Journal of General Internal Medicine

, Volume 22, Issue 6, pp 719–726

PTSD in Urban Primary Care: High Prevalence and Low Physician Recognition

  • Jane Liebschutz
  • Richard Saitz
  • Victoria Brower
  • Terence M. Keane
  • Christine Lloyd-Travaglini
  • Tali Averbuch
  • Jeffrey H. Samet
Original Article

Abstract

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with medical and psychological morbidity. The prevalence of PTSD in urban primary care has not been well described.

OBJECTIVE

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).

DESIGN

Cross-sectional study.

PARTICIPANTS

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.

MEASUREMENTS

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.

RESULTS

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).

CONCLUSIONS

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 WORDS

underserved populations PTSD prevalence 

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Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Jane Liebschutz
    • 1
    • 2
  • Richard Saitz
    • 1
    • 3
    • 4
  • Victoria Brower
    • 5
  • Terence M. Keane
    • 6
    • 7
    • 8
  • Christine Lloyd-Travaglini
    • 9
  • Tali Averbuch
    • 1
  • Jeffrey H. Samet
    • 1
    • 2
  1. 1.Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of MedicineBoston Medical Center and Boston University School of MedicineBostonUSA
  2. 2.Department of Social and Behavioral SciencesBoston University School of Public HealthBostonUSA
  3. 3.Department of EpidemiologyBoston University School of Public HealthBostonUSA
  4. 4.Youth Alcohol Prevention CenterBoston University School of Public HealthBostonUSA
  5. 5.Massachusetts Behavioral Health PartnershipBostonUSA
  6. 6.Department of PsychiatryBoston University School of MedicineBostonUSA
  7. 7.National Center for Post-Traumatic Stress DisorderBostonUSA
  8. 8.Veterans Affairs Boston Healthcare SystemBostonUSA
  9. 9.Data Coordinating CenterBoston University School of Public HealthBostonUSA

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