Prevalence of interpersonal trauma exposure and trauma-related disorders in severe mental illness

Figures & data

Fig. 1 Selection in scheme.

Table 1 Study design, population characteristics, and instruments used in the 33 studies of this review

											Instruments for assessing
	Author	Study design	Country	N	SC	Response	Mean age/SD or range	Setting	Diagnosis/disorder	TI	Diagnosis	Trauma exposure	PTSD
Bipolar disorder
1	Assion et al., 2009	Prevalence study	Germany	N= 74 (f=44)	Y		48.3 (13)	In- and outpatient	Bipolar-I: euthymic/mild/mod. depressed	Y	MINI/HAM-D/YMRS	PDS	PDS/CAPS
2	Goldberg & Garno, 2005	Prevalence study	USA	N=100 (f=49)	N		42.6 (13.2) 36.6 (9.7) (T)	Inpatient	Bipolar-I (73) Bipolar-II (27)	N	SCID-I/HAM-D/YRMS	CTQ/TSS	SCID-I
3	Kauer et al., 2007	Correlation study	Brazil	N= 163 (f=117)	N		42.5 (SD 11.6)	Outpatient	Bipolar-I Bipolar-II	N	Chart DSM-IV/HDRS/YMRS	SCID-I (criteria A1 and A2)	SCID-I-PTSD module
4	Leverich et al., 2002ab	Correlation study	USA	N=651 (f=274)	N		41 (12)	Outpatient	Bipolar-I (475) Bipolar-II (137) Bipolar NOS (12)	N	SCID-P/IDS/YMRS	Patient Quest. with items: EA, PA, SA	SC-I
5	Maguire et al., 2008	Prevalence study	N Ireland (UK)	N=60 (f=34)	Y	Non-response 24; drop-out 15	49 (25–70)	Outpatient	Bipolar-I Bipolar-II	Y	Chart DSM-IV/BDI	CHQ/THQ	PDS
6	Meade et al., 2009	Treatment study	USA	N=90 (f=41)	Y	Non-response 57; drop-out 42	40.6 (±11.7)	In- and outpatient	Bipolar-I with SUD	Y	SCID-I/HAM-D/YRMS	ASI: 2 items	SCID-I
7	Neria et al., 2005	Correlation study	USA	N=109 (f=58)	N	Response 88,7%	m=23 (15–54) f=29 (16–57)	Inpatient	Bipolar with psychotic features	N	SCID-I-DSM-III and IV	CIDI-PTSD/SCID-PTSD	CIDI-PTSD/SCID-PTSD
8	Neria et al., 2008	Prevalence study	USA	N=96 (f=64)	Y		50 (18–70)	Outpatient	Bipolar spectrum	N	MDQ/PDQ	LES	PCL-C
Major depressive disorder
9	Bernet et al., 1999	Correlation study	USA	N=47 (f=24)	Y		39.0	Outpatient	Major depressive disorder	Y	SCID-I/HRSD	CTQ	SCID-I
10	Carlier et al., 2000	Prevalence study	The Netherlands	N=69 (f=45)	Y		45.4 (12.9)	Outpatient	Major depressive episode	N	SCID-DSM-III-R	LTE	SI-PTSD
11	Gaudiano et al., 2010	Correlation study	USA	N=623 (f=397)	N		38.5 (12)	Outpatient	Major depressive disorder (psychotic n=32)	Y	SCID-I/SIDP-IV/CGI	CTQ	SCID-I
12	Oquendo et al., 2005	Correlation study	USA	N=230 (f=180)	N		41.7 (0.6)	In- (113) and outpatient (117)	Major depressive episode	Y	SCID-I/SCID-II/HMDRS/BDI	SCID-I	SCID-I
13	Zimmerman et al., 1999	Correlation study	USA	N=235 (f=152)	N		40.6 (14.03)	Outpatient	Major depression (psychotic n=19)	Y	SCID-I	SCID-PTSD	SCID-PTSD
14	Zlotnick et al., 2001	Correlation study	USA	N=235 (f=152)	N		40.6 (14.0)	Outpatient	Major depression	Y	SCID-I/SIDP/SADS	SCID-PTSD	SCID-PTSD
Schizophrenia spectrum disorder
15	Beattie et al., 2009	Correlation study	N Ireland (UK)	N=47 (f=22)	N		37.5 (11.5)	Outpatient <12 months	Schizophrenia (25) Schizoaffective (7) Other psychosis (10)	N	KGV:pos./neg./affect symptoms	CTQ/THQ	IES-R
16	Calhoun et al., 2007	Prevalence study	USA	N=165 (f=0)	N		48 (7.8)	Inpatient (veterans)	Schizophrenia Schizoaffective	Y	SCID-I	SAEQ/CTS-R/CES	PCL
17	Kilcommons & Morrison, 2005	Prevalence study	UK	N=32 (f=7)	N	Non-response 3%	34.5 (10.0)	Outpatient	Schizophrenia spectrum	N	Chart DSM-IV/PANSS	THQ	PSS-R
