Trauma exposure and posttraumatic stress disorder in primary care patients: Cross-sectional criterion standard study

Bernd Löwe, Kurt Kroenke, Robert L. Spitzer, Janet B W Williams, Monika Mussell, Matthias Rose, Katja Wingenfeld, Nina Sauer, Carsten Spitzer

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Objective: Posttraumatic stress disorder (PTSD) is one of the most common but least recognized anxiety disorders in primary care. This study aimed to describe the association of PTSD and trauma exposure with somatic symptoms, psychiatric comorbidity, functional impairment, and the actual treatment of PTSD in primary care. Method: This cross-sectional criterion standard study included 965 consecutive primary care patients from 15 civilian primary care clinics in the United States. The Structured Clinical Interview for DSM-IV (SCID) was used to establish diagnosis of PTSD and other anxiety disorders. Somatic symptoms, depression, and anxiety were measured with the Patient Health Questionnaire (PHQ), and functional impairment was measured with the Medical Outcomes Study Short-Form General Health Survey (SF-20). The study was conducted from November 2004 to June 2005. Results: PTSD was diagnosed in 83 patients (8.6%; 95% CI, 7.0%-10.5%), and trauma exposure without fulfilling DSM-IV criteria for PTSD was reported by 169 patients (17.5%; 15.2%-20.0%). With odds ratios ranging between 2.1 (95% CI, 1.2-3.6) for headache and 9.7 (3.8-24.8) for chest pain, PTSD patients had markedly elevated somatic symptom rates compared to the reference group of patients with no PTSD or trauma exposure. PTSD was significantly associated with elevated rates of psychiatric comorbidity, pain, and impaired functioning. Patients reporting trauma but no PTSD had rates of somatic symptoms, psychiatric comorbidity, and functional impairment that were intermediate between PTSD and reference group patients. Adjusting for depression substantially attenuated the association of PTSD and trauma with somatic symptoms, suggesting that depression may be an important mediator of the PTSD-somatic symptoms relationship. Conclusions: The high frequency of PTSD in primary care and its association with psychiatric comorbidity and functional impairment underscore the need to better detect and treat PTSD in primary care. Recognizing the frequent somatic presentation of PTSD and appreciating the salience of comorbid depression may be especially important in optimizing PTSD care.

Original languageEnglish
Pages (from-to)304-312
Number of pages9
JournalJournal of Clinical Psychiatry
Volume72
Issue number3
DOIs
StatePublished - Mar 2011

Fingerprint

Post-Traumatic Stress Disorders
Primary Health Care
Wounds and Injuries
Psychiatry
Comorbidity
Depression
Anxiety Disorders
Diagnostic and Statistical Manual of Mental Disorders
Health Surveys
Chest Pain
Headache

ASJC Scopus subject areas

  • Psychiatry and Mental health

Cite this

Trauma exposure and posttraumatic stress disorder in primary care patients : Cross-sectional criterion standard study. / Löwe, Bernd; Kroenke, Kurt; Spitzer, Robert L.; Williams, Janet B W; Mussell, Monika; Rose, Matthias; Wingenfeld, Katja; Sauer, Nina; Spitzer, Carsten.

In: Journal of Clinical Psychiatry, Vol. 72, No. 3, 03.2011, p. 304-312.

