Skip to main content
Top
Published in: Community Mental Health Journal 6/2015

01-08-2015 | Original Paper

Coping Styles Among Individuals with Severe Mental Illness and Comorbid PTSD

Authors: Shannon A. McNeill, Tara E. Galovski

Published in: Community Mental Health Journal | Issue 6/2015

Login to get access

Abstract

There is little known about coping styles used by individuals with severe mental illness (SMI) and even less known about the influence of a comorbid posttraumatic stress disorder (SMI-PTSD) diagnosis on coping. The current study examines differences in utilization of coping strategies, overall psychological distress, and exposure to traumatic events between SMI only and SMI-PTSD individuals seeking community mental health clinic services (N = 90). Results demonstrate that overall psychological distress and use of avoidance coping were significantly higher among the SMI-PTSD sample. Avoidance coping partially mediated the relationship between PTSD symptom severity and psychological distress. Findings suggest that the experience of PTSD for those with SMI is associated with increases in avoidance coping, a coping style that significantly contributes to psychological distress. Implications for further study and treatment within community mental health clinics are considered.
Literature
go back to reference Alvarez, M.-J., Roura, P., Foguet, Q., Oses, A., Sola, J., & Arrufat, F.-X. (2012). Posttraumatic stress disorder comorbidity and clinical implications in patients with severe mental illness. Journal of Nervous and Mental Disease, 200(6), 549–552.PubMedCrossRef Alvarez, M.-J., Roura, P., Foguet, Q., Oses, A., Sola, J., & Arrufat, F.-X. (2012). Posttraumatic stress disorder comorbidity and clinical implications in patients with severe mental illness. Journal of Nervous and Mental Disease, 200(6), 549–552.PubMedCrossRef
go back to reference American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington: Author American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (Revised 4th ed.). Washington: Author
go back to reference Baron, R. M., & Kenny, D. A. (1986). The moderator, Äìmediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. doi:10.1037/0022-3514.51.6.1173.PubMedCrossRef Baron, R. M., & Kenny, D. A. (1986). The moderator, Äìmediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182. doi:10.​1037/​0022-3514.​51.​6.​1173.PubMedCrossRef
go back to reference Betensky, J. D., Robinson, D. G., Gunduz-Bruce, H., Sevy, S., Lencz, T., Kane, J. M., & Szeszko, P. R. (2008). Patterns of stress in schizophrenia. Psychiatry Research, 160(1), 38–46.PubMedCentralPubMedCrossRef Betensky, J. D., Robinson, D. G., Gunduz-Bruce, H., Sevy, S., Lencz, T., Kane, J. M., & Szeszko, P. R. (2008). Patterns of stress in schizophrenia. Psychiatry Research, 160(1), 38–46.PubMedCentralPubMedCrossRef
go back to reference Breslau, N., Davis, G. C., Andreski, P., & Peterson, E. (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry, 48(3), 216–222.PubMedCrossRef Breslau, N., Davis, G. C., Andreski, P., & Peterson, E. (1991). Traumatic events and posttraumatic stress disorder in an urban population of young adults. Archives of General Psychiatry, 48(3), 216–222.PubMedCrossRef
go back to reference Christensen, R. C., Hodgkins, C. C., Garces, L. K., Estlund, K. L., Miller, M. D., & Touchton, R. (2005). Homeless, mentally ill and addicted: The need for abuse and trauma services. Journal of Health Care for the Poor and Underserved, 16(4), 615–621. doi:10.1353/hpu.2005.0091.PubMedCrossRef Christensen, R. C., Hodgkins, C. C., Garces, L. K., Estlund, K. L., Miller, M. D., & Touchton, R. (2005). Homeless, mentally ill and addicted: The need for abuse and trauma services. Journal of Health Care for the Poor and Underserved, 16(4), 615–621. doi:10.​1353/​hpu.​2005.​0091.PubMedCrossRef
go back to reference Clark, R. E., Ricketts, S. K., & McHugo, G. J. (1999). Legal system involvement an costs for persons in treatment for severe mental illness and substance use disorders. Psychiatric Services, 50(5), 641–647.PubMedCrossRef Clark, R. E., Ricketts, S. K., & McHugo, G. J. (1999). Legal system involvement an costs for persons in treatment for severe mental illness and substance use disorders. Psychiatric Services, 50(5), 641–647.PubMedCrossRef