18	Lommen et al., 2009	Prevalence study	Netherlands	N=33 (f=10)	Y	Non-response; 40 drop-out 2	42.3 (10.6)	Outpatient	Schizophrenia (23)/Schizoaffective (10)	N		THQ-R	PSS-SR/PCTI
19	Resnick et al., 2003	Correlation study	USA	N=47 (f=30)	N		44.1 (9.7)	Outpatient	Schizophrenia (39) Schizoaffective (8)	Y	SCID-I/PANSS	THQ-R	CAPS
20	Rosenberg et al., 2007	Correlation study	USA	N=569 (f=183)	N		42 (9.0)	Outpatient	Schizophrenia (288) Schizoaffective (98)	N	Chart DSM-IV (81%)/SCID (19%)	SAEQ/CTS	PCL
21	Ross & Keyes, 2004	Prevalence study	USA	N=60 (f=23)	N	Non-response 3	40.1 (13.4)	In- and outpatient	Schizophrenia	N	Chart DSM III-R/SAPS/SANS	Not specified	DDIS/DES-T
Personality disorder
22	Barnow et al., 2005	Prevalence study	Germany	N=51 (f=44)	Y		26.5 (±7.6)	Inpatient	Borderline personality	Y	SCID-II/BPI/DIA-X (CIDI)	SCID-I-PTSD	SCID-I-PTSD/SIDES
23	van den Bosch et al., 2003	Correlation study	The Netherlands	N=63 (f=63, addicted)	Y		34.9 (7.7)	Inpatient	Borderline personality (addicted 34)	Y	SCID-II/PDQ4+	STI	SCID-I-PTSD
24	Sar et al., 2003	Prevalence study	Turkey	N=25 (f=20)	Y	Response 79,5%	30.0	Outpatient	Borderline personality	Y	SCID-II (DSM-III-R)	History Form for Childhood Abuse and Neglect	SCID-PTSD/DES/DDIS/SCID-D
25	Zlotnick et al., 2003	Correlation study	USA	N= 266 (f=186)	Y		31.5 (7.5)	In- and outpatient	Borderline personality	N	DIPD-IV/SCID-I/SNAP	CEQ	SCID-I/DIPD-IV
26	Yen et al., 2002	Correlation study	USA	N=653 (f=324)	Y	Dropout 15	32.8 (8.0)	In- and outpatient	Borderline (176, f=123) Schizotypal (86, f=39) Avoidant (153, f=100) Obs. Compulsive (153, f=62)	N	DIPV-IV/SCID-I	SCID-I trauma module	SCID-I trauma module
Severe mental illness
27	Cusack et al., 2006.	Prevalence study	USA	N=142 (f=63)	Y		46.2 (11.6)	Outpatient	Schizophrenia Bipolar Major depression	N	Chart Review Instrument	TAA	PCL
28	Davies-Netzley, Hurlburt, & Hough, 1996	Correlation study	USA	N=120 (f=120)	Y		37.0 (18–63)	Outpatient	Schizophrenia (57) Bipolar (26) Major Depression (37)	Y	DIS (DSM-III-R)/CES-D	Specified questions about child abuse	PTSD section of DIS
29	Ford & Fournier, 2007	Prevalence study	USA	N=35 (f=35)	N		41.0 (29–68)	Outpatient	Schizophrenia Bipolar Major depression	Y	SCID-I	TESI	CAPS/SIDES
30	Goodman et al., 1999	Reliability study	USA	N=50 (f=29)	Y	Response 80%; drop-out 3	m=37.6 (7.3) f=42.1 (7.6)	Outpatient	Schizophrenia (32) Bipolar (16) Psychotic (2)	N	SCID-I	SAEQ/CTS-2 (PA/SA/injury)	PCL-S
31	Lu et al., 2008	Correlation study	USA	N=254 (f=112)	N	Non-response; 20	42.9 (11.0)	In- (109) and outpatient (145)	Major depression (100) Bipolar (154)	N	Chart (81.0%) SCID-I (19.0%)	SAEQ/CTS-R	PCL
32	Mueser et al., 1998	Prevalence study	USA	N=275 (f=153)	N	Non-response 10%	40.0 (11.6)	In- (92) and outpatient (183)	Schizophrenia (64) Schizoaffective (30) Bipolar (50) Depression (65) Borderline pers. (22) Other pers. (10) Other diagnosis (34)	Y	Chart (81.0%) SCID-I (19.0%)	THQ (childhood and adulthood separated asked)/CVS	SCID/PCL-S
33	Mueser et al., 2004	Prevalence and correlation study	USA	N=782 (f=321)	N	Response 87%	age≥18	Outpatient	Schizophrenia (363) Schizoaffective (163) Bipolar (141) Major depression (78) Other diagnosis (26)	N	Chart (81.0%) SCID-I (19.0%)	SAEQ/CTS (child)/CTS-2 (adult)	PCL

