Skip to main content

Prevalence, Detection and Correlates of PTSD in the Primary Care Setting: A Systematic Review

Abstract

Research suggests that posttraumatic stress disorder (PTSD) is common, debilitating and frequently associated with comorbid health conditions, including poor functioning, and increased health care utilization. This article systematically reviewed the empirical literature on PTSD in primary care settings, focusing on prevalence, detection and correlates. Twenty-seven studies were identified for inclusion. Current PTSD prevalence in primary care patients ranged widely between 2 % to 39 %, with significant heterogeneity in estimates explained by samples with different levels of trauma exposure. Six studies found detection of PTSD by primary care physicians (PCPs) ranged from 0 % to 52 %. Studies examining associations between PTSD and sociodemographic variables yielded equivocal results. High comorbidity was reported between PTSD and other psychiatric disorders including depression and anxiety, and PTSD was associated with functional impairment or disability. Exposure to multiple types of trauma also raised the risk of PTSD. While some studies indicated that primary care patients with PTSD report higher levels of substance and alcohol abuse, somatic symptoms, pain, health complaints, and healthcare utilization, other studies did not find these associations. This review proposes that primary care settings are important for the early detection of PTSD, which can be improved through indicated screening and PCP education.

This is a preview of subscription content, access via your institution.

Fig. 1

References

References marked with an asterisk indicate studies included in the review.

  • * Alim, T. N., Graves, E., Mellman, T. A., Aigbogun, N., Gray, E., Lawson, W., & Charney, D. S. (2006). Trauma exposure, posttraumatic stress disorder and depression in an African-American primary care population. Journal of the National Medical Association, 98(10), 1630–1636.

    PubMed  PubMed Central  Google Scholar 

  • * Andersen, J., Wade, M., Possemato, K., & Ouimette, P. (2010). Association between posttraumatic stress disorder and primary care provider-diagnosed disease among Iraq and Afghanistan veterans. Psychosomatic Medicine, 72(5), 498–504.

    Article  PubMed  Google Scholar 

  • APA. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington DC: American Psychiatric Press.

    Google Scholar 

  • APA. (2013). Diagnostic and statistical manual of mental disorders, fifth edition (DSM-5). Washington DC: American Psychiatric Association.

    Google Scholar 

  • Babor, T. F., Higgins-Biddle, J. C., Saunders, J. B., & Monteiro, M. G. (2001). The alcohol use disorders idenfitication test: Guidelines for use in primary care (2nd ed.). Geneva: World Health Organisation.

    Google Scholar 

  • Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Gusman, F. D., Charney, D. S., & Keane, T. M. (1995). The development of a clinician-administered PTSD scale. Journal of Traumatic Stress, 8(1), 75–90.

    CAS  Article  PubMed  Google Scholar 

  • Blake, D. D., Weathers, F. W., Nagy, L. M., Kaloupek, D. G., Klauminzer, G., Charney, D. S., & Keane, T. M. (1990). A clinician rating scale for assessing current and lifetime PTSD: The CAPS-1. Behavior Therapist, 18, 187–188.

    Google Scholar 

  • Blanchard, E. B., Jones-Alexander, J., Buckley, T. C., & Forneris, C. A. (1996). Psychometric properties of the PTSD checklist (PCL). Behaviour Research and Therapy, 34(8), 669–673.

    CAS  Article  PubMed  Google Scholar 

  • Bower, P., Gilbody, S., Richards, D., Fletcher, J., & Sutton, A. (2006). Collaborative care for depression in primary care: Making sense of a complex intervention: systematic review and meta-regression. The British Journal of Psychiatry, 189(6), 484–493.

    Article  PubMed  Google Scholar 

  • Breslau, N., Kessler, R. C., Chilcoat, H. D., Schultz, L. R., Davis, G. C., & Andreski, P. (1998). Trauma and posttraumatic stress disorder in the community: The 1996 Detroit area survey of trauma. Archives of General Psychiatry, 55(7), 626–632.

