Recognizing the hurt: Prevalence and correlates of elevated PTSD symptoms among adolescents receiving mental/behavioral health services in primary care.

Abstract

Youth are commonly exposed to potentially traumatic events (PTEs). Following exposure, approximately 25% develop persistent mental and behavioral health (M/BH) symptoms, yet many go untreated or are misdiagnosed and suffer adverse outcomes. Primary care is an ideal setting for detection of trauma-related symptoms. The current article uses archival data to (1) examine the prevalence of posttraumatic stress symptoms that are unlikely, possible, and likely to meet diagnostic criteria for posttraumatic stress disorder (PTSD) and the M/BH and physical health concerns that co-occur with PTSD symptoms among adolescents (n = 133, mean age = 15.1 years, 67% female, 60% White) referred for brief, integrated M/BH services within primary care and (2) identify the prevalence of referred adolescents with elevated symptoms of PTSD that would not be identified for services by traditional depression screening. M/BH providers assessed referred patients for PTSD, M/BH, and physical health symptoms as a routine part of services. Fifty-eight percent screened positive for PTSD (PTSD-possible or PTSD-likely range). The subset of adolescents in the PTSD-likely range (29%) reported significantly greater stress, depression, anxiety, anger, and externalizing symptoms than those categorized as PTSD-possible or PTSD-unlikely. Adolescents in the PTSD-possible or PTSD-unlikely ranges did not differ on any M/BH variables; PTSD groups’ physical health did not differ. Of note, 15% of adolescents reporting symptoms likely to meet PTSD criteria did not report elevated depressive symptoms and would have been overlooked by depression screening alone. Given the prevalence of PTEs among M/BH patients, trauma-informed care is necessary for quality patient care.

The “3 Es” of trauma‐informed care in a federally qualified health center: TraumaticEvent‐ andExperience‐related predictors of physical and mental healthEffectsamong female patients

“…Similarly, while many healthcare systems have yet to implement universal trauma screening, FQHCs are increasingly implementing universal depression and/or anxiety screening. In conjunction with previous findings (Selwyn et al, 2019), results suggest patients who screen positive for anxiety/depression may warrant additional screening for trauma exposure.…”

“…With numbers of low-income, minority patients steadily increasing (HRSA, 2019a;Nath et al, 2016), FQHCs are well-positioned to enhance underserved patients' and communities' recovery and resilience by enacting systemwide trauma-informed care. Yet, to date, many FQHCs have failed to systematically inquire about patients' trauma exposure (Selwyn et al, 2019;Weinreb et al, 2010), with primary care physicians (PCPs) citing barriers such as limited time to counsel and provide psychoeducation to patients, lack of confidence in their ability to diagnose and treat PTSD, inadequate referral options, and patient financial burden (Chung et al, 2012;Maunder et al, 2020;Meredith et al, 2009). Without trauma screening, it is likely that PCPs remain unaware of a patient's trauma history and fail to incorporate aforementioned Event-and Experience-related factors into treatment plans as key therapeutic targets, despite their documented influence on outcomes.…”

“…This rate may underestimate the actual trauma exposure rate, however, as avoidance, the hallmark of trauma symptomatology, likely reduces the odds of patient-initiated disclosure. Another study found that 58% of adolescent FQHC patients referred to mental/behavioral health services for a self-or provider-identified concern screened positive for PTSD (Selwyn et al, 2019). The prevalence rate of trauma exposure within the general FQHC patient population, not only rates among specific patient groups (i.e., patients receiving prenatal care; Kim et al, 2014) or those referred to mental/behavioral healthcare, needs to be established to begin transforming FQHCs' routine clinical practice into trauma-informed care.…”

School Nurses on the Front Lines of Healthcare: The Approach to a Student With Anxiety and Posttraumatic Stress Disorder

“…I ntrusive symptoms: Symptoms of intrusion must begin after the traumatic event and involve distressing memories and/or dreams, feeling that the event is recurring, and psychological distress and physiological reactions when reminded of the trauma. The latter could present with somatic symptoms, such as stomachaches or headaches (Selwyn et al, 2019).…”

Risk factors and health related quality of life among adult patients of depression presenting at psychiatric OPD clinic of Aziz Fatima Medical College and Hospital Faisalabad.

“…Presence of symptoms for the longer period of time leads to social and professional dyfu0nctioning. 2 Patients with depressive disorder also experience somatic symptoms that mainly appear as gastrointestinal symptoms, body aches, headache, easily fatigue and generalized weakness in the body. In developing countries like Pakistan different studies conclude that approximately 44.4 % of the population suffered from depression which is higher than other developing countries.…”