go back to reference Cusack, K. J., Grubaugh, A. L., Knapp, R. G., & Frueh, B. C. (2006). Unrecognized trauma and PTSD among public mental health consumers with chronic and severe mental illness. Community Mental Health Journal, 42(5), 487–500. doi:10.1007/s10597-006-9049-4.PubMedCrossRef Cusack, K. J., Grubaugh, A. L., Knapp, R. G., & Frueh, B. C. (2006). Unrecognized trauma and PTSD among public mental health consumers with chronic and severe mental illness. Community Mental Health Journal, 42(5), 487–500. doi:10.​1007/​s10597-006-9049-4.PubMedCrossRef
go back to reference Derogatis, L. R. (1975). Brief symptom inventory. Baltimore: Clinical Psychometric Research. Derogatis, L. R. (1975). Brief symptom inventory. Baltimore: Clinical Psychometric Research.
go back to reference Derogatis, L. R., & Melisaratos, N. (1983). The brief symptom inventory: An introductory report. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 13(3), 595–605. doi:10.1017/s0033291700048017.CrossRef Derogatis, L. R., & Melisaratos, N. (1983). The brief symptom inventory: An introductory report. Psychological Medicine: A Journal of Research in Psychiatry and the Allied Sciences, 13(3), 595–605. doi:10.​1017/​s003329170004801​7.CrossRef
go back to reference First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). User’s guide for the structured clinical interview for DSM-IV axis II personality disorders (SCID-II). Washington: American Psychiatric Press. First, M. B., Gibbon, M., Spitzer, R. L., Williams, J. B. W., & Benjamin, L. S. (1997). User’s guide for the structured clinical interview for DSM-IV axis II personality disorders (SCID-II). Washington: American Psychiatric Press.
go back to reference First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). User’s guide for the structured clinical interview for DSM-IV axis I disorders-research version (SCID-I). New York: Biometrics Research Department. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1996). User’s guide for the structured clinical interview for DSM-IV axis I disorders-research version (SCID-I). New York: Biometrics Research Department.
go back to reference Ford, J. D. (2012). Ethnoracial and educational differences in victimization history, trauma-related symptoms, and coping style. Psychological Trauma: Theory, Research, Practice, And Policy, 4(2), 177–185. doi:10.1037/a0023670.CrossRef Ford, J. D. (2012). Ethnoracial and educational differences in victimization history, trauma-related symptoms, and coping style. Psychological Trauma: Theory, Research, Practice, And Policy, 4(2), 177–185. doi:10.​1037/​a0023670.CrossRef
go back to reference Fortier, M. A., DiLillo, D., Messman-Moore, T. L., Peugh, J., DeNardi, K. A., & Gaffey, K. J. (2009). Severity of child sexual abuse and revictimization: The mediating role of coping and trauma symptoms. Psychology of Women Quarterly, 33(3), 308–320. doi:10.1111/j.1471-6402.2009.01503.x.CrossRef Fortier, M. A., DiLillo, D., Messman-Moore, T. L., Peugh, J., DeNardi, K. A., & Gaffey, K. J. (2009). Severity of child sexual abuse and revictimization: The mediating role of coping and trauma symptoms. Psychology of Women Quarterly, 33(3), 308–320. doi:10.​1111/​j.​1471-6402.​2009.​01503.​x.CrossRef
go back to reference Frueh, B., Grubaugh, A. L., Cusack, K. J., & Elhai, J. D. (2009). Disseminating evidence-based practices for adults with PTSD and severe mental illness in public-sector mental health agencies. Behavior Modification, 33(1), 66–81. doi:10.1177/0145445508322619.PubMedCrossRef Frueh, B., Grubaugh, A. L., Cusack, K. J., & Elhai, J. D. (2009). Disseminating evidence-based practices for adults with PTSD and severe mental illness in public-sector mental health agencies. Behavior Modification, 33(1), 66–81. doi:10.​1177/​0145445508322619​.PubMedCrossRef