    CAS  Article  PubMed  Google Scholar 

  • Breslau, N., Peterson, E. L., Kessler, R. C., & Schultz, L. R. (1999). Short screening scale for DSM-IV posttraumatic stress disorder. American Journal of Psychiatry, 156, 908–911.

    CAS  Article  PubMed  Google Scholar 

  • * Bruce, S. E., Weisberg, R. B., Dolan, R. T., Machan, J. T., Kessler, R. C., Manchester, G., & Keller, M. B. (2001). Trauma and posttraumatic stress disorder in primary care patients. Primary Care Companion to the Journal of Clinical Psychiatry, 3(5), 211–217.

    Article  PubMed  PubMed Central  Google Scholar 

  • Calhoun, P. S., Bosworth, H. B., Grambow, S. C., Dudley, T. K., & Beckham, J. C. (2002). Medical service utilization by veterans seeking help for posttraumatic stress disorder. American Journal of Psychiatry, 159(12), 2081–2086.

    Article  PubMed  Google Scholar 

  • * Carey, P. D., Stein, D. J., Zungu-Dirwayi, N., & Seedat, S. (2003). Trauma and posttraumatic stress disorder in an urban Xhosa primary care population: Prevalence, comorbidity, and service use patterns. The Journal of Nervous and Mental Disease, 191(4), 230–236.

    PubMed  Google Scholar 

  • Cigrang, J. A., Rauch, S. A., Avila, L. L., Bryan, C. J., Goodie, J. L., Hryshko-Mullen, A., & Peterson, A. L. (2011). Treatment of active-duty military with PTSD in primary care: Early findings. Psychological Services, 8(2), 104–113.

    Article  Google Scholar 

  • Connor, K. M., Kobak, K. A., Churchill, L. E., Katzelnick, D., & Davidson, J. R. (2001). Mini-SPIN: A brief screening assessment for generalized social anxiety disorder. Depression and Anxiety, 14(2), 137–140.

    CAS  Article  PubMed  Google Scholar 

  • Corso, K., Bryan, C., Morrow, C., Appolonio, K., Dodendorf, D., & Baker, M. (2009). Managing posttraumatic stress disorder symptoms in active-duty military personnel in primary care settings. Journal of Mental Health Counseling, 31(2), 119–136.

    Article  Google Scholar 

  • * Cwikel, J., Zilber, N., Feinson, M., & Lerner, Y. (2008). Prevalence and risk factors of threshold and sub-threshold psychiatric disorders in primary care. Social Psychiatry and Psychiatric Epidemiology, 43(3), 184–191.

    Article  PubMed  Google Scholar 

  • Davidson, J. R. T., Hughes, D., Blazer, D. G., & George, L. K. (1991). Post-traumatic stress disorder in the community: An epidemiological study. Psychological Medicine, 21, 712–721.

    Article  Google Scholar 

  • Derogatis, L. R. (1977). SCL-90R (revised version) manual I. Baltimore: John Hopkins University School of Medicine.

    Google Scholar 

  • Derogatis, L. R., Lipman, R. S., Rickels, K., Uhlenhuth, E. H., & Covi, L. (1974). The hopkins symptom checklist (HSCL): A self-report symptom inventory. Behavioral Science, 19(1), 1–15.

    CAS  Article  PubMed  Google Scholar 

  • Engel, C. C., Oxman, T., Yamamoto, C., Gould, D., Barry, S., Stewart, P., & Dietrich, A. J. (2008). RESPECT-Mil: Feasibility of a systems-level collaborative care approach to depression and post-traumatic stress disorder in military primary care. Military Medicine, 173(10), 935.

    Article  PubMed  Google Scholar 

  • * Escalona, R., Achilles, G., Waitzkin, H., & Yager, J. (2004). PTSD and somatization in women treated at a VA primary care clinic. Psychosomatics, 45(4), 291–296.

    Article  PubMed  Google Scholar 

  • Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., … Marks, J. S. (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: The adverse childhood experiences (ACE) study. American Journal of Preventive Medicine, 14(4), 245–258.

  • First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. M. (1997). Structured clinical interview diagnostic (SCID) for DSM-IV axis I disorders. New York: Biometrics Research, New York State Psychiatric Institute.

