Abstract
BackgroundRates of trauma and Posttraumatic Stress Disorder (PTSD) were examined in order to compare the profile in clients of an Australian Public Mental Health Service with that reported in the international literature for clients with major mental illness and to explore the effect of this on client health outcomes. Potential factors contributing to increased levels of trauma/PTSD in this group of clients and the issue of causality between PTSD and subsequent mental illness was also explored.MethodsA convenience sample of 29 clients was screened for trauma and PTSD using the Posttraumatic Stress Diagnostic Scale™ (PDS) and selected outcome measures. Paired and independent samples t-test and ANOVA were applied to the data.ResultsHigh levels of undocumented trauma and PTSD were found. Twenty clients, (74%) reported exposure to multiple traumatic events; 33.3% (9) met DSM IV diagnostic criteria for PTSD. Significant difference was found for PTSD symptomatology, severity and impairment and for client and clinician-rated scores of Quality of Life (QOL) outcomes in the PTSD group. No effect for PTSD symptomatology on the Working Alliance (WA) was found. Factors that may influence higher rates of PTSD in this group were identified and included issues associated with the population studied, the predominance of assaultive violence found, and vulnerability and risks factors associated with re-traumatisation within the social and treating environments.ConclusionA similar trauma and PTSD profile to that reported in the international literature, including greater levels of trauma and PTSD and a poorer QOL, was found in this small sample of clients. It is postulated that the increased levels of trauma/PTSD as reported for persons with major mental illness, including those found in the current study, are primarily related to the characteristics of the population that access public mainstream psychiatric services and that these factors have specific implications for service delivery, and raise issues of efficiency and effectiveness of resource use in achieving successful outcomes in public mental health services for clients with co-morbid PTSD. Further research with a more rigorous design is needed to test these preliminary findings within Australian Community Mental Health Services.
Highlights
Rates of trauma and Posttraumatic Stress Disorder (PTSD) were examined in order to compare the profile in clients of an Australian Public Mental Health Service with that reported in the international literature for clients with major mental illness and to explore the effect of this on client health outcomes
Attempts to address this were undertaken during the recruitment phase, for example, a large poster listing the selection criteria was designed for each team, with the request that it be prominently displayed at team meetings in which clients were allocated to case managers to aid referral
The trauma/PTSD profile for this small sample of Australian Community Mental Health Services (CMHS) clients with major mental illness was consistent with findings from other reported studies of similar populations on all key elements and was largely unknown by treating clinicians
Summary
Rates of trauma and Posttraumatic Stress Disorder (PTSD) were examined in order to compare the profile in clients of an Australian Public Mental Health Service with that reported in the international literature for clients with major mental illness and to explore the effect of this on client health outcomes. Recent epidemiological studies within Australia [2] and America [3] identified rates of PTSD within the general population as 1.3% (DSM IV criteria) 3.3% (ICD 10 criteria) and 7.8% (DSM-III-R criteria) respectively. Whilst this growing recognition of the prevalence of PTSD is stimulating research, activity in the broad spectrum of psychiatry is still limited. Despite the knowledge that high rates of trauma are associated with persons with mental illness few studies have examined trauma and PTSD in this population [4,5,6], and the majority of these stem from the United States of America [7]. The general lack of recognition and documentation of trauma and PTSD evidenced in a number of studies [4,6,9,11,12,14,15] coupled with the high rates of trauma and PTSD found, reflects the general consensus in the psychiatric literature that the problem is under diagnosed and potentially untreated in this population
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