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Research ArticleRegular Articles

Prevalence of Traumas and PTSD Among Individuals Adjudicated Not Guilty by Reason of Insanity

Jeffrey Guina, Alexandra K. Audu, James Cameron, Andrew Lemmen, Anusha Mamidipaka and Nicole Kletzka
Journal of the American Academy of Psychiatry and the Law Online June 2021, 49 (2) 194-201; DOI: https://doi.org/10.29158/JAAPL.200062-20
Jeffrey Guina
Dr. Guina is Chief Medical Officer, Easterseals Michigan, Auburn Hills, MI, and Psychiatry Residency Program Director, Beaumont Health, Royal Oak, MI. Dr. Audu is a senior resident in psychiatry at the University of Michigan, Ann Arbor, MI. Mr. Cameron is a child care worker at the Hawthorn Center, Northville, MI. Mr. Lemmen is an undergraduate at University of Michigan, Ann Arbor, MI. Ms. Mamidipaka is an undergraduate at Michigan State University, Lansing, MI. Dr. Kletzka is a Forensic Psychologist at the Center for Forensic Psychiatry, Saline, MI.
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Alexandra K. Audu
Dr. Guina is Chief Medical Officer, Easterseals Michigan, Auburn Hills, MI, and Psychiatry Residency Program Director, Beaumont Health, Royal Oak, MI. Dr. Audu is a senior resident in psychiatry at the University of Michigan, Ann Arbor, MI. Mr. Cameron is a child care worker at the Hawthorn Center, Northville, MI. Mr. Lemmen is an undergraduate at University of Michigan, Ann Arbor, MI. Ms. Mamidipaka is an undergraduate at Michigan State University, Lansing, MI. Dr. Kletzka is a Forensic Psychologist at the Center for Forensic Psychiatry, Saline, MI.
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James Cameron
Dr. Guina is Chief Medical Officer, Easterseals Michigan, Auburn Hills, MI, and Psychiatry Residency Program Director, Beaumont Health, Royal Oak, MI. Dr. Audu is a senior resident in psychiatry at the University of Michigan, Ann Arbor, MI. Mr. Cameron is a child care worker at the Hawthorn Center, Northville, MI. Mr. Lemmen is an undergraduate at University of Michigan, Ann Arbor, MI. Ms. Mamidipaka is an undergraduate at Michigan State University, Lansing, MI. Dr. Kletzka is a Forensic Psychologist at the Center for Forensic Psychiatry, Saline, MI.
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Andrew Lemmen
Dr. Guina is Chief Medical Officer, Easterseals Michigan, Auburn Hills, MI, and Psychiatry Residency Program Director, Beaumont Health, Royal Oak, MI. Dr. Audu is a senior resident in psychiatry at the University of Michigan, Ann Arbor, MI. Mr. Cameron is a child care worker at the Hawthorn Center, Northville, MI. Mr. Lemmen is an undergraduate at University of Michigan, Ann Arbor, MI. Ms. Mamidipaka is an undergraduate at Michigan State University, Lansing, MI. Dr. Kletzka is a Forensic Psychologist at the Center for Forensic Psychiatry, Saline, MI.
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Anusha Mamidipaka
Dr. Guina is Chief Medical Officer, Easterseals Michigan, Auburn Hills, MI, and Psychiatry Residency Program Director, Beaumont Health, Royal Oak, MI. Dr. Audu is a senior resident in psychiatry at the University of Michigan, Ann Arbor, MI. Mr. Cameron is a child care worker at the Hawthorn Center, Northville, MI. Mr. Lemmen is an undergraduate at University of Michigan, Ann Arbor, MI. Ms. Mamidipaka is an undergraduate at Michigan State University, Lansing, MI. Dr. Kletzka is a Forensic Psychologist at the Center for Forensic Psychiatry, Saline, MI.
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Nicole Kletzka
Dr. Guina is Chief Medical Officer, Easterseals Michigan, Auburn Hills, MI, and Psychiatry Residency Program Director, Beaumont Health, Royal Oak, MI. Dr. Audu is a senior resident in psychiatry at the University of Michigan, Ann Arbor, MI. Mr. Cameron is a child care worker at the Hawthorn Center, Northville, MI. Mr. Lemmen is an undergraduate at University of Michigan, Ann Arbor, MI. Ms. Mamidipaka is an undergraduate at Michigan State University, Lansing, MI. Dr. Kletzka is a Forensic Psychologist at the Center for Forensic Psychiatry, Saline, MI.
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    Table 1

