Is posttraumatic stress disorder underdiagnosed in routine clinical settings?

The goal of the present study was to examine whether posttraumatic stress d isorder (PTSD) is underrecognized in routine clinical practice. One thousan d patients were evaluated at the Rhode Island Hospital Department of Psychi atry outpatient practice. The first 500 patients completed a psychiatric di agnostic screening questionnaire that included a PTSD subscale. The next 50 0 individuals were interviewed with the Structured Clinical Interview for D SM-IV (SCID). In the first 500 patients, 36 (7.2%) patients were diagnosed by their clinicians with PTSD and an additional 18.6% of the sample screene d positive on the questionnaire hut were not diagnosed with PTSD. The patie nts who were diagnosed with PTSD and the patients who screened positive but were not given the diagnosis were significantly younger, had lower GAP sco res, and less frequently graduated from college than the non-PTSD group. Th e frequency of suicidal thoughts was identical in the two PTSD groups and t wice as high as the frequency in the non-PTSD group. Scores on 9 of the oth er 12 psychopathology dimensions assessed by the screening questionnaire we re significantly higher in the two PTSD groups than the non-PTSD group. In the 500 patients interviewed with the SCID the prevalence of PTSD was two t imes higher than in the 500 patients diagnosed with an unstructured clinica l interview (14.4% vs. 7.2%). The difference in prevalence rates of PTSD be tween the SCID and clinical samples was significant when considering PTSD a s an additional diagnosis; there was no difference in prevalence rates when restricting the analysis to principal diagnoses. The results of this study suggest that PTSD is frequently overlooked in routine clinical practice wh en symptoms of PTSD are not the presenting complaint.