Correctly and complete describes all measures used in the study (10 points)

To complete the attached worksheet, download and save a copy of it with your first and last name in the document title, answer the questions and attach your completed copy here. Also attached are the article which must be used for completing it and a completion tip sheet.  The tip worksheet can be used both for preparation review before beginning the worksheet and as a checklist after you have completed the work to make sure you didn’t miss anything.

The worksheet guides you through the process of unpacking the key elements of the published scholarly journal article attached to this screen and demonstrating APA source citation skills, activities you will engage in frequently in the completion of a variety of assignments including essays, research papers and literature reviews in future courses.

Quoting is not permitted.  All answers must be written as paraphrases, meaning that you must restate what you read in your own words, with the exception of technical terms such as the names of diagnostic tests. You are not required to source credit the article in your answers to the Section I. “Key Article Components” questions.  Section II. “Source citing and reference listing in APA format” is where you will demonstrate knowledge of how to correctly format source crediting in APA style.

Answers will be graded for accuracy, thoroughness, clarity and correct grammar and spelling. Your typed responses beneath each section of the worksheet should be double spaced and the total page length when completed should be at least 7 pages.

• Accurately identifies the research method used and why it was well suited for the study.  (10 points)
• Accurately identifies and describes the participants in the study. (10 points)
• Correctly and complete describes all measures used in the study (10 points)
• Correctly and complete describes all data analyses used in the study (10 points)
• Thoroughly summarizes the results of the study. (15 points)
• Thoughtfully describes the conclusions reached by the authors, the implications of the results, and the limitations of the study. (15 points)

Citation: Maximum of 20 points (10 points each)

• Accurately presents how to give credit to published authors with in-text source citing
• Accurately presents how to give credit to published authors with a Reference listing

  Journal of Traumatic Stress April 2013, 26, 266–273

  Public Mental Health Clients with Severe Mental Illness and Probable Posttraumatic Stress Disorder: Trauma Exposure and

  Correlates of Symptom Severity

  Weili Lu,1 Philip T. Yanos,2 Steven M. Silverstein,3 Kim T. Mueser,4 Stanley D. Rosenberg,4

  Jennifer D. Gottlieb,4 Stephanie Marcello Duva,5 Thanuja Kularatne,1 Stephanie Dove-Williams,5

  Danielle Paterno,5 Danielle Hawthorne,5 and Giovanna Giacobbe5 1Department of Psychiatric Rehabilitation and Counseling Professions, University of Medicine and Dentistry of New Jersey,

  Scotch Plains, New Jersey, USA 2John Jay College of Criminal Justice, Department of Psychology, CUNY, New York, New York, USA

  3Division of Schizophrenia Research, Robert Wood Johnson Medical School, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA

  4Department of Psychiatry, Dartmouth Medical School, Concord, New Hampshire, USA 5University Behavioral Health Care, University of Medicine and Dentistry of New Jersey, Piscataway, New Jersey, USA

  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.

  Over the past two decades, a growing body of research has shown that individuals with severe mental illness (SMI) are at greatly increased risk for trauma exposure (see Grubaugh, Zinzow, Paul, Egede, & Frueh, 2011, for a review). Although national surveys indicate that more than half of people in the general population report exposure to at least one event that according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Associa- tion, 1994) meets criteria for trauma (Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995), studies of people with a SMI (such as

  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, Rose- marie Rosati, Christopher Kosseff, Karen Somers, John Swanson, Avis Scott, Rena Gitlitz, John Markey, Zygmond Gray, Marilyn Green, Alex Shay, Leila Hosseini, and Yetunde Adetona.

  Correspondence concerning this article should be addressed to Philip Yanos, 445 W. 59th St., New York, NY 10019. E-mail: pyanos@jjay.cuny.edu

  Copyright C© 2013 International Society for Traumatic Stress Studies. View this article online at wileyonlinelibrary.com DOI: 10.1002/jts.21791

  schizophrenia, bipolar disorder, or major depression) suggest that trauma exposure is nearly universal, with multiple trau- mas being the norm (Goodman, Rosenberg, Mueser, & Drake, 1997; Mueser et al., 1998; Mueser, Essock, Haines, Wolfe, & Xie, 2004). Violent victimization, a particularly toxic class of trauma, is unusually common in people with SMI, with 34%– 53% reporting child abuse, and 43%–81% reporting lifetime victimization (Mueser et al., 1998).

  The high rates of trauma exposure among people with SMI, combined with possibly increased vulnerability to the effects of trauma, are associated with an increased prevalence of PTSD in this population (Grubaugh, Elhai, Cusack, Wells, & Frueh, 2007). Specifically, in most studies, the current preva- lence of PTSD among persons with SMI has been found to range from 28%–43% (Cascardi, Mueser, DeGiralomo, & Murrin, 1996; Craine, Henson, Colliver, & MacLean, 1988; Cusack, Grubaugh, Knapp, & Frueh, 2006; Goldberg & Garno, 2005; Howgego et al., 2005; McFarlane, Bookless, & Air, 2001; Mueser et al., 1998, 1998, 2004; Picken & Tarrier, 2011), although a few studies have reported lower, but nevertheless increased rates ranging from 16%–18% (Fan et al., 2008; Lommen & Restifo, 2009; Neria, Bromet, Sievers, Lavelle,

