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PTSD in Urban Primary Care: High Prevalence and Low Physician Recognition

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Abstract

BACKGROUND

Posttraumatic stress disorder (PTSD) is associated with medical and psychological morbidity. The prevalence of PTSD in urban primary care has not been well described.

OBJECTIVE

To measure the prevalence of PTSD in primary care patients overall and among those with selected conditions (chronic pain, depression, anxiety, heavy drinking, substance dependence (SD), irritable bowel syndrome (IBS), and immigrant status).

DESIGN

Cross-sectional study.

PARTICIPANTS

English-speaking patients aged 18–65 years old, awaiting primary care appointments in an urban academic medical center, were eligible for enrollment to determine PTSD prevalence (N = 509). Additional eligible participants (n = 98) with IBS or SD were subsequently enrolled.

MEASUREMENTS

PTSD (past year) and trauma exposure were measured with Composite International Diagnostic Interview. We calculated the prevalence of PTSD associated with depression, anxiety, heavy drinking, SD, IBS, and chronic pain. Only the analyses on heavy drinking, SD, and IBS used all 607 participants.

RESULTS

Among the 509 adults in primary care, 23% (95% CI, 19–26%) had PTSD, of whom 11% had it noted in the medical record. The prevalence of PTSD, adjusted for age, gender, race, and marital and socioeconomic statuses, was higher in participants with, compared to those without, the following conditions: chronic pain (23 vs 12%, p = .003), major depression (35 vs 11%, p < .0001), anxiety disorders (42 vs 14%, p < .0001), and IBS (34 vs 18%, p = .01) and lower in immigrants (13 vs 21%, p = .05).

CONCLUSIONS

The prevalence of PTSD in the urban primary care setting, and particularly among certain high-risk conditions, compels a critical examination of optimal approaches for screening, intervention, and referral to PTSD treatment.

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References

  1. Yehuda R. Post-traumatic stress disorder. N Engl J Med. 2002;346(2):108–14 (Jan 10).

    Article  PubMed  CAS  Google Scholar 

  2. Goode E. A nation challenged: psychological trauma. The New York Times. September 18, 2001;B:1.

  3. Mishra R. Mental toll on troops detailed. The Boston Globe. July 1, 2004:A1.

  4. Hoge CW, Auchterlonie JL, Milliken CS. Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA. 2006;295(9):1023–32 (Mar 1).

    Article  PubMed  CAS  Google Scholar 

  5. Weisler RH, Barbee JG, Townsend MH. Mental health and recovery in the Gulf Coast after Hurricanes Katrina and Rita. JAMA. 2006;296(5):585–8.

    Article  PubMed  CAS  Google Scholar 

  6. Centers for Disease Control and Prevention. Health hazard evaluation of police officers and firefighters after Hurricane Katrina, New Orleans, Louisiana, October 17–28 and November 30–December 5, 2005: Centers for Disease Control and Prevention; 2006.

  7. Lamberg L. Katrina survivors strive to reclaim their lives. JAMA. 2006;296(5):499–502.

    Article  PubMed  CAS  Google Scholar 

  8. American Psychiatric Association, ed. Diagnostic and Statistical Manual of Mental Disorders Fourth Edition. Washington, DC: American Psychiatric Association; 1994.

  9. Mollica RF, Cardozo BL, Osofsky HJ, Raphael B, Ager A, Salama P. Mental health in complex emergencies. Lancet. 2004;364(9450):2058–67 (Dec 4–10).

    Article  PubMed  CAS  Google Scholar 

  10. Murray CJ, Lopez AD, eds. The global burden of disease: a comprehensive assessment of mortality and disability from diseases, injuries and risk factors in 1990 and projected to 2020. Cambridge, MA: Harvard University Press; 1996; No. 1.

  11. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.

    Article  PubMed  Google Scholar 

  12. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52:1048–60.

    PubMed  CAS  Google Scholar 

  13. Breslau N, Kessler R, Chilcoat H, Schultz L, Davis G, Andreski P. Trauma and posttraumatic stress disorder in the community: The 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry. 1998; 55:626–32.