Research output: Contribution to journalArticle

Löwe, B, Kroenke, K, Spitzer, RL, Williams, JBW, Mussell, M, Rose, M, Wingenfeld, K, Sauer, N & Spitzer, C 2011, 'Trauma exposure and posttraumatic stress disorder in primary care patients: Cross-sectional criterion standard study', Journal of Clinical Psychiatry, vol. 72, no. 3, pp. 304-312. https://doi.org/10.4088/JCP.09m05290blu
Löwe, Bernd ; Kroenke, Kurt ; Spitzer, Robert L. ; Williams, Janet B W ; Mussell, Monika ; Rose, Matthias ; Wingenfeld, Katja ; Sauer, Nina ; Spitzer, Carsten. / Trauma exposure and posttraumatic stress disorder in primary care patients : Cross-sectional criterion standard study. In: Journal of Clinical Psychiatry. 2011 ; Vol. 72, No. 3. pp. 304-312.
@article{0cc9b56bb28449e58cb2c60566576c26,
title = "Trauma exposure and posttraumatic stress disorder in primary care patients: Cross-sectional criterion standard study",
abstract = "Objective: Posttraumatic stress disorder (PTSD) is one of the most common but least recognized anxiety disorders in primary care. This study aimed to describe the association of PTSD and trauma exposure with somatic symptoms, psychiatric comorbidity, functional impairment, and the actual treatment of PTSD in primary care. Method: This cross-sectional criterion standard study included 965 consecutive primary care patients from 15 civilian primary care clinics in the United States. The Structured Clinical Interview for DSM-IV (SCID) was used to establish diagnosis of PTSD and other anxiety disorders. Somatic symptoms, depression, and anxiety were measured with the Patient Health Questionnaire (PHQ), and functional impairment was measured with the Medical Outcomes Study Short-Form General Health Survey (SF-20). The study was conducted from November 2004 to June 2005. Results: PTSD was diagnosed in 83 patients (8.6{\%}; 95{\%} CI, 7.0{\%}-10.5{\%}), and trauma exposure without fulfilling DSM-IV criteria for PTSD was reported by 169 patients (17.5{\%}; 15.2{\%}-20.0{\%}). With odds ratios ranging between 2.1 (95{\%} CI, 1.2-3.6) for headache and 9.7 (3.8-24.8) for chest pain, PTSD patients had markedly elevated somatic symptom rates compared to the reference group of patients with no PTSD or trauma exposure. PTSD was significantly associated with elevated rates of psychiatric comorbidity, pain, and impaired functioning. Patients reporting trauma but no PTSD had rates of somatic symptoms, psychiatric comorbidity, and functional impairment that were intermediate between PTSD and reference group patients. Adjusting for depression substantially attenuated the association of PTSD and trauma with somatic symptoms, suggesting that depression may be an important mediator of the PTSD-somatic symptoms relationship. Conclusions: The high frequency of PTSD in primary care and its association with psychiatric comorbidity and functional impairment underscore the need to better detect and treat PTSD in primary care. Recognizing the frequent somatic presentation of PTSD and appreciating the salience of comorbid depression may be especially important in optimizing PTSD care.",
author = "Bernd L{\"o}we and Kurt Kroenke and Spitzer, {Robert L.} and Williams, {Janet B W} and Monika Mussell and Matthias Rose and Katja Wingenfeld and Nina Sauer and Carsten Spitzer",
year = "2011",
month = "3",
doi = "10.4088/JCP.09m05290blu",
language = "English",
volume = "72",
pages = "304--312",
journal = "Journal of Clinical Psychiatry",
issn = "0160-6689",
publisher = "Physicians Postgraduate Press Inc.",
number = "3",

}

TY - JOUR

T1 - Trauma exposure and posttraumatic stress disorder in primary care patients

T2 - Cross-sectional criterion standard study

AU - Löwe, Bernd

AU - Kroenke, Kurt

AU - Spitzer, Robert L.

