Although marked gains in the identification and treatment of depression have been made in many primary care (PC) settings, such is not the case with posttraumatic stress disorder (PTSD). PTSD may be difficult to detect, particularly in those veterans whose primary expression of the disorder involves avoidance of trauma-related experiences and social contact. Thus, although community epidemiologic studies of PTSD have documented lifetime prevalence of PTSD and associated characteristics, and studies of patients seeking treatment in the mental health sector document poor functioning and psychiatric comorbidity, there are few studies that jointly address the prevalence and burden of this disorder in primary care settings.
The overall objective of this study is to establish the clinical epidemiology of PTSD in VA primary care settings. Specifically, we aim to: 1) establish the prevalence of PTSD using DSM-IV diagnostic criteria in VA primary care settings; 2) describe associated socio-demographic characteristics, functioning status, and psychiatric comorbidities; 3) establish the burden of PTSD in terms of functioning status; and 4) determine rates of recognition and treatment by VA providers.
A prevalence survey was conducted of 885 consenting patients who were randomly selected from patients who had an outpatient visit in FY1999 in one of four VA medical centers. Study materials (sociodemographic information, PTSD screen, functioning status) were administered at a clinic visit. Arrangements were made for a follow-up telephone call to administer a lifetime trauma exposure index, a PTSD diagnostic instrument, and diagnostic assessments of psychiatric comorbidity. Electronic medical records were abstracted for notations concerning PTSD and other mental disorders and health services use.
The overall prevalence of current PTSD was 11.6 percent. In multivariable models, male gender, age 45-54, less than a four year college degree, war zone service, and unemployment were significantly related to presence of PTSD. Patients with PTSD had significantly worse functioning than those without PTSD in all areas measured. Furthermore, they were significantly more likely to have psychiatric comorbidities than those without PTSD. Additionally, only 46.5 percent of those with PTSD were recognized in their medical chart as having PTSD, and only 47.7 percent had used mental health specialty services in the previous 12 months.
Key findings from this study indicate the unmet need and patient burden in terms of undetected and untreated PTSD in VA primary care settings. The findings point to the need for improved case finding and treatments that would be acceptable to PTSD patients in primary care.
- Gros DF, Frueh BC, Magruder KM. Prevalence and features of panic disorder and comparison to posttraumatic stress disorder in VA primary care. General hospital psychiatry. 2011 Sep 1; 33(5):482-8.
- Magruder KM, Frueh BC, Hamner MB, =et al. PTSD Symptoms among Elderly Primary Care Patients. Paper presented at: New Clinical Drug Evaluation Unit Annual Meeting; 2002 Jun 1; Boca Raton, FL.
- Magruder KM, Frueh BC, Knapp RG, =et al. PTSD symptom severity in VA primary care patients. Paper presented at: VA HSR&D National Meeting; 2002 Feb 15; Washington, DC.