Langhinrichsen-Rohling Jennifer, Selwyn Candice N, Jackson Selena, Johns Keri, Wornell Cory, Finnegan Heather, Smith-West Mary B
Gulf Coast Behavioral Health and Resiliency Center, University of South Alabama, Mobile, Alabama.
J Public Health Manag Pract. 2017 Nov/Dec;23 Suppl 6 Suppl, Gulf Region Health Outreach Program:S32-S39. doi: 10.1097/PHH.0000000000000654.
The prevalence of trauma exposure among vulnerable, impoverished patients seeking primary care services is considerable. However, assessment of trauma-related symptoms is rare, even among behavioral health patients receiving primary care services within integrated health care centers.
To determine the prevalence of clinically noteworthy trauma-related symptoms and their associations with other co-occurring mental and physical symptoms as well as self-reported resiliency.
Primary care patients (n = 120) referred to behavioral health services (76.7% black/African American; 70.8% female).
Federally qualified health center.
Abbreviated Posttraumatic Stress Disorder Checklist-Civilian, 2-item version; Patient Health Questionnaire (PHQ)-15: physical health symptoms; PHQ-9: depression symptoms; Generalized Anxiety Disorder Scale, 7-item; Connor-Davidson Resilience Scale, 2-items.
Seventy-three percent (n = 88) of provider-referred behavioral health patients screened positive for potential posttraumatic stress disorder. Patients most likely to meet criteria for posttraumatic stress disorder reported significantly higher levels of stress, depression, anxiety, and suicide ideation as well as more severe headaches, chest pains, dizziness, and poorer health care.
Results support the need for a trauma-informed integrated approach to health care within primary care settings, particularly those serving vulnerable populations. Integrated health care services foster an environment in which patient access to and satisfaction with services is maximized while overall well-being is enhanced. Adding resiliency-enhancing strategies to patients' integrated health care treatment plans might also be health-promoting. PTSD symptoms can be assessed as part of routine integrated practice via a 2-item screener. Information obtained from trauma screening provides the health care team with useful contextual information about patients' physical and behavioral health symptoms.
在寻求初级保健服务的弱势贫困患者中，创伤暴露的发生率相当高。然而，即使在综合医疗中心接受初级保健服务的行为健康患者中，对创伤相关症状的评估也很少见。
确定临床上值得关注的创伤相关症状的发生率，以及它们与其他同时出现的心理和身体症状以及自我报告的恢复力之间的关联。
转介至行为健康服务的初级保健患者（n = 120）（76.7%为黑人/非裔美国人；70.8%为女性）。
联邦合格健康中心。
简明创伤后应激障碍检查表-平民版，2项版本；患者健康问卷（PHQ）-15：身体健康症状；PHQ-9：抑郁症状；广泛性焦虑障碍量表，7项；康纳-戴维森恢复力量表，2项。
在转介至行为健康服务的患者中，73%（n = 88）筛查出可能患有创伤后应激障碍呈阳性。最有可能符合创伤后应激障碍标准的患者报告的压力、抑郁、焦虑和自杀意念水平显著更高，以及头痛、胸痛、头晕更严重，健康状况更差。
结果支持在初级保健环境中，尤其是为弱势群体服务的环境中，需要采用以创伤为导向的综合医疗方法。综合医疗服务营造了一种环境，使患者获得服务的机会和对服务的满意度最大化，同时提高整体幸福感。在患者的综合医疗治疗计划中加入增强恢复力的策略也可能促进健康。创伤后应激障碍症状可通过2项筛查作为常规综合实践的一部分进行评估。从创伤筛查中获得的信息为医疗团队提供了有关患者身体和行为健康症状的有用背景信息。
