Ce Shen

High-risk behaviors and drinking-to-cope as mediators of lifetime abuse and PTSD symptoms in clients with severe mental illness

Face-to-face interviews with 276 community mental health clients (56.2% women; 42.8% men) diagnosed with schizophrenia spectrum disorders (44.6%) and major mood disorders (55.4%) were used to examine mediating relationships among physical and sexual abuse, high-risk behaviors, drink-to-cope motives, and posttraumatic stress disorder (PTSD) symptom severity. Structural equation modeling revealed that both high-risk behaviors and drinking-to-cope significantly mediated the relationship between lifetime abuse and PTSD symptom severity with an excellent fit of model to data. Alternative models using PTSD symptom level as mediator were also tested, but did not meet optimal goodness-of-fit standards. Implications of findings call for vigilant screening for trauma, substance abuse, and high risk behaviors in clients with severe mental illnesses to inform treatment, and the need for longitudinal studies to test causal pathways.

Validation of a Brief PTSD Scale for Clients With Severe Mental Illnesses

Trauma and Posttraumatic Stress Disorder (PTSD) are more common in severe mental illnesses (SMI) clients than in the general population, yet brief screens for detecting probable PTSD in SMI clients are nonexistent. In a two-part study, the authors used correlation analysis and receiver operating characteristics (ROC) analysis to develop and validate a 3-item PTSD scale derived from the PTSD Symptom scale (PSS) with SMI clients. Results from Study #1 (N = 220) revealed that a 3-item Brief PSS showed excellent accuracy for detecting PTSD, good internal consistency, and good concurrent validity with other relevant measures. In Study #2 (N = 327) comparable reliability and concurrent validity were found with measures similar to those used in Study #1. Practitioners are encouraged to use the Brief PSS with SMI clients, and if positive, conduct a full assessment and diagnosis. Limitations of the study include the lack of a structured interview for primary Axis I diagnosis.

Lifetime abuse and self-harm in people with severe mental illness: a structural equation model

We tested the hypothesis that lifetime physical and sexual abuse would have direct effects on self-harm (i.e., thoughts of self-harm, self-harming behaviors, and suicide attempts) and indirect effects on self-harm via negative appraisals of trauma and psychiatric symptoms in a sample of 242 clients with severe mental illness (SMI). Structural equation modeling partly confirmed our expectations. Although there was no direct effect between abuse and self-harm, abuse and self-harm appear to be fully mediated by negative appraisal and psychiatric symptoms. Limitations to this study include the cross-sectional nature of the research, which precludes firm causal inferences regarding the relationships among these factors. Longitudinal designs are needed to understand better the direct and indirect effects of abuse on people with SMI.

Abstinence self-efficacy in people with severe mental illness

To validate the Brief Situational Confidence Questionniare (BSCQ) with people diagnosed with severe mental illness (N=129), we examined the associations between abstinence self-efficacy (BSCQ) and alcohol consumption level (within the previous 6months), drug use, and problems related to substance use while controlling for key symptoms of major mental illness and motives for alcohol use (Drinking Motives Questionnaire). Regression models revealed that abstinence self-efficacy was a significant predictor of all three substance use measures suggesting that, even when controlling for psychiatric symptoms and substance use motives, abstinence self-efficacy accounts for unique variance in alcohol use, drug use, and related problems. This study is limited by the cross sectional design and lack of structured diagnostic interviewing.

Suicide Attempts and Trauma-Related Subjective Distress in People with Severe Mental Illnesses

Suicide Attempts and Trauma-Related Subjective Distress in People with Severe Mental Illnesses We tested the relationship between subjective distress from common lifetime trauma and lifetime suicide attempts in people with severe mental illness (N = 371) including schizophrenia (109, 29.4%), schizoaffective (82, 22.1%), major depression (105, 28.3%), or bipolar I disorder (75, 20.2%). About half were women (51.2%), mean age was 47, and most were white (270, 72.8%), but included a significant proportion of minorities [African-American (41, 11.1%) and Hispanic (33, 8.9%)]. Measures included “lifetime suicide attempts” (dependent variable), trauma-related “subjective distress,”psychiatric symptoms and functioning (BASIS-24), lifetime self-injury, and gender.

