Untreated Posttraumatic Stress Among Persons With Severe Mental Illness Despite Marked Trauma and Symptomatology

The study examined the degree to which trauma was addressed among clients being treated for a severe mental illness and a substance use disorder at a community mental health center.

Participants (N=74) were a randomly selected sample of clients who were enrolled for at least two years in an outpatient clinic and who had at least one clinic visit in the month preceding the study's start. The primary diagnoses were schizophrenia or schizoaffective disorder (53%), bipolar disorder (24%), and major depression (23%), and all participants had a current or past substance use disorder. A majority had a history of trauma, including sexual trauma, physical assault, the loss of a family member, or having witnessed someone being killed or seriously injured.

Clients were asked about past sexual or physical assault history by a median of zero providers, and 59% said a history of assault was not addressed during treatment. Severity of posttraumatic stress disorder and the range of traumas experienced by the client were not predictors of the degree to which trauma and its consequences were a part of treatment. Clients' desire to discuss trauma during treatment and feeling upset while discussing trauma were both predictors of whether trauma was a focus of treatment.

Clinicians may not adequately address trauma during treatment of severe mental illness. Future research is required to examine more effective methods to screen and treat trauma among individuals with severe mental illnesses. (Psychiatric Services 62:1201–1206, 2011)