Prevalence of depression-PTSD comorbidity: Implications for clinical practice guidelines and primary care-based interventions

Duncan G. Campbell; Bradford L. Felker; Chuan Fen Liu; Elizabeth M. Yano; Jo Ann E. Kirchner; Domin Chan; Lisa V. Rubenstein; Edmund F. Chaney

doi:10.1007/s11606-006-0101-4

Prevalence of depression-PTSD comorbidity: Implications for clinical practice guidelines and primary care-based interventions

Duncan G. Campbell
, Bradford L. Felker
, Chuan Fen Liu
, Elizabeth M. Yano
, Jo Ann E. Kirchner
, Domin Chan
, Lisa V. Rubenstein
, Edmund F. Chaney

Psychology

Research output: Contribution to journal › Article › peer-review

403 Scopus citations

Abstract

BACKGROUND: Compared to those with depression alone, depressed patients with posttraumatic stress disorder (PTSD) experience more severe psychiatric symptomatology and factors that complicate treatment. OBJECTIVE: To estimate PTSD prevalence among depressed military veteran primary care patients and compare demographic/illness characteristics of PTSD screen-positive depressed patients (MDD-PTSD+) to those with depression alone (MDD). DESIGN: Cross-sectional comparison of MDD patients versus MDD-PTSD+ patients. PARTICIPANTS: Six hundred seventy-seven randomly sampled depressed patients with at least 1 primary care visit in the previous 12 months. Participants composed the baseline sample of a group randomized trial of collaborative care for depression in 10 VA primary care practices in 5 states. MEASUREMENTS: The Patient Health Questionnaire-9 assessed MDD. Probable PTSD was defined as a Primary Care PTSD Screen≥3. Regression-based techniques compared MDD and MDD-PTSD+ patients on demographic/illness characteristics. RESULTS: Thirty-six percent of depressed patients screened positive for PTSD. Adjusting for sociodemographic differences and physical illness comorbidity, MDD-PTSD+ patients reported more severe depression (P<.001), lower social support (P<.001), more frequent outpatient health care visits (P<.001), and were more likely to report suicidal ideation (P<.001) than MDD patients. No differences were observed in alcohol consumption, self-reported general health, and physical illness comorbidity. CONCLUSIONS: PTSD is more common among depressed primary care patients than previously thought. Comorbid PTSD among depressed patients is associated with increased illness burden, poorer prognosis, and delayed response to depression treatment. Providers should consider recommending psychotherapeutic interventions for depressed patients with PTSD.

Original language	English
Pages (from-to)	711-718
Number of pages	8
Journal	Journal of General Internal Medicine
Volume	22
Issue number	6
DOIs	https://doi.org/10.1007/s11606-006-0101-4
State	Published - Jun 2007

Funding

Acknowledgments: The results reported here were from the Well-Being Among Veterans Enhancement Study (WAVES). WAVES received financial support from a grant (MHI 99-375: Chaney EF & Rubenstein LV, Co-PIs) from the Department of Veterans Affairs, Health Services Research and Development (HSR&D). An HSR&D Postdoctoral Traineeship (Campbell) provided additional support. The views expressed here are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Montana, the University of Washington, the University of California Los Angeles, or the RAND Health Program. Portions of this project were presented at the Department of Veterans Affairs HSR&D National Annual Meeting (2005, February), Baltimore, MD. The authors wish to acknowledge the contributions of Robert Petzel, MD; Kathy Henderson, MD; Scott Ober, MD; Maurilio Garcia-Maldinado, MD; Laura M. Bonner, PhD; Barbara Simon, MA; Carol Simons; and the WAVES research group.

