One size doesn’t fit all: gender differences in trauma, PTSD, substance use and the SMI-PTSD conceptual model in persons with severe mental illness in Assertive Community Treatment

The literature on severe mental illness (SMI), trauma, PTSD, and substance use is expansive, yet no research exists examining the specific population served by Assertive Community Treatment (ACT) concerning these relationships and particularly the SMI-PTSD model proposed in the literature. In this paper, we employed retrospective chart reviews to extract information on trauma histories, PTSD, substance use, and psychosocial factors in a sample of 282 clients from four ACT teams (178 males; 104 females) to assess the gender differences in types of trauma, instances of PTSD, substances of choice, problematic substance use, and the SMI-PTSD model. Results indicated that rates of sexual trauma, emotional abuse, serious suicide attempts, rates of trauma in adulthood and PTSD were higher among women, whereas rates of alcohol, marijuana, and stimulant use as well as lifetime problematic substance use were higher among men. In terms of the SMI-PTSD model, results suggest that the model fits the experiences and possible trajectory of men with SMI better. Future work should investigate gender differences and gendered trajectories around the complex relationships between SMI, trauma, PTSD, substance use and examine how the SMI-PTSD model applies to persons of diverse backgrounds.