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Ask the Mental Health Expert Archives 2001-2004

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Q. I am a consumer advocate who is part of a trauma survivors project in Oregon. This committee of consumers and providers are working to improve the manner in which crisis services are delivered (mental health HMO).

Some of the members have voiced their concern about recurrent hospitalization as a cause of increased lethality of suicidal ideation. They have also presented some information concerning re-hospitalization as re-traumatizing, and disempowering to the trauma survivor.

Would you know of any research that tends to prove or disprove these concerns?

A. I'm not aware of any published studies directly addressing the issue of retraumatizing PTSD victims or trauma survivors, though I am aware of some advocacy groups making this claim. It is, of course, very difficult to prove that someone was disempowered by re-hospitalization, or that suicidal ideation stemmed from that specific cause rather than the PTSD or depression itself.

You may want to see the paper by Rosenberg et al in the November 2001 issue of Psychiatric Services (52:1453-61). These authors do discuss the claim that some victims of sexual abuse may feel re-victimized by certain coercive interventions, such as involuntary hospitalization or the use of physical restraints while in the hospital.

A number of consumer-oriented conferences are cited in the bibliography to support this claim. Of course, in the realm of combat-related PTSD, there is a large literature on the benefits and lack of benefits stemming from inpatient hospitalization; e.g., see Johnson et al, Am J Psychiatry July 1997, on the relatively poor outcome of long-term (4 month) inpatient treatment of combat-related PTSD.

It is possible, on the basis of some of these data, to conclude that some PTSD sufferers may experience more symptoms as a result of hospitalization. Personally, I think much depends on the nature of the intervention; how coercive it is; on whether the individual in question has been sexually abused; on the use of physical restraints in the hospital; and on the personality of the survivor and his/her treaters.

Other Resources:

November 2003

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