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

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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.

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Acknowledgments

This work was supported by a Generalist Physician Faculty Scholar Award from the Robert Wood Johnson Foundation, Princeton, New Jersey (RWJF #045452) and by a career development award from the National Institute on Drug Abuse, National Institutes of Health (K23 DA016665).

We thank Jessica Geier, Minga Claggett-Borne, Lauren Kelly, Michael Rosas, Mary Reyes, Pavan Sekhar, Jen Tran, Eric Holder, and Mary Benitta Schickel for their aid in data collection, and Joann Elmore (MD MPH), Roger Weiss (MD), and Larry Culpepper (MD) for their comments on research design and analysis.

Conflict of Interest Summary

None disclosed.

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Authors and Affiliations

  1. Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 91 East Concord St., Suite 200, Boston, MA, 02118, USA

    Jane Liebschutz MD, MPH, Richard Saitz MD, MPH, Tali Averbuch MPP & Jeffrey H. Samet MD, MA, MPH

  2. Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, MA, USA

    Jane Liebschutz MD, MPH & Jeffrey H. Samet MD, MA, MPH

  3. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA

    Richard Saitz MD, MPH

  4. Youth Alcohol Prevention Center, Boston University School of Public Health, Boston, MA, USA

    Richard Saitz MD, MPH

  5. Massachusetts Behavioral Health Partnership, Boston, MA, USA

    Victoria Brower MPH

  6. Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA

    Terence M. Keane PhD

  7. National Center for Post-Traumatic Stress Disorder, Boston, MA, USA

    Terence M. Keane PhD

  8. Veterans Affairs Boston Healthcare System, Boston, MA, USA

    Terence M. Keane PhD

  9. Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA

    Christine Lloyd-Travaglini MPH

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  1. Jane Liebschutz MD, MPH
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  2. Richard Saitz MD, MPH
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  3. Victoria Brower MPH
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  4. Terence M. Keane PhD
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  5. Christine Lloyd-Travaglini MPH
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  6. Tali Averbuch MPP
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  7. Jeffrey H. Samet MD, MA, MPH
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Corresponding author

Correspondence to Jane Liebschutz MD, MPH.

Appendix

Appendix

Table 4 Trauma exposure of participants recruited in primary care (consecutive sample)
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Liebschutz, J., Saitz, R., Brower, V. et al. PTSD in Urban Primary Care: High Prevalence and Low Physician Recognition. J GEN INTERN MED 22, 719–726 (2007). https://doi.org/10.1007/s11606-007-0161-0

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  • DOI: https://doi.org/10.1007/s11606-007-0161-0

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