    Article  PubMed  CAS  Google Scholar 

  14. Stein M, McQuaid J, Pedrelli P, Lenox R, McCahill M. Posttraumatic stress disorder in the primary care medical setting. Gen Hosp Psychiatry. 2000;22:261–9.

    Article  PubMed  CAS  Google Scholar 

  15. Taubman-Ben-Ari O, Rabinowitz J, Feldman D, Vaturi R. Post-traumatic stress disorder in primary care settings: prevalence and physicians’ detection. Psychol Med. 2001;31:555–60.

    Article  PubMed  CAS  Google Scholar 

  16. Alim TN, Graves E, Mellman TA, Aigbogun N. Trauma exposure, posttraumatic stress disorder and depression in an African-American primary care population. J Natl Med Assoc. 2006;98(10):1630–6.

    PubMed  Google Scholar 

  17. Magruder KM, Frueh BC, Knapp RG, et al. Prevalence of posttraumatic stress disorder in Veterans Affairs primary care clinics [see comment]. Gen Hosp Psychiatry. 2005;27(3):169–79.

    Article  PubMed  Google Scholar 

  18. Escalona R, Achilles G, Waitzkin H, Yager J. PTSD and somatization in women treated at a VA primary care clinic. Psychosomatics. 2004;45(4):291–6 (Jul–Aug).

    Article  PubMed  Google Scholar 

  19. Zlotnick C, Rodriguez BF, Weisberg RB, et al. Chronicity in posttraumatic stress disorder and predictors of the course of posttraumatic stress disorder among primary care patients. J Nerv Ment Dis. 2004;192(2):153–9 (Feb).

    Article  PubMed  Google Scholar 

  20. Weisberg RB, Bruce SE, Machan JT, Kessler RC, Culpepper L, Keller MB. Nonpsychiatric illness among primary care patients with trauma histories and posttraumatic stress disorder. Psychiatr Serv. 2002;53(7):848–54 (Jul).

    Article  PubMed  Google Scholar 

  21. Samson AY, Bensen S, Beck A, Price D, Nimmer C. Posttraumatic stress disorder in primary care. J Fam Pract. 1999;48(3):222–7.

    PubMed  CAS  Google Scholar 

  22. Breslau N, Davis GC, Andreski P. Risk factors for PTSD-related traumatic events: a prospective analysis. Am J Psychiatry. 1995;152(4):529–35.

    PubMed  CAS  Google Scholar 

  23. Edlund MJ, Unutzer J, Wells KB. Clinician screening and treatment of alcohol, drug, and mental problems in primary care: results from healthcare for communities. Med Care. 2004;42(12):1158–66 (Dec).

    Article  PubMed  Google Scholar 

  24. Walker EA, Katon W, Russo J, Ciechanowski P, Newman E, Wagner AW. Health care costs associated with posttraumatic stress disorder symptoms in women. Arch Gen Psychiatry. 2003;60(4):369–74.

    Article  PubMed  Google Scholar 

  25. Calhoun PS, Bosworth HB, Grambow SC, Dudley TK, Beckham JC. Medical service utilization by veterans seeking help for posttraumatic stress disorder. Am J Psychiatry. 2002;159(12):2081–6 (Dec).

    Article  PubMed  Google Scholar 

  26. Spertus IL, Yehuda R, Wong CM, Halligan S, Seremetis SV. Childhood emotional abuse and neglect as predictors of psychological and physical symptoms in women presenting to a primary care practice. Child Abuse Negl. 2003;27(11):1247–58 (Nov).

    Article  PubMed  Google Scholar 

  27. Andreski P, Chilcoat H, Breslau N. Post-traumatic stress disorder and somatization symptoms: a prospective study. Psychiatry Res. 1998;79(2):131–8 (Jun 15).

    Article  PubMed  CAS  Google Scholar 

  28. Asmundson GJ, Coons MJ, Taylor S, Katz J. PTSD and the experience of pain: research and clinical implications of shared vulnerability and mutual maintenance models. Can J Psychiatry. 2002;47(10):930–7.