go back to reference Harris, M., & Fallot, R. D. (2001a). Using trauma theory to design service systems. San Francisco: Jossey-Bass. Harris, M., & Fallot, R. D. (2001a). Using trauma theory to design service systems. San Francisco: Jossey-Bass.
go back to reference Harris, M., & Fallot, R. D. (2001b). Envisioning a trauma-informed service system: A vital paradigm shift. New Directions for Mental Health Service, 89, 3–22.CrossRef Harris, M., & Fallot, R. D. (2001b). Envisioning a trauma-informed service system: A vital paradigm shift. New Directions for Mental Health Service, 89, 3–22.CrossRef
go back to reference Hiday, V. A., Swartz, M. S., Swanson, J. W., Borum, R., & Wagner, H. R. (1999). Criminal victimization of persons with severe mental illness. Psychiatric Services (Washington, D. C.), 50(1), 62–68.CrossRef Hiday, V. A., Swartz, M. S., Swanson, J. W., Borum, R., & Wagner, H. R. (1999). Criminal victimization of persons with severe mental illness. Psychiatric Services (Washington, D. C.), 50(1), 62–68.CrossRef
go back to reference Hoe, M., & Brekke, J. S. (2008). Cross-ethnic measurement invariance of the brief symptom inventory for individuals with severe and persistent mental illness. Social Work Research, 32(2), 71–78.CrossRef Hoe, M., & Brekke, J. S. (2008). Cross-ethnic measurement invariance of the brief symptom inventory for individuals with severe and persistent mental illness. Social Work Research, 32(2), 71–78.CrossRef
go back to reference Holahan, C. J., Moos, R. H., & Schaefer, J. A. (1996). Coping, stress resistance and growth: Conceptualizing adaptive functioning. In M. Zeidner & N. S. Endler (Eds.), Handbook of coping: Theory, research and applications (pp. 24–43). New York: John Wiley & Sons. Holahan, C. J., Moos, R. H., & Schaefer, J. A. (1996). Coping, stress resistance and growth: Conceptualizing adaptive functioning. In M. Zeidner & N. S. Endler (Eds.), Handbook of coping: Theory, research and applications (pp. 24–43). New York: John Wiley & Sons.
go back to reference Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., et al. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52(12), 1048–1060.PubMedCrossRef Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., et al. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52(12), 1048–1060.PubMedCrossRef
go back to reference Krageloh, C. (2011). A systematic review of studies using the Brief COPE: Religious coping in factor analyses. Religions, 2, 216–246.CrossRef Krageloh, C. (2011). A systematic review of studies using the Brief COPE: Religious coping in factor analyses. Religions, 2, 216–246.CrossRef
go back to reference Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer Publishing. Lazarus, R., & Folkman, S. (1984). Stress, appraisal, and coping. New York: Springer Publishing.
go back to reference Lobbestael, J., Leurgans, M., & Arntz, A. (2011). Inter-rater reliability of the structured clinical interview for DSM-IV axis I disorders (SCID-I) and axis II disorders (SCID-II). Clinical Psychology Psychotherapy, 18(1), 75–90. doi:10.1002/cpp.693.PubMedCrossRef Lobbestael, J., Leurgans, M., & Arntz, A. (2011). Inter-rater reliability of the structured clinical interview for DSM-IV axis I disorders (SCID-I) and axis II disorders (SCID-II). Clinical Psychology Psychotherapy, 18(1), 75–90. doi:10.​1002/​cpp.​693.PubMedCrossRef
go back to reference Lysaker, P. H., Wilt, M. A., Plascak-Hallberg, C. D., Brenner, C. A., & Clements, C. A. (2003). Personality dimensions in schizophrenia: Associations with symptoms and coping. Journal of Nervous and Mental Disease, 191(2), 80–86. doi:10.1097/00005053-200302000-00003.PubMed Lysaker, P. H., Wilt, M. A., Plascak-Hallberg, C. D., Brenner, C. A., & Clements, C. A. (2003). Personality dimensions in schizophrenia: Associations with symptoms and coping. Journal of Nervous and Mental Disease, 191(2), 80–86. doi:10.​1097/​00005053-200302000-00003.PubMed
