Unrecognized trauma and PTSD among public mental health consumers with chronic and severe mental illness

Lifetime prevalence of traumatic events and current PTSD was assessed among 142 mental health consumers with serious mental illness served by a psychosocial rehabilitation day program. Lifetime exposure to trauma was high (87%). The rate of PTSD based on the PTSD Checklist (PCL) was also high (19–30% depending on different scoring criteria). Overall, the PCL had strong internal reliability for this sample. Documentation of trauma and PTSD was exceptionally low in medical records. Results suggest that trauma and PTSD are significantly overlooked in the public mental health system. Improved recognition of trauma and PTSD are needed in order to provide meaningful services to this highly vulnerable population.1Karen J. Cusack is affiliated with the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC2Anouk L. Grubaugh and Rebecca G. Knapp are affiliated with the Medical University of South Carolina2,3B. Christopher Frueh is affiliated with the Medical University of South Carolina and the Ralph H. Johnson Veterans Affairs Medical Center, Charleston, SCKaren J. Cusack, Ph.D., Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, CB 7590, 725 Martin Luther King, Chapel Hill, NC 27599-7590 Telephone: 919.966.6725, Fax: 919.966.1384, kcusack@schsr.unc.edu <mailto:kcusack@schsr.unc.edu>     

The need for trauma assessment and related clinical services in a state-funded mental health system

Previous data show that trauma is highly prevalent in public sector consumers and is associated with severe mental illness and high service use costs. Despite this, evidence suggests that trauma victims tend to go unrecognized and to receive inadequate mental health services. We surveyed all facilities (6 inpatient, 17 outpatient) within the South Carolina Department of Mental Health about their current services for trauma victims. Results indicate that most public mental health facilities do not routinely evaluate trauma history in an adequate manner or provide specialized trauma-related services. Implications and future directions are addressed, including the current trauma initiatives of many state-funded systems.     

Service use patterns and mental health symptoms among adolescents exposed to multiple types of trauma

Few studies have explored how different trauma experiences influence service use. This study explores patterns of service use amongst 6483 adolescents aged between 13 and 18, and examines if such patterns are associated with trauma profiles, demographic variables, and mental health disorders. Data from the National Comorbidity Survey – Adolescent Supplement (NCS-A) were used. A latent class analysis identified four adolescent trauma sub-groups: ‘high risk’, ‘sexual risk’ ‘non-sexual risk’, and ‘low risk’. Regression analysis was used to explore the relationship between service use, trauma classes, and mental health outcomes. Significant relationships were found between service use, trauma sub-groups, demographics and mental health outcomes. Despite the effectiveness of mental health services, only a minority of adolescents exposed to different traumas use such resources. However, this study may go some way towards providing an understanding of the trauma backgrounds, demographic predictors and mental health disorders associated with service use.     

Psychological aftermath of the Lviv air show disaster: a prospective controlled study

OBJECTIVE: To investigate the psychological aftermath of an air show disaster using prospectively obtained epidemiologic data. METHOD: Participants in a recently completed epidemiologic mental health survey in Lviv (disaster site) and controls from western Ukraine were interviewed shortly before and 6 months after a gruesome air show disaster. RESULTS: The Lviv group reported more psychopathology and post-traumatic stress symptom severity, but less anomie than controls. Somatization symptoms were similar in the two groups. Predisaster mental health and postdisaster threat were the strongest risk factors while demographic characteristics, emotional support, and repeated television viewing of the event were only weakly associated with postdisaster mental health. CONCLUSION: This is the first prospective study to find a significantly higher rate of disorder as well as post-traumatic stress disorder symptomatology after a disaster. The risk factor findings suggest avenues for targeting postdisaster interventions.     