    PubMed  Google Scholar 

  29. Bryant RA, Marosszeky JE, Crooks J, Baguley IJ, Gurka JA. Interaction of posttraumatic stress disorder and chronic pain following traumatic brain injury. J Head Trauma Rehabil. 1999;14(6):588–94.

    Article  PubMed  CAS  Google Scholar 

  30. Otis JD, Keane TM, Kerns RD. An examination of the relationship between chronic pain and post-traumatic stress disorder. J Rehabil Res Dev. 2003;40(5):397–405.

    Article  PubMed  Google Scholar 

  31. Frayne SM, Seaver MR, Loveland S, et al. Burden of medical illness in women with depression and posttraumatic stress disorder. Arch Intern Med. 2004;164(12):1306–12.

    Article  PubMed  Google Scholar 

  32. Bonin MF, Norton GR, Asmundson GJ, Dicurzio S, Pidlubney S. Drinking away the hurt: the nature and prevalence of PTSD in substance abuse patients attending a community-based treatment program. J Behav Ther Exp Psychiatry. 2000;31(1):55–66 (Mar).

    Article  PubMed  CAS  Google Scholar 

  33. Rodriguez BF, Weisberg RB, Pagano ME, Machan JT, Culpepper L, Keller MB. Mental health treatment received by primary care patients with posttraumatic stress disorder. J Clin Psychiatry. 2003;64(10):1230–6.

    Article  PubMed  Google Scholar 

  34. Smith MV, Rosenheck RA, Cavaleri MA, Howell HB, Poschman K, Yonkers KA. Screening for and detection of depression, panic disorder, and PTSD in public-sector obstetric clinics. Psychiatr Serv. 2004;55(4):407–14 (Apr).

    Article  PubMed  Google Scholar 

  35. Hankin CS, Spiro A, 3rd, Miller DR, Kazis L. Mental disorders and mental health treatment among U.S. Department of Veterans Affairs outpatients: the Veterans Health Study. Am J Psychiatry. 1999;156(12):1924–30 (Dec).

    PubMed  CAS  Google Scholar 

  36. Kubany ES, McKenzie WF, Owens JA, Leisen MB, Kaplan AS, Pavich E. PTSD among women survivors of domestic violence in Hawaii. Hawaii Med J. 1996;55(9):164–5 (Sep).

    PubMed  CAS  Google Scholar 

  37. Davis TM, Wood PS. Substance abuse and sexual trauma in a female veteran population. J Subst Abuse Treat. 1999;16(2):123–7.

    Article  PubMed  CAS  Google Scholar 

  38. Najavits LM, Weiss RD, Shaw SR. The link between substance abuse and posttraumatic stress disorder in women. A research review. Am J Addict. 1997;6(4):273–83.

    Article  PubMed  CAS  Google Scholar 

  39. Reynolds M, Mezey G, Chapman M, Wheeler M, Drummond C, Baldacchino A. Co-morbid post-traumatic stress disorder in a substance misusing clinical population. Drug Alcohol Depend. 2005;77(3):251–8 (Mar 7).

    Article  PubMed  Google Scholar 

  40. Brown PJ, Recupero PR, Stout R. PTSD substance abuse comorbidity and treatment utilization. Addict Behav. 1995;20(2):251–4 (Mar–Apr).

    Article  PubMed  CAS  Google Scholar 

  41. Drossman DA, Leserman J, Nachman G, et al. Sexual and physical abuse in women with functional or organic gastrointestinal disorders. Ann Intern Med. 1990;113:828–33.

    PubMed  CAS  Google Scholar 

  42. Drossman DA, Talley NJ, Leserman J, Olden KW, Barreiro MA. Sexual and physical abuse and gastrointestinal illness: review and recommendations. Ann Intern Med. 1995;123:782–94.

