The Prevalence and Mental and Physical Health Correlates of Posttraumatic Stress Disorder Symptoms in Vulnerable and Underresourced Primary Care Patients Referred to a Behavioral Health Provider

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Abstract

Context:

The prevalence of trauma exposure among vulnerable, impoverished patients seeking primary care services is considerable. However, assessment of trauma-related symptoms is rare, even among behavioral health patients receiving primary care services within integrated health care centers.

Objective:

To determine the prevalence of clinically noteworthy trauma-related symptoms and their associations with other co-occurring mental and physical symptoms as well as self-reported resiliency.

Participants:

Primary care patients (n = 120) referred to behavioral health services (76.7% black/African American; 70.8% female).

Setting:

Federally qualified health center.

Main Outcome Measures:

Abbreviated Posttraumatic Stress Disorder Checklist-Civilian, 2-item version; Patient Health Questionnaire (PHQ)-15: physical health symptoms; PHQ-9: depression symptoms; Generalized Anxiety Disorder Scale, 7-item; Connor-Davidson Resilience Scale, 2-items.

Results:

Seventy-three percent (n = 88) of provider-referred behavioral health patients screened positive for potential posttraumatic stress disorder. Patients most likely to meet criteria for posttraumatic stress disorder reported significantly higher levels of stress, depression, anxiety, and suicide ideation as well as more severe headaches, chest pains, dizziness, and poorer health care.

Conclusions:

Results support the need for a trauma-informed integrated approach to health care within primary care settings, particularly those serving vulnerable populations. Integrated health care services foster an environment in which patient access to and satisfaction with services is maximized while overall well-being is enhanced. Adding resiliency-enhancing strategies to patients' integrated health care treatment plans might also be health-promoting. PTSD symptoms can be assessed as part of routine integrated practice via a 2-item screener. Information obtained from trauma screening provides the health care team with useful contextual information about patients' physical and behavioral health symptoms.

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