Public Mental Health Clients with Severe Mental Illness and Probable Posttraumatic Stress Disorder: Trauma Exposure and Correlates of Symptom Severity

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 statew...

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Published in:	Journal of traumatic stress Vol. 26; no. 2; pp. 266 - 273
Main Authors:	Lu, Weili, Yanos, Philip T., Silverstein, Steven M., Mueser, Kim T., Rosenberg, Stanley D., Gottlieb, Jennifer D., Duva, Stephanie Marcello, Kularatne, Thanuja, Dove-Williams, Stephanie, Paterno, Danielle, Hawthorne, Danielle, Giacobbe, Giovanna
Format:	Journal Article
Language:	English
Published:	Hoboken, NJ Blackwell Publishing Ltd 01-04-2013 Wiley Wiley Subscription Services, Inc
Subjects:	Adult Adult and adolescent clinical studies Anxiety disorders. Neuroses Biological and medical sciences Community Mental Health Centers Female Hispanic Americans - psychology Humans Illnesses Life Change Events Male Medical sciences Mental disorders Mental Disorders - complications Mental Disorders - psychology Middle Aged New Jersey - epidemiology Post traumatic stress disorder Probability Psychiatric Status Rating Scales Psychology. Psychoanalysis. Psychiatry Psychopathology. Psychiatry Risk Factors Severity of Illness Index Stress Disorders, Post-Traumatic - classification Stress Disorders, Post-Traumatic - complications Stress Disorders, Post-Traumatic - ethnology New Jersey Symptomatology Customer Anxiety disorder Mental health Mental disorder Posttraumatic stress disorder Exposure Severity score Trauma Public health Stress
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Summary:	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. Traditional and Simplified Chinese s by AsianSTSS 標題：孩童面對家長離世的HPA軸功能與心理及環境因素的關鍵：初步研究結果撮要：本文檢視孩童喪親後HPA軸功能(包括皮質醇睡醒反應；CAR) 與心理困擾、應對、和另一尚存家長的悲傷反應之間的關係。樣本包括38名孩童(20名女童曾在過去6個月有家長離世)和28名尚存的孩童家長(23名女性)，他們會接受自我答問工具和半結構面談，而面談包括討論孩童對喪親的想法及感受，面談後連續三日，受訪者會提供3個在家唾液樣本(睡醒時，30分鐘後和黃昏時)。結果顯示孩童第1天CAR減退與更多焦慮症狀(r= ‐.45) 、抑鬱症狀(r= ‐.40) 、創傷後壓力症狀(r= ‐.45) 、不適應哀悼症狀(r= ‐.43) 和迴避性應對水平(r= ‐.53)有顯著關連。家長的更高不適應哀悼水平(r= ‐.47) 亦與孩童第1天CAR減退有關連。這些數據突出了減弱的CAR可能是累積穩態負荷和(又或)情緒上刺激的事件(與死者相關的討論)，及在家庭中相關的後續處理(或缺少處理)而導致的。這些可能對喪親兒童(已經歷高度心理困擾、迴避應對和家長的不適應哀悼)來說已是特別壓力。标题：孩童面对家长离世的HPA轴功能与心理及环境因素的关键：初步研究结果撮要：本文检视孩童丧亲后HPA轴功能(包括皮质醇睡醒反应；CAR) 与心理困扰、应对、和另一尚存家长的悲伤反应之间的关系。样本包括38名孩童(20名女童曾在过去6个月有家长离世)和28名尚存的孩童家长(23名女性)，他们会接受自我答问工具和半结构面谈，而面谈包括讨论孩童对丧亲的想法及感受，面谈后连续三日，受访者会提供3个在家唾液样本(睡醒时，30分钟后和黄昏时)。结果显示孩童第1天CAR减退与更多焦虑症状(r= ‐.45) 、抑郁症状(r= ‐.40) 、创伤后压力症状(r= ‐.45) 、不适应哀悼症状(r= ‐.43) 和回避性应对水平(r= ‐.53)有显著关连。家长的更高不适应哀悼水平(r= ‐.47) 亦与孩童第1天CAR减退有关连。这些数据突出了减弱的CAR可能是累积稳态负荷和(又或)情绪上刺激的事件(与死者相关的讨论)，及在家庭中相关的后续处理(或缺少处理)而导致的。这些可能对丧亲儿童(已经历高度心理困扰、回避应对和家长的不适应哀悼)来说已是特别压力。
Bibliography:	istex:ECD5B0162A7A1557695AE628E99ACDDDCE35AD92 ark:/67375/WNG-6F9WXV1R-S National Institute of Mental Health - No. R01 MH064662 ArticleID:JTS21791 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, Rosemarie Rosati, Christopher Kosseff, Karen Somers, John Swanson, Avis Scott, Rena Gitlitz, John Markey, Zygmond Gray, Marilyn Green, Alex Shay, Leila Hosseini, and Yetunde Adetona. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Article-2 ObjectType-Feature-1
ISSN:	0894-9867 1573-6598
DOI:	10.1002/jts.21791