Journal of General Internal Medicine

, Volume 22, Issue 6, pp 711–718 | Cite as

Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions

  • Duncan G. Campbell
  • Bradford L. Felker
  • Chuan-Fen Liu
  • Elizabeth M. Yano
  • JoAnn E. Kirchner
  • Domin Chan
  • Lisa V. Rubenstein
  • Edmund F. Chaney
Original Article

BACKGROUND

Compared to those with depression alone, depressed patients with posttraumatic stress disorder (PTSD) experience more severe psychiatric symptomatology and factors that complicate treatment.

OBJECTIVE

To estimate PTSD prevalence among depressed military veteran primary care patients and compare demographic/illness characteristics of PTSD screen-positive depressed patients (MDD-PTSD+) to those with depression alone (MDD).

DESIGN

Cross-sectional comparison of MDD patients versus MDD-PTSD+ patients.

PARTICIPANTS

Six hundred seventy-seven randomly sampled depressed patients with at least 1 primary care visit in the previous 12 months. Participants composed the baseline sample of a group randomized trial of collaborative care for depression in 10 VA primary care practices in 5 states.

MEASUREMENTS

The Patient Health Questionnaire-9 assessed MDD. Probable PTSD was defined as a Primary Care PTSD Screen ≥ 3. Regression-based techniques compared MDD and MDD-PTSD+ patients on demographic/illness characteristics.

RESULTS

Thirty-six percent of depressed patients screened positive for PTSD. Adjusting for sociodemographic differences and physical illness comorbidity, MDD-PTSD+ patients reported more severe depression (P < .001), lower social support (P < .001), more frequent outpatient health care visits (P < .001), and were more likely to report suicidal ideation (P < .001) than MDD patients. No differences were observed in alcohol consumption, self-reported general health, and physical illness comorbidity.

CONCLUSIONS

PTSD is more common among depressed primary care patients than previously thought. Comorbid PTSD among depressed patients is associated with increased illness burden, poorer prognosis, and delayed response to depression treatment. Providers should consider recommending psychotherapeutic interventions for depressed patients with PTSD.

Key words

depression PTSD primary care clinical practice guidelines 

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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Duncan G. Campbell
    • 1
    • 2
  • Bradford L. Felker
    • 1
    • 3
    • 4
  • Chuan-Fen Liu
    • 1
    • 5
  • Elizabeth M. Yano
    • 6
    • 7
  • JoAnn E. Kirchner
    • 8
  • Domin Chan
    • 1
    • 5
  • Lisa V. Rubenstein
    • 6
    • 9
    • 10
  • Edmund F. Chaney
    • 1
    • 3
    • 4
  1. 1.Department of Veterans Affairs, Health Services Research and Development Center of ExcellenceVA Puget Sound Health Care SystemSeattleUSA
  2. 2.Department of PsychologyUniversity of MontanaMissoulaUSA
  3. 3.Department of Veterans Affairs, Mental Health ServiceVA Puget Sound Health Care SystemSeattleUSA
  4. 4.Department of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleUSA
  5. 5.Department of Health ServicesUniversity of Washington School of Public Health and Community MedicineSeattleUSA
  6. 6.Department of Veterans Affairs, Health Services Research and Development Center of ExcellenceVA Greater Los Angeles Healthcare SystemSepulvedaUSA
  7. 7.School of Public HealthUniversity of California, Los AngelesLos AngelesUSA
  8. 8.Department of Veterans Affairs, Health Services Research and DevelopmentCentral Arkansas Veterans Healthcare SystemNorth Little RockUSA
  9. 9.University of California, Los Angeles School of MedicineLos AngelesUSA
  10. 10.RAND Health ProgramSanta MonicaUSA

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