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Prevalence of interpersonal trauma exposure and
trauma-related disorders in severe mental illness
Maria Mauritz MSc, APRN 1,2, Peter Goossens PhD, APRN 2,3, Nel Draijer PhD 4, Theo van Achterberg PhD, RN 2,5
(1) Poli Complex Trauma, GGNet, Mental Health Care Center, Warnsveld, The Netherlands, (2) Radboud University Medical Center Nijmegen,
Scientific Institute for Quality of Healthcare, The Netherlands, (3) Dimence Mental Health Care Center, Deventer, The Netherlands, (4) Vrije
University Medical Center, Department of Psychiatry, Amsterdam, The Netherlands, (5) Center for Health Services and Nursing Research, KU
Leuven, Leuven, Belgium.
Journal of Psychotraumatology, 2013, 4, 19985. E-mail: m.mauritz@ggnet.nl
Background: Interpersonal trauma exposure and trauma-related disorders in people with severe mental illness are often
not recognized in clinical practice. Objective: The aim of this study was to substantiate the prevalence of interpersonal
trauma exposure and trauma-related disorders in people with severe mental illness.
Methods: A systematic search of four databases
(Medline, Psychinfo, Embase, Cinahl) for the period
1980-2010 resulted in 6299 unique hits.
After selection 33 studies were described and
analysed in terms of primary diagnosis and
instruments used to measure trauma exposure and
trauma-related disorders.
6299
based on
title
1877
based on
abstract
104
based on
full text
33
included
for review
757
1204
953
1085
1658
8 Bipolar disorder (BD)
6 Major depression (MDD)
7 Schizophrenia spectrum (SSD)
5 Personality disorder (PD)
7 Severe mental illness (SMI)
Studies by disorder group (N = 5657) 1998-2009 Prevalence of trauma exposure and PTSD
Selection in scheme
0
10
20
30
40
50
60
70
80
BD MDD SSD SMI BPD
Physical abuse (47%)
Sexual abuse (37%)
PTSD (30%)
Results: 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%). Women showed a higher prevalence of sexual
abuse in schizophrenia spectrum disorder, bipolar disorder, and mixed diagnosis groups labelled as having SMI.
0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
General population SMI patients
Physical abuse
Sexual abuse (m)
Sexual abuse (f)
PTSD
Conclusions: 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.
Prevalences in general population and SMI Notable clinical findings
SMI patients with comorbid trauma exposure
and PTSD have:
•an earlier start of illness symptoms
•a worse course of illness
•severe psychiatric and somatic comorbidity
•more substance use problems
•attempted suicide five more times