Paige Ouimette

The primary care PTSD screen (PC-PTSD): development and operating characteristics

Posttraumatic stress disorder (PTSD) is a frequently unrecognized anxiety disorder in primary care settings. This study reports on the development and operating characteristics of a brief 4-item screen for PTSD in primary care (PC-PTSD). 188 VA primary care patients completed the PC-PTSD, the PTSD Symptom Checklist (PCL) and the Clinician Administered Scale for PTSD (CAPS). The prevalence of PTSD was 24.5%. Signal detection analyses showed that with this base rate, the PC-PTSD had an optimally efficient cutoff score of 3 for both male and female patients. A cutoff score of 2 is recommended when sensitivity rather than efficiency is optimized. The PC-PTSD outperformed the PCL in terms of overall quality, sensitivity, specificity, efficiency, and quality of efficiency. The PC-PTSD appears to be a psychometrically sound screen for PTSD with comparable operating characteristtics to other screens for mental disorders.

Trauma and substance abuse : causes, consequences, and treatment of comorbid disorders

Over the past decade, research on the epidemiology, nature, and meaning of the comorbidity between trauma, posttraumatic stress disorder (PTSD), and substance abuse has burgeoned. Changes in the political and social climate of the United States during this time have brought with them new challenges. Changes in the definitions of both PTSD and substance abuse have been proposed by those involved with diagnosing and treating people with these issues; some of these changes are expected to be reflected in future diagnostic systems. Trauma and Substance Abuse: Causes, Consequences, and Treatment of Comorbid Disorders, Second Edition offers a broad overview of current trends in the field of co-occurring substance abuse and PTSD from both clinical and research perspectives. The goal of this volume, newly revised to include special settings, such as court systems and disasters, and special populations, such as veterans, is to clarify issues specific to trauma, PTSD, and substance abuse and to translate both quantitative and qualitative data into specific recommendations for clinicians, researchers, and administrators.

BRIEF REPORT: Utility of a Short Screening Scale for DSM-IV PTSD in Primary Care

OBJECTIVE: To evaluate Breslau’s 7-item screen for posttraumatic stress disorder (PTSD) for use in primary care.DESIGN: One hundred and thirty-four patients were recruited from primary care clinics at a large medical center. Participants completed the self-administered 7-item PTSD screen. Later, psychologists blinded to the results of the screen-interviewed patients using the Clinician Administered PTSD Scale (CAPS). Sensitivity, specificity, and likelihood ratios (LR) were calculated using the CAPS as the criterion for PTSD.RESULTS: The screen appears to have test-retest reliability (r=.84), and LRs range from 0.04 to 13.4.CONCLUSIONS: Screening for PTSD in primary care is time efficient and has the potential to increase the detection of previously unrecognized PTSD.

Physical and Sexual Abuse Among Women and Men with Substance Use Disorders

Abstract This study focuses on the association of physical and sexual abuse with psychological symptoms and associated functioning among substance use disorder (SUD) patients and whether patient gender moderates these associations. A total of 24,959 treatment seeking patients who had SUDs were assessed with the Addiction Severity Index (ASI) as part of a Department of Veterans Affairs (VA) initiative to evaluate the quality of VA mental health treatment. A high proportion of SUD patients had trauma histories and women experienced more sexual victimization and more dual abuse (both physical and sexual abuse) than men. Abuse history was associated with more problems across ASI domains, which include alcohol, drug, psychiatric, medical, social/family, legal, and employment problems. In addition, abuse was related to receiving comorbid psychiatric diagnoses, including affective, anxiety, and psychotic disorders, and posttraumatic stress disorder. Patient gender emerged as a moderator of several of these associations. Clinicians who work with female and male patients with SUDs and comorbid histories of interpersonal trauma should be aware of the distinct clinical presentation and consequent treatment needs.

Sexual Harassment and Assault as Predictors of PTSD Symptomatology Among U.S. Female Persian Gulf War Military Personnel

Rates and sequelae of sexual harassment and assault among women in a wartime military sample were examined. A second goal was to explore the comparative impacts of these stressors and combat exposure on posttraumatic stress disorder (PTSD) symptomatology. Army women (n=160) were interviewed on return from the Persian Gulf War and again 18 to 24 months later. Rates of sexual assault (7.3%), physical sexual harassment (33.1%), and verbal sexual harassment (66.2%) were higher than those typically found in civilian and peacetime military samples. Sexual assault had a larger impact on PTSD symptomatology than combat exposure. Frequency of physical sexual harassment was significantly predictive of PTSD symptomatology. Furthermore, the number of postwar stressful life events mediated the relationship between physical sexual harassment and symptomatology but was not related to combat exposure. Sexual assault, sexual harassment, and combat exposure appear to be qualitatively different stressors for women, with different correlates and mechanisms of action.

Posttraumatic Stress Disorder and Health Status Among Female and Male Medical Patients

Posttraumatic stress disorder (PTSD) is associated with objective health problems in specific populations, such as Vietnam veterans. Less is known about PTSD and health among medical samples, especially PTSD patients with different etiologic traumas. This study examined PTSD and health in medical patients within the Department of Veterans Affairs healthcare system. A total of 134 patients completed an interview and questionnaires. Data on physician-diagnosed illnesses were gathered from medical records. PTSD diagnosis and symptoms were associated with a higher likelihood of circulatory and musculoskeletal disorders. In addition, PTSD symptoms were associated with more medical conditions. PTSD symptoms and diagnoses were also associated with poorer health related quality of life. Most of these findings remained significant after controlling for comorbid depressive, generalized anxiety disorder, and panic attack symptoms. Overall, gender did not moderate the relationship between PTSD and poorer health.