go back to reference Macdonald, E. M., Jackson, H. J., Hayes, R. L., Baglioni, A. J, Jr, & Madden, C. (1998). Social skill as a determinant of social networks and perceived social support in schizophrenia. Schizophrenia Research, 29(3), 275–286. doi:10.1016/s0920-9964(97)00096-0.PubMedCrossRef Macdonald, E. M., Jackson, H. J., Hayes, R. L., Baglioni, A. J, Jr, & Madden, C. (1998). Social skill as a determinant of social networks and perceived social support in schizophrenia. Schizophrenia Research, 29(3), 275–286. doi:10.​1016/​s0920-9964(97)00096-0.PubMedCrossRef
go back to reference Meyer, B. (2001). Coping with severe mental illness: Relations of the Brief COPE with symptoms, functioning, and well-being. Journal of Psychopathology and Behavioral Assessment, 23(4), 265–277. doi:10.1023/a:1012731520781.CrossRef Meyer, B. (2001). Coping with severe mental illness: Relations of the Brief COPE with symptoms, functioning, and well-being. Journal of Psychopathology and Behavioral Assessment, 23(4), 265–277. doi:10.​1023/​a:​1012731520781.CrossRef
go back to reference Mueser, K. T., Goodman, L. B., Trumbetta, S. L., Rosenberg, S. D., Osher, C., Vidaver, R., & Foy, D. W. (1998). Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 66(3), 493–499.PubMedCrossRef Mueser, K. T., Goodman, L. B., Trumbetta, S. L., Rosenberg, S. D., Osher, C., Vidaver, R., & Foy, D. W. (1998). Trauma and posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 66(3), 493–499.PubMedCrossRef
go back to reference Mueser, K. T., Rosenberg, S. D., Fox, L., Salyers, M. P., Ford, J. D., & Carty, P. (2001). Psychometric evaluation of trauma and posttraumatic stress disorder assessments in persons with severe mental illness. Psychological Assessment, 13(1), 110–117. doi:10.1037/1040-3590.13.1.110.PubMedCrossRef Mueser, K. T., Rosenberg, S. D., Fox, L., Salyers, M. P., Ford, J. D., & Carty, P. (2001). Psychometric evaluation of trauma and posttraumatic stress disorder assessments in persons with severe mental illness. Psychological Assessment, 13(1), 110–117. doi:10.​1037/​1040-3590.​13.​1.​110.PubMedCrossRef
go back to reference Mueser, K. T., Rosenberg, S. D., Hamblen, J. L., & Decamps, M. (2004). A cognitive-behavioral treatment program for posttraumatic stress disorder in persons with severe mental illness. American Journal of Psychiatric Rehabilitation, 7, 107–146. doi:10.1080/1587760490476183.CrossRef Mueser, K. T., Rosenberg, S. D., Hamblen, J. L., & Decamps, M. (2004). A cognitive-behavioral treatment program for posttraumatic stress disorder in persons with severe mental illness. American Journal of Psychiatric Rehabilitation, 7, 107–146. doi:10.​1080/​1587760490476183​.CrossRef
go back to reference O’Hare, T., Sherrer, M. V., & Shen, C. (2006). Subjective distress from stressful events and high-risk behaviors as predictors of PTSD symptom severity in clients with severe mental illness. Journal of Traumatic Stress, 19(3), 375–386. doi:10.1002/jts.20131.PubMedCrossRef O’Hare, T., Sherrer, M. V., & Shen, C. (2006). Subjective distress from stressful events and high-risk behaviors as predictors of PTSD symptom severity in clients with severe mental illness. Journal of Traumatic Stress, 19(3), 375–386. doi:10.​1002/​jts.​20131.PubMedCrossRef
go back to reference Phillips, L. J., Francey, S. M., Edwards, J., & McMurray, N. (2009). Strategies used by psychotic individuals to cope with life stress and symptoms of illness: A systematic review. Anxiety, Stress & Coping: An International Journal, 22(4), 371–410. doi:10.1080/10615800902811065.CrossRef Phillips, L. J., Francey, S. M., Edwards, J., & McMurray, N. (2009). Strategies used by psychotic individuals to cope with life stress and symptoms of illness: A systematic review. Anxiety, Stress & Coping: An International Journal, 22(4), 371–410. doi:10.​1080/​1061580090281106​5.CrossRef
go back to reference Pineles, S. L., Mostoufi, S. M., Ready, C. B., Street, A. E., Griffin, M. G., & Resick, P. A. (2011). Trauma reactivity, avoidant coping, and PTSD symptoms: A moderating relationship? Journal of Abnormal Psychology,. doi:10.1037/a0022123.PubMedCentralPubMed Pineles, S. L., Mostoufi, S. M., Ready, C. B., Street, A. E., Griffin, M. G., & Resick, P. A. (2011). Trauma reactivity, avoidant coping, and PTSD symptoms: A moderating relationship? Journal of Abnormal Psychology,. doi:10.​1037/​a0022123.PubMedCentralPubMed
