Traumatic events and mental health in civilian primary care: implications for training and practice.
OBJECTIVE
Primary care research into post-traumatic stress disorder (PTSD) is less developed than primary care depression research. This study documents lifetime traumatic events and past month depression and PTSD in adult patients of a large family medicine residency practice.


METHODS
We used a telephone survey of 411 adult patients from a family medicine residency practice in the Southeastern United States. Standardized measures were used.


RESULTS
Seventy-nine percent of study enrollees completed the study. Women were significantly more likely than men to have been diagnosed with PTSD (35.8% versus 20.0%) or depression (36.1% versus 21.1%), with a high degree of diagnosis overlap (76.5%). Most adults (>90%) reported one or more traumatic events. Men reported more war zone/combat events; women reported more sexual victimization. More than 80% of patients thought family physicians should ask about traumatic events; only a minority recalled being asked (26.8% men, 43.6% women). Regression models determined that current depression and several traumatic events were significant correlates of current PTSD.


CONCLUSIONS
Key gender differences in frequency of lifetime traumatic events, past month depression and PTSD, and patient attitudes about trauma questions existed. Current PTSD was best predicted by a combination of coexisting depression and traumatic events. Discussion explores training and practice implications.
Freedy
John R
JR
Department of Family Medicine, Medical University of South Carolina. 9228 Medical Plaza Drive, Charleston, SC 29406, USA. freedyjr@musc.edu
Magruder
Kathryn M
KM
Zoller
James S
JS
Hueston
William J
WJ
Carek
Peter J
PJ
Brock
Clive D
CD
D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003625:Data Collection; D003863:Depression / Q000453:epidemiology* / Q000209:etiology; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D011320:Primary Health Care; D011594:Psychometrics; D012307:Risk Factors; D012737:Sex Factors; D013022:South Carolina / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D013315:Stress, Psychological / Q000150:complications*; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries; D055815:Young Adult