SC: Selection criteria other than inclusion criteria.

TI: Trained interviewers.

Fig. 2 Prevalence rates for physical abuse, sexual abuse, and PTSD by disorder and reference period. BD, bipolar disorder; MDD, major depressive disorder; SSD, schizophrenia spectrum disorder; SMI, severe mental illness; B, borderline; ST, schizotypal; AV, avoidant; OC, obsessive compulsive (personality disorder).

Fig. 3 Overview of mean prevalence of physical abuse, sexual abuse, and PTSD by diagnostic group.

Fig. 4 Prevalence rates for physical abuse, sexual abuse, and PTSD by disorder and gender. BD, bipolar disorder; SSD, schizophrenia spectrum disorder; SMI, severe mental illness.

Assion H.-J, Brune N, Schmidt N, Aubel T, Edel M.-A, Basilowski M, etal. Trauma exposure and post-traumatic stress disorder in bipolar disorder. Social Psychiatry and Psychiatric Epidemiology. 2009; 44: 1041–1049.

 PubMed Web of Science ®Google Scholar

Goldberg J. F, Garno J. L. Development of posttraumatic stress disorder in adult bipolar patients with histories of severe childhood abuse. Journal of Psychiatric Research. 2005; 39: 595–601.

 PubMed Web of Science ®Google Scholar

Kauer-Sant’ Anna M, Tramontina J, Andreazza A. C, Cereser K, da Costa S, Santin A, etal. Traumatic life events in bipolar disorder: Impact on BDNF levels and psychopathology. Bipolar Disorders. 2007; 9(Suppl. 1): 128–135.

 Web of Science ®Google Scholar

Leverich G. S, McElroy S. L, Suppes T, Keck P. E Jr , Denicoff K. D, Nolen W. A, etal. Early physical and sexual abuse associated with an adverse course of bipolar illness. Biological Psychiatry. 2002a; 51(4): 288–297.

 PubMed Web of Science ®Google Scholar

Maguire C, Mc Cusker C. G, Meenagh C, Mulholland C, Shannon C. Effects of trauma on bipolar disorder: The mediational role of interpersonal difficulties and alcohol dependence. Bipolar Disorders. 2008; 10: 293–302.