    PubMed  CAS  Google Scholar 

  43. Holman EA, Silver RC, Waitzkin H. Traumatic life events in primary care patients: a study in an ethnically diverse sample. Arch Fam Med. 2000;9(9):802–10 (Sept/Oct).

    Article  PubMed  CAS  Google Scholar 

  44. Force UPST. Guide to Clinical Preventive Services, 2nd Edition. Bethesda, MD; 1996.

  45. Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: the PHQ primary care study. Primary Care Evaluation of Mental Disorders. Patient Health Questionnaire. JAMA. 1999;282(18):1737–44.

    Article  PubMed  CAS  Google Scholar 

  46. Drossman DA, Corazziari E, Talley NJ, Thompson WG, Whitehead WE. Rome II. The Functional Gastrointestinal Disorders. Diagnosis, Pathophysiology and Treatment: A Multinational Consensus. McLean, VA: Degnon Associates; 2000.

    Google Scholar 

  47. NIAAA. Helping Patients Who Drink Too Much: A Clinician’s Guide. http://pubs.niaaa.nih.gov/publications/Practitioner/CliniciansGuide2005/clinicians_guide.htm; 2006.

  48. Purves AM, Penny KI, Munro C, et al. Defining chronic pain for epidemiological research assessing a subjective definition. Pain Clinic. 1998;10(3):139–47.

    Google Scholar 

  49. World Health Organization. Composite International Diagnostic Interview (CIDI): Version 2.1. Geneva: World Health Organization; 1997.

    Google Scholar 

  50. Kessler R, Andrews G, Mroczek D, Ustun B, Wittchen HU. The World Health Organization Composite International Diagnostic Interview Short-Form (CIDI-SF). Int J Methods Psychiatr Res. 1998;7(4):171–85.

    Article  Google Scholar 

  51. Health, United States, 2004 With Chartbook on Trends in the Health of Americans. Hyattsville, MD: National Center for Health Statistics; 2004.

  52. Dobie DJ, Kivlahan DR, Maynard C, Bush KR, Davis TM, Bradley KA. Posttraumatic stress disorder in female veterans: association with self-reported health problems and functional impairment. Arch Intern Med. 2004;164(4):394–400 (Feb 23).

    Article  PubMed  Google Scholar 

  53. Sherman JJ, Turk DC, Okifuji A. Prevalence and impact of posttraumatic stress disorder-like symptoms on patients with fibromyalgia syndrome. Clin J Pain. 2000;16(2):127–34 (Jun).

    Article  PubMed  CAS  Google Scholar 

  54. Engel CC, Jr., Liu X, McCarthy BD, Miller RF, Ursano R. Relationship of physical symptoms to posttraumatic stress disorder among veterans seeking care for gulf war-related health concerns. Psychosom Med. 2000;62(6):739–45 (Nov–Dec).

    PubMed  Google Scholar 

  55. Asmundson GJ, Wright KD, Stein MB. Pain and PTSD symptoms in female veterans. Eur J Pain. 2004;8(4):345–50 (Aug).

    Article  PubMed  Google Scholar 

  56. Amir M, Kaplan Z, Neumann L, Sharabani R, Shani N, Buskila D. Posttraumatic stress disorder, tenderness and fibromyalgia. J Psychosom Res. 1997;42(6):607–13 (Jun).

    Article  PubMed  CAS  Google Scholar 

  57. Lauterbach D, Vora R, Rakow M. The relationship between posttraumatic stress disorder and self-reported health problems. Psychosom Med. 2005;67(6):939–47 (Nov–Dec).

    Article  PubMed  Google Scholar 

  58. Beckham J, Crawford A, Feldman ME, et al. Chronic posttraumatic stress disorder and chronic pain in Vietnam combat veterans. J Psychiatr Res. 1997;43(4):379–89.

    CAS  Google Scholar 

  59. Frayne SM, Skinner KM, Sullivan LM, et al. Medical profile of women Veterans Administration outpatients who report a history of sexual assault occurring while in the military. J Womens Health Gend Based Med. 1999;8(6):835–45 (Jul–Aug).

