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Articles   |    
PTSD as a Mediator Between Lifetime Sexual Abuse and Substance Use Among Jail Diversion Participants
Karen J. Cusack, Ph.D.; Amy H. Herring, Sc.D.; Henry J. Steadman, Ph.D.
Psychiatric Services 2013; doi: 10.1176/appi.ps.000052012
View Author and Article Information

Dr. Cusack is now with the Raymond G. Murphy Veterans Affairs Medical Center, 1501 San Pedro SE, Albuquerque, NM 87108 (e-mail: karen.cusack@va.gov). Dr. Herring is with the Department of Biostatistics, University of North Carolina Chapel Hill. Dr. Steadman is with Policy Research Associates, Inc., Delmar, New York.

Copyright © 2013 by the American Psychiatric Association

Abstract

Objective  Many of the individuals with serious mental illness involved in the criminal justice system have experienced interpersonal victimization, such as sexual abuse, and have high rates of alcohol and drug use disorders. Little attention has been paid to the prevalence of posttraumatic stress disorder (PTSD) and its potential role in the substance misuse of offenders with mental illness.

Methods  The study used a path analytic framework to test the hypothesis that PTSD mediates the relationship between sexual abuse and level of alcohol and drug use among individuals (N=386) with mental illness enrolled in a multisite (N=7) jail diversion project.

Results  Sexual abuse was strongly associated with PTSD, which was in turn associated with both heavy drug use and heavy drinking.

Conclusions  These findings suggest that PTSD may be an important target for jail diversion programs.

Abstract Teaser
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Figure 1 Model of intoxicationa

a N=384. Confidence intervals containing 1 are not significant.

Figure 2 Model of drug usea

a N=385. Confidence intervals containing 1 are not significant.

Anchor for Jump
Table 1Descriptive statistics for 386 persons with serious mental illness in jail diversion programs
Table Footer Note

a PTSD Checklist. Possible scores range from 17 to 85, with higher scores indicating greater symptom severity.

Table Footer Note

b Missing data for one participant

Table Footer Note

c Missing data for two participants

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