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. 2007 Jun;22(6):719-26.
doi: 10.1007/s11606-007-0161-0. Epub 2007 Mar 10.

PTSD in urban primary care: high prevalence and low physician recognition

Jane Liebschutz  1 , Richard Saitz, Victoria Brower, Terence M Keane, Christine Lloyd-Travaglini, Tali Averbuch, Jeffrey H Samet
Affiliations

PTSD in urban primary care: high prevalence and low physician recognition

Jane Liebschutz et al. J Gen Intern Med. 2007 Jun.

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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Figure 1
Figure 1
Study enrollment of patients in primary care. Consecutive sample: patients approached consecutively after registering for appointment. Oversampled group: consecutive sample criteria plus positive screen for irritable bowel symptoms, heavy drinking in past month, use of drugs in past month, or none of 6 select conditions (see text for details).
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