    Article  PubMed  CAS  Google Scholar 

  60. Liebschutz JM, Feinman G, Sullivan L, Stein MD, Samet J. Physical and sexual abuse in women infected with the human immunodeficiency virus: increased illness and health care utilization. Arch Intern Med. 2000;160:1659–64.

    Article  PubMed  CAS  Google Scholar 

  61. Liebschutz JM, Mulvey KP, Samet JH. Victimization among substance-abusing women: worse health outcomes. Arch Intern Med. 1997;157:1093–97.

    Article  PubMed  CAS  Google Scholar 

  62. Sharp TJ, Harvey AG. Chronic pain and posttraumatic stress disorder: mutual maintenance? Clin Psychol Rev. 2001;21(6):857–77 (Aug).

    Article  PubMed  CAS  Google Scholar 

  63. Griffin MG, Resick PA, Yehuda R. Enhanced cortisol suppression following dexamethasone administration in domestic violence survivors. Am J Psychiatry. 2005;162(6):1192–9 (Jun).

    Article  PubMed  Google Scholar 

  64. Nixon RD, Bryant RA, Moulds ML, Felmingham KL, Mastrodomenico JA. Physiological arousal and dissociation in acute trauma victims during trauma narratives. J Trauma Stress. 2005;18(2):107–13 (Apr).

    Article  PubMed  Google Scholar 

  65. Zlotnick C, Bruce SE, Weisberg RB, Shea MT, Machan JT, Keller MB. Social and health functioning in female primary care patients with post-traumatic stress disorder with and without comorbid substance abuse. Compr Psychiatry. 2003;44(3):177–83.

    Article  PubMed  Google Scholar 

  66. Jacobsen LK, Southwick SM, Kosten TR. Substance use disorders in patients with posttraumatic stress disorder: a review of the literature. Am J Psychiatry. 2001;158(8):1184–90.

    Article  PubMed  CAS  Google Scholar 

  67. Brady KT, Sinha R. Co-occurring mental and substance use disorders: the neurobiological effects of chronic stress. Am J Psychiatry. 2005;162(8):1483–93.

    Article  PubMed  Google Scholar 

  68. Bremner JD, Southwick SM, Darnell A, Charney DS. Chronic PTSD in Vietnam combat veterans: course of illness and substance abuse. Am J Psychiatry. 1996;153(3):369–75.

    PubMed  CAS  Google Scholar 

  69. Bruce SE, Weisberg RB, Dolan RT, et al. Trauma and posttraumatic stress disorder in primary care patients. Prim Care Companion J Clin Psychiat. 2001;3(5):211–7 (Oct).

    Google Scholar 

  70. Kessler RC, Berglund P, Demler O, et al. The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA. 2003;289(23):3095–105 (Jun 18).

    Article  PubMed  Google Scholar 

  71. Wang PS, Berglund P, Kessler RC. Recent care of common mental disorders in the United States: prevalence and conformance with evidence-based recommendations. J Gen Intern Med. 2000;15(5): 284–92.

    Article  PubMed  CAS  Google Scholar 

  72. Oquendo MA, Malone KM, Ellis SP, Sackeim HA, Mann JJ. Inadequacy of antidepressant treatment for patients with major depression who are at risk for suicidal behavior. Am J Psychiatry. 1999;156(2):190–4.

    PubMed  CAS  Google Scholar 

  73. Seong-Yi B, Bowers B, Oakley L, Susman J. The recognition of depression: the primary care clinician’s perspective. Ann Fam Med. 2005;3:31–7.

    Article  Google Scholar 

  74. Foa EB, Davidson JRT, Frances A. The expert consensus guideline series: treatment of post-traumatic stress disorder. J Clin Psychiatry. 1999;60(suppl 16):1–76.

    Google Scholar 

  75. Bradley R, Greene J, Russ E, Dutra L, Westen D. A multidimensional meta-analysis of psychotherapy for PTSD. Am J Psychiatry. 2005;162(2):214–27 (Feb).

