Prevalence of posttraumatic stress disorder in veterans affairs primary care clinics
Prevalence of posttraumatic stress disorder in veterans affairs primary care clinics
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DOI：
10.1016/j.genhosppsych.2004.11.001
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发表时间：
2005-05-01
影响因子：
7
通讯作者：
Arana, GW
中科院分区：
文献类型：
--
作者：
Magruder, KM;Frueh, BC;Arana, GW
尽管创伤后应激障碍(PTSD)在社区流行病学调查中相对常见(男性为5%-6%，女性为10%-12%)，而且患有PTSD的精神病患者功能不佳和精神共病水平较高，但还没有关于初级保健环境中PTSD的患病率、功能和负担的研究。本文报告了(1)使用《精神障碍诊断和统计手册》第四版在退伍军人事务部(VA)初级保健环境中的诊断标准，(2)相关的社会人口学特征和合并症，(3)与创伤后应激障碍相关的功能状态，(4)提供者对创伤后应激障碍的认可程度，以及(5)创伤后应激障碍患者的卫生服务使用模式(包括特殊精神健康)。患者是从4家退伍军人医院1999财年的门诊患者中随机挑选出来的；888名患者同意(在1198名接触者中占74.1%)；746名患者(同意者占84.0%；接触者占62.3%)接受电话诊断访谈。对临床医生实施的创伤后应激障碍量表的诊断性访谈得出了目前创伤后应激障碍患病率的估计为11.5%。在有统计学意义的水平上，创伤后应激障碍与各种共病精神障碍、战区服役、65岁、未工作、受教育程度较低和功能减退呈正相关。在通过研究程序被诊断为创伤后应激障碍的患者中，12个月的病历回顾表明，提供者只确定了46.5%，只有47.7%使用过心理健康专科服务。在过去12个月中使用精神卫生服务的PTSD阳性[PTSD(+)]患者比使用非精神卫生服务的患者更容易被确定为患有PTSD(78.0%比17.8%)。虽然PTSD(+)患者比PTSD阴性患者有更多的病历诊断(6.28比4.95)，但他们在初级护理、紧急护理和住院护理方面的使用与PTSD(-)患者没有区别。(C)2005 Elsevier Inc.保留所有权利。
Although posttraumatic stress disorder (PTSD) is relatively common in community epidemiologic surveys (5-6% for men, 10-12% for women), and psychiatric patients with PTSD are known to have poor functioning and high levels of psychiatric comorbidity, there are no studies that address PTSD prevalence, functioning, and burden in primary care settings. This article reports on (1) the prevalence of PTSD using Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition diagnostic criteria in Veterans Affairs (VA) primary care settings, (2) associated sociodemographic characteristics and comorbidities, (3) functional status related to PTSD, (4) the extent to which PTSD was recognized by providers and (5) health services use patterns (including specialty mental health) of PTSD patients. Patients were randomly selected from those who had an outpatient visit in FY 1999 at one of four VA hospitals; 888 patients consented (74.1% of 1198 contacted); 746 patients (84.0% of consenting patients; 62.3% of contacted patients) were reached for telephone diagnostic interviews. Diagnostic interviews with the Clinician Administered PTSD Scale yielded estimates of current PTSD prevalence of 11.5%. At statistically significant levels, PTSD was positively associated with a variety of comorbid psychiatric disorders, war zone service, age < 65 years, not working, less formal education and decreased functioning. Of patients diagnosed with PTSD by study procedures, 12-month medical record review indicated that providers identified only 46.5% and only 47.7% had used mental health specialty services. PTSD-positive [PTSD(+)] patients who used mental health care in the past 12 months were more apt to be identified as having PTSD than nonmental health service users (78.0% vs. 17.8%). Although PTSD(+) patients had more medical record diagnoses than PTSD-negative [PTSD(-)] patients (6.28 vs. 4.95), their use of primary care, urgent care and inpatient care was not different from PTSD(-) patients. (c) 2005 Elsevier Inc. All rights reserved.