Blanchard Brittany E, Bluett Ellen J, Johnson Morgan, Zimberoff Anya, Fortney John C
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
Family Medicine Residency of Western Montana, University of Montana, Missoula, Montana, USA.
J Trauma Stress. 2024 Dec;37(6):864-876. doi: 10.1002/jts.23055. Epub 2024 May 14.
Over 80% of adults in the general population experience trauma. Rates of patients with posttraumatic stress disorder (PTSD) are high in primary care settings and are likely to be even higher in federally qualified health centers (FQHCs). Trauma exposure has been linked to psychiatric symptoms and physical health comorbidities, though little research has focused on FQHC patients. This study addresses this by examining clinical and sociodemographic correlates of specific trauma types among FQHC patients. We analyzed secondary data from patients who screened positive for PTSD and were receiving health care in FQHCs in a clinical trial (N = 978). Individuals who did versus did not experience a specific trauma type were compared using between-group tests. In the sample, 91.3% of participants were exposed to a DSM-5 Criterion A traumatic event, with 79.6% experiencing two or more trauma types. Witnessing a life-threatening event (57.3%) and physical assault (55.7%) were the most common traumatic experiences. Physical health comorbidities and worse physical health functioning were associated with a higher likelihood of exposure to all trauma types, with effect sizes larger than PTSD, ds = 0.78-1.35. Depressive and anxiety symptoms were also associated with a higher likelihood of experiencing nearly all trauma types to a lesser magnitude. People of color, OR = 2.45, and individuals experiencing financial inequities, OR = 1.73, had higher odds of experiencing serious accidents as well as other trauma types. The findings highlight the need for trauma-informed care, including routine trauma and PTSD screening, for FQHC patients.
普通人群中超过80%的成年人经历过创伤。创伤后应激障碍(PTSD)患者在初级保健机构中的比例很高,在联邦合格健康中心(FQHCs)可能更高。创伤暴露与精神症状和身体健康合并症有关,尽管很少有研究关注FQHC患者。本研究通过检查FQHC患者中特定创伤类型的临床和社会人口学相关因素来解决这一问题。我们分析了一项临床试验中在FQHC接受医疗保健且PTSD筛查呈阳性的患者的二级数据(N = 978)。使用组间检验比较经历与未经历特定创伤类型的个体。在样本中,91.3%的参与者暴露于DSM-5 A标准创伤事件,79.6%的人经历了两种或更多种创伤类型。目睹危及生命的事件(57.3%)和身体攻击(55.7%)是最常见的创伤经历。身体健康合并症和较差的身体健康功能与接触所有创伤类型的可能性较高有关,效应大小大于PTSD,ds = 0.78 - 1.35。抑郁和焦虑症状也与经历几乎所有创伤类型的较高可能性在较小程度上相关。有色人种(OR = 2.45)和经历经济不平等的个体(OR = 1.73)经历严重事故以及其他创伤类型的几率更高。研究结果强调了对FQHC患者进行创伤知情护理的必要性,包括常规创伤和PTSD筛查。
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