Posttraumatic stress disorder in primary care

BACKGROUND. Primary care providers are aware of the importance of identifyi ng depression and anxiety in their patients. The diagnosis of posttraumatic stress disorder (PTSD), however, is less of a priority. METHODS. Primary care physicians and nurse practitioners in an outpatient f acility of a large health maintenance organization administered a psychiatr ic screening questionnaire to patients whom they suspected had depression o r anxiety. Patients with positive results were referred for immediate consu ltation with a clinical psychologist. RESULTS. One hundred fourteen (38.6%) of the 296 patients referred for cons ultation met Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnostic criteria for PTSD. The most frequent traumas associated with PTSD were adult domestic violence and childhood abuse. Patients with a diagnosis of PTSD were frequent users of medical services in the 12 month s before diagnosis. The majority of patients sought treatment in primary ca re settings, not menial health settings. CONCLUSIONS. Patients with PTSD often visit outpatient primary care setting s. Medical providers may identify symptoms of depression or anxiety but may not recognize PTSD because of the high degree of overlap between these con ditions, and the lack of familiarity with PTSD diagnostic criteria. We prov ide screening questions that may help physicians detect PTSD in their pract ices.