Research shows that people with severe mental illness (SMI) have extensive trauma histories and higher rates of post-traumatic stress disorder (PTSD) than the general population. However, research also shows that both the trauma history and PTSD in people with SMIs are vastly unrecognized and untreated. Additionally, the relationships between SMI, trauma, PTSD, substance use, and other psychosocial factors is still not well understood, as there has been limited experimental research examining these relationships despite an awareness of their connections. The SMI-PTSD descriptive model was originally proposed by Mueser et al. (2002) to better understand these variables, and is often referenced in the literature, yet there is very little empirical evidence and understanding of how this model may differ by gender in people with SMI. Assertive Community Treatment (ACT) is an evidence-based treatment for those with SMI, yet the extent to which trauma is addressed within the ACT model is not consistently known, nor how the team’s practitioners work with their clients on trauma-related issues and PTSD. By definition, all ACT clients have an SMI and represent a population with complex and intensive needs; therefore, a better understanding the population ACT serves, as well as how the teams work with the trauma present in their clients, will aid in providing better and more consistent treatment and care. This dissertation examines gender differences in the relationship between SMI, substance use, trauma, PTSD, psychosocial factors, the SMI-PTSD descriptive model, and attempts to ascertain the perspectives of ACT providers in working with trauma and PTSD in clients. In Study 1, I conducted retrospective chart reviews to extract information on trauma histories, PTSD, substance use, and psychosocial factors in 282 clients from four ACT teams (178 men, 104 women) to assess the gender differences in types of trauma, instances of PTSD, substances of choice, problematic substance use, and the SMI-PTSD model. Findings indicate that rates of sexual trauma, emotional abuse, serious suicide attempts, rates of trauma in adulthood, and PTSD are higher among women, whereas rates of alcohol, marijuana, and stimulant use as well as lifetime problematic substance use are higher among men. For the SMI-PTSD model, results suggest that the model better corresponds to the experiences and possible trajectory of men with SMI. In Study 2, I employed thematic analysis through interviewing ACT providers to better understand their perspectives on working with trauma and PTSD in clients. Five overarching themes with 21 sub-themes emerged. The five themes were the role and scope of ACT teams and model regarding trauma; discussions of trauma with clients; current treatment of trauma; barriers to working with trauma; and recommendations for enabling trauma discussions and treatment. These two studies have important implications for further research. Research should take gender identity into consideration when proposing and testing models, as Study 1 has demonstrated that two genders experience a well-accepted proposed model differently; this finding may be applicable to people of all genders, as well as other models. Further research could be done to gather perspectives from workers on the strengths and challenges of the ACT model. Future work should also include the views of ACT clients to get a fuller picture of their experience with receiving care for their trauma experiences. Clinically, health care providers should better recognize and treat PTSD and traumatic-stress symptoms of people with SMI. Doing so will ensure that health-care is moving towards trauma-informed practice on a systemic level.
| Identifer | oai:union.ndltd.org:uottawa.ca/oai:ruor.uottawa.ca:10393/42562 |
| Date | 20 August 2021 |
| Creators | Sharif, Noor |
| Contributors | Farrell, Susan |
| Publisher | Université d'Ottawa / University of Ottawa |
| Source Sets | Université d’Ottawa |
| Language | English |
| Detected Language | English |
| Type | Thesis |
| Format | application/pdf |
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