Keywords

Clinical practice guidelines
Depression
PTSD
Primary care

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s11606-006-0101-4

Cite this

@article{3672e63abebc450dafef72f964750f1e,

title = "Prevalence of depression-PTSD comorbidity: Implications for clinical practice guidelines and primary care-based interventions",

abstract = "BACKGROUND: Compared to those with depression alone, depressed patients with posttraumatic stress disorder (PTSD) experience more severe psychiatric symptomatology and factors that complicate treatment. OBJECTIVE: To estimate PTSD prevalence among depressed military veteran primary care patients and compare demographic/illness characteristics of PTSD screen-positive depressed patients (MDD-PTSD+) to those with depression alone (MDD). DESIGN: Cross-sectional comparison of MDD patients versus MDD-PTSD+ patients. PARTICIPANTS: Six hundred seventy-seven randomly sampled depressed patients with at least 1 primary care visit in the previous 12 months. Participants composed the baseline sample of a group randomized trial of collaborative care for depression in 10 VA primary care practices in 5 states. MEASUREMENTS: The Patient Health Questionnaire-9 assessed MDD. Probable PTSD was defined as a Primary Care PTSD Screen≥3. Regression-based techniques compared MDD and MDD-PTSD+ patients on demographic/illness characteristics. RESULTS: Thirty-six percent of depressed patients screened positive for PTSD. Adjusting for sociodemographic differences and physical illness comorbidity, MDD-PTSD+ patients reported more severe depression (P<.001), lower social support (P<.001), more frequent outpatient health care visits (P<.001), and were more likely to report suicidal ideation (P<.001) than MDD patients. No differences were observed in alcohol consumption, self-reported general health, and physical illness comorbidity. CONCLUSIONS: PTSD is more common among depressed primary care patients than previously thought. Comorbid PTSD among depressed patients is associated with increased illness burden, poorer prognosis, and delayed response to depression treatment. Providers should consider recommending psychotherapeutic interventions for depressed patients with PTSD.",

keywords = "Clinical practice guidelines, Depression, PTSD, Primary care",

author = "Campbell, \{Duncan G.\} and Felker, \{Bradford L.\} and Liu, \{Chuan Fen\} and Yano, \{Elizabeth M.\} and Kirchner, \{Jo Ann E.\} and Domin Chan and Rubenstein, \{Lisa V.\} and Chaney, \{Edmund F.\}",

note = "Funding Information: Acknowledgments: The results reported here were from the Well-Being Among Veterans Enhancement Study (WAVES). WAVES received financial support from a grant (MHI 99-375: Chaney EF \& Rubenstein LV, Co-PIs) from the Department of Veterans Affairs, Health Services Research and Development (HSR\&D). An HSR\&D Postdoctoral Traineeship (Campbell) provided additional support. The views expressed here are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Montana, the University of Washington, the University of California Los Angeles, or the RAND Health Program. Portions of this project were presented at the Department of Veterans Affairs HSR\&D National Annual Meeting (2005, February), Baltimore, MD. The authors wish to acknowledge the contributions of Robert Petzel, MD; Kathy Henderson, MD; Scott Ober, MD; Maurilio Garcia-Maldinado, MD; Laura M. Bonner, PhD; Barbara Simon, MA; Carol Simons; and the WAVES research group.",

year = "2007",

month = jun,

doi = "10.1007/s11606-006-0101-4",

language = "English",

volume = "22",

pages = "711--718",

journal = "Journal of General Internal Medicine",

issn = "0884-8734",

publisher = "Springer",

number = "6",

}

TY - JOUR

T1 - Prevalence of depression-PTSD comorbidity

T2 - Implications for clinical practice guidelines and primary care-based interventions

AU - Campbell, Duncan G.

AU - Felker, Bradford L.

AU - Liu, Chuan Fen

AU - Yano, Elizabeth M.

AU - Kirchner, Jo Ann E.

AU - Chan, Domin

AU - Rubenstein, Lisa V.

AU - Chaney, Edmund F.

N1 - Funding Information: Acknowledgments: The results reported here were from the Well-Being Among Veterans Enhancement Study (WAVES). WAVES received financial support from a grant (MHI 99-375: Chaney EF & Rubenstein LV, Co-PIs) from the Department of Veterans Affairs, Health Services Research and Development (HSR&D). An HSR&D Postdoctoral Traineeship (Campbell) provided additional support. The views expressed here are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs, the University of Montana, the University of Washington, the University of California Los Angeles, or the RAND Health Program. Portions of this project were presented at the Department of Veterans Affairs HSR&D National Annual Meeting (2005, February), Baltimore, MD. The authors wish to acknowledge the contributions of Robert Petzel, MD; Kathy Henderson, MD; Scott Ober, MD; Maurilio Garcia-Maldinado, MD; Laura M. Bonner, PhD; Barbara Simon, MA; Carol Simons; and the WAVES research group.

