1
|
Rodríguez MN, Colgan DD, Leyde S, Pike K, Merrill JO, Price CJ. Trauma exposure across the lifespan among individuals engaged in treatment with medication for opioid use disorder: differences by gender, PTSD status, and chronic pain. Subst Abuse Treat Prev Policy 2024; 19:25. [PMID: 38702783 PMCID: PMC11067259 DOI: 10.1186/s13011-024-00608-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/22/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND There is little study of lifetime trauma exposure among individuals engaged in medication treatment for opioid use disorder (MOUD). A multisite study provided the opportunity to examine the prevalence of lifetime trauma and differences by gender, PTSD status, and chronic pain. METHODS A cross-sectional study examined baseline data from participants (N = 303) enrolled in a randomized controlled trial of a mind-body intervention as an adjunct to MOUD. All participants were stabilized on MOUD. Measures included the Trauma Life Events Questionnaire (TLEQ), the Brief Pain Inventory (BPI), and the Posttraumatic Stress Disorder Checklist (PCL-5). Analyses involved descriptive statistics, independent sample t-tests, and linear and logistic regression. RESULTS Participants were self-identified as women (n = 157), men (n = 144), and non-binary (n = 2). Fifty-seven percent (n = 172) self-reported chronic pain, and 41% (n = 124) scored above the screening cut-off for PTSD. Women reported significantly more intimate partner violence (85%) vs 73%) and adult sexual assault (57% vs 13%), while men reported more physical assault (81% vs 61%) and witnessing trauma (66% vs 48%). Men and women experienced substantial childhood physical abuse, witnessed intimate partner violence as children, and reported an equivalent exposure to accidents as adults. The number of traumatic events predicted PTSD symptom severity and PTSD diagnostic status. Participants with chronic pain, compared to those without chronic pain, had significantly more traumatic events in childhood (85% vs 75%). CONCLUSION The study found a high prevalence of lifetime trauma among people in MOUD. Results highlight the need for comprehensive assessment and mental health services to address trauma among those in MOUD treatment. TRIAL REGISTRATION NCT04082637.
Collapse
Affiliation(s)
- Monique N Rodríguez
- Department of Individual, Family, and Community Education, University of New Mexico USA, Simpson Hall MSC053042, 502 Campus, Blvd, Albuquerque, NM, 87131, USA
| | - Dana D Colgan
- Department of Neurology, Oregon Health and Science University USA, 3818 SW Sam Jackson Parkway, Portland, OR, 97229, USA
- Helfgott Research Center, National University of Natural Medicine USA, Portland, USA
| | - Sarah Leyde
- School of Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Kenneth Pike
- Department of Child Family and Population Health Nursing, University of Washington USA, Seattle, USA
| | - Joseph O Merrill
- School of Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Cynthia J Price
- Department of Biobehavioral Nursing and Health Informatics, University of WA, Seattle, USA.
| |
Collapse
|
2
|
Rodríguez MN, Colgan DD, Leyde S, Pike K, Merrill JO, Price CJ. Trauma Exposure Across the Lifespan among Individuals Engaged in Treatment with Medication for Opioid Use Disorder: Differences by Gender, PTSD Status, and Chronic Pain. RESEARCH SQUARE 2023:rs.3.rs-3750143. [PMID: 38196650 PMCID: PMC10775379 DOI: 10.21203/rs.3.rs-3750143/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2024]
Abstract
Background There is little study of lifetime trauma exposure among individuals engaged in medication treatment for opioid use disorder (MOUD). A multisite study provided the opportunity to examine the prevalence of lifetime trauma and differences by gender, PTSD status, and chronic pain. Methods A cross-sectional study examined baseline data from participants (N = 303) enrolled in a randomized controlled trial of a mind-body intervention as an adjunct to MOUD. All participants were stabilized on MOUD. Measures included the Trauma Life Events Questionnaire (TLEQ), the Brief Pain Inventory (BPI), and the Posttraumatic Stress Disorder Checklist (PCL-5). Analyses involved descriptive statistics, independent sample t-tests, and linear and logistic regression. Results Participants were self-identified as women (n = 157), men (n = 144), and non-binary (n = 2). Fifty-seven percent (n = 172) self-reported chronic pain, and 41% (n = 124) scored above the screening cut-off for PTSD. Women reported significantly more intimate partner violence (85%) vs 73%) and adult sexual assault (57% vs 13%), while men reported more physical assault (81% vs 61%) and witnessing trauma (66% vs 48%). Men and women experienced substantial childhood physical abuse, witnessed intimate partner violence as children, and reported an equivalent exposure to accidents as adults. The number of traumatic events predicted PTSD symptom severity and PTSD diagnostic status. Participants with chronic pain, compared to those without chronic pain, had significantly more traumatic events in childhood (85% vs 75%). Conclusions The study found a high prevalence of lifetime trauma among people in MOUD. Results highlight the need for comprehensive assessment and mental health services to address trauma among those in MOUD treatment. Trial Registration NCT04082637.