AU - Williams, Janet B W

AU - Mussell, Monika

AU - Rose, Matthias

AU - Wingenfeld, Katja

AU - Sauer, Nina

AU - Spitzer, Carsten

PY - 2011/3

Y1 - 2011/3

N2 - Objective: Posttraumatic stress disorder (PTSD) is one of the most common but least recognized anxiety disorders in primary care. This study aimed to describe the association of PTSD and trauma exposure with somatic symptoms, psychiatric comorbidity, functional impairment, and the actual treatment of PTSD in primary care. Method: This cross-sectional criterion standard study included 965 consecutive primary care patients from 15 civilian primary care clinics in the United States. The Structured Clinical Interview for DSM-IV (SCID) was used to establish diagnosis of PTSD and other anxiety disorders. Somatic symptoms, depression, and anxiety were measured with the Patient Health Questionnaire (PHQ), and functional impairment was measured with the Medical Outcomes Study Short-Form General Health Survey (SF-20). The study was conducted from November 2004 to June 2005. Results: PTSD was diagnosed in 83 patients (8.6%; 95% CI, 7.0%-10.5%), and trauma exposure without fulfilling DSM-IV criteria for PTSD was reported by 169 patients (17.5%; 15.2%-20.0%). With odds ratios ranging between 2.1 (95% CI, 1.2-3.6) for headache and 9.7 (3.8-24.8) for chest pain, PTSD patients had markedly elevated somatic symptom rates compared to the reference group of patients with no PTSD or trauma exposure. PTSD was significantly associated with elevated rates of psychiatric comorbidity, pain, and impaired functioning. Patients reporting trauma but no PTSD had rates of somatic symptoms, psychiatric comorbidity, and functional impairment that were intermediate between PTSD and reference group patients. Adjusting for depression substantially attenuated the association of PTSD and trauma with somatic symptoms, suggesting that depression may be an important mediator of the PTSD-somatic symptoms relationship. Conclusions: The high frequency of PTSD in primary care and its association with psychiatric comorbidity and functional impairment underscore the need to better detect and treat PTSD in primary care. Recognizing the frequent somatic presentation of PTSD and appreciating the salience of comorbid depression may be especially important in optimizing PTSD care.

AB - Objective: Posttraumatic stress disorder (PTSD) is one of the most common but least recognized anxiety disorders in primary care. This study aimed to describe the association of PTSD and trauma exposure with somatic symptoms, psychiatric comorbidity, functional impairment, and the actual treatment of PTSD in primary care. Method: This cross-sectional criterion standard study included 965 consecutive primary care patients from 15 civilian primary care clinics in the United States. The Structured Clinical Interview for DSM-IV (SCID) was used to establish diagnosis of PTSD and other anxiety disorders. Somatic symptoms, depression, and anxiety were measured with the Patient Health Questionnaire (PHQ), and functional impairment was measured with the Medical Outcomes Study Short-Form General Health Survey (SF-20). The study was conducted from November 2004 to June 2005. Results: PTSD was diagnosed in 83 patients (8.6%; 95% CI, 7.0%-10.5%), and trauma exposure without fulfilling DSM-IV criteria for PTSD was reported by 169 patients (17.5%; 15.2%-20.0%). With odds ratios ranging between 2.1 (95% CI, 1.2-3.6) for headache and 9.7 (3.8-24.8) for chest pain, PTSD patients had markedly elevated somatic symptom rates compared to the reference group of patients with no PTSD or trauma exposure. PTSD was significantly associated with elevated rates of psychiatric comorbidity, pain, and impaired functioning. Patients reporting trauma but no PTSD had rates of somatic symptoms, psychiatric comorbidity, and functional impairment that were intermediate between PTSD and reference group patients. Adjusting for depression substantially attenuated the association of PTSD and trauma with somatic symptoms, suggesting that depression may be an important mediator of the PTSD-somatic symptoms relationship. Conclusions: The high frequency of PTSD in primary care and its association with psychiatric comorbidity and functional impairment underscore the need to better detect and treat PTSD in primary care. Recognizing the frequent somatic presentation of PTSD and appreciating the salience of comorbid depression may be especially important in optimizing PTSD care.

UR - http://www.scopus.com/inward/record.url?scp=79953047308&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79953047308&partnerID=8YFLogxK

U2 - 10.4088/JCP.09m05290blu

DO - 10.4088/JCP.09m05290blu

M3 - Article

C2 - 20584519

AN - SCOPUS:79953047308

VL - 72

SP - 304

EP - 312

JO - Journal of Clinical Psychiatry

JF - Journal of Clinical Psychiatry

SN - 0160-6689

IS - 3

ER -