  • Geisser, M. E., Roth, R. S., Bachman, J. E., & Eckert, T. A. (1996). The relationship between symptoms of post-traumatic stress disorder and pain, affective disturbance and disability among patients with accident and non-accident related pain. Pain, 66(2–3), 207–214.

    CAS  Article  PubMed  Google Scholar 

  • * Gillock, K. L., Zayfert, C., Hegel, M. T., & Ferguson, R. J. (2005). Posttraumatic stress disorder in primary care: Prevalence and relationships with physical symptoms and medical utilization. General Hospital Psychiatry, 27(6), 392–399.

    Article  PubMed  Google Scholar 

  • * Glover, K., Olfson, M., Gameroff, M. J., & Neria, Y. (2010). Assault and mental disorders: A cross-sectional study of urban adult primary care patients. Psychiatric Services, 61(10), 1018–1023.

    Article  PubMed  PubMed Central  Google Scholar 

  • Goldberg, D. P. (1972). The detection of psychiatric illness by questionnaire. Maudsley Monograph No 21. London: Oxford University Press.

  • * Graves, R., Freedy, J. R., Aigbogun, N. U., Lawson, W. B., Mellman, T. A., & Alim, T. N. (2011). PTSD treatment of African American adults in primary care: The gap between current practice and evidence-based treatment guidelines. Journal of the National Medical Association, 103(7), 585–593.

    Article  PubMed  Google Scholar 

  • Greenberg, P. E., Sisitsky, T., Kessler, R. C., Finkelstein, S. N., Berndt, E. R., Davidson, J. R. T., & Fyer, A. J. (1999). The economic burden of anxiety disorders in the 1990s. Journal of Clinical Psychiatry, 60(7), 427–435.

    CAS  Article  PubMed  Google Scholar 

  • * Grubaugh, A. L., Magruder, K. M., Waldrop, A. E., Elhai, J. D., Knapp, R. G., & Frueh, B. C. (2005). Subthreshold PTSD in primary care: Prevalence, psychiatric disorders, healthcare use, and functional status. Journal of Nervous and Mental Disease, 193(10), 658–664.

    Article  PubMed  Google Scholar 

  • Hirschfeld, R. M., Williams, J. B., Spitzer, R. L., Calabrese, J. R., Flynn, L., Keck Jr., P. E., … Zajecka, J. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: The mood disorder questionnaire. American Journal of Psychiatry, 157(11), 1873–1875.

  • Hoge, C. W., Terhakopian, A., Castro, C. A., Messer, S. C., & Engel, C. C. (2007). Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. American Journal of Psychiatry, 164(1), 150.

    Article  PubMed  Google Scholar 

  • * Kartha, A., Brower, V., Saitz, R., Samet, J. H., Keane, T. M., & Liebschutz, J. (2008). The impact of trauma exposure and post-traumatic stress disorder on healthcare utilization among primary care patients. Medical Care, 46(4), 388–393.

    Article  PubMed  PubMed Central  Google Scholar 

  • Katon, W. J., & Walker, E. A. (1998). Medically unexplained symptoms in primary care. Journal of Clinical Psychiatry, 59(Suppl 20), 15–21.

    PubMed  Google Scholar 

  • Keane, T. M., & Kaloupek, D. G. (1997). Comorbid psychiatric disorders in PTSD. Annals of the New York Academy of Sciences, 821(1), 24–34.

    CAS  Article  PubMed  Google Scholar 

  • Kessler, R. C., Andrews, G., Mroczek, D., Ustun, B., & Wittchen, H. U. (1998). The world health organization composite international diagnostic interview short form (CIDI SF) (Vol. 7, pp. 171–185). Wiley Online Library.

  • Kessler, R. C., Demler, O., Frank, R. G., Olfson, M., Pincus, H. A., Walters, E. E., … Zaslavsky, A. M. (2005). Prevalence and treatment of mental disorders, 1990 to 2003. New England Journal of Medicine, 352(24), 2515–2523.