Natural disaster and mental health in Asia

The purpose of the present article was to review the literature on disaster mental health in relation to natural disasters such as earthquakes, volcanic eruptions, typhoons and cyclones throughout Asia. Articles reviewed show that disaster psychiatry in Asia is beginning to emerge from and leave behind the stigma attached to mental health. The emergence of the acceptance of disaster mental health throughout Asia can be attributed in part to the acceptance of the notion of post-traumatic stress disorder (PTSD). This has allowed greater involvement of mental health professionals in providing ongoing support to survivors of natural disasters as well as providing greater opportunities for further research. Also, articles reviewed in the present paper commonly suggested the need for using standardized diagnostic tools for PTSD to appropriately interpret the discrepancy of results among studies. The importance of post-disaster support services and cultural differences is highlighted.     

Mass violence and mental health: Attachment and trauma

This article focuses on post-traumatic stress disorder (PTSD) as both one of the most important mental health consequences of mass violence and as the manifestation of a disrupted human attachment system. The implications are many in terms of treatment and prevention. For instance, since the vulnerability to PTSD appears to be transmitted down the generations via the psychobiological manifestations of the parents’ attachment system, prevention requires the effective treatment of afflicted communities within a context of strong social support. More specific guidelines for intervention are outlined focusing on the role of psychosocial workers and their need to be carefully selected, trained and supervised. Failure to tackle the effects of mass violence and to prevent further psychological damage through political action has serious implications in terms of the future of mankind.     

Relationship of youth satisfaction with mental health services and changes in symptoms and functioning

This study examined how youth-reported satisfaction with specialty mental health services was associated with youths' symptom and functioning change. Change in clinical functioning was assessed prospectively on the basis of parent, youth, and interviewer report for 369 youths (aged nine to 18 years at study entry) receiving mental health services. Satisfaction was assessed at two-year follow-up. The results indicated that satisfaction was only minimally associated with clinical change, and only in the case of youth-reported clinical change. Parent- and interviewer-reported change were not associated with consumer satisfaction. These results suggest that consumer satisfaction is not a good indicator of effectiveness of treatment in changing clinical functioning.     

Psychopathology and alexithymia in severe mental illness: the impact of trauma and posttraumatic stress symptoms

Objective To empirically investigate whether or not symptoms of posttraumatic stress disorder (PTSD) are essential for transferring the negative effects of trauma on the severity of severe mental illness (SMI) as recently suggested by an interactive model. Methods About 122 inpatients with either schizophrenia or major affective disorder were administered the Posttraumatic Diagnostic Scale, the Symptom Checklist and the Toronto Alexithymia Scale. Results At least one trauma was reported by 83 participants (68%) and 28 patients (23%) reported symptoms of current PTSD. Those SMI subjects with current PTSD sympoms had significantly more psychopathological distress and alexithymic features than those with a trauma exposure but without PTSD symptoms and those patients without any traumatic experiences. Discussion In line with prior research, our data indicate that patients with SMI have frequently been exposed to traumatic events and that a third suffers from current posttraumatic stress symptoms. Despite some methodological limitations our findings support the interactive model, which posits that a comorbid PTSD increases the symptom severity of SMI. More attention should be directed at assessing trauma and PTSD in SMI patients and at developing therapeutic interventions.     

The rebirth of PTSD: the rise of a new paradigm in psychiatry

Abstract. The new conception of psychological trauma that arose in the 1980s with the definition of PTSD in the DSM-III was a major change compared to the previous traumatic neurosis. While the clinical features were in some way similar, the political and sociological meanings of trauma were absolutely different. At that time, the invention of PTSD was much more the consequence of a broad mutation in mentality that introduced a new moral perspective in trauma studies than of a scientific discovery. In this paper, the author underlines from an anthropological point of view the second turning point that occurred in trauma studies in the mid 1990s when large epidemiological surveys did not confirm the first hypothesis. Readdressing the issues of vulnerability and risk factors that the previous version of PTSD had withdrawn, this second conception raises new epistemological questions that stay unsolved.     

Developmental psychobiology and response to threats: relevance to trauma in children and adolescents.

