Association of symptom severity, pain and other behavioral and medical comorbidities with diverse measures of functioning among adults with post-traumatic stress disorder

Manhapra, Ajay; Stefanovics, Elina; Rhee, Taeho Greg; Rosenheck, Robert A.

doi:10.1016/j.jpsychires.2020.12.063

Cited by 7 publications

(2 citation statements)

References 60 publications

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“…PTSD can traverse a protracted course, occasionally lasting decades. Frequently, it is diagnosed with comorbid conditions such as depression, anxiety, and substance use disorders 2,3 . Longitudinally, those with PTSD carry higher rates of being diagnosed with persistent pain, ranging from back and neck problems, arthritic pains, and intractable headaches 4 .…”

Section: Introductionmentioning

confidence: 99%

Impact of an opioid prescribing alert system on patients with posttraumatic stress disorder

et al. 2022

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Background and Objectives Posttraumatic stress disorder (PTSD) is associated with higher rates of chronic pain and increased risk of developing Opioid use disorder. This paper evaluates the impact of PRIMUM, an electronic health record‐embedded (EHR) clinical decision support intervention on opioid prescribing patterns for patients with diagnosis of PTSD. Methods Inpatient, emergency department (ED), urgent care, and outpatient encounters with ICD‐10 codes F43.1 (PTSD), F43.10 (PTSD, unspecified), F43.11 (PTSD, acute), and F43.12 (PTSD, chronic) at Atrium Health between 1/1/2016 and 12/29/2018 were included in the study. Results A total of 3121 patients with a diagnosis of PTSD were seen in 37,443 encounters during the study period. Ten percent (n = 3761) of the encounters resulted in prescriptions for opioids and PRIMUM alerts were triggered in 1488 of these encounters. These alerts resulted in “decision influenced” for 17% of patients (n = 255) or no prescriptions for opioids or benzodiazepines for 5.8% (n = 86). The majority of the prescriptions were below 50 Morphine milligram equivalents (MME)/day, but there were 570 (15.5%) prescriptions for doses of 50–90 MME and 721 (19.6%) prescriptions for >90 MME/day. Discussion and Conclusion The PRIMUM alert system helps improve patient safety. PRIMUM affected clinician decisions 17% of the time, and the effect was greater in patients with opioid overdose history and those presenting for early refills. Scientific Significance The effectiveness of clinical support interventions for opioid prescribing for patients with PTSD has not been documented previously. Our findings provide novel evidence that the EHR can be used to improve patient safety among patients with PTSD in the context of substance use.

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Section: Introductionmentioning

confidence: 99%

Impact of an opioid prescribing alert system on patients with posttraumatic stress disorder

et al. 2022

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“…Understanding the consequences of PTSD-multimorbidity is a pressing concern, because there is growing evidence that co-occurring mental and physical health conditions confer additional risk for functional impairment (Kessler et al, 2003; Larkin et al, 2021; Ouimette et al, 2011; Pagotto et al, 2015) beyond that associated with PTSD alone (Manhapra et al, 2021; Nichter et al, 2019). However, the specific means by which multimorbidity increases risk for poor outcomes are unclear.…”

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confidence: 99%

The transition to civilian life: Impact of comorbid PTSD, chronic pain, and sleep disturbance on veterans’ social functioning and suicidal ideation.

Shor¹,

Borowski²,

Zelkowitz³

et al. 2023

Psychological Trauma: Theory, Research, Practice, and

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Objective: Trauma-exposed veterans may be more likely to experience posttraumatic stress disorder (PTSD), chronic pain, and sleep disturbance together rather than in isolation. Although these conditions are independently associated with distress and impairment, how they relate to social functioning and suicidal ideation (SI) when experienced comorbidly is not clear. Method: Using longitudinal data on 5,461 trauma-exposed U.S. veterans from The Veterans Metrics Initiative study and self-reported disorders, we assessed (a) the extent to which PTSD co-occurs with sleep disturbance and chronic pain (CP); (b) the relationship of PTSD in conjunction with sleep disturbance and chronic pain with later social functioning and SI; and (c) the extent to which social functioning mediates the impact of multimorbidity on SI. Results: At approximately 15 months postseparation, 90.5% of veterans with probable PTSD also reported sleep disturbance and/or CP. Relative to veterans without probable PTSD, veterans with all 3 conditions (n = 907) experienced the poorest social functioning (B = −.56, p < .001) and had greater risk for SI (OR = 3.78, p < .001); Social functioning partially mediated the relationship between multimorbidity and SI. However, relative to those with PTSD alone, sleep disturbance and CP did not confer greater risk for SI. Conclusions: Although these findings underscore the impact of PTSD on functioning and SI, they also highlight the complexity of multimorbidity and the importance of bolstering social functioning for veterans.

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Gender Differences in Diagnostic Remission of Posttraumatic Stress Disorder (PTSD): Proportions and Correlates of Remission in a Nationally Representative U.S. Sample

2022

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Association of symptom severity, pain and other behavioral and medical comorbidities with diverse measures of functioning among adults with post-traumatic stress disorder

Cited by 7 publications

References 60 publications

Impact of an opioid prescribing alert system on patients with posttraumatic stress disorder

Impact of an opioid prescribing alert system on patients with posttraumatic stress disorder

The transition to civilian life: Impact of comorbid PTSD, chronic pain, and sleep disturbance on veterans’ social functioning and suicidal ideation.

Gender Differences in Diagnostic Remission of Posttraumatic Stress Disorder (PTSD): Proportions and Correlates of Remission in a Nationally Representative U.S. Sample

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