title: Does comorbid chronic pain affect posttraumatic stress disorder diagnosis and treatment? Outcomes of posttraumatic stress disorder screening in Department of Veterans Affairs primary care.
abstract: Because posttraumatic stress disorder (PTSD) is both prevalent and underrecognized, routine primary care-based screening for PTSD has been implemented across the Veterans Health Administration. PTSD is frequently complicated by the presence of comorbid chronic pain, and patients with both conditions have increased symptom severity and poorer prognosis. Our objective was to determine whether the presence of pain affects diagnosis and treatment of PTSD among Department of Veterans Affairs (VA) patients who have a positive PTSD screening test. This retrospective cohort study used clinical and administrative data from six Midwestern VA medical centers. We identified 4,244 VA primary care patients with a positive PTSD screen and compared outcomes for those with and without a coexisting pain diagnosis. Outcomes were three clinically appropriate responses to positive PTSD screening: (1) mental health visit, (2) PTSD diagnosis, and (3) new selective serotonin reuptake inhibitor (SSRI) prescription. We found that patients with coexisting pain had a lower rate of mental health visits than those without pain (hazard ratio: 0.889, 95% confidence interval: 0.821-0.962). There were no significant differences in the rate of PTSD diagnosis or new SSRI prescription between patients with and without coexisting pain.
authors.affiliation: Center for Health Information and Communication, Department of Veterans Affairs (VA) Health Services Research & Development Service, Indianapolis, IN; Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN; and Regenstrief Institute Inc, Indianapolis, IN;
authors.forename: Samantha D
authors.initials: SD
authors.lastname: Outcalt
authors.forename: Helena Maria
authors.initials: HM
authors.lastname: Hoen
authors.forename: Zhangsheng
authors.initials: Z
authors.lastname: Yu
authors.forename: Tenesha Marie
authors.initials: TM
authors.lastname: Franks
authors.forename: Erin E
authors.initials: EE
authors.lastname: Krebs
mesh_terms: D059350:Chronic Pain / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008605:Mental Health Services / Q000458:organization & administration*; D008875:Middle Aged; D059408:Pain Management / Q000379:methods*; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*
keywords: Veterans; Veterans health; comorbidity; health services research; healthcare utilization; mental health; pain; posttraumatic stress disorder; primary care; screening