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
- 2.Goode E. A nation challenged: psychological trauma. The New York Times. September 18, 2001;B:1.Google Scholar
- 3.Mishra R. Mental toll on troops detailed. The Boston Globe. July 1, 2004:A1.Google Scholar
- 6.Centers for Disease Control and Prevention. Health hazard evaluation of police officers and firefighters after Hurricane Katrina, New Orleans, Louisiana, October 17–28 and November 30–December 5, 2005: Centers for Disease Control and Prevention; 2006.Google Scholar
- 8.American Psychiatric Association, ed. Diagnostic and Statistical Manual of Mental Disorders Fourth Edition. Washington, DC: American Psychiatric Association; 1994.Google Scholar
- 10.Murray CJ, Lopez AD, eds. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard University Press; 1996; No. 1.Google Scholar
- 44.Force UPST. Guide to Clinical Preventive Services, 2nd Edition. Bethesda, MD; 1996.Google Scholar
- 46.Drossman DA, Corazziari E, Talley NJ, Thompson WG, Whitehead WE. Rome II. The Functional Gastrointestinal Disorders. Diagnosis, Pathophysiology and Treatment: A Multinational Consensus. McLean, VA: Degnon Associates; 2000.Google Scholar
- 47.NIAAA. Helping Patients Who Drink Too Much: A Clinician’s Guide. http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide.htm; 2006.
- 48.Purves AM, Penny KI, Munro C, et al. Defining chronic pain for epidemiological research assessing a subjective definition. Pain Clinic. 1998;10(3):139–47.Google Scholar
- 49.World Health Organization. Composite International Diagnostic Interview (CIDI): Version 2.1. Geneva: World Health Organization; 1997.Google Scholar
- 51.Health, United States, 2004 With Chartbook on Trends in the Health of Americans. Hyattsville, MD: National Center for Health Statistics; 2004.Google Scholar
- 58.Beckham J, Crawford A, Feldman ME, et al. Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans. J Psychiatr Res. 1997;43(4):379–89.Google Scholar
- 69.Bruce SE, Weisberg RB, Dolan RT, et al. Trauma and posttraumatic stress disorder in primary care patients. Prim Care Companion J Clin Psychiat. 2001;3(5):211–7 (Oct).Google Scholar
- 74.Foa EB, Davidson JRT, Frances A. The expert consensus guideline series: treatment of post-traumatic stress disorder. J Clin Psychiatry. 1999;60(suppl 16):1–76.Google Scholar
- 76.Institute of Medicine, ed. Improving the Quality of Health Care for Mental and Substance Use Conditions: Quality Chasm Series. Washington, DC: The National Academies Press; 2006.Google Scholar
- 86.Hemenway D, Prothrow-Stith D, Browne A. Report of the 2004 Boston Youth Survey. Boston: City of Boston; 2005 (Aug).Google Scholar