Survey data collected from 257 community mental health center clients tested direct and indirect relationships among subjective distress associated with stressful/traumatic events and high-risk behaviors, substance abuse, and posttraumatic stress disorder (PTSD) symptoms. Structural equation modeling (SEM) revealed substantial direct effects of subjective distress associated with lifetime physical and sexual abuse on PTSD symptom severity. Subjective distress related to high-risk behaviors (e.g., suicide attempts) mediated subjective distress and PTSD symptom severity. Subjective distress from physical and sexual abuse was also strongly related to problem drinking. Adding gender to the model revealed greater subjective distress from physical and sexual abuse for women and greater drinking problems for men. Otherwise, gender had little effect on the model overall.

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Face-to-face interviews with 276 community mental health clients (56.2% women; 42.8% men) diagnosed with schizophrenia spectrum disorders (44.6%) and major mood disorders (55.4%) were used to examine mediating relationships among physical and sexual abuse, high-risk behaviors, drink-to-cope motives, and posttraumatic stress disorder (PTSD) symptom severity. Structural equation modeling revealed that both high-risk behaviors and drinking-to-cope significantly mediated the relationship between lifetime abuse and PTSD symptom severity with an excellent fit of model to data. Alternative models using PTSD symptom level as mediator were also tested, but did not meet optimal goodness-of-fit standards. Implications of findings call for vigilant screening for trauma, substance abuse, and high risk behaviors in clients with severe mental illnesses to inform treatment, and the need for longitudinal studies to test causal pathways.

A compelling body of literature suggests that negative appraisal may be associated with adverse reactions to traumatic stress. However, very few studies have examined how appraisal influences posttraumatic adaptation in people with serious mental illness (SMI) despite evidence of disproportionately high prevalence rates of trauma exposure and Posttraumatic Stress Disorder (PTSD) in this population. The purpose of this article is to provide a critical analysis of the theoretical and empirical literature on cognitive appraisal and psychological adaptation to traumatic stress with a specific focus on individuals diagnosed with SMI. It will be argued that appraisal is a key correlate that may partially account for higher rates of PTSD in people diagnosed with major mood and schizophrenia-spectrum disorders, meriting special consideration for future research.