  • Kessler, R. C., Sonnega, A., Bromet, E., Hughes, M., & Nelson, C. B. (1995). Posttraumatic stress disorder in the national comorbidity survey. Archives of General Psychiatry, 52, 1048–1060.

    CAS  Article  PubMed  Google Scholar 

  • Kimerling, R. (2004). An investigation of sex differences in nonpsychiatric morbidity associated with posttraumatic stress disorder. Journal of the American Medical Womens Association, 59(1), 43–47.

    Google Scholar 

  • Kimerling, R., & Calhoun, K. S. (1994). Somatic symptoms, social support, and treatment seeking among sexual assault victims. Journal of Consulting and Clinical Psychology, 62(2), 333–340.

    CAS  Article  PubMed  Google Scholar 

  • * Kimerling, R., Ouimette, P., Prins, A., Nisco, P., Lawler, C., Cronkite, R., & Moos, R. H. (2006). BRIEF REPORT: Utility of a short screening scale for DSM-IV PTSD in primary care. Journal of General Internal Medicine, 21(1), 65–67.

    Article  PubMed  PubMed Central  Google Scholar 

  • Kimerling, R., Serpi, T., Weathers, F., Kilbourne, A. M., Kang, H., Collins, J. F., … Magruder, K. (2014). Diagnostic accuracy of the composite international diagnostic interview (CIDI 3.0) PTSD module among female Vietnam era veterans. Journal of Traumatic Stress, 27(2), 160–167.

  • Koss, M. P., Koss, P. G., & Woodruff, W. J. (1991). Deleterious effects of criminal victimization on women’s health and medical utilization. Archives of Internal Medicine, 151(2), 342–347.

    CAS  Article  PubMed  Google Scholar 

  • * Kroenke, K., Spitzer, R. L., Williams, J. B., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: Prevalence, impairment, comorbidity, and detection. Annals of Internal Medicine, 146(5), 317–325.

    Article  PubMed  Google Scholar 

  • Lange, J. T., Lange, C. L., & Cabaltica, R. B. (2000). Primary care treatment of post-traumatic stress disorder. American Family Physician, 62(5), 1035–1040.

    CAS  PubMed  Google Scholar 

  • Lecrubier, Y. (2004). Posttraumatic stress disorder in primary care: a hidden diagnosis. Journal of Clinical Psychiatry, 65(Suppl 1), 49–54.

    PubMed  Google Scholar 

  • Lefevre, F., Reifler, D., Lee, P., Sbenghe, M., Nwadiaro, N., & Verma, S. (1999). Screening for undetected mental disorders in high utilizers of primary care services. Journal of General Internal Medicine, 14(7), 425–431.

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  • Leon, A. C., Olfson, M., Portera, L., Farber, L., & Sheehan, D. V. (1997). Assessing psychiatric impairment in primary care with the Sheehan disability scale. International Journal of Psychiatry in Medicine, 27(2), 93–105.

    CAS  Article  PubMed  Google Scholar 

  • Leon, A. C., Shear, M. K., Portera, L., & Klerman, G. L. (1992). Assessing impairment in patients with panic disorder: The Sheehan disability scale. Social Psychiatry and Psychiatric Epidemiology, 27(2), 78–82.

    CAS  Article  PubMed  Google Scholar 

  • * Liebschutz, J., Saitz, R., Brower, V., Keane, T. M., Lloyd-Travaglini, C., Averbuch, T., & Samet, J. H. (2007). PTSD in urban primary care: high prevalence and low physician recognition. Journal of General Internal Medicine, 22(6), 719–726.

    Article  PubMed  PubMed Central  Google Scholar 

  • * Löwe, B., Kroenke, K., Spitzer, R. L., Williams, J., Mussell, M., Rose, M., & Spitzer, C. (2011). Trauma exposure and posttraumatic stress disorder in primary care patients: Cross-sectional criterion standard study. Journal of Clinical Psychiatry, 72(3), 304–312.

