ABSTRACT

The literature on severe mental illness (SMI), trauma, PTSD, and substance use is expansive, yet no research exists examining the specific population served by Assertive Community Treatment (ACT) concerning these relationships and particularly the SMI-PTSD model proposed in the literature. In this paper, we employed retrospective chart reviews to extract information on trauma histories, PTSD, substance use, and psychosocial factors in a sample of 282 clients from four ACT teams (178 males; 104 females) to assess the gender differences in types of trauma, instances of PTSD, substances of choice, problematic substance use, and the SMI-PTSD model. Results indicated that rates of sexual trauma, emotional abuse, serious suicide attempts, rates of trauma in adulthood and PTSD were higher among women, whereas rates of alcohol, marijuana, and stimulant use as well as lifetime problematic substance use were higher among men. In terms of the SMI-PTSD model, results suggest that the model fits the experiences and possible trajectory of men with SMI better. Future work should investigate gender differences and gendered trajectories around the complex relationships between SMI, trauma, PTSD, substance use and examine how the SMI-PTSD model applies to persons of diverse backgrounds.

摘要

关于严重精神疾病 (SMI)、创伤、PTSD 和物质使用的文献非常广泛，但尚无研究针对这些关系，特别是文献中提出的 SMI-PTSD 模型，研究由自信社区治疗 (ACT) 服务的特定人群. 在本文中，我们采用回顾性图表审查从四个 ACT 团队（178 名男性；104 名女性）的 282 名客户样本中提取有关创伤史、PTSD、物质使用和心理社会因素的信息，以评估创伤类型的性别差异、PTSD 实例、选择的物质、有问题的物质使用和 SMI-PTSD 模型。结果表明，女性的性创伤、情感虐待、严重自杀未遂、成年期创伤和创伤后应激障碍发生率较高，而酒精、大麻、和兴奋剂使用以及终生有问题的物质使用在男性中更高。就 SMI-PTSD 模型而言，结果表明该模型更符合 SMI 男性的经历和可能的轨迹。未来的工作应该围绕 SMI、创伤、PTSD、物质使用之间的复杂关系调查性别差异和性别轨迹，并检查 SMI-PTSD 模型如何适用于不同背景的人。