Psychometric properties of post-traumatic stress disorder (PTSD) checklist for DSM-5 in persons with serious mental illness.

BACKGROUND: PCL-5 is a self-report measure consisting of 20 items that are used to assess the symptoms of Post-Traumatic Stress Disorder (PTSD) according to the DSM-5. OBJECTIVE: This study evaluated the factor structure of the Post-Traumatic Stress Disorder (PTSD) Checklist for DSM-5 (PCL-5) in people with serious mental illness. METHOD: The sample in Study 1 included 536 participants with serious mental illness who were receiving supported employment services through community mental health agencies or supported housing programmes. Confirmatory factor analysis assessed the fit of six different models of PTSD. RESULTS: Results indicated that Armour's Hybrid 7-factor model composed of re-experiencing, avoidance, dysphoria, dysphoric arousal, anxious arousal, negative affect, anhedonia, and externalizing behaviours demonstrated the best fit. Study 2 found support for convergent validity for PCL-5 among 132 participants who met criteria for PTSD. CONCLUSION: Findings provide support for the psychometric properties of the PCL-5 and the conceptualization of the 7-factor hybrid model and the 4-factor DSM-5 model of PTSD among persons living with serious mental illness.

Antecedentes:PCL-5 es una medida de autoinforme que consta de 20 ítems que se utilizan para evaluar los síntomas del TEPT de acuerdo al DSM-5.Objetivo:Este estudio evaluó la estructura factorial de la Lista de verificación de Trastorno de Estrés Postraumático (TEPT) para DSM-5 (PCL-5) en personas con enfermedades mentales graves.Método:La muestra del Estudio 1 incluyó a 536 participantes con enfermedad mental grave que estaban recibiendo servicios de empleo subvencionado a través de agencias comunitarias de salud mental o programas de vivienda subvencionados. El análisis factorial confirmatorio evaluó el ajuste de seis modelos diferentes de TEPT.Resultados:Los resultados indicaron que el modelo híbrido de 7 factores de Armour - compuesto de reexperimentación, evitación, disforia, excitación disfórica, excitación ansiosa, afecto negativo, anhedonia y conductas de externalización - demostró el mejor ajuste. El estudio 2 encontró sustento para la validez convergente de PCL-5 entre 132 participantes que cumplieron con los criterios para TEPT.Conclusión:Los hallazgos respaldan las propiedades psicométricas del PCL-5 y la conceptualización del modelo híbrido de 7 factores y el modelo DSM-5 de 4 factores de TEPT entre personas que viven con una enfermedad mentales graves.

I feel frozen: Client perceptions of how posttraumatic stress disorder impacts employment.

Objective: There is evidence that posttraumatic stress disorder (PTSD) is a hidden barrier to employment among individuals with serious mental illnesses (SMI) among whom PTSD is highly prevalent. This study aimed to explore how PTSD interferes with achieving employment outcomes among persons with SMI. Methods: Participants included 119 individuals with SMI and co-occurring PTSD receiving Supported Employment services. Responses to the question, "In what ways are PTSD symptoms interfering with your work during the past month?" were analyzed. Results: Six themes emerged: (a) I don't like being around people, (b) I feel frozen and unable to get started, (c) troubling negative affect, (d) mind is scattered and all over the place, (e) feeling fatigued all the time, and (f) flashbacks and triggers can happen whenever. Conclusions and Implications for Practice: Findings provide insight into how PTSD symptoms impact work outcomes and suggest that there is a need for Supported Employment providers to screen clients for trauma exposure to identify those in need of additional support in order to improve work outcomes. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Trauma Exposure and Prolonged Grief Disorder Among Persons Receiving Community Mental Health Services: Rates and Correlates.

BACKGROUND: Persons with serious mental illnesses (SMIs) are at increased risk for exposure to trauma and posttraumatic stress disorder (PTSD). Prolonged Grief Disorder (PGD) may also impact this population but has been seldom studied. AIMS: The present study investigated the rate of both PTSD and PGD among clients receiving community mental health services, and the clinical correlates of co-occurring PTSD/PGD. METHODS: Trauma history, PTSD and PGD were assessed among 536 individuals receiving community mental health services (Study 1). A subsample of 127 individuals from Study 1 who met DSM-5 criteria for PTSD based on diagnostic interview completed measures of psychiatric symptoms (Study 2). RESULTS: In Study 1, 92.4% of participants receiving community mental health services had experienced a traumatic event, 49.6% met criteria for probable and provisional PTSD, 14.7% scored positive for probable PGD, and 11.9% met criteria for probable and provisional PTSD as well as probable PGD. In Study 2, participants meeting diagnostic DSM-5 criteria for PTSD and probable PGD had more self-reported PTSD symptoms, but did not differ on other outcomes. CONCLUSIONS: Findings highlight the need for trauma informed services including grief counseling for persons with SMI.