Collapse
|
3
|
Ng LC, Oblath R, Brigham R, Tai MH, Coles M. Development and pilot testing of a five item traumatic stress screener for use with adolescents in pediatric primary care. Child Adolesc Psychiatry Ment Health 2022; 16:71. [PMID: 35999580 PMCID: PMC9397184 DOI: 10.1186/s13034-022-00501-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/11/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Almost 80% of adolescents in the US have experienced a traumatic event, and approximately 7% have post-traumatic stress disorder. However, there is a lack of validated and feasible assessments for assessing traumatic stress symptoms in pediatric primary care, and traumatic stress symptoms are routinely unidentified. This study aimed to develop, pilot test, and assess the psychometric properties of the Adolescent Primary Care Traumatic Stress Screen (APCTSS), a five-item yes/no screener for post-traumatic stress symptoms in adolescents designed for use in pediatric primary care. METHODS The APCTSS was developed by pediatricians, psychiatrists, psychologists, and social workers who all provide care to trauma-affected adolescent patients. The providers sought to create a developmentally appropriate tool that accurately reflected DSM-5 posttraumatic stress symptoms and that was feasible and acceptable for use in pediatric primary care. To develop the APCTSS, they combined and adapted the UCLA Post-traumatic Stress Disorder (PTSD) Reaction Index for DSM-5 with the adult Primary Care PTSD Screen for DSM-5. Next, 213 adolescent medicine patients were universally approached during routine clinic visits and 178 agreed to participate and were enrolled. The 178 patients were aged 13-22 (M=18.4, SD=2.3), 64.4% female; 62.1% Black or African-American, and 20.7% Hispanic/Latinx. Patients completed APCTSS, Patient Health Questionnaire for Adolescents (PHQ-A), and the Child PTSD Symptom Scale for DSM-5 Interview (CPSS-5-I), and 61 completed the Traumatic Events Screening Inventory for Children (TESI-C). RESULTS 56.7% reported a criterion A trauma, 30.1% met criteria for DSM-5 PTSD, 7.4% met criteria for subsyndromal PTSD symptoms, and 19.0% for post-event impairing symptoms. Validity and reliability testing indicated that the APCTSS was internally consistent, had good concurrent and discriminant validity, and demonstrated good sensitivity and specificity in identifying adolescents at high risk for post-trauma symptoms. Over half of patients (56.0%) who screened positive on the APCTSS (score ≥2) would not have been identified as having a mental health concern using the PHQ-A, including 60.8% of patients who had probable PTSD, subsyndromal PTSD, or post-event impairing symptoms. CONCLUSIONS Many youth with trauma-related mental health symptoms are unidentified in pediatric primary care, which is a missed opportunity for early identification and may contribute to a host of poor outcomes. The development of an effective and feasible traumatic stress screening tool for youth primary care may improve early intervention, and the health and well-being of trauma affected youth.