    Article  PubMed  Google Scholar 

  • * Magruder, K. M., Frueh, B. C., Knapp, R. G., Davis, L., Hamner, M. B., Martin, R. H., & Arana, G. W. (2005). Prevalence of posttraumatic stress disorder in veterans affairs primary care clinics. General Hospital Psychiatry, 27(3), 169–179.

    Article  PubMed  Google Scholar 

  • Maoz, B., Rabinowitz, S., Mark, M., Antonovsky, H., Ribak, J., & Kotler, M. (1991). Physicians’ detection of psychological distress in primary-care clinics. Psychological Reports, 69(3 Pt 1), 999–1003.

    CAS  Article  PubMed  Google Scholar 

  • Markowitz, J. S., Weissman, M. M., Ouellette, R., Lish, J. D., & Klerman, G. L. (1989). Quality of life in panic disorder. Archives of General Psychiatry, 46(11), 984–992.

    CAS  Article  PubMed  Google Scholar 

  • * McDevitt-Murphy, M. E., Williams, J. L., Bracken, K. L., Fields, J. A., Monahan, C. J., & Murphy, J. G. (2010). PTSD symptoms, hazardous drinking, and health functioning among US OEF and OIF veterans presenting to primary care. Journal of Traumatic Stress, 23(1), 108–111.

    PubMed  PubMed Central  Google Scholar 

  • McFarlane, A., Atchison, M., Rafalowicz, E., & Papay, P. (1994). Physical symptoms in post-traumatic stress disorder. Journal of Psychosomatic Research, 38(7), 715–726.

    CAS  Article  PubMed  Google Scholar 

  • * McQuaid, J. R., Pedrelli, P., McCahill, M. E., & Stein, M. B. (2001). Reported trauma, post-traumatic stress disorder and major depression among primary care patients. Psychological Medicine, 31(7), 1249–1257.

    CAS  Article  PubMed  Google Scholar 

  • Meredith, L. S., Eisenman, D. P., Green, B. L., Basurto-Dávila, R., Cassells, A., & Tobin, J. (2009). System factors affect the recognition and management of post-traumatic stress disorder by primary care clinicians. Medical Care, 47(6), 686–694.

    Article  PubMed  PubMed Central  Google Scholar 

  • Miller, J. L. (2000). Posttraumatic stress disorder in primary care practice. Journal of the American Academy of Nurse Practitioners, 12, 475–482.

    CAS  Article  PubMed  Google Scholar 

  • National Collaborating Centre for Mental Health UK. (2005). Post-traumatic stress disorder: The management of PTSD in adults and children in primary and secondary care. London: Gaskell.

    Google Scholar 

  • * Neria, Y., Gross, R., Olfson, M., Gameroff, M. J., Wickramaratne, P., Das, A., & Marshall, R. D. (2006). Posttraumatic stress disorder in primary care one year after the 9/11 attacks. General Hospital Psychiatry, 28(3), 213–222.

    Article  PubMed  PubMed Central  Google Scholar 

  • * Neria, Y., Olfson, M., Gameroff, M. J., DiGrande, L., Wickramaratne, P., Gross, R., & Weissman, M. M. (2010). Long-term course of probable PTSD after the 9/11 attacks: A study in urban primary care. Journal of Traumatic Stress, 23, 474–482.

    Article  PubMed  PubMed Central  Google Scholar 

  • Norquist, G. S., & Regier, D. A. (1996). The epidemiology of psychiatric disorders and the de facto mental health care system. Annual Review of Medicine, 47, 473–479.

    CAS  Article  PubMed  Google Scholar 

  • * Olfson, M., Fireman, B., Weissman, M. M., Leon, A. C., Sheehan, D. V., Kathol, R. G., & Farber, L. (1997). Mental disorders and disability among patients in a primary care group practice. American Journal of Psychiatry, 154(12), 1734–1740.

    CAS  Article  PubMed  Google Scholar 

  • Ozer, E. J., Best, S. R., Lipsey, T. L., & Weiss, D. S. (2008). Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. Paper presented at the Annual Meeting of the International Society for Traumatic Stress Studies, 14th, Nov, 1998, Washington, DC, US. This article is based on a paper presented at the aforementioned meeting.

