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Research ArticleRegular Article

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 February 2021, JAAPL.200062-20; DOI: https://doi.org/10.29158/JAAPL.200062-20
Jeffrey Guina
Easterseals Michigan, Auburn Hills, MI, , Beaumont Health, Royal Oak, MI. University of Michigan, Ann Arbor, MI. and Mr. Lemmen are child care workers at the Hawthorn Center, Northville, MI. Michigan State University, Lansing, MI. Center for Forensic Psychiatry, Saline, MI.
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Alexandra K. Audu
Easterseals Michigan, Auburn Hills, MI, , Beaumont Health, Royal Oak, MI. University of Michigan, Ann Arbor, MI. and Mr. Lemmen are child care workers at the Hawthorn Center, Northville, MI. Michigan State University, Lansing, MI. Center for Forensic Psychiatry, Saline, MI.
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James Cameron
Easterseals Michigan, Auburn Hills, MI, , Beaumont Health, Royal Oak, MI. University of Michigan, Ann Arbor, MI. and Mr. Lemmen are child care workers at the Hawthorn Center, Northville, MI. Michigan State University, Lansing, MI. Center for Forensic Psychiatry, Saline, MI.
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Andrew Lemmen
Easterseals Michigan, Auburn Hills, MI, , Beaumont Health, Royal Oak, MI. University of Michigan, Ann Arbor, MI. and Mr. Lemmen are child care workers at the Hawthorn Center, Northville, MI. Michigan State University, Lansing, MI. Center for Forensic Psychiatry, Saline, MI.
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Anusha Mamidipaka
Easterseals Michigan, Auburn Hills, MI, , Beaumont Health, Royal Oak, MI. University of Michigan, Ann Arbor, MI. and Mr. Lemmen are child care workers at the Hawthorn Center, Northville, MI. Michigan State University, Lansing, MI. Center for Forensic Psychiatry, Saline, MI.
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Nicole Kletzka
Easterseals Michigan, Auburn Hills, MI, , Beaumont Health, Royal Oak, MI. University of Michigan, Ann Arbor, MI. and Mr. Lemmen are child care workers at the Hawthorn Center, Northville, MI. Michigan State University, Lansing, MI. 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: 53 (1)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 53, Issue 1
1 Mar 2025
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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 Feb 2021, JAAPL.200062-20; 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 Feb 2021, JAAPL.200062-20; DOI: 10.29158/JAAPL.200062-20
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Keywords

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