Interest in developmental and psychobiological aspects of trauma has grown with recent research in adults with mood and anxiety disorders reporting histories of trauma during childhood. Studies conducted directly in children and adolescents could add much to ongoing research in this area. This review summarizes data in three areas of developmental science that might inform future studies. First, the review briefly summarizes current data on clinical aspects of trauma in juveniles, focusing on associations with psychopathology and moderators of outcome. Second, the review summarizes data from the basic sciences delineating experiential and developmental changes in brain systems involved in threat perception and response. This review incorporates knowledge gained from research examining the effects of rearing manipulations on regulation of the stress response in rodents and primates. Third, the review summarizes data from cognitive neuroscience studies among both adults and children, again focusing on studies examining aspects of the threat response. This summary includes a review from studies in patients with posttraumatic stress disorder.     

Predictors of psychological distress in survivors of the 1999 earthquakes in Turkey: effects of relocation after the disaster

OBJECTIVE: Relocations after disasters are known to cause added distress in survivors. This study examined the effects of migration and other factors on psychological status of survivors 4 years after the two severe earthquakes in Turkey. METHOD: Five hundred and twenty-six adult survivors of the 1999 earthquakes currently living in Ankara were given self-report measures assessing traumatic stress, depression, earthquake experience and social support. RESULTS: The rates of current post-traumatic stress disorder (PTSD) and depression were 25% and 11%, respectively. Although both traumatic stress and depression factors were predicted by some demographic and trauma severity variables, relocation status predicted depression but not traumatic stress. CONCLUSION: The rates of psychological distress were higher than expected in a city considered to be safe in terms of earthquake risk. Relocation after the disaster may increase psychological distress by disrupting the social network.     

癌症相关创伤后应激障碍患者心率变异性研究

目的:探讨癌症相关创伤后应激障碍(PTSD)患者的心率变异性(HRV). 方法:采用临床用创伤后应激功能障碍诊断量表(CAPS)对150例癌症患者进行诊断性访谈,并分为PTSD组(37例)和非PTSD组(nPTSD组,30例);应用PTSD自评量表(PCL-C)对两组患者进行评估;采用生理相干与自主神经平衡系统对PTSD组、nPTSD组、健康对照(NC)组(30名)进行短时HRV检测,分析HRV指标与PTSD核心症状的相关性. 结果:与nPTSD组和NC组比较,PTSD组平静状态下R-R间期标准差(SDNN)和高频功率(HF)较显著下降,低频功率(LF)/HF显著升高(P均＜0.001);应激状态下PTSD组SDNN应激差值明显降低,HF和LF/HF应激差值显著增高(P均＜0.001);HRV指标与PTSD核心症状的严重程度显著相关(P均＜0.05). 结论:癌症相关PTSD患者自主神经功能紊乱,其核心症状的严重程度与自主神经功能紊乱显著相关.     

Post-traumatic stress symptoms and trauma exposure in youth with first episode bipolar disorder

Aims: To examine the prevalence of trauma exposure as well as the rates and effects of post-traumatic stress disorder (PTSD) in adolescents with bipolar disorder following a first manic episode. Methods: Adolescents (12–18 years) with DSM-IV bipolar I disorder and experiencing their first manic or mixed episode were recruited. Participants underwent structured diagnostic interviews, completed the Trauma Symptom Checklist for Children (TSCC), and were prospectively evaluated using diagnostic, symptomatic and functional assessments over the course of 12 months. Results: Seventy-six adolescents (14.9 ± 1.7 years) completed the TSCC and 66% (50 individuals) reported exposure to traumatic events. Two (3%) subjects met DSM-IV criteria for PTSD, 11 (14%) had post-traumatic stress t-scores ≥65, the threshold for clinically significant symptoms. Subjects with and without post-traumatic stress t-scores ≥65 did not differ in demographic characteristics. When compared by t-score, TSCC subscores of the first episode bipolar adolescents were similar to normative data. Regression models incorporating TSCC subcomponents, did not predict syndromic recovery or recurrence or symptomatic recovery. Conclusions: Rates of PTSD were lower in this sample of bipolar adolescents at the time of their first hospitalization compared with rates in samples of bipolar adults. These differences coupled with the low incidence of PTSD and trauma symptoms in this young sample suggests that bipolar disorder may be a risk factor for the development of PTSD later in the course of illness or following recurrent affective episodes.