  • Possemato, K. (2011). The current state of intervention research for posttraumatic stress disorder within the primary care setting. Journal of Clinical Psychology in Medical Settings, 18(3), 268–280.

    Article  PubMed  Google Scholar 

  • * Prins, A., Ouimette, P., Kimerling, R., Camerond, R. P., Hugelshofer, D. S., Shaw-Hegwer, J., & Sheikh, J. I. (2004). The primary care PTSD screen (PC-PTSD): Development and operating characteristics. International Journal of Psychiatry in Clinical Practice, 9(1), 9–14.

    Google Scholar 

  • Purves, A. M., Penny, K. I., Munro, C., Smith, B. H., Grimshaw, J., Wilson, B., & Chambers, W. A. (1998). Defining chronic pain for epidemiological research—Assessing a subjective definition. Pain Clinic, 10(3), 139–147.

    Google Scholar 

  • Radloff, L. S. (1977). The CES-D scale: A self-report depression scale for research in the general. Applied Psychological Measurement, 1(3), 385–401.

    Article  Google Scholar 

  • Resnick, H. S. (1996). Psychometric review of trauma assessment for adults (TAA). In B. H. Stamm (Ed.), Measurement of stress, trauma, and adaption (pp. 362–365).

  • Resnick, H. S., Best, C. L., Kilpatrick, D. G., Freedy, J. S., & Falsetti, S. A. (1993). Trauma assessment for adults. Charleston, SC: Crime Victims Research and Treatment Center, Department of Psychiatry, Medical University of South Carolina.

  • Samson, A. Y., Bensen, S., Beck, A., Price, D., & Nimmer, C. (1999). Posttraumatic stress disorder in primary care. The Journal of Family Practice, 48, 222–227.

    CAS  PubMed  Google Scholar 

  • Sayer, N. A., Friedemann-Sanchez, G., Spoont, M., Murdoch, M., Parker, L. E., Chiros, C., & Rosenheck, R. (2009). A qualitative study of determinants of PTSD treatment initiation in veterans. Psychiatry: Interpersonal and Biological Processes, 72(3), 238–255.

  • Schnurr, P. P., Friedman, M. J., Oxman, T. E., Dietrich, A. J., Smith, M. W., Shiner, B., & Thurston, V. (2013). RESPECT-PTSD: Re-engineering systems for the primary care treatment of PTSD, a randomized controlled trial. Journal of General Internal Medicine, 28(1), 32–40.

    Article  PubMed  PubMed Central  Google Scholar 

  • Schnurr, P. P., Friedman, M. J., Sengupta, A., Jankowski, M., & Holmes, T. (2000). PTSD and utilization of medical treatment services among male Vietnam veterans. Journal of Nervous and Mental Disease, 188(8), 496–504.

    CAS  Article  PubMed  Google Scholar 

  • Schnurr, P. P., & Green, B. L. (2004). Trauma and health: Physical health consequences of exposure to extreme stress. Washington, DC: American Psychological Association.

  • Seal, K. H. (2013). Online PTSD diagnosis and treatment training for primary care physicians. DTIC Document.

  • Sheehan, D., Lecrubier, Y., Janavs, J., Knapp, E., Weiller, E., Sheehan, M., … Teherani, M. (1992). Mini-international neuropsychiatric interview. Clinician-Rated.

  • Solomon, S. D., & Davidson, J. R. T. (1997). Trauma: Prevalence, impairment, service use, and cost. Journal of Clinical Psychiatry, 58(Suppl9), 5–11.

    PubMed  Google Scholar 

  • Solomon, Z., Weisenberg, M., Schwarzwald, J., & Mikulincer, M. (1987). Posttraumatic stress disorder among frontline soldiers with combat stress reaction: The 1982 Israeli experience. American Journal of Psychiatry, 144(4), 448–454.

    CAS  Article  PubMed  Google Scholar 

  • Sonis, J. (2013). PTSD in primary care—An update on evidence-based management. Current Psychiatry Reports, 15(7), 1–9.