PY - 2007/6

Y1 - 2007/6

N2 - BACKGROUND: Compared to those with depression alone, depressed patients with posttraumatic stress disorder (PTSD) experience more severe psychiatric symptomatology and factors that complicate treatment. OBJECTIVE: To estimate PTSD prevalence among depressed military veteran primary care patients and compare demographic/illness characteristics of PTSD screen-positive depressed patients (MDD-PTSD+) to those with depression alone (MDD). DESIGN: Cross-sectional comparison of MDD patients versus MDD-PTSD+ patients. PARTICIPANTS: Six hundred seventy-seven randomly sampled depressed patients with at least 1 primary care visit in the previous 12 months. Participants composed the baseline sample of a group randomized trial of collaborative care for depression in 10 VA primary care practices in 5 states. MEASUREMENTS: The Patient Health Questionnaire-9 assessed MDD. Probable PTSD was defined as a Primary Care PTSD Screen≥3. Regression-based techniques compared MDD and MDD-PTSD+ patients on demographic/illness characteristics. RESULTS: Thirty-six percent of depressed patients screened positive for PTSD. Adjusting for sociodemographic differences and physical illness comorbidity, MDD-PTSD+ patients reported more severe depression (P<.001), lower social support (P<.001), more frequent outpatient health care visits (P<.001), and were more likely to report suicidal ideation (P<.001) than MDD patients. No differences were observed in alcohol consumption, self-reported general health, and physical illness comorbidity. CONCLUSIONS: PTSD is more common among depressed primary care patients than previously thought. Comorbid PTSD among depressed patients is associated with increased illness burden, poorer prognosis, and delayed response to depression treatment. Providers should consider recommending psychotherapeutic interventions for depressed patients with PTSD.

AB - BACKGROUND: Compared to those with depression alone, depressed patients with posttraumatic stress disorder (PTSD) experience more severe psychiatric symptomatology and factors that complicate treatment. OBJECTIVE: To estimate PTSD prevalence among depressed military veteran primary care patients and compare demographic/illness characteristics of PTSD screen-positive depressed patients (MDD-PTSD+) to those with depression alone (MDD). DESIGN: Cross-sectional comparison of MDD patients versus MDD-PTSD+ patients. PARTICIPANTS: Six hundred seventy-seven randomly sampled depressed patients with at least 1 primary care visit in the previous 12 months. Participants composed the baseline sample of a group randomized trial of collaborative care for depression in 10 VA primary care practices in 5 states. MEASUREMENTS: The Patient Health Questionnaire-9 assessed MDD. Probable PTSD was defined as a Primary Care PTSD Screen≥3. Regression-based techniques compared MDD and MDD-PTSD+ patients on demographic/illness characteristics. RESULTS: Thirty-six percent of depressed patients screened positive for PTSD. Adjusting for sociodemographic differences and physical illness comorbidity, MDD-PTSD+ patients reported more severe depression (P<.001), lower social support (P<.001), more frequent outpatient health care visits (P<.001), and were more likely to report suicidal ideation (P<.001) than MDD patients. No differences were observed in alcohol consumption, self-reported general health, and physical illness comorbidity. CONCLUSIONS: PTSD is more common among depressed primary care patients than previously thought. Comorbid PTSD among depressed patients is associated with increased illness burden, poorer prognosis, and delayed response to depression treatment. Providers should consider recommending psychotherapeutic interventions for depressed patients with PTSD.

KW - Clinical practice guidelines

KW - Depression

KW - PTSD

KW - Primary care

UR - https://www.scopus.com/pages/publications/34248586059

U2 - 10.1007/s11606-006-0101-4

DO - 10.1007/s11606-006-0101-4

M3 - Article

C2 - 17503104

AN - SCOPUS:34248586059

SN - 0884-8734

VL - 22

SP - 711

EP - 718

JO - Journal of General Internal Medicine

JF - Journal of General Internal Medicine

IS - 6

ER -

Prevalence of depression-PTSD comorbidity: Implications for clinical practice guidelines and primary care-based interventions

Abstract

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Keywords

UN SDGs

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