Trauma exposure and posttraumatic stress disorder among primary care patients with bipolar spectrum disorder

Authors

  • Yuval Neria,

    1. Department of Psychiatry, College of Physicians and Surgeons
    2. Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center
    3. Trauma Studies and Services
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  • Mark Olfson,

    1. Department of Psychiatry, College of Physicians and Surgeons
    2. Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute
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  • Marc J Gameroff,

    1. Department of Psychiatry, College of Physicians and Surgeons
    2. Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute
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  • Priya Wickramaratne,

    1. Department of Psychiatry, College of Physicians and Surgeons
    2. Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute
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  • Daniel Pilowsky,

    1. Department of Psychiatry, College of Physicians and Surgeons
    2. Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center
    3. Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute
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  • Helen Verdeli,

    1. Department of Psychiatry, College of Physicians and Surgeons
    2. Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute
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  • Raz Gross,

    1. Department of Psychiatry, College of Physicians and Surgeons
    2. Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center
    3. Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute
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  • Julián Manetti-Cusa,

    1. Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute
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  • Randall D Marshall,

    1. Department of Psychiatry, College of Physicians and Surgeons
    2. Trauma Studies and Services
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  • Rafael Lantigua,

    1. Division of General Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
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  • Steven Shea,

    1. Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center
    2. Division of General Medicine, Department of Medicine, College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA
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  • Myrna M Weissman

    1. Department of Psychiatry, College of Physicians and Surgeons
    2. Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center
    3. Division of Clinical and Genetic Epidemiology, New York State Psychiatric Institute
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  • All funding agencies are listed in the ‘Acknowledgements’ and no additional commercial associations that might pose a conflict of interest in connection with this manuscript were reported by the authors.

Corresponding author: Yuval Neria, PhD, Department of Psychiatry, College of Physicians and Surgeons, Columbia University Medical Center, 1051 Riverside Drive, Unit 69, New York, NY 10032, USA. Fax: +1 212 543 6515; e-mail: ny126@columbia.edu

Abstract

Objective:  To examine relationships between exposure to trauma, bipolar spectrum disorder (BD) and posttraumatic stress disorder (PTSD) in a sample of primary care patients.

Methods:  A systematic sample (n = 977) of adult primary care patients from an urban general medicine practice were interviewed with measures including the Mood Disorders Questionnaire, the PTSD Checklist–Civilian Version, and the Medical Outcomes Study 12-Item Short Form Health Survey.

Results:  Compared with patients who screened negative for BD (n = 881), those who screened positive (n = 96) were 2.6 times [95% confidence interval (CI): 1.6–4.2] as likely to report physical or sexual assault, and 2.9 times (95% CI: 1.6–5.1) as likely to screen positive for current PTSD. Among those screening positive for BD, comorbid PTSD was associated with significantly worse social functioning. These results controlled for selected background characteristics, current major depressive episode, and current alcohol/drug use disorder.

Conclusion:  In an urban general medicine setting, trauma exposure was related to BD, and the frequency of PTSD among patients with BD appears to be common and clinically significant. These results suggest an unmet need for mental health care in this specific population and are especially important in view of available treatments for BD and PTSD.

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