Prevalence of posttraumatic stress disorder in Veterans Affairs primary care clinics

Magruder, Kathryn M.; Frueh, B. Christopher; Knapp, Rebecca G.; Davis, Lori L.; Hamner, Mark B.; Martin, Renée; Gold, Paul B.; Arana, George W.

doi:10.1016/j.genhosppsych.2004.11.001

Cited by 244 publications

(218 citation statements)

References 46 publications

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“…However, since the study was not advertised as a PTSD study, recruitment may not have triggered PTSD-related responses such as avoidance, increasing the likelihood that these individuals were included in our sample. Further, because the rate of PTSD in our sample was comparable to rates of PTSD in other primary care samples, 3,39,40 we are cautiously optimistic that our results are generalizable. It is also possible that many of these participants had already been screened for PTSD and/or given a PTSD diagnosis prior to the study.…”

Section: Discussionsupporting

confidence: 52%

“…Veteran primary care samples is two to three times higher than PTSD prevalence in the general population (10-20 % versus 6-7 %) [1][2][3] and is similar to the prevalence of depression and generalized anxiety disorder in primary care settings (18.9 % and 14.8 %, respectively). 4,5 PTSD is consistently associated with increased health care utilization, medical morbidity, and health-compromising behaviors such as tobacco and alcohol abuse.…”

Section: T He Prevalence Of Posttraumatic Stress Disorder (Ptsd) Inmentioning

confidence: 72%

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The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample

et al. 2016

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BACKGROUND: Posttraumatic Stress Disorder (PTSD) is associated with increased health care utilization, medical morbidity, and tobacco and alcohol use. Consequently, screening for PTSD has become increasingly common in primary care clinics, especially in Veteran healthcare settings where trauma exposure among patients is common. OBJECTIVE: The objective of this study was to revise the Primary Care PTSD screen (PC-PTSD) to reflect the new Diagnostic and Statistical Manual of Mental Disorders (DSM-5) criteria for PTSD (PC-PTSD-5) and to examine both the diagnostic accuracy and the patient acceptability of the revised measure. DESIGN: We compared the PC-PTSD-5 results with those from a brief psychiatric interview for PTSD. Participants also rated screening preferences and acceptability of the PC-PTSD-5. PARTICIPANTS: A convenience sample of 398 Veterans participated in the study (response rate = 41 %). Most of the participants were male, in their 60s, and the majority identified as non-Hispanic White. MEASURES: The PC-PTSD-5 was used as the screening measure, a modified version of the PTSD module of the MINI-International Neuropsychiatric Interview was used to diagnose DSM-5 PTSD, and five brief survey items were used to assess acceptability and preferences. Patients found the screen acceptable and indicated a preference for administration by their primary care providers as opposed to by other providers or via self-report.

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Section: Discussionsupporting

confidence: 52%

Section: T He Prevalence Of Posttraumatic Stress Disorder (Ptsd) Inmentioning

confidence: 72%

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample

et al. 2016

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“…Formal diagnosis of PTSD and subsequent patient compliance with mental health management have been shown to be challenging [19]. Delayed diagnosis of PTSD may occur, since some patients who deny PTSD symptoms at initial screening by primary care and/or mental health providers may subsequently develop-or reach the point to endorse-these symptoms at a later date.…”

Section: Discussionmentioning

confidence: 99%

Management of Operation Iraqi Freedom and Operation Enduring Freedom veterans in a Veterans Health Administration chiropractic clinic: A case series

Lisi

2010

JRRD

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Abstract-Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) veterans commonly seek care for musculoskeletal complaints in Veterans Health Administration (VHA) facilities. Chiropractic services for musculoskeletal conditions have recently been introduced to VHA. No reports have been published on chiropractic care for OIF/OEF veterans. This study was designed to describe elements of the processes and outcomes of care for OIF/OEF veterans in a VHA chiropractic clinic. A retrospective review of consecutive cases consulted to one VHA chiropractic clinic was conducted. Thirty-one cases were identified. Consultations originated in primary care and specialty clinics that commonly manage musculoskeletal conditions. Military traumatic injury and posttraumatic stress disorder were common. Adverse effects of treatment were mild and transitory. In 19 cases (61%), a pain decrease above the threshold for minimally important change was reported. This article is the first description of health services delivered to OIF/OEF veterans in a VHA chiropractic clinic. Chiropractic management was safe in these cases, and results support the hypothesis that such management may be effective in certain OIF/OIF veterans. A better understanding of the characteristics of these particular patients and the processes of care received in VHA chiropractic clinics is needed to improve the clinical care of these veterans.

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“…Posttraumatic stress disorder (PTSD) affects over 10 % of adults, 1,2 up to 23 % in primary care settings, [3][4][5][6][7][8] and is associated with poor functioning, quality of life, [9][10][11][12] and financial costs to society. 13,14 Evidence-based treatments for PTSD include the use of selected serotonin reuptake inhibitors, especially sertraline but also fluoxetine, as the first line of pharmacological treatment, and evidence-based psychotherapies-exposure therapy, cognitive-behavioral therapy, and eye movement desensitization and reprocessing, along with patient education and adjunctive support services.…”

Section: Introductionmentioning

confidence: 99%

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

et al. 2016

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BACKGROUND:The effectiveness of collaborative care of mental health problems is clear for depression and growing but mixed for anxiety disorders, including posttraumatic stress disorder (PTSD). We know little about whether collaborative care can be effective in settings that serve low-income patients such as Federally Qualified Health Centers (FQHCs). OBJECTIVE: We compared the effectiveness of minimally enhanced usual care (MEU) versus collaborative care for PTSD with a care manager (PCM). DESIGN: This was a multi-site patient randomized controlled trial of PTSD care improvement over 1 year. PARTICIPANTS: We recruited and enrolled 404 patients in six FQHCs from June 2010 to October 2012. Patients were eligible if they had a primary care appointment, no obvious physical or cognitive obstacles to participation, were age 18-65 years, planned to continue care at the study location for 1 year, and met criteria for a past month diagnosis of PTSD. MAIN MEASURES: The main outcomes were PTSD diagnosis and symptom severity (range, 0-136) based on the Clinician-Administered PTSD Scale (CAPS). Secondary outcomes were medication and counseling for mental health problems, and health-related quality of life assessed at baseline, 6 months, and 12 months. KEY RESULTS: Patients in both conditions improved similarly over the 1-year evaluation period. At 12 months, PTSD diagnoses had an absolute decrease of 56.7 % for PCM patients and 60.6 % for MEU patients. PTSD symptoms decreased by 26.8 and 24.2 points, respectively. MEU and PCM patients also did not differ in process of care outcomes or health-related quality of life. Patients who actually engaged in care management had mental health care visits that were 14 % higher (p < 0.01) and mental health medication prescription rates that were 15.2 % higher (p < 0.01) than patients with no engagement. CONCLUSIONS:A minimally enhanced usual care intervention was similarly effective as collaborative care for patients in FQHCs.

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Prevalence of posttraumatic stress disorder in Veterans Affairs primary care clinics

Cited by 244 publications

References 46 publications

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample

The Primary Care PTSD Screen for DSM-5 (PC-PTSD-5): Development and Evaluation Within a Veteran Primary Care Sample

Management of Operation Iraqi Freedom and Operation Enduring Freedom veterans in a Veterans Health Administration chiropractic clinic: A case series

Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial

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