 PubMed Web of Science ®Google Scholar

Meade C. S, Mc Donald L. J, Graff F. S, Fitzmaurice G. M, Griffin M. L, Weiss R. D. A prospective study examining the effects of gender and sexual/physical abuse on mood outcomes in patients with co-occurring bipolar I and substance use disorders. Bipolar Disorders. 2009; 11: 425–433.

 Web of Science ®Google Scholar

Neria Y, Bromet E. J, Carlson G. A, Naz B. Assaultive trauma and illness course in psychotic bipolar disorder: Findings from the Suffolk county mental health project. Acta Psychiatrica Scandinavica. 2005; 111: 380–383.

 PubMed Web of Science ®Google Scholar

Neria Y, Olfson M, Gameroff M. J, Wickramaratne P, Pilowsky D, Verdeli H, etal. Trauma exposure and posttraumatic stress disorder among primary care patients with bipolar spectrum disorder. Bipolar Disorders. 2008; 10: 503–510.

 PubMed Web of Science ®Google Scholar

Bernet C. Z, Stein M. B. Relationship of childhood maltreatment to the onset and course of major depression in adulthood. Depression and Anxiety. 1999; 9: 169–174.

 PubMedGoogle Scholar

Carlier I. V. E, Voerman B. E, Gersons B. P. R. Intrusive traumatic recollections and comorbid posttraumatic stress disorder in depressed patients. Psychosomatic Medicine. 2000; 62: 26–32.

 PubMed Web of Science ®Google Scholar

Gaudiano B. A, Zimmerman M. The relationship between childhood trauma history and the psychotic subtype of major depression. Acta Psychiatrica Scandinavica. 2010; 121: 462–470.

 PubMed Web of Science ®Google Scholar

Oquendo M, Brent D. A, Birmaher B, Greenhill L, Kolko D, Stanley B, etal. Posttraumatic stress disorder comorbid with major depression: Factors mediating the association with suicidal behavior. American Journal of Psychiatry. 2005; 162: 560–566.

 PubMed Web of Science ®Google Scholar

Zimmerman M, Mattia J. I. Psychotic subtyping of major depressive disorder and posttraumatic stress disorder. Journal of Clinical Psychiatry. 1999; 60: 311–314.

 PubMed Web of Science ®Google Scholar

Zlotnick C, Mattia J. I, Zimmerman M. Clinical features of survivors of sexual abuse with major depression. Child Abuse and Neglect. 2001; 25: 357–367.

 PubMed Web of Science ®Google Scholar

Beattie N, Shannon C, Kavanagh M, Mulholland C. Predictors of PTSD symptoms in response to psychosis and psychiatric admission. The Journal of Nervous and Mental Disease. 2009; 197(1): 56–60.

 Web of Science ®Google Scholar

Calhoun P. S, Stechuchak K. M, Strauss J, Bosworth H. B, Marx C. E, Butterfield M. I. Interpersonal trauma, war zone exposure, and posttraumatic stress disorder among veterans with schizophrenia. Schizophrenia Research. 2007; 91: 210–216.

 PubMed Web of Science ®Google Scholar

Kilcommons A. M, Morrison A. P. Relationships between trauma and psychosis: An exploration of cognitive and dissociative factors. Acta Psychiatrica Scandinavica. 2005; 112: 351–359.

 PubMed Web of Science ®Google Scholar

Lommen M. J. J, Restifo K. Trauma and posttraumatic stress disorder (PTSD) in patients with schizophrenia or schizoaffective disorder. Community Mental Health Journal. 2009; 45: 485–496.

 PubMed Web of Science ®Google Scholar

Resnick S. G, Bond G. R, Mueser K. T. Trauma and posttraumatic stress disorder in people with schizophrenia. Journal of Abnormal Psychology. 2003; 112(3): 415–423.

