Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions
- 3.6k Downloads
Compared to those with depression alone, depressed patients with posttraumatic stress disorder (PTSD) experience more severe psychiatric symptomatology and factors that complicate treatment.
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).
Cross-sectional comparison of MDD patients versus MDD-PTSD+ patients.
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.
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.
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.
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 wordsdepression PTSD primary care clinical practice guidelines
The results reported here were from the Well-Being Among Veterans Enhancement Study (WAVES). WAVES received financial support from a grant (MHI 99-375: Chaney EF & Rubenstein LV, Co-PIs) from the Department of Veterans Affairs, Health Services Research and Development (HSR& D). An HSR& D Postdoctoral Traineeship (Campbell) provided additional support. The views expressed here are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Montana, the University of Washington, the University of California Los Angeles, or the RAND Health Program. Portions of this project were presented at the Department of Veterans Affairs HSR& D National Annual Meeting (2005, February), Baltimore, MD. The authors wish to acknowledge the contributions of Robert Petzel, MD; Kathy Henderson, MD; Scott Ober, MD; Maurilio Garcia-Maldinado, MD; Laura M. Bonner, PhD; Barbara Simon, MA; Carol Simons; and the WAVES research group.
Potential Financial Conflicts of Interest
Dr. Felkier reported receiving honoraria from Pfizer for speaking. Dr. Chaney reported receiving honorarium from The RAND Corporation for article review. The other authors reported no conflicts of interest.
- 7.Depression Guideline Panel. Clinical practice guideline number 5: depression in primary care, volumes 1 & 2. Rockville, MD: US Department of Health and Human Services, Agency for Health Care Policy and Research; 1993. AHCPR Publications 93-0550-51.Google Scholar
- 8.American Psychiatric Association Workgroup on Major Depressive Disorder. Practice guideline for the treatment of patients with major depressive disorder, 2nd edition. Washington: 2000; American Psychiatric Publishing, Inc. Website: http://www.psych.org/psych_pract/treatg/pg/Depression2e.book.cfm.
- 9.The Management of Major Depressive Disorder Working Group. Veterans Health Administration/Department of Defense clinical practice guideline for the management of major depressive disorder in adults. Version 2.0, February 2000, Washington DC.Google Scholar
- 27.Office of Quality and Performance. FY2005 VA Performance Measurement System Technical Manual. Washington, DC: Department of Veterans Affairs, Veterans Health Administration; 2005.Google Scholar
- 31.American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association; 1994:327.Google Scholar
- 48.Felker BL, Hedrick SC, Chaney EF, et al. Identifying depressed patients with a high risk of comorbid anxiety in primary care. Prim Care Companion J Clin Psychiat. 2003;5:104–10.Google Scholar
- 56.Kilbourne AM, Rollman BL, Schulberg HC, Herbeck Belnap B, Pincus HA. A clinical framework for depression treatment in primary care. Psychiatr Ann. 2002;32:545–53.Google Scholar