Mental health treatment received by primary care patients with posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) is an often-debilitating anxiety disorder that can severely impair the lives of individuals exposed to significant traumatic events. Individuals with the disorder, a usually chronic condition, often experience sustained impairment in several domains of psychosocial functioning.1–3 Although the disorder was originally conceptualized as an extreme psychological reaction to what were believed to be infrequent human experiences (see DSM-III,4 DSM-III-R,5 and DSM-IV6 diagnostic criteria), recent research suggests that both exposure to traumatic events and the subsequent development of PTSD are more common than previously thought.7,8 Given the severity of symptoms and the usually significant psychosocial impairment associated with PTSD, it might be expected that most individuals with the disorder would seek and receive mental health treatment. However, empirical studies indicate that individuals with PTSD infrequently receive mental health treatment,2 with poor recognition of the disorder in both academic and community mental health settings.9,10 Since PTSD represents significant burdens to individuals in terms of suffering and impairment, to the families of these individuals, and to society in general through direct and indirect economic costs,11–14 a better understanding of the factors associated with PTSD patients receiving appropriate treatment is necessary. Recent trends in the health care delivery system make the general medical setting an important area in which to study factors related to the treatment of PTSD patients. Research shows that individuals with mental disorders are more likely to seek treatment from a non-psychiatric physician than from a mental health professional.15 Individuals exposed to trauma frequently utilize health care services.10,11 Both exposure to traumatic events in general and the development of PTSD in particular are associated with poor physical health and increased rates of physician-diagnosed medical conditions.16–22 Moreover, people with PTSD often engage in behaviors associated with negative effects on health, such as alcohol and drug abuse/dependence, smoking, and risky sexual behavior,16,23,24 that increase the likelihood that PTSD patients will encounter the primary care system. A recent study25 of primary care patients found that a notable proportion of patients would meet diagnostic criteria for full or partial PTSD. Another survey suggests that over 70% of patients with PTSD used medical services in the past 6 months.2 Since the majority of studies to date have focused on the characteristics of PTSD and its treatment in specially defined, homogeneous populations such as combat veterans, motor vehicle accident victims, crime victims, rape victims, and child sexual abuse victims, studies examining the psychopharmacologic and psychosocial treatment of PTSD patients in the more heterogeneous primary care population are particularly needed. The present study explores the nature of mental health services received by primary care patients with PTSD enrolled in the Primary Care Anxiety Project (PCAP), a prospective, naturalistic, longitudinal study of the course of anxiety disorders in primary care and general medical patients. We have previously reported on the nature of trauma and PTSD in primary care.21,26 In this article, we describe the treatment received by primary care patients with PTSD. First, we report the rates and types of mental health treatment received by PTSD patients in primary care and general medical practices, including the characteristics of any psychosocial treatment being received and the rates of specific psychopharmacologic interventions. Second, we identify the sociodemographic and clinical factors that are predictive of which PTSD patients will and will not receive mental health treatment. Given the high rates of psychiatric comorbidity that typify PTSD patients,27 we hypothesized that having a current comorbid anxiety or mood disorder would increase the likelihood that a PTSD patient would receive mental health treatment. Finally, we provide descriptive data on self-reported reasons patients provide for not engaging in mental health treatment.