 PubMed Web of Science ®Google Scholar

Rosenberg S. D, Lu W, Mueser K. T, Jankowski M. K, Cournos F. Correlates of adverse childhood events among adults with schizophrenia spectrum disorders. Psychiatric Services. 2007; 58(2): 245–253.

 PubMed Web of Science ®Google Scholar

Ross C. A, Keyes B. Dissociation and schizophrenia. Journal of Trauma and Dissociation. 2004; 5(3): 69–83.

 Google Scholar

Barnow S, Plock K, Spitzer C, Hamann N, Freyberger H.-J. Trauma, spirit and qualities of character in patients with borderline personality disorder and complex posttraumatic disorder. Verhaltenstherapie. 2005; 15: 148–156.

 Web of Science ®Google Scholar

van den Bosch L. M. C, Verheul R, Langeland W, van den Brink W. Trauma, dissociation, and posttraumatic stress disorder in female borderline patients with and without substance abuse problems. Australian and New Zealand Journal of Psychiatry. 2003; 37: 549–555.

 PubMed Web of Science ®Google Scholar

Sar V, Kundakci T, Kiziltan E, Yargic I. L, Tutkun H, Bakim B, etal. The axis-I dissociative disorder comorbidity of borderline personality disorder among psychiatric outpatients. Journal of Trauma & Dissociation. 2003; 4(1): 119–136.

 Google Scholar

Zlotnick C, Johnson D. M, Yen S, Battle C. L, Sanislow C. A, Skodol A. E, etal. Clinical features and impairment in women with borderline personality disorder (BPD) with posttraumatic stress disorder (PTSD), BPD without PTSD, and other personality disorders with PTSD. The Journal of Nervous and Mental Disease. 2003; 191(11): 706–713.

 PubMed Web of Science ®Google Scholar

Yen S, Shea T. M, Battle C. L, Johnson D. M, Zlotnick C, Dolan-Sewell R, etal. Traumatic exposure and posttraumatic stress disorder in borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders: Findings from the collaborative longitudinal personality disorders study. The Journal of Nervous and Mental Disease. 2002; 190(8): 510–518.

 PubMed Web of Science ®Google Scholar

Cusack K. J, Grubaugh A. L, Knapp R. G, Frueh B. C. Unrecognized trauma and PTSD among public mental health consumers with chronic and severe mental illness. Community Mental Health Journal. 2006; 42(5): 487–500.

 PubMed Web of Science ®Google Scholar

Davies-Netzley S, Hurlburt M. S, Hough R. L. Childhood abuse as a precursor to homelessness for homeless women with severe mental illness. Violence and Victims. 1996; 11(2): 129–142.

 PubMedGoogle Scholar

Ford J. D, Fournier D. Psychological trauma and post-traumatic stress disorder among women in community mental health aftercare following psychiatric intensive care. Journal of Psychiatric Intensive Care. 2007; 3(1): 27–34.

 Google Scholar

Goodman L. A, Thompson K. M, Weinfurt K, Cod S, Acker P, Mueser K. T, etal. Reliability of reports of violent victimization and posttraumatic stress disorder among men and women with serious mental illness. Journal of Traumatic Stress. 1999; 12(4): 587–599.

 PubMed Web of Science ®Google Scholar

Lu W, Fite R, Kim E, Hyer L, Yanos P. T, Mueser K. T. Cognitive-behavioral treatment of PTSD in severe mental illness. American Journal of Psychiatric Rehabilitation. 2008; 12(1): 73–91.

 Google Scholar

Mueser K. T, Goodman L, Trumbetta S. L, Rosenberg S, Osher F. C, Vidaver R. Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology. 1998; 66: 493–499.

 PubMed Web of Science ®Google Scholar

Mueser K. T, Salyers M. P, Rosenberg S. D, Goodman L. A, Essock S. M, Osher F. C, etal. Interpersonal trauma and posttraumatic stress disorder in patients with severe mental illness: Demographic, clinical, and health correlates. Schizophrenia Bulletin. 2004; 30(1): 45–57.

 PubMed Web of Science ®Google Scholar