    Lifetime Trauma Exposure and ACEs

    n (%)Mean (range)MenWomenp
    Any trauma92 (85.98)11.42 (1–101)79 (84.04)13 (100).207
        Sudden death of loved one63 (58.88)2.49 (1–16)53 (56.38)10 (76.92).231
        Witnessed death/serious injury38 (35.51)2.13 (1–10)33 (35.11)5 (38.46)1
        Adult physical assault36 (33.64)3.28 (1–16)30 (31.91)6 (46.15).354
        MVA36 (33.64)1.56 (1–4)31 (32.98)5 (38.46).758
        Weapon attack34 (31.77)1.79 (1–10)28 (29.79)6 (46.15).340
        Childhood physical abuse30 (28.04)3.20 (1–12)27 (28.72)3 (23.08)1
        Childhood sexual abuse25 (23.36)3.32 (1–15)19 (20.21)6 (46.15).073
        Natural disaster21 (19.63)1.24 (1–3)18 (19.15)3 (23.08).716
        Adult sexual assault20 (18.69)4.05 (1–20)13 (13.83)7 (53.85)a.002b
        Severe accident (other than MVA)17 (15.89)1.47 (1–3)16 (17.02)1 (7.69).668
        Military trauma5 (4.67)4.6 (1–10)5 (5.32)01
        Other sudden event that caused severe fear/helplessness/horror36 (33.64)4.55 (1–25)30 (31.91)6 (46.15).354
    Nontraumatic stressor
        Sudden move or loss of home/possessions51 (47.66)3.06 (1–20)42 (44.68)9 (69.23).139
        Sudden abandonment by spouse/partner/parent/family28 (26.17)3.39 (1–20)23 (24.47)5 (38.46).318
    Any ACE82 (76.63)NA69 (73.40)13 (100)a.036c
        Parents separated/divorced54 (50.47)NA47 (50)7 (53.85)1
        Household member with substance abuse43 (40.19)NA35 (37.23)8 (61.54).132
        Childhood emotional abuse40 (37.38)NA31 (32.98)9 (69.23)a.016c
        Childhood physical abuse37 (34.58)NA30 (31.91)7 (53.85).132
        Childhood emotional neglect37 (34.58)NA28 (29.78)9 (69.23)a.010b
        Household member with mental illness28 (26.17)NA19 (20.21)9 (69.23)a.001d
        Childhood sexual abuse23 (21.49)NA18 (19.15)5 (38.42).147
        Childhood physical neglect20 (18.69)NA15 (15.96)5 (38.46).065
        Witnessed domestic violence19 (17.76)NA13 (13.83)6 (46.15)a.011c
        Household member in prison17 (15.89)NA13 (13.83)4 (30.77).216
    Mean ACE score2.97NA2.6495.308a.0005d
    • N = 107 subjects; Men: n = 94 (87.9%); Women: n = 13 (12.1%).

    • ↵a Significantly greater levels than the comparison group.