During Treatment Changes in Substance Abuse Patients with Posttraumatic Stress Disorder The Influence of Specific Interventions and Program Environments

Male substance abuse patients with posttraumatic stress disorder (PTSD) (SA-PTSD; N = 140) were compared to patients with only substance use disorders (SA-only; N = 1,262), and those with other Axis I diagnoses (SA-PSY; N = 228) on changes during substance abuse treatment. Diagnoses were determined by chart review, and patients completed questionnaires assessing coping, cognitions, and psychological distress. Although SA-PTSD patients improved on outcomes during treatment, they showed less benefit relative to SA-only patients. At discharge, SA-PTSD patients reported less use of effective coping styles, and endorsed more positive beliefs about substance use than SA-only patients. They had more psychological distress than SA-only and SA-PSY patients. More counseling sessions devoted to substance abuse and family problems, and increased involvement in 12-step activities partially counteracted the negative effects of having a PTSD diagnosis on several outcomes. SA-PTSD patients reported fewer psychological symptoms at discharge in programs that were high in support and order/organization.

Modeling associations between posttraumatic stress symptoms and substance use.

Comorbid substance use and posttraumatic stress disorders (SUD-PTSD) predict poorer treatment outcomes. Self-medication has been forwarded as a symptom-level explanatory model. However, research has yet to be conducted that can provide detailed examination of SUD and PTSD symptom fluctuations over time as posited by such a process. This pilot study examined associations between PTSD and substance dependence (SD) symptoms/substance use using two established methodologies that assess week-by-week symptom and substance use/dependence status. Outpatients (N=35) in SUD treatment completed the Longitudinal Follow-Up Evaluation and the Time Lime Follow-Back Interview, retrospectively reporting weekly PTSD and SD symptoms, and substance use over the previous 6-months. Results indicated that weekly PTSD symptom fluctuations were concurrently associated with the presence of alcohol and cocaine dependence symptoms and were associated with the presence of opiate dependence symptoms in the following week. These findings support a self-medication conceptualization, underscore the utility of using a more detailed process analysis of PTSD and SD symptoms, and suggest that PTSD fluctuations are associated with substance problems, rather than with substance use per se.

Post-traumatic Stress Disorder and Diabetes: Co-Morbidity and Outcomes in a Male Veterans Sample

The purpose of this study was to assess the prevalence and correlates of comorbid diabetes and Post-Traumatic Stress disorder(PTSD)and potential relationships between PTSD and diabetes outcomes. Male patients enrolled in a VA primary care database (N = 73,270) were classified as having diabetes from pharmacy records (N = 14,438) and grouped into those with diagnoses of PTSD with depression (N = 649), PTSD-only (N = 480), Depression-only (N = 1696), Other psychiatric diagnosis (N = 736), or No psychiatric diagnosis (N = 10,877) based on the Purpose of Visit diagnoses in the medical record. Outcomes included glycemic control (HbA1c), cholesterol and tryglycerides. Correlates were age, substance use disorder, other psychiatric diagnosis, number of primary care encounters, and medications. The prevalence of comorbid diabetes and PTSD was 8% (n = 1129). Of these, 57% (n = 649) had comorbid depression. Patients with PTSD and depression had higher rates of substance use disorder and higher cholesterol and LDL. Patients with depression had poorer glycemic control. Patients with PTSD and depression weighed more and had higher BMI than patients with neither diagnosis. Thus, male diabetes patients with PTSD and depression may be vulnerable to substance use disorders and to weight/lipid problems that can affect health. Depression is a likely contributor to poor glycemic control. Careful screening for mental health comorbidities is needed for diabetes patients.

Trauma and Posttraumatic Stress Symptoms Predict Alcohol and Other Drug Consequence Trajectories in the First Year of College

OBJECTIVE College matriculation begins a period of transition into adulthood, one that is marked by new freedoms and responsibilities. This transition also is marked by an escalation in heavy drinking and other drug use as well as a variety of use-related negative consequences. Trauma and symptoms of posttraumatic stress disorder (PTSD) may affect alcohol and drug problems and, thus, may be a point of intervention. Yet, no studies have examined trauma, PTSD, and alcohol and drug problem associations during this developmental period. The present study provides such an examination. METHOD Matriculating college students (N = 997) completed surveys in September (Time 1) and at 5 subsequent time points (Time 2-Time 6) over their 1st year of college. With latent growth analysis, trajectories of alcohol- and drug-related consequences were modeled to examine how trauma (No Criterion A Trauma, Criterion A Only, No PTSD Symptoms) and PTSD (partial or full) symptom status predicted these trajectories. RESULTS Results showed substantial risk for alcohol- and other drug-related negative consequences that is conferred by the presence of PTSD at matriculation. Those with both partial and full PTSD started the year with more alcohol and drug consequences. These individuals showed a steeper decrease in consequences in the 1st semester, which leveled off as the year progressed. Both alcohol and drug consequences remained higher for those in the PTSD group throughout the academic year. Hyperarousal symptoms showed unique effects on substance consequence trajectories. Risk patterns were consistent for both partial and full PTSD symptom presentations. Trajectories did not vary by gender. CONCLUSIONS Interventions that offer support and resources to students entering college with PTSD may help to ameliorate problem substance use and may ultimately facilitate a stronger transition into college and beyond.