The high burden of exposure to chronic life adversities and trauma is quite prevalent, but assessment of this risk burden is uncommon in primary care settings. This calls for a brief, multiple dimensional mental health risk screening tool in primary care settings. We aimed to develop such a screening tool named the UCLA Life Adversities Screener (LADS). Using pooled data across four studies from the UCLA Center for Culture, Trauma and Mental Health Disparities, five domains of mental health risk including perceived discrimination, sexual abuse histories, family adversity, interpersonal violence, and trauma histories, were identified. Regression models for depression (Centers for Epidemiology Studies-Depression scale (CES-D)) and PTSD (Posttraumatic Diagnostic Scale (PDS)), controlling for demographic factors, were fitted to to develop a weighted continuous scale score for the UCLA LADS. Confirmatory factor analysis supported the five-domain structure, while Item Response Theory (IRT) endorsed the inclusion of each item. Receiver Operating Characteristic (ROC) analysis indicated that the score was predictive for classifying subjects as reaching clinical threshold criteria for either depression (Beck Depression Inventory-II (BDI-II) ≥14 or Patient Health Questionnaire-9 (PHQ-9) ≥ 10) or anxiety (Patient Health Questionnaire-13 (PHQ-13) ≥10). An optimal cut of 0.33 is suggested based on maximizing sensitivity and specificity of the LADS score, identifying patients at high risk for mental health problems. Given its predictive utility and ease of administration, the UCLA LADS could be useful as a screener to identify racial minority individuals in primary care settings who have a high trauma burden, needing more extensive evaluation.

To investigate predisaster mental illness as a risk factor of poor postdisaster mental health outcomes, veterans with (n = 249) and without (n = 250) preexisting mental illness residing in the Gulf Coast during Hurricane Katrina were surveyed after Katrina and screened for posttraumatic stress disorder (PTSD), depression, generalized anxiety disorder, and panic. Logistic regression examined the association between preexisting mental disorders and positive screens after the hurricane, adjusting for demographics and exposure to hurricane-related stressors. The odds of screening positive for any new mental disorder were 6.8 times greater for those with preexisting mental illness compared with those without preexisting mental illness. Among those with preexisting PTSD, the odds of screening positive for any new mental illness were 11.9 times greater; among those with schizophrenia, 9.1 times greater; and among those with affective disorders, 4.4 times greater. Persons with preexisting mental illnesses, particularly PTSD, should be considered a high-risk group for poor outcomes after a disaster.

BACKGROUND: Post-traumatic stress disorder (PTSD) is common in women veterans (WVs), and associated with significant co-morbidity. Effective treatment is available; however, PTSD is often unrecognized. OBJECTIVES: Identify PTSD prevalence and mental healthcare (MHC) use in a representative national WV sample. DESIGN AND PARTICIPANTS: Cross-sectional, population-based 2008-2009 national survey of 3,611 WVs, weighted to the population. MAIN MEASURES: We screened for PTSD using a validated instrument, and also assessed demographic characteristics, health characteristics, and MHC use in the prior 12 months. Among those screening positive, we conducted multivariate logistic regression to identify independent predictors of MHC use. KEY RESULTS: Overall, 13.0 % (95 % confidence interval [CI] 9.8-16.2) of WVs screened PTSD-positive. Veterans Health Administration (VA) healthcare was used by 31.1 % of PTSD-positives and 11.4 % of PTSD-negatives (p<0.001). Among those screening positive, 48.7 % (95 % CI 35.9-61.6) used MHC services (66.3 % of VA-users, 40.8 % of VA-nonusers; p<0.001). Having a diagnosis of depression (OR=8.6; 95 % CI 1.5-48.9) and VA healthcare use (OR=2.7; 95 % CI 1.1-7.0) predicted MHC use, whereas lacking a regular provider for health care (OR=0.2; 95 % CI 0.1-0.4) and household income below the federal poverty level (OR=0.2; 95 % CI 0.1-0.5) predicted nonuse. CONCLUSIONS: More than one in eight WVs screened positive for PTSD. Though a majority of VA-users received MHC, low income predicted nonuse. Only a minority of VA-nonusers received MHC. The majority of WVs use non-VA healthcare providers, who may be unaware of their veteran status and PTSD risk. VA outreach to educate VA-nonusers and their healthcare providers about WVs' PTSD risk and available evidencebased VA treatment options is one approach to extend the reach of VA MHC. Research to characterize barriers to VA MHC use for VA-nonusers and low income VAusers is warranted to better understand low service utilization, and to inform program development to engage more WVs in needed MHC.

Racial disparities in depression care may be ameliorated through collaborative care programs.