    Article  Google Scholar 

  • Spitzer, R. L., Kroenke, K., & Williams, J. B. W. (1999). Validation and utility of a self-report version of PRIME-MD. JAMA, 282(18), 1737–1744.

    CAS  Article  PubMed  Google Scholar 

  • Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Archives of Internal Medicine, 166(10), 1092–1097.

    Article  PubMed  Google Scholar 

  • Spitzer, R. L., Williams, J. B., Kroenke, K., Linzer, M., Verloin deGruy, F., Hahn, S. R., … Johnson, J. G. (1994). Utility of a new procedure for diagnosing mental disorders in primary care: The PRIME-MD 1000 study. JAMA, 272(22), 1749–1756.

  • Spitzer, R. L., Williams, J. B. W., & Gibbon, M. (1992). The structured clinical interview for DSM-III-R (SCID) I: history, rationale, and description. Archives of General Psychiatry, 49(8), 624–629.

    CAS  Article  PubMed  Google Scholar 

  • Spitzer, R. L., Yanovski, S., Wadden, T., Wing, R., Marcus, M. D., Stunkard, A., & Horne, R. L. (1993). Binge eating disorder: its further validation in a multisite study. International Journal of Eating Disorders, 13(2), 137–153.

    CAS  Article  PubMed  Google Scholar 

  • Spoont, M., Arbisi, P., Fu, S., Greer, N., Kehle-Forbes, S., Meis, L., & Rutks, I. (2013). Screening for post-traumatic stress disorder (PTSD) in primary care: A systematic review. Washington DC: Department of Veteran Affair.

    Google Scholar 

  • Spoont, M. R., Williams, J. W., Kehle-Forbes, S., Nieuwsma, J. A., Mann-Wrobel, M. C., & Gross, R. (2015). Does this patient have posttraumatic stress disorder? Rational clinical examination systematic review. JAMA, 314(5), 501–510.

    CAS  Article  PubMed  Google Scholar 

  • Stein, M. B. (2003). Attending to anxiety disorders in primary care. Journal of Clinical Psychiatry, 64(15), 35–39.

    PubMed  Google Scholar 

  • * Stein, M. B., McQuaid, J. R., Pedrelli, P., Lenox, R., & McCahill, M. E. (2000). Posttraumatic stress disorder in the primary care medical setting. General Hospital Psychiatry, 22(4), 261–269.

    CAS  Article  PubMed  Google Scholar 

  • Stewart, A. L., Hays, R. D., & Ware, J. E. (1988). The MOS short-form general health survey: reliability and validity in a patient population. Medical Care, 26, 724–735.

  • * Taubman-Ben-Ari, O., Rabinowitz, J., Feldman, D., & Vaturi, R. (2001). Post-traumatic stress disorder in primary-care settings: Prevalence and physicians’ detection. Psychological Medicine, 31(3), 555–560.

    CAS  Article  PubMed  Google Scholar 

  • Trusz, S. G., Wagner, A. W., Russo, J., Love, J., & Zatzick, D. F. (2011). Assessing barriers to care and readiness for cognitive behavioral therapy in early acute care PTSD interventions. Psychiatry: Interpersonal & Biological Processes, 74(3), 207–223.

  • Wahler, H. J. (1983). Wahler physical symptoms inventory manual (p. 56). Los Angeles: Western Psychological Services.

    Google Scholar 

  • Ware, J. E, Jr., Kosinski, M., & Keller, S. D. (1996). A 12-item short-form health survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.

    Article  PubMed  Google Scholar 

  • Ware, J. E., & Sherbourne, C. D. (1992). The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Medical Care, 30(6), 473–483.

    Article  PubMed  Google Scholar 

  • Ware, J. E., Snow, K. K., Kosinski, M., & Gandek, B. (1993). SF-36 health survey: manual and interpretation guide. The Health Institute, New England Medical Center.

  • Weathers, F., Huska, J., & Keane, T. (1991). The PTSD checklist military version (PCL-M). Boston, MA: National Center for PTSD.

