Childhood Physical and Sexual Trauma and Complex Comorbid Mental and Physical Health Conditions Among Ethnically Diverse Individuals with SMI

Purpose: Individuals with serious mental illness (SMI), i.e., individuals with schizophrenia-spectrum or bipolar disorders, endure high rates of trauma exposure and PTSD comorbidity. Within this population, PTSD has been shown to be associated with numerous mental and physical health challenges, likely contributing to a more problematic course of psychiatric illness and psychosocial recovery. General population data indicates that childhood physical and sexual traumatic stressors trigger negative outcomes across multiple domains of functioning, the effects of which persist over time. Less is known about the distinct effects of PTSD-precipitating events on individuals with SMI. This study examined the relationships between childhood trauma (physical and sexual abuse) and mental and physical heath functioning in an ethnically diverse psychiatric sample.

Methods: The sample consisted of 175 individuals with SMI recruited from public-sector outpatient programs in Hawai‘i. Participants were of multiracial (33%), Asian (29%), Native Hawaiian and Pacific Islander (11%), Euro-American (16%), and other (11%) heritages. Data came from self-report measures assessing trauma exposure, PTSD symptomatology, mental and physical health functioning, severity of depression, and serious physical illness/disability. Hierarchical linear regressions were conducted to test hypotheses that childhood physical and sexual trauma would predict participants’ PTSD and depression symptomatology as well as physical health status. Risk was calculated using odds ratios.

Results:  Participants reported elevated rates of clinical PTSD (32%) with considerable comorbidity with serious physical illness/disability (59%) and major depression (38%). Individuals exposed to childhood physical abuse and/or childhood sexual abuse generally reported significantly greater (all significant mean group differences at p<0.01) overall trauma exposure (5.79 vs. 2.65; 6.20 vs. 2.67 respectively) than non-exposed participants. Exposure to these events also increased risk for distress (p<0.05). Childhood physical abuse exposure increased risk for clinical PTSD (OR=2.63). For childhood sexual trauma, the increased risks varied by distress type: clinical PTSD (OR=4.69), major depression (OR=3.11), and serious illness/disability (OR=2.04). In support of study hypotheses, regression results indicated that childhood sexual trauma significantly predicted levels of PTSD, depression, and physical health after controlling for age and gender. Specifically, history of childhood abuse accounted for 13%, 7%, and 7% of respective variance in PTSD, depression, and physical health (p<0.01).

Implications: This study underscores the challenges early maltreatment and sexual victimization pose to the mental and physical welfare of individuals with SMI. Among ethnically diverse individuals with SMI, exposure to childhood traumatic stressors is common and pernicious, leading to PTSD, depression, and other mental and physical health problems. Social workers are asked to consider the influence of early physical and sexual traumatic events in all phases of recovery-oriented practice. Targeted assessment of trauma and PTSD may lead to the development of integrated treatment approaches that promote more comprehensive recovery from SMI.