Primary care clinics at Veterans Affairs hospitals are not recognizing posttraumatic stress disorder

Primary care clinics at Veterans Affairs hospitals are not recognizing posttraumatic stress disorder in a significant number of cases, according to a Medical University of South Carolina study of 746 patients.

The study, conducted Dr. Kathryn M. Magruder and colleagues, showed that the clinics examined recognized less than half (46.5 percent) the PTSD cases identified by the researchers.

The study, which appears in the June issue of General Hospital Psychiatry, shows an overall 11.5 percent prevalence of PTSD among the patients of four southern Veterans Affairs hospitals, a figure consistent with other recent studies.

According to the study, veterans with PTSD have higher rates of major depressive disorders as well as other co-morbid psychiatric illnesses such as substance use, severe social and occupational disability and poor quality of life.

PTSD "undoubtedly is costing society much more than presently estimated" said Magruder, adding that the condition also “exacerbates other health problems that often afflict PTSD sufferers.”

PTSD is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults, and it has been identified as one of the most costly psychiatric conditions in the U.S. health care system.

PTSD symptoms include nightmares and flashbacks, difficulty in sleeping, and feelings of detachment and estrangement, and can be so severe and long lasting as to significantly impair a person's daily life.

Investigators analyzed findings from a survey of patients seen at two Alabama and two South Carolina facilities. The patients underwent psychiatric interviews using standard diagnostic tests and were subject to 12-month retrospective chart reviews.

“What the research really shows is the need for a more structured approach to identifying veterans suffering from PTSD and a better understanding of both patient and provider reasons for not recognizing and addressing PTSD,” Magruder says. “Without additional resources, primary care clinics simply cannot be expected to do the job that should be done."

Dr. Charles C. Engel, an Army colonel and psychiatrist, and an associate professor at the Uniformed Service University of the Health Sciences in Bethesda, Md., says that the study shows a "substantial room for improvement in both screening for PTSD and the delivery of care needed by PTSD sufferers.”

The study is funded by the U.S. Department of Veterans Affairs.