Functional impairment in adults with past posttraumatic stress disorder: findings from primary care

Authors

  • Maren Westphal Ph.D.,

    Corresponding author
    1. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City, New York
    2. Division of Clinical Therapeutics, New York State Psychiatric Institute, New York City, New York
    • Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit 69, New York, NY 10032
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  • Mark Olfson M.D. M.P.H.,

    1. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City, New York
    2. Division of Epidemiology, New York State Psychiatric Institute, New York City, New York
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  • Marc J. Gameroff Ph.D.,

    1. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City, New York
    2. Division of Epidemiology, New York State Psychiatric Institute, New York City, New York
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  • Priya Wickramaratne Ph.D.,

    1. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City, New York
    2. Division of Epidemiology, New York State Psychiatric Institute, New York City, New York
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  • Daniel J. Pilowsky M.D.,

    1. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City, New York
    2. Division of Epidemiology, New York State Psychiatric Institute, New York City, New York
    3. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York
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  • Richard Neugebauer Ph.D.,

    1. Division of Epidemiology, New York State Psychiatric Institute, New York City, New York
    2. G.H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York City, New York
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  • Rafael Lantigua M.D.,

    1. Division of General Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York City, New York
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  • Steven Shea M.D.,

    1. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York
    2. Division of General Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University, New York City, New York
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  • Yuval Neria Ph.D.

    1. Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York City, New York
    2. Division of Clinical Therapeutics, New York State Psychiatric Institute, New York City, New York
    3. Division of Epidemiology, New York State Psychiatric Institute, New York City, New York
    4. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, New York
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Abstract

Background: Although many patients with posttraumatic stress disorder (PTSD) experience a reduction in posttraumatic symptoms over time, little is currently known about the extent of their residual functional impairment. This study examines functional impairment in primary care patients with a history of PTSD as compared to patients with current PTSD, and those who never developed PTSD following exposure to trauma. Methods: The sample consisted of 321 trauma-exposed low-income, predominantly Hispanic adults attending a large urban primary care practice. PTSD was assessed with the Lifetime Composite International Diagnostic Interview and other psychiatric disorders with the SCID-I. Physical and mental health-related quality of life was assessed with the Medical Outcome Health Survey (SF-12), and functional impairment with items from the Sheehan Disability Scale and Social Adjustment Scale Self-Report. Results: Logistic regression analyses controlling for gender, psychiatric comorbidity, and interpersonal traumas showed that although patients with past PTSD function significantly better than patients with current PTSD, they experience persisting deficits in mental health-related quality of life compared to trauma-exposed patients who never developed PTSD. Overall, results revealed a continuum of severity in psychiatric comorbidity, functioning, and quality of life, with current PTSD associated with the most impairment, never having met criteria for PTSD with the least impairment, and history of PTSD falling in between. Conclusions: In this primary care sample, adults with a history of past PTSD but no current PTSD continued to report enduring functional deficits, suggesting a need for ongoing clinical attention. Depression and Anxiety, 2011.© 2011 Wiley-Liss, Inc.

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