    Google Scholar 

  • Weathers, F. W., Litz, B. T., Huska, J. A., & Keane, T. M. (1994). The PTSD checklist-civilian version (PCL-C). Boston: MA National Center for PTSD.

    Google Scholar 

  • * Weissman, M. M., Neria, Y., Das, A., Feder, A., Blanco, C., Lantigua, R., … Olfson, M. (2005). Gender differences in posttraumatic stress disorder among primary care patients after the World Trade Center attack of September 11, 2001. Gender Medicine, 2(2), 76–87.

  • Weissman, M. M., Prusoff, B. A., Thompson, W. D., Harding, P. S., & Myers, J. K. (1978). Social adjustment by self-report in a community sample and in psychiatric outpatients. The Journal of Nervous and Mental Disease, 166(5), 317–326.

    CAS  Article  PubMed  Google Scholar 

  • * Westphal, M., Olfson, M., Bravova, M., Gameroff, M. J., Gross, R., Wickramaratne, P., … Neria, Y. (2013). Borderline personality disorder, exposure to interpersonal trauma, and psychiatric comorbidity in urban primary care patients. Psychiatry, 76(4), 365–380.

  • * Westphal, M., Olfson, M., Gameroff, M. J., Wickramaratne, P., Pilowsky, D. J., Neugebauer, R., … Neria, Y. (2011). Functional impairment in adults with past posttraumatic stress disorder: Findings from primary care. Depression and Anxiety, 28(8), 686–695.

  • WHO. (1990). Composite international diagnostic interview (CIDI). Geneva: World Health Organization.

    Google Scholar 

  • WHO. (1997). Composite international diagnostic interview (CIDI): Version 2.1. Geneva: World Health Organization.

  • Williams, J. W., Gerrity, M., Holsinger, T., Dobscha, S., Gaynes, B., & Dietrich, A. (2007). Systematic review of multifaceted interventions to improve depression care. General Hospital Psychiatry, 29(2), 91–116.

    Article  PubMed  Google Scholar 

  • Yehuda, R. (2002). Post-traumatic stress disorder. New England Journal of Medicine, 346(2), 108–114.

    CAS  Article  PubMed  Google Scholar 

  • Zanarini, M. C., Vujanovic, A. A., Parachini, E. A., Boulanger, J. L., Frankenburg, F. R., & Hennen, J. (2003). A screening measure for BPD: The McLean screening instrument for borderline personality disorder (MSI-BPD). Journal of Personality Disorders, 17(6), 568–573.

    Article  PubMed  Google Scholar 

  • Zimmerman, M., & Mattia, J. I. (1999). Psychiatric diagnosis in clinical practice: Is comorbidity being missed? Comprehensive Psychiatry, 40(3), 182–191.

    CAS  Article  PubMed  Google Scholar 

Download references

Disclosure of Interest

I, the undersigned author, certify that I have no commercial associations (e.g., consultancies, stock ownership, equity interests, patent-licensing arrangements, etc.) that might pose a conflict of interest in connection with the submitted article, except as disclosed on a separate attachment. All funding sources supporting the work and all institutional or corporate affiliations are stated in the acknowledgment section. I also certify that the submitted article contains no descriptions of individuals, family history, and/or photographs in which a person’s identity can be recognized, except as disclosed on an attached signed release.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Talya Greene.

Ethics declarations

Conflict of Interest

Talya Greene, Yuval Neria, and Raz Gross declare that they have no conflicts of interest.

Human and Animal Rights and Informed Consent

All procedures followed were in accordance with ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. Informed consent was obtained from all patients for being included in the study. No animal or human studies were carried out by the authors for this article.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Greene, T., Neria, Y. & Gross, R. Prevalence, Detection and Correlates of PTSD in the Primary Care Setting: A Systematic Review. J Clin Psychol Med Settings 23, 160–180 (2016). https://doi.org/10.1007/s10880-016-9449-8

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10880-016-9449-8

Keywords

  • PTSD
  • Family Practice
  • Prevalence
  • Detection
  • Comorbid Mental Health
  • Healthcare Utilization; Primary Care