Long-term consequences of unrecognised PTSD in general outpatient psychiatry

Abstract

Background: Although a number of studies have shown a high prevalence of PTSD in the population, the diagnosis has hardly been recognised in general psychiatric practice. This raises two important questions. How widespread is extreme trauma and PTSD in the general psychiatry population? How does the long-term outcome among patients with PTSD differ from that of other psychiatric patients? The present study examines a psychiatry outpatient population in which none of the patients have received the primary diagnosis of PTSD.

Method: The 233 patients from four ethnic groups who, during a period of 1 year, visited a psychiatric outpatient clinic were asked, 3-4 years later, to complete a questionnaire that included the Self-rating Inventory for Posttraumatic Stress Disorder. Patients were divided into probable PTSD and non-PTSD. Subjects with probable PTSD were compared with non-PTSD, regarding outcome at follow-up.

Results: The response rate was 56%. Fifty-three patients fulfilled the instrument's diagnostic criteria for PTSD, whereas 62 did not. In the foreign-born groups PTSD patients constituted a majority (53-69 %) compared to 29% of Swedish-born patients. Although the clinic's original diagnoses and assessment of immediate treatment outcome did not differ between the two groups, PTSD patients did not report improvement to the same extent and had poorer self-rated health at follow-up (p < 0.001) as well as lower participation in working life.

Conclusions: A high proportion of PTSD and poorer outcome for PTSD patients compared to other psychiatric patients warrants a primary focus upon PTSD in outpatient psychiatry.