Collapse
Affiliation(s)
- Lauren C. Ng
- grid.19006.3e0000 0000 9632 6718Present Address: Department of Psychology, University of California Los Angeles, Psychology Building 1285, Box 951563, Los Angeles, CA 90095-1563 USA ,Department of Psychiatry, Boston Medical Center, Boston University, Boston, MA USA
| | - Rachel Oblath
- grid.239424.a0000 0001 2183 6745Department of Psychiatry, Boston Medical Center, Boston, MA United States
| | - Rebecca Brigham
- grid.239424.a0000 0001 2183 6745Department of Pediatrics, Boston Medical Center, Boston, MA USA
| | - Ming Him Tai
- grid.239424.a0000 0001 2183 6745Department of Psychiatry, Boston Medical Center, Boston, MA United States ,grid.17635.360000000419368657Present Address: University of Minnesota, Minneapolis, MN USA ,grid.189504.10000 0004 1936 7558Department of Psychology, Boston University, Boston, MA USA
| | - Mandy Coles
- grid.239424.a0000 0001 2183 6745Department of Pediatrics, Boston Medical Center, Boston, MA USA ,grid.189504.10000 0004 1936 7558Department of Pediatrics, Boston University, Boston, MA USA
| |
Collapse
|
4
|
Ferrell EL, Russin SE, Grant JT. On being a client with posttraumatic stress disorder: Interactions with treatment providers and institutional barriers. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:791-805. [PMID: 32266984 DOI: 10.1002/jcop.22359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 12/13/2019] [Accepted: 03/26/2020] [Indexed: 06/11/2023]
Abstract
Premature dropout from psychological treatment for posttraumatic stress disorder (PTSD) is common. Little research has sought to understand perceptions of treatment and barriers to treatment in this population. This study analyzed anonymous posts among an online community of individuals with PTSD (93 forum users comprising 158 posts regarding treatment providers and 40 forum users comprising 50 posts regarding institutional barriers). Results indicated that individuals with PTSD desire greater clarity about expectations for treatment, collaboration toward treatment goals, open discussion of client-therapist boundaries, and increased validation among therapists in response to trauma disclosure. Individuals with PTSD also reported multiple systemic issues that were barriers to treatment including a lack of available services in their area, being placed on a waitlist for long periods of time, the cost of treatment as a financial burden, and poor crisis response in emergency rooms. Findings indicated areas of growth for treatment providers which will help inform future treatment studies in improving care and treatment adherence among individuals with PTSD.
Collapse
Affiliation(s)
- Emily L Ferrell
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio
| | - Sarah E Russin
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio
| | - Jennifer T Grant
- Department of Psychology, Bowling Green State University, Bowling Green, Ohio
| |
Collapse
|
5
|
Brown M, Moore CA, MacGregor J, Lucey JR. Primary Care and Mental Health: Overview of Integrated Care Models. J Nurse Pract 2021. [DOI: 10.1016/j.nurpra.2020.07.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
|
6
|
Gehringer R, Freytag A, Krause M, Schlattmann P, Schmidt K, Schulz S, Zezulka SJ, Wolf F, Grininger J, Berger M, Vollmar HC, Gensichen J. Psychological interventions for posttraumatic stress disorder involving primary care physicians: systematic review and Meta-analysis of randomized controlled trials. BMC FAMILY PRACTICE 2020; 21:176. [PMID: 32847509 PMCID: PMC7450546 DOI: 10.1186/s12875-020-01244-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/11/2020] [Indexed: 11/21/2022]
Abstract
Background Evidence-based psychological interventions for posttraumatic stress disorder (PTSD) are available in specialized settings, but adequate care in primary care is often lacking. The aim of this systematic review was to determine the effectiveness of psychological interventions for PTSD involving primary care physicians (PCPs) and to characterize these interventions as well as their providers. Method A systematic review and meta-analyses of randomized controlled trials (RCTs). Primary outcome were symptoms of PTSD. Results Four RCTs with a total of 774 patients suffering from PTSD symptoms were included, all applying cognitive behavioural based interventions. Three studies with psychological interventions being conducted by case managers were pooled in a meta-analysis. Interventions were not effective in the short term (0–6 months; SMD, − 0.1; 95% CI, − 0.24-0.04; I2 = 0%). Only two studies contributed to the meta-analysis for long term (12–18 months) outcomes yielding a small effect (SMD, − 0.23; 95% CI, − 0.38- -0.08; I2 = 0%). Conclusions Psychological interventions for PTSD in primary care settings may be effective in the long term but number and quality of included studies was limited so the results should be interpreted with caution.