    Article  PubMed  Google Scholar 

  76. Institute of Medicine, ed. Improving the Quality of Health Care for Mental and Substance Use Conditions: Quality Chasm Series. Washington, DC: The National Academies Press; 2006.

  77. Katzelnick DJ, Simon GE, Pearson SD, et al. Randomized trial of a depression management program in high utilizers of medical care. Arch Fam Med. 2000;9(4):345–51 (Apr).

    Article  PubMed  CAS  Google Scholar 

  78. Lin EH, Katon W, Von Korff M, et al. Effect of improving depression care on pain and functional outcomes among older adults with arthritis: a randomized controlled trial. JAMA. 2003;290(18):2428–29 (Nov 12).

    Article  PubMed  CAS  Google Scholar 

  79. Simon GE, Katon W, Rutter C, et al. Impact of improved depression treatment in primary care on daily functioning and disability. Psychol Med. 1998;28(3):693–701 (May).

    Article  PubMed  CAS  Google Scholar 

  80. Von Korff M, Balderson BH, Saunders K, et al. A trial of an activating intervention for chronic back pain in primary care and physical therapy settings. Pain. 2005;113(3):323–30 (Feb).

    Article  Google Scholar 

  81. Lin EH, VonKorff M, Russo J, et al. Can depression treatment in primary care reduce disability? A stepped care approach. Arch Fam Med. 2000;9(10):1052–8 (Nov–Dec).

    Article  PubMed  CAS  Google Scholar 

  82. Newbold KB. Self-rated health within the Canadian immigrant population: risk and the healthy immigrant effect. Soc Sci Med. 2005;60(6):1359–70.

    Article  PubMed  Google Scholar 

  83. Chen AW, Kazanjian A. Rate of mental health service utilization by Chinese immigrants in British Columbia. Can J Public Health. 2005;96(1):49–51.

    PubMed  Google Scholar 

  84. Marshall GN, Schell TL, Elliott MN, Berthold SM, Chun CA. Mental health of Cambodian refugees 2 decades after resettlement in the United States. JAMA. 2005;294(5):571–9.

    Article  PubMed  CAS  Google Scholar 

  85. Dobie DJ, Maynard C, Kivlahan DR, et al. Posttraumatic stress disorder screening status is associated with increased VA medical and surgical utilization in women. J Gen Intern Med. 2006;21(suppl 3):S58–S64 (Mar).

    Article  PubMed  Google Scholar 

  86. Hemenway D, Prothrow-Stith D, Browne A. Report of the 2004 Boston Youth Survey. Boston: City of Boston; 2005 (Aug).

    Google Scholar 

  87. Ahern J, Galea S, Fernandez WG, Koci B, Waldman R, Vlahov D. Gender, social support, and posttraumatic stress in postwar Kosovo. J Nerv Ment Dis. 2004;192(11):762–70.

    Article  PubMed  Google Scholar 

  88. Glynn SM, Asarnow JR, Asarnow R, et al. The development of acute post-traumatic stress disorder after orofacial injury: a prospective study in a large urban hospital. J Oral Maxillofac Surg. 2003;61(7):785–92.

    Article  PubMed  Google Scholar 

  89. Muller RT, Goebel-Fabbri AE, Diamond T, Dinklage D. Social support and the relationship between family and community violence exposure and psychopathology among high risk adolescents. Child Abuse Negl. 2000;24(4):449–64.

    Article  PubMed  CAS  Google Scholar 

  90. Viinamaki H, Kontula O, Niskanen L, Koskela K. The association between economic and social factors and mental health in Finland. Acta Psychiatr Scand. 1995;92(3):208–13.

    Article  PubMed  CAS  Google Scholar 

  91. Steptoe A, Marmot M. Burden of psychosocial adversity and vulnerability in middle age: associations with biobehavioral risk factors and quality of life. Psychosom Med. 2003;65(6):1029–37.

