Margaret V. Sherrer

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.

Validating the Alcohol Use Disorders Identification Test with Persons Who Have a Serious Mental Illness.

Objective/Method: The use of brief, reliable, valid, and practical measures of substance use is critical for conducting individual assessments and program evaluation for integrated mental health–substance abuse services for persons with serious mental illness. This investigation examines the internal consistency reliability, concurrent validity, and receiver operating characteristics of the Alcohol Use Disorders Identification Test (AUDIT) with 149 mentally ill adults in community programs. Results/Conclusions: Results suggest that the AUDIT is a reliable screening tool and shows good concurrent validity with other measures of alcohol abuse and psychosocial difficulties. In addition, receiver operating characteristics suggest that, for this population, a lower cutoff score (= 3) leads to more accurate detection of an alcohol use disorder (based on the Alcohol Use Scale) than the traditional cutoff (= 8). This article discusses implications for using screens routinely as part of assessment and evaluation with this population.

Co-Occurring Stress and Substance Abuse in College First Offenders

Abstract Little research has been conducted on the co-occurrence of stress symptoms and substance abuse in young people. The current study of 315 college students adjudicated the first time for violating university drinking rules reveals significant relationships between moderate stress symptoms, problem drinking, recent increases in alcohol consumption level and the frequency of marijuana use. As expected, the relationship between stress and substance abuse is mediated by gender showing a disproportionate risk of co-occurring stress symptoms and substance abuse in women. Theoretical implications as well as suggestions for assessment, intervention and programming are noted.

Drinking motives as mediators between PTSD symptom severity and alcohol consumption in persons with severe mental illnesses

Research has consistently shown that drinking to alleviate negative emotional states predicts alcohol use and relapse among clients with co-occurring disorders including depressive and posttraumatic stress disorders. However, studies examining the mediating role of drinking motives in persons with severe mental illness (SMI) are few. The current survey of 116 community mental health clients (51.7% men; 47.4% women) diagnosed with either a schizophrenia spectrum disorder (41, 35.3%) or major mood disorder (75, 64.7%) tested the hypothesis that convivial drinking and drinking to cope with negative emotions would mediate posttraumatic stress symptoms (PSS-I) and alcohol consumption (QF). A series of path models revealed that convivial drinking fully mediated hyper-arousal symptoms and alcohol consumption, and negative coping fully mediated total posttraumatic stress symptoms, avoidance and hyper-arousal symptoms and alcohol consumption. The results support an emotional distress reduction model of alcohol use in people with severe mental illness, and highlight the need to assess specific drinking motives and target them in cognitive-behavioral treatment approaches. The cross sectional design employed limits cause-effect inferences regarding mediation, and highlights the need for longitudinal designs to sort out causal pathways among symptoms, drinking motives and alcohol consumption in clients with SMI.

The Role of Cognitive Appraisal in Adaptation to Traumatic Stress in Adults With Serious Mental Illness: A Critical Review

A compelling body of literature suggests that negative appraisal may be associated with adverse reactions to traumatic stress. However, very few studies have examined how appraisal influences posttraumatic adaptation in people with serious mental illness (SMI) despite evidence of disproportionately high prevalence rates of trauma exposure and Posttraumatic Stress Disorder (PTSD) in this population. The purpose of this article is to provide a critical analysis of the theoretical and empirical literature on cognitive appraisal and psychological adaptation to traumatic stress with a specific focus on individuals diagnosed with SMI. It will be argued that appraisal is a key correlate that may partially account for higher rates of PTSD in people diagnosed with major mood and schizophrenia-spectrum disorders, meriting special consideration for future research.

Validating the Posttraumatic Stress Disorder Symptom Scale With Persons Who Have Severe Mental Illnesses

Objective: Interview data collected from 275 clients with severe mental illnesses are used to test the construct and criterion validity of the Posttraumatic Stress Disorder Symptom Scale (PSS). Method: First, exploratory and confirmatory factor analyses are used to test whether the scale reflects the posttraumatic stress disorder (PTSD) symptom criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text rev. (DSM-IV-TR). Second, structural equation modeling (SEM) is used to test concurrent validity. Results: A 2-factor PSS reveals an excellent fit to the data, and SEM shows good concurrent validity with key study variables. Conclusion: The PSS reveals a 2-factor structure (Re-experiencing and Avoidance) in this particular sample, and stress from high-risk behaviors and drinking to cope with negative emotions mediate the relationship between subjective distress from trauma and PTSD symptoms.

Correlates of Post-Traumatic Stress Disorder in Male and Female Community Clients

ABSTRACT The current survey of 354 community clients examined the relationship among degree of subjective distress related to traumatic events, risky and criminal behaviors, drinking context (Drinking Context Scale), and gender as predictors of post-traumatic stress disorder (PTSD) symptoms. Logistic analyses demonstrated that current subjective distress associated with traumatic events predicted PTSD status as well as re-experiencing, avoidance, and arousal subscales. Distress associated with risky behaviors also predicted re-experiencing and hyperarousal. Although convivial drinking and drinking to cope with negative emotions both predicted PTSD, women who drank to cope with negative emotions predicted PTSD status in addition to re-experiencing and avoidance subscales. Implications for assessment and intervention are briefly addressed in the Discussion.

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.

Impact of the Most Frequently Reported Traumatic Events on Community Mental Health Clients

This survey of 354 community mental health clients examined the relative impact of client self-reported events that they deemed “most traumatic” for predicting posttraumatic stress syndrome (PTSD) symptom severity. Results of the voluntary survey revealed the most traumatic lifetime events to be (in descending order of frequency): sudden death of a loved one, sexual abuse, physical abuse, suicide attempt, and having been in a serious/life-threatening accident. These factors were then tested for gender differences, and regression models were developed to test the predictive power of traumatic events relative to primary diagnosis, psychosocial well-being, other key psychiatric indicators, and drinking to cope with negative emotions. Results demonstrated that sexual abuse was reported to be among the strongest predictors of PTSD symptom severity. Separate regression models also revealed important gender differences. Implications for social work assessment of seriously mentally ill clients are suggested.

Subjective distress associated with sudden loss in clients with severe mental illness.

Data from interviews with 276 community mental health clients diagnosed with a severe mental illness were used to examine the association between clients’ subjective distress from sudden loss of a close friend or loved one and PTSD symptoms. Over three-quarters of these clients reported sudden losses in their lives, and regression analysis showed that distress related to sudden losses accounted for significant and unique variance in PTSD symptoms when all other sources of traumatic distress were controlled. Practitioners should routinely assess interpersonal losses among clients with SMI and offer brief interventions specifically aimed at helping clients cope with such losses.