    • ↵b p < .01

    • ↵c p < .05

    • ↵d p < .001

    • ACE = adverse childhood experience

    • MVA = motor vehicle accident

    • NA = not applicable

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    Table 2

    Subject Characteristics

    PTSDNo PTSDp
    Age, years33.0742.31a.003b
    Gender
        Male24 (88.89)70 (87.50)1
        Female3 (11.11)10 (12.50)
    Race
        White17 (62.96)43 (53.75).503
        Black9 (33.33)25 (31.25).816
        Native American2 (7.41)6 (7.50)1
        Asian0 (0)3 (3.75).570
        Hispanic0 (0)2 (2.50)1
        Other1 (3.70)6 (7.50).676
    Psychiatric disorder
        Schizophrenia-spectrum18 (66.67)62 (77.50).308
        Substance use14 (51.85)28 (35.00).171
        Bipolar6 (22.22)17 (21.25)1
        Anxiety4 (14.81)5 (6.25).226
        Posttraumatic stress1 (3.70)4 (5.00)1
        Borderline personality3 (11.11)2 (2.50).101
        Antisocial personality2 (7.41)3 (3.75).598
        Intellectual disability2 (7.41)2 (2.50).264
        Neurocognitive0 (0)2 (2.50)1
        Autism spectrum1 (3.70)1 (1.25).443
        Depressive0 (0)1 (1.25)1
        Other personality0 (0)1 (1.25)1
        Other mental1 (3.70)1 (1.25).443
    Any trauma27 (100)a65 (81.25).011c
        Sudden death of loved one20 (74.07)43 (53.75)1
        Witnessed death/serious injury12 (44.44)26 (32.50).352
        Adult physical assault11 (40.74)25 (31.25).480
        MVA11 (40.74)25 (31.25).480
        Weapon attack9 (33.33)25 (31.25).816
        Childhood physical abuse11 (40.74)19 (23.75).136
        Childhood sexual abuse11 (40.74)a14 (17.50).019c
        Natural disaster10 (37.04)a11 (13.75).013c
        Adult sexual assault9 (33.33)a11 (13.75).042c
        Severe accident (other than MVA)5 (18.52)12 (15.00).762
        Military trauma05 (6.25).327
        Other sudden event that caused severe fear/helplessness/horror11 (40.74)25 (31.25).480
    Nontraumatic stressor
        Sudden move or loss of home/possessions10 (37.04)41 (51.25).266
        Sudden abandonment by spouse/partner/parent/family10 (37.04)18 (22.50).204
    Any ACE22 (81.48)60 (75.00).604
        Parents separated/divorced15 (55.56)39 (48.75).657
        Household member with substance abuse13 (48.15)30 (37.50).369
        Childhood emotional abuse9 (33.33)31 (38.75).653
        Childhood physical abuse10 (37.04)27 (33.75).817
        Childhood emotional neglect12 (44.44)25 (31.25).246
        Household member with mental illness8 (29.63)20 (25.00).622
        Childhood sexual abuse10 (37.04)a13 (16.25).031c
        Childhood physical neglect8 (29.63)12 (15.00).151
        Witnessed domestic violence8 (29.63)11 (13.75).081
        Household member went to prison7 (25.93)10 (12.50).128
    Mean ACE score3.7042.725.094
    • Data are presented as n (%) unless otherwise noted. N = 107 subjects; PTSD Group: n = 27 (25.2%); No PTSD Group: n = 80 (74.8%).

    • ↵a Significantly greater levels than the comparison group.

    • ↵b p < .01

    • ↵c p < .05

    • ACE = adverse childhood experience

    • MVA = motor vehicle accident

    • View popup
    Table 3

    Comparison of Survey Questions About Childhood Physical and Sexual Abuse

    Trauma History ScreenACE Questionnaire
    Childhood physical abuseHit or kicked hard enough to injure – as a childDid a parent or other adult in the household often push, grab, slap, or throw something at you? or Did a parent or other adult in the household ever hit you so hard that you had marks or were injured?
    Childhood sexual abuseForced or made to have sexual contact – as a childDid an adult or person at least five years older than you ever touch or fondle you or have you touch their body in a sexual way? or Did an adult or person at least five years older than you try to or actually have oral, anal, or vaginal sex with you?
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Journal of the American Academy of Psychiatry and the Law Online: 49 (2)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 49, Issue 2
1 Jun 2021
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Prevalence of Traumas and PTSD Among Individuals Adjudicated Not Guilty by Reason of Insanity
Jeffrey Guina, Alexandra K. Audu, James Cameron, Andrew Lemmen, Anusha Mamidipaka, Nicole Kletzka
Journal of the American Academy of Psychiatry and the Law Online Jun 2021, 49 (2) 194-201; DOI: 10.29158/JAAPL.200062-20

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Prevalence of Traumas and PTSD Among Individuals Adjudicated Not Guilty by Reason of Insanity
Jeffrey Guina, Alexandra K. Audu, James Cameron, Andrew Lemmen, Anusha Mamidipaka, Nicole Kletzka
Journal of the American Academy of Psychiatry and the Law Online Jun 2021, 49 (2) 194-201; DOI: 10.29158/JAAPL.200062-20
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