    Article  PubMed  Google Scholar 

  92. Sherbourne CD, Stewart AL. The MOS social support survey. Soc Sci Med. 1991;32(6):705–14.

    Article  PubMed  CAS  Google Scholar 

  93. Miller DK, Malmstrom TK, Joshi S, Andresen EM, Morley JE, Wolinsky FD. Clinically relevant levels of depressive symptoms in community-dwelling middle-aged African Americans. J Am Geriatr Soc. 2004;52(5):741–8.

    Article  PubMed  Google Scholar 

  94. Matheson FI, Moineddin R, Dunn JR, Creatore MI, Gozdyra P, Glazier RH. Urban neighborhoods, chronic stress, gender and depression. Soc Sci Med. 2006;63(10):2604–16.

    Article  PubMed  Google Scholar 

  95. O’Toole TP, Arbelaez JJ, Lawrence RS; Baltimore Community Health Consortium. Medical debt and aggressive debt restitution practices: predatory billing among the urban poor. J Gen Intern Med. 2004;19(7):772–8.

    Article  PubMed  Google Scholar 

  96. Gaskin DJ, Hadley J. Population characteristics of markets of safety-net and non-safety-net hospitals. J Urban Health. 1999;76(3):351–70.

    Article  PubMed  CAS  Google Scholar 

  97. Bassuk EL, Buckner JC, Perloff JN, Bassuk SS. Prevalence of mental health and substance use disorders among homeless and low-income housed mothers. Am J Psychiatry. 1998;155(11):1561–4.

    PubMed  CAS  Google Scholar 

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Acknowledgments

This work was supported by a Generalist Physician Faculty Scholar Award from the Robert Wood Johnson Foundation, Princeton, New Jersey (RWJF #045452) and by a career development award from the National Institute on Drug Abuse, National Institutes of Health (K23 DA016665).

We thank Jessica Geier, Minga Claggett-Borne, Lauren Kelly, Michael Rosas, Mary Reyes, Pavan Sekhar, Jen Tran, Eric Holder, and Mary Benitta Schickel for their aid in data collection, and Joann Elmore (MD MPH), Roger Weiss (MD), and Larry Culpepper (MD) for their comments on research design and analysis.

Conflict of Interest Summary

None disclosed.

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Authors and Affiliations

  1. Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 91 East Concord St., Suite 200, Boston, MA, 02118, USA

    Jane Liebschutz MD, MPH, Richard Saitz MD, MPH, Tali Averbuch MPP & Jeffrey H. Samet MD, MA, MPH

  2. Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, MA, USA

    Jane Liebschutz MD, MPH & Jeffrey H. Samet MD, MA, MPH

  3. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA

    Richard Saitz MD, MPH

  4. Youth Alcohol Prevention Center, Boston University School of Public Health, Boston, MA, USA

    Richard Saitz MD, MPH

  5. Massachusetts Behavioral Health Partnership, Boston, MA, USA

    Victoria Brower MPH

  6. Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA

    Terence M. Keane PhD

  7. National Center for Post-Traumatic Stress Disorder, Boston, MA, USA

    Terence M. Keane PhD

  8. Veterans Affairs Boston Healthcare System, Boston, MA, USA

    Terence M. Keane PhD

  9. Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA

    Christine Lloyd-Travaglini MPH

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  1. Jane Liebschutz MD, MPH
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  2. Richard Saitz MD, MPH
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  3. Victoria Brower MPH
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  4. Terence M. Keane PhD
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  5. Christine Lloyd-Travaglini MPH
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  6. Tali Averbuch MPP
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  7. Jeffrey H. Samet MD, MA, MPH
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Corresponding author

Correspondence to Jane Liebschutz MD, MPH.

Appendix

Appendix

Table 4 Trauma exposure of participants recruited in primary care (consecutive sample)
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Liebschutz, J., Saitz, R., Brower, V. et al. PTSD in Urban Primary Care: High Prevalence and Low Physician Recognition. J GEN INTERN MED 22, 719–726 (2007). https://doi.org/10.1007/s11606-007-0161-0

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  • DOI: https://doi.org/10.1007/s11606-007-0161-0

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