). The main contribution of this study is that these gender differences have been found in patients who seek treatment for SUD and who have suffered lifetime physical and/or sexual abuse. ...
Aim: To explore the differential characteristics in sociodemographic variables, severity of consumption, psychopathological symptomatology, life maladjustment, trauma characteristics, and post-traumatic stress symptomatology between women and men who seek treatment for substance use disorder (SUD) and have experienced lifetime physical and/or sexual abuse. Method: The sample consisted of 26 women and 31 men who had experienced physical/sexual abuse and sought treatment for SUD. Results: Women had been victims of sexual abuse in a significantly higher percentage than men. Women presented a significantly higher frequency of revictimization to another traumatic event and a significantly higher presence of avoidance symptoms than men. Conclusions: This study supports the existence of a more severe profile in women than in men with SUD who have experienced lifetime physical and/or sexual abuse. Consequently, gender-related trauma-informed practice in SUD treatment programmes should be promoted. More research in this field is needed, as this is a preliminary study.
... Both PTSD and SUD are more prevalent amongst persons with SMI (Hunt et al., 2016;Hunt et al., 2018). The elevated prevalence of PTSD amongst persons with SMI may be partially attributed to the greater risk of victimisation amongst persons with co-occurring disorders (de Waal et al., 2017;Sharif et al., 2021). ...
This photovoice study explores the experiences of adaptive coping and safety amongst adults with co-occurring post-traumatic stress disorder (PTSD) and substance use disorder (SUD). Participants (n = 6) were purposively sampled from Seeking Safety groups at a community mental health centre in the United States of America. Participants identified primarily as women (83 per cent), white (50 per cent) and had a mean age of 42 years (standard deviation = 11). Data were gathered through individual photo-elicitation interviews. Through reflexive thematic analysis, the authors generated five themes related to coping safely with distress: (1) similar to other views on mental health recovery, the process of learning to cope with distress was framed as a journey; (2) participants cited several behavioural and meaning-making strategies for coping with distress; (3) feelings of agency were promoted through mastery of wellness skills; (4) healthy personal and professional relationships contributed to positive growth and use of adaptive coping strategies; and (5) participants’ social and physical environments greatly impacted perceptions of safety. Findings provide new evidence on the range of adaptive coping strategies persons with SUD and PTSD employ to realise feelings of safety and the assets relationships and communities can provide to support post-traumatic growth and recovery.
... As mentioned, those with SMI report disproportionately high instances of traumatic exposure through their lifetimes. Still, research shows that certain demographic groups with SMI are even more impacted by trauma than others, including Black and Indigenous persons, migrants and refugees, and especially women (Brand 2003;Brave Heart et al. 2011;Knipscheer et al. 2015;Roberts et al. 2011;Sharif et al. 2020). There is also evidence that systemic issues and biases against people of colour in the mental health system further marginalize these communities (Corneau and Stergiopoulos 2012;Rollock and Gordon 2000;Fernando 2012). ...
Assertive Community Treatment (ACT) is the most widely used evidence-based community mental health intervention for people with severe mental illness (SMI). Despite research showing that the vast majority of those with SMI have traumatic histories, the ACT service model does not have consistent guidelines on how to address trauma in their client population. This study employed thematic-analysis through interviewing ACT providers to better understand their perspectives on working with trauma in clients. Five overarching themes with 21 sub-themes emerged: the role and scope of ACT teams and model regarding trauma, discussions of trauma with clients, current treatment of trauma, barriers to working with trauma, and recommendations for enabling trauma discussions and treatment. Some examples for recommendations were: a need for more training regarding trauma, increasing resources like including a psychologist and trauma specialized professionals on the team, more support from leadership, and a cultural change from medicalization. Implications of the barriers and suggestions are discussed.