Collapse
Affiliation(s)
- Rebekka Gehringer
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany.
| | - Antje Freytag
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Markus Krause
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Peter Schlattmann
- Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Friedrich-Schiller-University, Jena, Germany
| | - Konrad Schmidt
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Sven Schulz
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Sophie Jana Zezulka
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Florian Wolf
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany
| | - Jonas Grininger
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Munich, Germany
| | - Mathias Berger
- Department of Psychiatry, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Horst Christian Vollmar
- Institute of General Practice and Family Medicine, Jena University Hospital, Friedrich-Schiller-University, Bachstr. 18, 07743, Jena, Germany.,Department of Family Medicine, Ruhr-University of Bochum, Bochum, Germany
| | - Jochen Gensichen
- Institute of General Practice/Family Medicine, University Hospital of LMU Munich, Munich, Germany
| |
Collapse
|
7
|
Cook JM, Zeber JE, Simiola V, Rossom R, Scherrer JF, Owen-Smith AA, Ahmedani BK, Zolfaghari K, Copeland LA. Comparisons Between Patients Diagnosed with PTSD in Primary Care Versus Mental Health Care in Five Large Civilian Health Care Systems. J Clin Psychol Med Settings 2020; 28:221-228. [PMID: 32048114 DOI: 10.1007/s10880-020-09706-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Posttraumatic stress disorder (PTSD) is a serious mental health disorder that may not be adequately detected or treated in primary care (PC). The purpose of this study was to compare the clinical characteristics and health care utilization of PTSD patients diagnosed in PC versus in specialty mental health care (MHC) across five large, civilian, not-for-profit healthcare systems. Electronic claims and medical record data on patients treated during 2014 were analyzed. Treatment was considered in terms of initiation and dose (i.e., psychotherapy sessions; pharmacotherapy-prescription psychotropics). Of 5256 patients aged 15-88 with a diagnosis of PTSD, 84.4% were diagnosed by a MHC provider. Patients diagnosed by MHC providers had 4 times the rate of and more enduring psychotherapy than those diagnosed by PC providers. Receipt of psychotropics varied by provider type, with generally higher prescription fill levels for patients in MHC. Strategies to better align patient needs with access and treatment modality in PC settings are needed.
Collapse
Affiliation(s)
- Joan M Cook
- Yale School of Medicine, New Haven, CT, USA. .,Department of Psychiatry, Yale School of Medicine, 300 George St #901, New Haven, CT, 06511, USA.
| | - John E Zeber
- University of Massachusetts, Amherst, MA, USA.,Central Texas Veterans Health Care System, Tempe, TX, USA
| | - Vanessa Simiola
- Kaiser Permanente, Center for Integrated Health Care Research, Honolulu, HI, USA
| | | | | | - Ashli A Owen-Smith
- Kaiser Permanente Center for Research and Evaluation, Atlanta, GA, USA.,Georgia State University School of Public Health, Atlanta, GA, USA
| | | | - Kiumars Zolfaghari
- Center for Applied Health Research, Baylor Scott & White Health, Dallas, TX, USA
| | | |
Collapse
|
8
|
Link KA, Smith LS. Primary Care Advanced Practice RNs' Knowledge of Posttraumatic Stress Disorder and Screening. J Psychosoc Nurs Ment Health Serv 2017; 55:23-32. [PMID: 28850648 DOI: 10.3928/02793695-20170818-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 06/22/2017] [Indexed: 11/20/2022]
Abstract
Individuals with posttraumatic stress disorder (PTSD) may seek treatment for their symptoms within the primary care setting. Research suggests PTSD often goes undiagnosed in primary care. Primary care providers (PCPs) might have deficiencies in their knowledge of PTSD screening and screening practices. A descriptive cross-sectional study design was used to examine primary care advanced practice RNs' (APRN) knowledge of PTSD screening and screening practices, along with subjective norms, attitudes, and self-efficacy regarding PTSD screening. Deficiencies in knowledge of PTSD screening and screening practices were identified. Discrepancies were found between reported subjective norms and screening practices, and most participants reported low self-efficacy and stated screening was not important. Numerous barriers to screening were identified. Additional education and training may be needed to improve primary care APRNs' PTSD screening knowledge and screening practices. [Journal of Psychosocial Nursing and Mental Health Services, 55(9), 23-32.].
