Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions

Campbell, Duncan G.; Felker, Bradford; Liu, Chuan Fen; Yano, Elizabeth M.; Kirchner, JoAnn E.; Chan, Daniel C.N.; Rubenstein, Lisa V.; Chaney, Edmund F.

doi:10.1007/s11606-006-0101-4

Cited by 396 publications

(282 citation statements)

References 57 publications

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“…Forty percent of patients in our sample had a positive 4-item screen using a cut point of trauma plus 2 or more symptom items. These results are consistent with findings from a recent study using the 4-item Primary Care PTSD Screen (PC-PTSD) 9 where 36% of depressed primary care patients had PTSD 6 .…”

Section: Discussionsupporting

confidence: 91%

“…PTSD is especially common in veteran populations 3,4 ; for individuals who faced combat, estimates of lifetime prevalence of PTSD are as high as 20 to 30% 5 . Recent studies suggest that PTSD is commonly comorbid with depression and that patients with both disorders have a poorer prognosis, poorer response to depression treatment, and greater health care utilization 2,6,7 . Several brief screens for PTSD have recently been developed for use in primary care [8][9][10][11][12] .…”

Section: Introductionmentioning

confidence: 99%

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Screening for Posttraumatic Stress Disorder in VA Primary Care Patients with Depression Symptoms

2007

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BACKGROUND: Unrecognized posttraumatic stress disorder (PTSD) is common and may be an important factor in treatment-resistant depression. Brief screens for PTSD have not been evaluated for patients with depression. OBJECTIVE:The objective was to evaluate a 4-item screen for PTSD in patients with depression. DESIGN:Baseline data from a depression study were used to evaluate sensitivity, specificity, and likelihood ratios (LRs) using the PTSD checklist (PCL-17) as the reference standard.SUBJECTS: Subjects are 398 depressed patients seen in Veterans Affairs (VA) primary care clinics. MEASURES:The Patient Health Questionnaire (PHQ) for depression, PCL-17, and 4-item screen for PTSD were used. RESULTS:Patients had a mean PHQ score of 14.8 (SD 3.7). Using a conservative PCL-17 cut point "(>50)", the prevalence of PTSD was 37%. PCL-17 scores were strongly associated with PHQ scores (r = 0.59, P < 0.001). Among the 342 (86%) patients endorsing trauma, a score of 0 on the remaining 3 symptom items had a LR=0.21, score of 1 a LR=.62, score of 2 a LR=1.36, and score of 3 a LR=4.38.CONCLUSIONS: Most depressed VA primary care patients report a history of trauma, and one third may have comorbid PTSD. Our 4-item screen has useful LRs for scores of 0 and 3. Modifying item rating options may improve screening characteristics.

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Section: Discussionsupporting

confidence: 91%

Section: Introductionmentioning

confidence: 99%

Screening for Posttraumatic Stress Disorder in VA Primary Care Patients with Depression Symptoms

2007

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“…However, there is a need to address the comorbidity that is often found (O’Donnell, Creamer, & Pattison, 2004), particularly at the PHC level (Campbell et al, 2007; Herman et al, 2009). Subthreshold presentations of PTSD are associated with similar levels of psychosocial impairment to those found in people diagnosed with PTSD (Cukor, Wyka, Jayasinghe, & Difede, 2010; Zlotnick, Franklin, & Zimmerman, 2002).…”

Section: Discussionmentioning

confidence: 99%

Prevalence and correlates of probable post-traumatic stress disorder and common mental disorders in a population with a high prevalence of HIV in Zimbabwe

Verhey

Gibson

Brakarsh

et al. 2018

European Journal of Psychotraumatology

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Background: We investigated the prevalence of and factors associated with post-traumatic stress disorder (PTSD) and common mental disorders (CMDs), which include depression and anxiety disorders, in a setting with a prevalence of high human immunodeficiency virus (HIV) within a primary care clinic, using the PTSD Checklist for DSM-5 and the 14-item Shona Symptom Questionnaire, both locally validated screening tools.Methods: A cross-sectional survey was carried out with adult patients (n = 204) from the largest primary care clinic facility in Harare, Zimbabwe, in June 2016.Results: A total of 83 patients (40.7%) met the criteria for probable PTSD, of whom 57 (69.5%) had comorbid CMDs. Among people living with HIV, 42 (55.3%) had PTSD. Probable PTSD was associated with having experienced a negative life event in the past 6 months [adjusted odds ratio (OR) 3.73, 95% confidence interval (CI) 1.49–9.34] or screening positive for one or more CMD (adjusted OR 6.48, 95% CI 3.35–2.54).Conclusion: People living with HIV showed a high prevalence of PTSD and CMD comorbidity. PTSD screening should be considered when the CMD screen is positive and there is a history of negative life events.

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“…Individuals with PTSD continue to experience the psychological effects of trauma, including symptoms of re-experiencing, avoidance of similar stimuli, negative cognition and mood, and increased physical arousal, long after being removed to a safe environment (SOLOMON, AVIGALSNIR, & ROSENBERG, 2015). PTSD is also highly comorbid with other psychological effects or mental illnesses that can occur following trauma, including depression (Campbell et al, 2007;Ginzburg, Ein-Dor, & Solomon, 2010), substance abuse (Breslau, Davis, & Schultz, 2003;McFall, Mackay, & Donovan, 1992), guilt and shame (Hendin & Haas, 1991;Henning & Frueh, 1997), and suicidality (Jakupcak et al, 2009).…”

Section: What Is Ptsd?mentioning

confidence: 99%

Model-Based Policy Analysis to Mitigate Post-Traumatic Stress Disorder

Ghaffarzadegan

Larson

Fingerhut

et al. 2017

Public Administration and Information Technology

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Abstract:A wide range of modeling methods have been used to inform health policies. In this chapter, we describe the use of three models for understanding the complexities of post-traumatic stress disorder (PTSD), a major mental disorder. The models are: 1) a qualitative model describing the social and psychological complexities of PTSD treatment; 2) a system dynamics model of a population of PTSD patients in the military and the Department of Veterans Affairs (VA); and 3) a Monte Carlo simulation model of PTSD prevalence and clinical demand over time among the OEF/OIF population. These models have two characteristics in common. First, they take systems approaches. In all models, we set a large boundary and look at the whole system, incorporating both military personnel and veterans. Second, our models are informed by a wide range of qualitative and quantitative data. Model I is rooted in qualitative data, and models II and III are calibrated to several data sources. These models are used to analyze the effect of different policy alternatives, such as more screening, more resiliency, and better recruitment procedures, on PTSD prevalence. They also provide analysis of healthcare costs in the military and the VA for each policy. Overall, the developed models offer examples of modeling techniques that can utilize a wide range of data sources and inform policy makers in developing programs for mitigating PTSD.

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Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions

Cited by 396 publications

References 57 publications

Screening for Posttraumatic Stress Disorder in VA Primary Care Patients with Depression Symptoms

Screening for Posttraumatic Stress Disorder in VA Primary Care Patients with Depression Symptoms

Prevalence and correlates of probable post-traumatic stress disorder and common mental disorders in a population with a high prevalence of HIV in Zimbabwe

Model-Based Policy Analysis to Mitigate Post-Traumatic Stress Disorder

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