Department of Community and Family Medicine, Howard University, Washington, DC 20060, USA.
J Natl Med Assoc. 2011 Jul;103(7):585-93. doi: 10.1016/s0027-9684(15)30384-9.
Posttraumatic stress disorder (PTSD) is a common, potentially disabling, underdiagnosed, and under-treated illness. Primary care physicians assume a critical role in the diagnosis, treatment, and referral of African Americans with PTSD since mental health access is limited for this population. This study is an examination of PTSD treatment of African Americans in the primary care setting. Actual treatment provision is contrasted with existing evidence-based PTSD treatment guidelines.
Researchers screened 738 consenting, mostly African American, adults in 4 academically affiliated primary care offices for both trauma exposure and mental health symptoms, including PTSD.
Employing criteria from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) (DSM-IV), investigators diagnosed 91 of the participants with current PTSD using the Structured Clinical Interview for DSM and the clinician-administered of PTSD Scale for DSM-IV. Treatment statistics include: 69.2% (n=63) had never received treatment from a mental health provider: 18.6% (n=17) were currently seeing a mental health practitioner; nearly half (47.9%, n=24) of a subsample had never discussed traumatic event exposure or mental health symptoms with their primary care doctor; 32% (n=29) were prescribed psychotropic medication and only 18.6% (n=17) were participating in any form of psychotherapy. Concurrent psychiatric disorders were found in 46.2% (n = 42) of the participants with PTSD.
Most African American adult primary care patients with PTSD were either undiagnosed or undertreated in this inner-city setting. These results demonstrate a clear need to improve screening and treatment services. Both individual (provider and patient) and system-based changes will be required to meet the demonstrated clinical need.
创伤后应激障碍（PTSD）是一种常见的、潜在的致残性疾病，其诊断率低、治疗率低、治疗不足。由于该人群的心理健康服务有限，初级保健医生在诊断、治疗和转介 PTSD 的非裔美国人方面发挥着关键作用。本研究考察了初级保健环境中非裔美国人 PTSD 的治疗情况。实际治疗提供情况与现有的基于循证的 PTSD 治疗指南进行了对比。
研究人员在 4 家学术附属的初级保健机构中筛选了 738 名同意参加的主要是非裔美国人的成年人，对他们进行创伤暴露和心理健康症状（包括 PTSD）的筛查。
研究人员采用《精神障碍诊断与统计手册》（第四版，文本修订版）（DSM-IV）的标准，通过 DSM 的结构性临床访谈和 DSM-IV 的 PTSD 临床医生评定量表，对 91 名参与者进行了目前患有 PTSD 的诊断。治疗统计数据包括：69.2%（n=63）从未接受过心理健康提供者的治疗；18.6%（n=17）正在接受心理健康从业者的治疗；近一半（47.9%，n=24）的亚样本从未与他们的初级保健医生讨论过创伤事件暴露或心理健康症状；32%（n=29）被开了精神类药物，只有 18.6%（n=17）接受了任何形式的心理治疗。在患有 PTSD 的参与者中，发现了 46.2%（n=42）并发的精神障碍。
在这个城市中心环境中，大多数患有 PTSD 的非裔美国成年初级保健患者要么未被诊断，要么治疗不足。这些结果表明，需要改善筛查和治疗服务。为了满足明显的临床需求，需要进行个人（提供者和患者）和系统层面的改变。
