Posttraumatic stress disorder in primary care one year after the 9/11 attacks

Department of Epidemiology, Columbia University, New York, New York, United States
General Hospital Psychiatry (Impact Factor: 2.61). 05/2006; 28(3):213-22. DOI: 10.1016/j.genhosppsych.2006.02.002
Source: PubMed


To screen for posttraumatic stress disorder (PTSD) in primary care patients 7-16 months after 9/11 attacks and to examine its comorbidity, clinical presentation and relationships with mental health treatment and service utilization.
A systematic sample (n=930) of adult primary care patients who were seeking primary care at an urban general medicine clinic were interviewed using the PTSD Checklist: the Primary Care Evaluation of Mental Disorders (PRIME-MD) Patient Health Questionnaire and the Medical Outcome Study 12-Item Short Form Health Survey (SF-12). Health care utilization data were obtained by a cross linkage to the administrative computerized database.
Prevalence estimates of current 9/11-related probable PTSD ranged from 4.7% (based on a cutoff PCL-C score of 50 and over) to 10.2% (based on the DSM-IV criteria). A comorbid mental disorder was more common among patients with PTSD than patients without PTSD (80% vs. 30%). Patients with PTSD were more functionally impaired and reported increased use of mental health medication as compared to patients without PTSD (70% vs. 18%). Among patients with PTSD there was no increase in hospital and emergency room (ER) admissions or outpatient care during the first year after the attacks.
In an urban general medicine setting, 1 year after 9/11, the frequency of probable PTSD appears to be common and clinically significant. These results suggest an unmet need for mental health care in this clinical population and are especially important in view of available treatments for PTSD.

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    • "and its prevalence is high among patients seen in primary care settings, such as Federally Qualified Health Centers (FQHCs), with rates ranging from 9% to 23% [3] [4] [5] [6] [7] [8] [9]. PTSD often co-occurs with depression, substance abuse, other psychological problems [10] [11] [12] [13], and medical conditions [14] [15] [16] [17] [18] [19] [20], and is associated with poor physical health functioning [21] and poor quality of life [14,18,21–23]. "
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    ABSTRACT: Posttraumatic stress disorder (PTSD) is a common problem in primary care. Although effective treatments are available, little is known about whether such treatments are effective within the context of Federally Qualified Health Centers (FQHCs) that serve as national "safety nets" for providing primary care for low income and underinsured patients. The Violence and Stress Assessment (ViStA) study is the first randomized controlled trial (RCT) to test the impact of a care management intervention for treating PTSD in FQHCs. To develop a PTSD management intervention appropriate for lower resource FQHCs and the predominantly Latino patients they serve, formative work was conducted through a collaborative effort between researchers and an FQHC practice-based research network. This article describes how FQHC stakeholders were convened to review, assess, and prioritize evidence-based strategies for addressing patient, clinician, and system-level barriers to care. This multi-component care management intervention incorporates diagnosis with feedback, patient education and activation; navigation and linkage to community resources; clinician education and medication guidance; and structured cross-disciplinary communication and continuity of care, all facilitated by care managers with FQHC experience. We also describe the evaluation design of this five-year RCT and the characteristics of the 404 English or Spanish speaking patients enrolled in the study and randomized to either the intervention or to usual care. Patients are assessed at baseline, six months, and 12months to examine intervention effectiveness on PTSD, other mental health symptoms, health-related quality-of-life, health care service use; and perceived barriers to care and satisfaction with care.
    Contemporary clinical trials 04/2014; 38(2). DOI:10.1016/j.cct.2014.04.005 · 1.94 Impact Factor
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    • "posttraumatic stress disorder (PTSD) diagnosis, depressive and anxiety disorders at an epidemiological level and their predictors (Galea et al., 2002; Schuster et al., 2001; Silver, Holman, McIntosh, Poulin, & Gil-Rivas, 2002). The predictors include: Socio-demographic and individual factors, such as female gender (Schlenger et al., 2002), low socio-economic status (Kumar et al., 2007), age (Telles, Sing, & Joshi, 2009), migrant background (Rivière et al., 2008; Rubin, Brewin, Greenberg, Simpson, & Wessely, 2005) and a psychiatric diagnosis of the survivor before the event (Neria et al., 2006). Also, culture is believed to have an influence, on emotional and cognitive processing both during and after the disaster (Freitag, Grimm, & Schmidt, 2010; Steger, Frazier, & Zacchanini, 2008). "
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    European Journal of Psychotraumatology 05/2012; 3:7382-7390. DOI:10.3402/ejpt.v3i0.7382 · 2.40 Impact Factor
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    • ", and selected a cutoff score of 50 to determine a diagnosis of probable PTSD, as used in a number of 9/11 studies (e.g., Neria et al., 2006; Schlenger et al., 2002). MDD was assessed with the Patient Health Questionnaire–9 (Spitzer et al., 1994), a nineitem screening instrument based on the diagnostic criteria of DSM–IV. "
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    ABSTRACT: This cross-sectional retrospective study examined self-perceived changes in importance of religious beliefs (RBs) following the attacks of September 11, 2001, and assessed their associations with complicated grief (CG), posttraumatic stress disorder (PTSD), and major depressive disorder (MDD). Data were collected from 608 participants 2.5 to 3.5 years after the attacks. Whereas the majority of the participants reported no change in importance of RBs, 11% reported increased importance and 10% reported decreased importance of RBs after 9/11. Decreased, but no increased, importance of RBs was found to be associated with severity of loss and trauma (i.e., loss of a child, direct exposure to the attacks, watching the attacks unfold live on TV). In addition, decreased RBs after 9/11, as compared with no change, was significantly associated with all mental health outcomes, namely CG, PTSD, and MDD. Theoretical and clinical implications are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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