Posttraumatic Stress Disorder in Primary Care: A Hidden Diagnosis

Posttraumatic stress disorder (PTSD) is common worldwide, with prevalence rates ranging from1% to nearly 40%, depending on the population studied. The disability and natural course of PTSD inpsychiatric patients have been well characterized. However, even though the primary care setting hasbeen described as the “de facto mental health care system,” surprisingly little is known about PTSD inprimary care. Available data from primary care clinics in the United States and Israel suggest thatPTSD may be as prevalent in this setting as has been reported in large epidemiologic studies. Patientsmay be unlikely to endorse traumatic experiences or may not consider them related to their currentpsychological problems. The prevalence of PTSD in primary care may indeed be higher than expectedbecause of underreporting of domestic violence and other histories of trauma. Recognition of PTSDin primary care could be greatly improved if simple trauma histories were integrated into routinemedical examinations. Primary care clinicians who maintain a high index of suspicion for PTSD intheir patients with positive histories of trauma plus symptoms of depression or anxiety or other signsof psychological distress, suicidal thoughts or actions, alcohol or substance abuse, or excessive healthcare service utilization may increase the recognition rate of this disorder in their practices.