Stein M B, McQuaid J R, Pedrelli P, Lenox R, McCahill M E
Department of Psychiatry, School of Medicine, University of California, San Diego, La Jolla, CA 92093-0985, USA.
Gen Hosp Psychiatry. 2000 Jul-Aug;22(4):261-9. doi: 10.1016/s0163-8343(00)00080-3.
Posttraumatic stress disorder (PTSD) is a prevalent disorder that adversely affects 2-5% of the general population. Little is known about PTSD in the primary care setting. The purpose of the present study was to evaluate the utility of a screening instrument for PTSD (the PCL-C) in primary care and to examine comorbidity, disability, and patterns of healthcare utilization among persons with PTSD in this setting. Adult, English-speaking patients attending for routine medical care (N=368) participated in a two-stage screening consisting of the administration of a self-report measure for posttraumatic stress disorder (the PCL-C) followed by a structured diagnostic interview. Current (1-month) prevalence of PTSD was determined, as were current comorbid disorders. Brief functional impairment and disability indices were administered, and healthcare utilization in the prior 6 months was ascertained. 11.8% (standard error 1.7%) of primary care attendees met diagnostic criteria for either full or partial PTSD. Comorbidity with major depression (61% of cases of PTSD) and generalized anxiety disorder (39%) was common, but less so with social phobia (17%) and panic disorder (6%). Substance use disorder comorbidity (22%) was also fairly common. Patients with PTSD reported significantly more functional impairment than patients without mental disorders. Patients with PTSD also made greater use of healthcare resources than not mentally ill patients. PTSD frequently is encountered in primary care, and is associated with considerable functional impairment and healthcare utilization. Comorbidity with other mood and anxiety disorders is extensive. It remains to be seen if greater awareness and more aggressive treatment of PTSD in primary care will lead to improved functioning and reduced (or more appropriate) healthcare utilization. These are topics for further study.
创伤后应激障碍（PTSD）是一种普遍存在的疾病，对2%-5%的普通人群产生不利影响。在初级保健环境中，人们对PTSD了解甚少。本研究的目的是评估一种PTSD筛查工具（PCL-C）在初级保健中的效用，并检查该环境下PTSD患者的共病情况、残疾状况和医疗保健利用模式。参加常规医疗护理的成年英语患者（N=368）参与了一个两阶段筛查，包括进行创伤后应激障碍的自我报告测量（PCL-C），随后进行结构化诊断访谈。确定了PTSD的当前（1个月）患病率以及当前的共病疾病。进行了简短的功能损害和残疾指数评估，并确定了前6个月的医疗保健利用情况。11.8%（标准误差1.7%）的初级保健就诊者符合完全或部分PTSD的诊断标准。与重度抑郁症（PTSD病例的61%）和广泛性焦虑症（39%）的共病很常见，但与社交恐惧症（17%）和惊恐障碍（6%）的共病较少。物质使用障碍共病（22%）也相当常见。PTSD患者报告的功能损害明显多于无精神障碍的患者。PTSD患者也比非精神病患者更多地利用医疗资源。PTSD在初级保健中经常遇到，并且与相当大的功能损害和医疗保健利用相关。与其他情绪和焦虑障碍的共病很广泛。在初级保健中提高对PTSD的认识并进行更积极的治疗是否会导致功能改善和医疗保健利用减少（或更合理），还有待观察。这些都是有待进一步研究的课题。