  266

   

   

  PTSD Severity 267

  & Fochtmann, 2002). This contrasts with an estimated cur- rent rate of 3.5% for PTSD in the general population (Kessler, Chiu, Demler, & Walters, 2005). Despite evidence that PTSD is a significant clinical problem among people with SMI, many questions remain regarding the nature of PTSD in this pop- ulation (Grubaugh et al., 2011). Although the types of trau- matic exposure commonly experienced by people with SMI have been previously reported (e.g., Mueser et al., 1998; Mc- Farlane et al., 2001; Goldberg & Garno, 2005; Goodman et al., 2001), limited data are available on which events are most distressing and most likely to lead to PTSD. In a survey of trauma exposure and associated distress and PTSD symptoms in people with SMI, O’Hare and Sherrer (2011) reported that the most distressing event was sexual assault (either in child- hood or adulthood), followed by physical assault, and the sud- den unexpected death of a loved one; sexual assault was the strongest predictor of PTSD symptoms, followed by unex- pected death. Another study of individuals with SMI reported that exposure to childhood sexual abuse was more uniquely predictive of PTSD than any other types of trauma (Mueser et al., 1998), whereas Goldberg and Garno (2005) found that a history of adult sexual assault or a history of suicide or homi- cide in a close friend or relative were more strongly related to PTSD.

  No studies that we know of have evaluated the relationship between exposure to different types of traumatic events and PTSD symptom severity among people with SMI and proba- ble PTSD. A better understanding of which traumatic events clients with SMI and PTSD find most distressing, and which events are most strongly related to PTSD symptom severity, could inform specific trauma interventions for this population. The experience of traumatic events and their relationship to PTSD symptom severity tends to differ by gender (Breslau, Davis, Andreski, & Peterson, 1991; Kessler, et al., 1995; Norris, Foster, & Weishaar, 2002), so the differential impact of traumatic events on PTSD among people with SMI also needs to be examined. Consistent with research in the general population, studies suggest that women with SMI are signif- icantly more likely to experience sexual violence than men, both in childhood and adulthood (see Grubaugh et al., 2011 for a review).

  In addition to evaluating the importance of exposure to dif- ferent types of traumatic events in people with SMI, there is a need to further examine the role of ethnicity in the experience of these events and their effects on PTSD symptoms. Some have suggested that culture may have an influence on the impact of traumatic events (Carlson, 2005; Fontes, 1995), for example, by moderating the relationship between trauma exposure and de- velopment of psychopathology (Garcia-Coll & Garrido, 2000). Studies in the general population have found that Hispanic individuals are more vulnerable to developing PTSD when ex- posed to sexual, assaultive, or combat-related traumatic events

  and among those with PTSD, Hispanics experience more severe symptoms than persons from other ethnic backgrounds (Mar- shall, Schell, & Miles, 2009). Although one study found higher rates of PTSD among Hispanic individuals with SMI (Mueser, Saylers, et al., 2004), we know of no other studies that have ex- amined the relationship between ethnicity and PTSD symptom severity in this population.

  To address these gaps in the literature, this study reports findings from a comprehensive screening of trauma and PTSD symptoms in public mental health clients in a statewide commu- nity mental health system. Among a large group of individuals with SMI and probable PTSD, we examined the types of trauma experienced; which traumatic events were most distressing to participants; and the association between traumatic events, de- mographic and clinical characteristics, and PTSD symptom severity.

  Method

  Participants and Procedures

  Study participants were clients with SMI (defined by the State of New Jersey) receiving services at the University of Medicine and Dentistry of New Jersey-University Behavioral HealthCare (UMDNJ-UBHC). UBHC serves approximately 15,000 clients annually, and is one of the largest mental health specialty providers in the United States. In addition to outpatient clinics and partial hospitalization clinics (five of which partici- pated in the study), UBHC is also equipped with programs such as intensive case management services, residential programs, an emergency room, and an inpatient unit. UBHC serves clients on Medicaid/Medicare (56%) as well as uninsured/self-pay clients (20%).

  Acceptance into services at UMDNJ-UBHC requires meet- ing New Jersey criteria for SMI, which include a DSM-IV di- agnosis; disability within the past 3–6 months from the mental disorder which has resulted in functional limitations in major life activities that would be appropriate for the client’s devel- opmental stage; and that during the past 2 years the mental disorder led to two or more treatment episodes of greater inten- sity than outpatient services, such as inpatient, emergency, or partial hospitalization care, or a single episode lasting 3 months or more or that the normal living situation was disrupted to the point that supportive services were required to maintain the client in that home or residence or housing, or law enforce- ment officials intervened. Although these criteria are similar to broad criteria for SMI that have been discussed in the literature (e.g., Ruggieri, Leese, Thornicroft, Bisoffi, & Tansella, 2000), we removed participants with no Axis I diagnosis other than substance use, as this is a further criterion for SMI in other jurisdictions.

  Journal of Traumatic Stress DOI 10.1002/jts. Published on behalf of the International Society for Traumatic Stress Studies.

   

   

  268 Lu et al.

  Study sites included five outpatient and partial hospitaliza- tion progr