Effect of Psychiatric Symptoms on Employment Outcomes for Individuals Receiving Supported Employment Services: A Preliminary Study.

Psychiatric symptoms are often cited by community-based providers as barriers to employment for individuals with mental health conditions. The current study assessed whether psychiatric symptoms and hospitalization in the past year predicted employment outcomes for participants receiving supported employment (SE) services. A total of 105 participants enrolled in SE services were assessed on their level of psychiatric symptoms, hospitalization in the past year, and employment outcomes. Simultaneous logistic regression was used. Eighty-two participants met for the 6-month follow up. Findings indicate that higher overall scores on the 6-month Brief Symptom Inventory (BSI) are predictive of an employment outcome, and suggest that psychiatric symptoms were not a barrier to employment. Participants with higher overall scores on the BSI, thus suggesting greater symptoms, were more likely to gain employment than individuals with lower BSI scores. [Journal of Psychosocial Nursing and Mental Health Services, 56(3), 33-38.].

The role of work related self-efficacy in supported employment for people living with serious mental illnesses.

OBJECTIVE: This study tested whether higher work-related self-efficacy would predict the achievement of competitive employment in supported employment (SE) programs. METHODS: N = 105 individuals were recruited from 5 state-funded SE programs in a Northeastern state. Participants were required to be unemployed and seeking employment to be eligible to enter the study. Research staff met with the individuals at baseline and collected demographic information and data on self-efficacy and psychiatric symptoms. For the follow-up assessment at 6 months, data were collected on participants, self-efficacy, psychiatric symptoms, and employment activity. RESULTS: Thirty-eight percent of the participants achieved competitive employment at the 6-month follow-up. However, self-efficacy was not a positive predictor of competitive employment. Surprisingly, 1 of the subscales, work-related social skills self-efficacy, was negatively associated with employment. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: These findings suggest that self-efficacy is not a predictor of competitive employment for individuals living with serious mental illness and receiving supported employment services. It appears that SE can be helpful for participants with a range of self-efficacy.

Improving Employment Outcomes in Assertive Community Treatment (ACT): The Role of the ACT Nurse.

Assertive community treatment (ACT) for individuals with serious mental illness is a community-based mental health service model where nurses play a significant leadership role as health and wellness educators and consultants to consumers and fellow staff members. The ACT model was designed to include a vocational focus as an important aspect of community integration. Nevertheless, research suggests that ACT does not assist a significant number of consumers in achieving employment goals. Nurses can play a critical part in the recovery and wellness of individuals receiving ACT services. Individual placement and support principles provide a foundation for implementing employment into current services.

The relationship between hope and symptoms.

OBJECTIVE: Hope is a critical aspect of the recovery process for persons with serious mental illnesses. The goal of this pilot study was to assess the relationship between hope and symptoms for a cohort of individuals with mental illnesses receiving supported employment services. METHOD: A total of 74 participants enrolled in supported employment were assessed on their level of hopefulness, hopelessness and psychiatric symptoms. Correlations were performed to determine the relationship between hope and psychiatric symptoms, and hopelessness and psychiatric symptoms. RESULTS: The findings indicated a significant inverse relationship between hope and symptoms, and a significant positive relationship between hopelessness and symptoms. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Hope and symptoms were inversely related, highlighting the importance of developing a wellness strategy that addresses managing symptoms as part of one's recovery process. Additionally, this finding highlights the critical role of PsyR providers in supporting people in recovery with developing a wellness strategy that will both help ameliorate symptoms and increase hope.

Barriers to vocational effectiveness in ACT: staff perspectives.

Assertive community treatment (ACT), for persons with serious mental illness, includes a vocational focus as an important aspect of community integration. Nevertheless, research suggests that ACT does not assist significant numbers of consumers in achieving employment goals. A two-step survey of New Jersey ACT team members was designed to identify the key issues that hinder ACT staff members in assisting consumers with obtaining employment. Survey items were categorized into three sections: (a) staff attitudes, (b) consumer barriers, and (c) staff barriers to working on employment. The initial survey asked staff members to rate items in each of these categories. Highly rated items were used in a subsequent paired comparison survey to determine the relative importance of each. This method highlighted the following issues: four staff attitude items-(a) returning to work is positive, (b) employment is key to recovery, (c) abstinence from substance abuse is needed to work, and (d) consumers are too ill to work; four consumer barrier items-(a) fear of loss of Social Security Administration benefits, (b) symptoms related to the illness, (c) lack of motivation, and (d) poor social skills; and three barriers to working on employment issues items-(a) clinical issues take priority, (b) other case management issues takes priority, and (c) too many emergencies. The implications for staff training are discussed.