Journal of Traumatic Stress Assignment

Journal of Traumatic Stress Assignment

Journal of Traumatic Stress Assignment

Public Mental Health Clients with Severe Mental Illness and Probable Posttraumatic Stress Disorder: Trauma Exposure and

Correlates of Symptom Severity

Weili Lu,1 Philip T. Yanos,2 Steven M. Silverstein,3 Kim T. Mueser,4 Stanley D. Rosenberg,4

Jennifer D. Gottlieb,4 Stephanie Marcello Duva,5 Thanuja Kularatne,1 Stephanie Dove-Williams,5

Danielle Paterno,5 Danielle Hawthorne,5 and Giovanna Giacobbe5 1Department of Psychiatric Rehabilitation and Counseling Professions, University of Medicine and Dentistry of New Jersey,

Scotch Plains, New Jersey, USA 2John Jay College of Criminal Justice, Department of Psychology, CUNY, New York, New York, USA

3Division of Schizophrenia Research, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA

4Department of Psychiatry, Dartmouth Medical School, Concord, New Hampshire, USA 5University Behavioral Health Care, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA

Individuals with severe mental illness (SMI) are at greatly increased risk for trauma exposure and for the development of posttraumatic stress disorder (PTSD). This study reports findings from a large, comprehensive screening of trauma and PTSD symptoms among public mental health clients in a statewide community mental health system. In 851 individuals with SMI and probable PTSD, childhood sexual abuse was the most commonly endorsed index trauma, followed closely by the sudden death of a loved one. Participants had typically experienced an average of 7 types of traumatic events in their lifetime. The number of types of traumatic events experienced and Hispanic ethnicity were significantly associated with PTSD symptom severity. Clients reported experiencing PTSD in relation to events that occurred on average 20 years earlier, suggesting the clinical need to address trauma and loss throughout the lifespan, including their prolonged after-effects.

Over the past two decades, a growing body of research has shown that individuals with severe mental illness (SMI) are at greatly increased risk for trauma exposure (see Grubaugh, Zinzow, Paul, Egede, & Frueh, 2011, for a review). Although national surveys indicate that more than half of people in the general population report exposure to at least one event that according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Associa- tion, 1994) meets criteria for trauma (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995), studies of people with a SMI (such as

This research was supported by National Institute of Mental Health grant R01 MH064662. We wish to thank the following individuals for their assistance with this project: Edward Kim, Lee Hyer, Rachael Fite, Kenneth Gill, Rose- marie Rosati, Christopher Kosseff, Karen Somers, John Swanson, Avis Scott, Rena Gitlitz, John Markey, Zygmond Gray, Marilyn Green, Alex Shay, Leila Hosseini, and Yetunde Adetona.

Journal of Traumatic Stress Assignment

Correspondence concerning this article should be addressed to Philip Yanos, 445 W. 59th St., New York, NY 10019. E-mail: [email protected]

Copyright C© 2013 International Society for Traumatic Stress Studies. View this article online at wileyonlinelibrary.com DOI: 10.1002/jts.21791

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schizophrenia, bipolar disorder, or major depression) suggest that trauma exposure is nearly universal, with multiple trau- mas being the norm (Goodman, Rosenberg, Mueser, & Drake, 1997; Mueser et al., 1998; Mueser, Essock, Haines, Wolfe, & Xie, 2004). Violent victimization, a particularly toxic class of trauma, is unusually common in people with SMI, with 34%– 53% reporting child abuse, and 43%–81% reporting lifetime victimization (Mueser et al., 1998).

The high rates of trauma exposure among people with SMI, combined with possibly increased vulnerability to the effects of trauma, are associated with an increased prevalence of PTSD in this population (Grubaugh, Elhai, Cusack, Wells, & Frueh, 2007). Specifically, in most studies, the current preva- lence of PTSD among persons with SMI has been found to range from 28%–43% (Cascardi, Mueser, DeGiralomo, & Murrin, 1996; Craine, Henson, Colliver, & MacLean, 1988; Cusack, Grubaugh, Knapp, & Frueh, 2006; Goldberg & Garno, 2005; Howgego et al., 2005; McFarlane, Bookless, & Air, 2001; Mueser et al., 1998, 1998, 2004; Picken & Tarrier, 2011), although a few studies have reported lower, but nevertheless increased rates ranging from 16%–18% (Fan et al., 2008; Lommen & Restifo, 2009; Neria, Bromet, Sievers, Lavelle,