go back to reference Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments & Computers, 36(4), 717–731. doi:10.3758/bf03206553.CrossRef Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments & Computers, 36(4), 717–731. doi:10.​3758/​bf03206553.CrossRef
go back to reference Schnider, K. R., Elhai, J. D., & Gray, M. J. (2007). Coping style use predicts posttraumatic stress and complicated grief symptom severity among college students reporting a traumatic loss. Journal of Counseling Psychology, 54(3), 344–350. doi:10.1037/0022-0167.54.3.344.CrossRef Schnider, K. R., Elhai, J. D., & Gray, M. J. (2007). Coping style use predicts posttraumatic stress and complicated grief symptom severity among college students reporting a traumatic loss. Journal of Counseling Psychology, 54(3), 344–350. doi:10.​1037/​0022-0167.​54.​3.​344.CrossRef
go back to reference So, S. H. W., & Wong, C. W. (2008). Experience and coping with auditory hallucinations in first-episode psychosis: Relationship with stress coping. Hong Kong Journal of Psychiatry, 18(3), 115–121. So, S. H. W., & Wong, C. W. (2008). Experience and coping with auditory hallucinations in first-episode psychosis: Relationship with stress coping. Hong Kong Journal of Psychiatry, 18(3), 115–121.
go back to reference Subica, A. M., Claypoole, K. H., & Wylie, A. M. (2012). PTSD’S mediation of the relationships between trauma, depression, substance abuse, mental health, and physical health in individuals with severe mental illness: Evaluating a comprehensive model. Schizophrenia Research, 136(1–3), 104–109. doi:10.1016/j.schres.2011.10.018.PubMedCrossRef Subica, A. M., Claypoole, K. H., & Wylie, A. M. (2012). PTSD’S mediation of the relationships between trauma, depression, substance abuse, mental health, and physical health in individuals with severe mental illness: Evaluating a comprehensive model. Schizophrenia Research, 136(1–3), 104–109. doi:10.​1016/​j.​schres.​2011.​10.​018.PubMedCrossRef
go back to reference Vogel, M., Spitzer, C., Barnow, S., Freyberger, H. J., & Grabe, H Jr. (2006). The role of trauma and PTSD-related symptoms for dissociation and psychopathological distress in inpatients with schizophrenia. Psychopathology, 39(5), 236–242. doi:10.1159/000093924.PubMedCrossRef Vogel, M., Spitzer, C., Barnow, S., Freyberger, H. J., & Grabe, H Jr. (2006). The role of trauma and PTSD-related symptoms for dissociation and psychopathological distress in inpatients with schizophrenia. Psychopathology, 39(5), 236–242. doi:10.​1159/​000093924.PubMedCrossRef
go back to reference Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the 9th annual meeting of the International Society for Traumatic Stress Studies, San Antonio, TX. Weathers, F. W., Litz, B. T., Herman, D. S., Huska, J. A., & Keane, T. M. (1993). The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at the 9th annual meeting of the International Society for Traumatic Stress Studies, San Antonio, TX.
go back to reference Whelan, P. J. P., Oleszek, J., Macdonald, A., & Gaughran, F. (2009). The utility of the mini-mental state examination in guiding assessment of capacity to consent to research. International Psychogeriatrics, 21(2), 338–344. doi:10.1017/s1041610208008314.PubMedCrossRef Whelan, P. J. P., Oleszek, J., Macdonald, A., & Gaughran, F. (2009). The utility of the mini-mental state examination in guiding assessment of capacity to consent to research. International Psychogeriatrics, 21(2), 338–344. doi:10.​1017/​s104161020800831​4.PubMedCrossRef
Metadata
Title
Coping Styles Among Individuals with Severe Mental Illness and Comorbid PTSD
Authors
Shannon A. McNeill
Tara E. Galovski
Publication date
01-08-2015
Publisher
Springer US
Published in
Community Mental Health Journal / Issue 6/2015
Print ISSN: 0010-3853
Electronic ISSN: 1573-2789
DOI
https://doi.org/10.1007/s10597-015-9887-z

Other articles of this Issue 6/2015

Community Mental Health Journal 6/2015 Go to the issue