Date: 10 Mar 2007
PTSD in Urban Primary Care: High Prevalence and Low Physician Recognition
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Posttraumatic stress disorder (PTSD) is associated with medical and psychological morbidity. The prevalence of PTSD in urban primary care has not been well described.
To measure the prevalence of PTSD in primary care patients overall and among those with selected conditions (chronic pain, depression, anxiety, heavy drinking, substance dependence (SD), irritable bowel syndrome (IBS), and immigrant status).
English-speaking patients aged 18–65 years old, awaiting primary care appointments in an urban academic medical center, were eligible for enrollment to determine PTSD prevalence (N = 509). Additional eligible participants (n = 98) with IBS or SD were subsequently enrolled.
PTSD (past year) and trauma exposure were measured with Composite International Diagnostic Interview. We calculated the prevalence of PTSD associated with depression, anxiety, heavy drinking, SD, IBS, and chronic pain. Only the analyses on heavy drinking, SD, and IBS used all 607 participants.
Among the 509 adults in primary care, 23% (95% CI, 19–26%) had PTSD, of whom 11% had it noted in the medical record. The prevalence of PTSD, adjusted for age, gender, race, and marital and socioeconomic statuses, was higher in participants with, compared to those without, the following conditions: chronic pain (23 vs 12%, p = .003), major depression (35 vs 11%, p < .0001), anxiety disorders (42 vs 14%, p < .0001), and IBS (34 vs 18%, p = .01) and lower in immigrants (13 vs 21%, p = .05).
The prevalence of PTSD in the urban primary care setting, and particularly among certain high-risk conditions, compels a critical examination of optimal approaches for screening, intervention, and referral to PTSD treatment.
Portions of this work were presented at the annual meeting of the Society of General Internal Medicine, May 2005, New Orleans, LA, at the annual meeting of the College on Problems of Drug Dependence, June 2005, Orlando, FL, and at the annual meeting of the American Public Health Association, November 2004, Washington, DC.
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- PTSD in Urban Primary Care: High Prevalence and Low Physician Recognition
Journal of General Internal Medicine
Volume 22, Issue 6 , pp 719-726
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- Author Affiliations
- 1. Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 91 East Concord St., Suite 200, Boston, MA, 02118, USA
- 2. Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, MA, USA
- 3. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- 4. Youth Alcohol Prevention Center, Boston University School of Public Health, Boston, MA, USA
- 5. Massachusetts Behavioral Health Partnership, Boston, MA, USA
- 6. Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- 7. National Center for Post-Traumatic Stress Disorder, Boston, MA, USA
- 8. Veterans Affairs Boston Healthcare System, Boston, MA, USA
- 9. Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA