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.
KEY WORDSunderserved populations PTSD prevalence
This work was supported by a Generalist Physician Faculty Scholar Award from the Robert Wood Johnson Foundation, Princeton, New Jersey (RWJF #045452) and by a career development award from the National Institute on Drug Abuse, National Institutes of Health (K23 DA016665).
We thank Jessica Geier, Minga Claggett-Borne, Lauren Kelly, Michael Rosas, Mary Reyes, Pavan Sekhar, Jen Tran, Eric Holder, and Mary Benitta Schickel for their aid in data collection, and Joann Elmore (MD MPH), Roger Weiss (MD), and Larry Culpepper (MD) for their comments on research design and analysis.
Conflict of Interest Summary
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