Racial Differences in Response to Trauma: Comparing African-American, White, and Hispanic People With Severe Mental Illness

ABSTRACT Objective: To test hypotheses that Hispanics will report greater posttraumatic stress symptoms than Whites or African-Americans with severe mental illness (N = 132) when lifetime trauma, psychiatric symptoms, and negative appraisal of trauma are controlled; and, that negative appraisal will mediate trauma and posttraumatic stress symptoms for Hispanics. Methods: Data were collected by staff in an urban community mental health center. Results: Hispanics reported greater posttraumatic stress symptoms, and negative appraisals mediated trauma and posttraumatic stress symptoms in Hispanics only. Conclusions: Practitioners should target both the intensity and meaning of trauma and its consequences as they may vary by ethnic/racial background.

Lifetime Physical and Sexual Abuse and Self-Harm in Women With Severe Mental Illness

In a sample of 242 women in treatment for severe mental illness (SMI), we used regression analysis to test the hypothesis that lifetime physical and sexual abuse would correlate with self-harm behaviors (thoughts of self-harm and suicide, self-harming behaviors, and suicide attempts) when controlling for psychiatric symptoms, substance abuse, and negative appraisals of trauma. Lifetime physical abuse and alcohol use were the only significant factors in the model. Women with SMI should be screened regularly for physical abuse, alcohol use, as well as thoughts and behaviors related to self-harming behaviors. Limitations of the study include its cross-sectional design.

Negative Appraisal and Traumatic Stress Symptoms in Community Clients With Serious Mental Illness

We examined the relationship between negative appraisal and posttraumatic stress disorder (PTSD) symptoms among adults diagnosed with severe mental illness (SMI). It was hypothesized that negative appraisals of the self, the world, and self-blame would have a positive and significant association with traumatic stress symptoms in a clinical sample of community clients diagnosed with an Axis I primary diagnosis of either severe major mood disorder or schizophrenia-spectrum disorder when controlling for gender, total lifetime trauma, substance abuse, and severity of symptoms of psychosis and depression. Multiple regression was employed to conduct a secondary analysis of clinical data from 291 community support clients who were receiving services from three community mental health centers. Results supported the main hypotheses that all three types of negative appraisal with respect to self, world/others, and self-blame were positively and significantly associated with PTSD symptoms. The authors recommend improvements in screening and intervention with trauma/PTSD, and fuller appreciation of the variable role of negative appraisal when conducting trauma/PTSD assessments.

Lifetime trauma and suicide attempts in older clients with severe mental illness

ABSTRACT Research examining links between lifetime trauma and suicide attempts in older clients with severe mental illness (SMI) is scarce. We examined associations among six common forms of lifetime trauma and lifetime suicide attempts while controlling for other known correlates of suicide attempts including gender, psychiatric symptoms, thoughts of self-harm/suicide, and lifetime self-injury in 174 community mental health clients with severe mental illness who were 50 years of age or older. Almost all clients reported at least one traumatic event with a mean of twelve, more than half had attempted suicide at least once, and about one-third had made multiple suicide attempts. Regression revealed that four factors were significantly associated with lifetime suicide attempts: lifetime self-injurious behaviors, lifetime physical abuse, lifetime frequency of having witnessed severe violence, and lifetime homelessness. Lifetime self-injury accounted for the most variance in suicide attempts, but having been physically abused accounted for the most variance in suicide attempts among the six trauma items. Lifetime trauma should be carefully screened in older clients with severe mental illness given preliminary evidence that it might be linked to suicide risk. Limitations of this study include the cross-sectional design.

Subjective distress from trauma in older clients with severe mental illness

ABSTRACT There is little research on older persons with severe mental illness (SMI) who have experienced trauma. We conducted an exploratory study with 174 community mental health clients with SMI who were 50 years of age or older (range 50–87; mean age 58) to examine the relationship between subjective distress related to six common traumas and post-traumatic stress symptoms while controlling for gender and other key psychiatric symptoms. With regression analysis, we found that of the six common traumas, only distress from unexpected loss of a loved one was significant. That factor accounted for the most variance in post-traumatic stress symptoms than all other factors in the model including gender, psychiatric symptoms of SMI, and other trauma. Gender and symptoms of psychosis were also significant in the model. Unexpected losses, particularly in older persons with SMI, can cause considerable emotional distress and could be related to post-traumatic stress symptoms. Practitioners should be vigilant in regularly screening older people with SMI for recent loss of loved ones and be prepared to address their distress with grief/bereavement counseling.