title: The association of traumatic experiences and posttraumatic stress disorder with health care utilization in the elderly - a German population based study.
abstract: OBJECTIVE
  Traumatic experiences (TE) and posttraumatic stress disorder (PTSD) are related to impaired mental and physical health and to increased health care utilization (HCU). However, general population studies simultaneously investigating the association of TE and PTSD with HCU in the elderly are lacking to date.
  
  
  METHODS
  A representative sample of 1456 people aged 60-85 years from the German general population was examined using self-rating instruments for TE, PTSD, HCU and physical health (PH).
  
  
  RESULTS
  In regression analyses including age and gender, TE are significantly associated with increased probability of visits to specialists and to mental health professionals, and of hospitalization, but not with the frequency of HCU. Current PTSD is significantly associated with increased probability of visits to mental health professionals and of hospitalization, and with increased frequency of general practitioner visits, of specialist visits, and of visits to mental health professionals. In two mediation models, the relationships between TE and PTSD, respectively, with HCU were weakened but remained significant after including PTSD and physical morbidity, respectively.
  
  
  CONCLUSIONS
  These results indicate that both trauma and PTSD are positively associated to some indicators of HCU. Posttraumatic stress disorder has a weak mediating role in the association of TE and HCU. Physical health has a weak mediating role in the association of PTSD and HCU.
authors: Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103 Leipzig/Germany. heide.glaesmer@medizin.uni-leipzig.de
authors: Heide
authors: H
authors: Glaesmer
authors: Elmar
authors: E
authors: Braehler
authors: Steffi G
authors: SG
authors: Riedel-Heller
authors: Harald J
authors: HJ
authors: Freyberger
authors: Philipp
authors: P
authors: Kuwert