Collapse
|
9
|
Milligan-Saville JS, Paterson HM, Harkness EL, Marsh AM, Dobson M, Kemp RI, Bryant RA, Harvey SB. The Amplification of Common Somatic Symptoms by Posttraumatic Stress Disorder in Firefighters. J Trauma Stress 2017; 30:142-148. [PMID: 28273379 DOI: 10.1002/jts.22166] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 09/22/2016] [Accepted: 11/30/2016] [Indexed: 01/07/2023]
Abstract
Posttraumatic stress disorder (PTSD) in emergency service personnel and other trauma-exposed populations is known to be associated with a variety of physical health problems. However, little attention has been paid to the health of ageing emergency service personnel, who may be forced into early medical retirement because of a combination of these issues. Currently employed (N = 274) Australian firefighters completed a cross-sectional survey using validated, self-report measures of PTSD and somatic symptoms. Analyses examined the association between probable PTSD and a range of common somatic symptoms, and whether any association differed depending on the age of the firefighters. Firefighters with PTSD reported greater levels of neurological (p = .024), gastrointestinal (p = .015), and cardiorespiratory (p = .027) symptoms compared to those without PTSD. After adjusting for sex, age, and rank, linear regression analysis demonstrated that PTSD was significantly associated with increased total somatic symptom severity (p = .024), with PTSD accounting for 9.8% of the variance in levels of somatic symptoms. There was no interaction between age and the association between PTSD and somatic symptom severity. These results suggest that PTSD is associated with a significant increase in a wide range of somatic symptoms among firefighters, regardless of age. The implications for the identification and treatment of PTSD are discussed.
Collapse
Affiliation(s)
| | | | | | - Annabel M Marsh
- School of Psychology, University of Sydney, Sydney, Australia
| | - Mark Dobson
- Fire and Rescue New South Wales, Sydney, Australia
| | - Richard I Kemp
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Sydney, Australia
| | - Samuel B Harvey
- School of Psychiatry, University of New South Wales, Sydney, Australia.,Black Dog Institute, Sydney, Australia.,St. George Hospital, Kogarah, Australia
| |
Collapse
|
10
|
Angstman KB, Marcelin A, Gonzalez CA, Kaufman TK, Maxson JA, Williams MD. The Impact of Posttraumatic Stress Disorder on the 6-Month Outcomes in Collaborative Care Management for Depression. J Prim Care Community Health 2016; 7:159-64. [PMID: 26994060 DOI: 10.1177/2150131916638329] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Posttraumatic stress disorder (PTSD) has symptoms that exist along a spectrum that includes depression and the 2 disorders may coexist. Collaborative care management (CCM) has been successfully used in outpatient mental health management (especially depression and anxiety) with favorable outcomes. Despite this, there exist limited data on clinical impact of a diagnosis of PTSD on depression outcomes in CCM. The present study used a retrospective cohort design to examine the association of PTSD with depression outcomes among 2121 adult patients involved in CCM in a primary care setting. Using standardized self-report measures, baseline depression scores and 6-month outcome scores were evaluated. Seventy-six patients had a diagnosis of PTSD documented in their electronic medical record. Patients with PTSD reported more severe depressive symptoms at baseline (Patient Health Questionnaire-9 score of 17.9 vs 15.4, P < .001) than those without PTSD. Controlling for sociodemographic and clinical characteristics, a clinical diagnosis of PTSD was associated with lower odds (AOR = 0.457, CI = 0.274-0.760, P = .003) of remission at 6 months and was also associated with higher odds (AOR = 3.112, CI = 1.921-5.041, P < .001) of persistent depressive symptoms at 6 months after CCM. When coexisting with depression, a diagnosis of PTSD was associated with worse depression outcomes, when managed with CCM in primary care. Opportunities still exist for more aggressive management of depression in these patients to help improve remission as well as reduce persistent depressive symptoms.
Collapse
|
11
|
Prevalence, Detection and Correlates of PTSD in the Primary Care Setting: A Systematic Review. J Clin Psychol Med Settings 2016; 23:160-80. [DOI: 10.1007/s10880-016-9449-8] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|