The Prevalence of Posttraumatic Stress Disorder in Primary Care: A Systematic Review

Spottswood, Margaret; Davydow, Dimitry S.; Huang, Hsiang

doi:10.1097/hrp.0000000000000136

Cited by 88 publications

(44 citation statements)

References 76 publications

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“…The primary outcome of this meta-analysis was the prevalence of ASD among RTA survivors, and for the purpose of this study, the following data were extracted: first author, year of publication, country of study, recruitment site, proportion of hospitalized participants, proportion of male participants, mean age of participants, instrument used to identify ASD, trauma-assessment interval, number of RTA survivors with ASD, and sample size. Consistent with previous meta-analyses exploring the post-traumatic stress responses among trauma-related populations [ 24 , 25 ], the instruments used to identify ASD were categorized into self-report questionnaire and structured interview. Additionally, if available, data on traumatic brain injury (TBI) were extracted to perform subgroup analysis.…”

Section: Methodsmentioning

confidence: 99%

Prevalence of acute stress disorder among road traffic accident survivors: a meta-analysis

et al. 2018

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BackgroundRoad traffic accident (RTA), an unexpected traumatic event, may not only lead to death and serious physical injuries, but also could put survivors at an increased risk for a wide range of psychiatric disorders, particularly acute stress disorder (ASD). Early assessment of trauma-related psychological responses is important because acute trauma responses in the early post-traumatic period are among the robust predictors of long-term mental health problems. However, estimates of the prevalence of ASD among RTA survivors varied considerably across studies. Therefore, this meta-analysis aimed to identify the pooled prevalence of ASD among RTA survivors.MethodsA systematic literature search in the databases of PubMed, PsycINFO, PsycARTICLES, Embase and Web of Science was performed from their inception dates to December 2017. Subject headings were used to identify relevant articles, and the search strategy was adjusted across databases. Heterogeneity across studies was evaluated by Cochran’s χ2 test and quantified by the I2 statistic. Subgroup analyses were performed to identify the pooled prevalence in relation to the country of study, instrument used to identify ASD, age, gender and traumatic brain injury. When significant heterogeneity was observed, the influence of some potential moderators was explored using meta-regression analyses.ResultsThirteen eligible studies conducted in 8 countries were included. A total of 2989 RTA survivors were assessed, of which 287 were identified with ASD. The overall heterogeneity was high across studies (I2=96.8%, P < 0.001), and the pooled prevalence of ASD among RTA survivors was 15.81% (95% confidence interval: 8.27–25.14%). Subgroup analyses indicated that the prevalence of ASD among RTA survivors differed significantly with regard to the country of study, instrument used to identify ASD, age and gender (P < 0.05). Meta-regression analyses showed that mean age of participants and quality assessment score were significant moderators for heterogeneity (P < 0.05).ConclusionsNearly one-sixth of RTA survivors suffer from ASD, indicating the need for regular assessment of early trauma responses among RTA survivors, as well as the importance of implementing early psychological interventions.Electronic supplementary materialThe online version of this article (10.1186/s12888-018-1769-9) contains supplementary material, which is available to authorized users.

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Section: Methodsmentioning

confidence: 99%

Prevalence of acute stress disorder among road traffic accident survivors: a meta-analysis

et al. 2018

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“…Pharmacological treatment using selective serotonin reuptake inhibitors may be helpful when trauma focused psychotherapies are not available or are refused by the patient [ 8 ]. Irrespective of the cause of trauma, most patients initially turn to general practitioners/primary care physicians (PCP – for reasons of consistency we refer to PCP in the further text) [ 9 ], with a median point prevalence of PTSD in primary care patients of 12.5% [ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Psychological interventions for posttraumatic stress disorder involving primary care physicians: systematic review and Meta-analysis of randomized controlled trials

et al. 2020

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Background: Evidence-based psychological interventions for posttraumatic stress disorder (PTSD) are available in specialized settings, but adequate care in primary care is often lacking. The aim of this systematic review was to determine the effectiveness of psychological interventions for PTSD involving primary care physicians (PCPs) and to characterize these interventions as well as their providers. Method: A systematic review and meta-analyses of randomized controlled trials (RCTs). Primary outcome were symptoms of PTSD. Results: Four RCTs with a total of 774 patients suffering from PTSD symptoms were included, all applying cognitive behavioural based interventions. Three studies with psychological interventions being conducted by case managers were pooled in a meta-analysis. Interventions were not effective in the short term (0-6 months; SMD, − 0.1; 95% CI, − 0.24-0.04; I 2 = 0%). Only two studies contributed to the meta-analysis for long term (12-18 months) outcomes yielding a small effect (SMD, − 0.23; 95% CI, − 0.38-0.08; I 2 = 0%). Conclusions: Psychological interventions for PTSD in primary care settings may be effective in the long term but number and quality of included studies was limited so the results should be interpreted with caution.

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“…Veterans with mental health disorders also have higher rates of comorbidity and greater severity of symptom presentation than non-veterans with mental health disorders 13 14. A recent systematic review revealed that the median prevalence of PTSD in primary care (across civilian and veteran populations) is equivalent to that of depression,12 though it is not typically the primary referral or complaint,15 highlighting the need for rigorous education, screening, assessment and appropriate treatment by providers.…”

Section: Introductionmentioning

confidence: 99%

Study protocol for a non-inferiority randomised controlled trial of SKY breathing meditation versus cognitive processing therapy for PTSD among veterans

et al. 2019

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IntroductionPost-traumatic stress disorder (PTSD) is a debilitating, highly prevalent condition. Current clinical practice guidelines recommend trauma-focused psychotherapy (eg, cognitive processing therapy; CPT) as the first-line treatment for PTSD. However, while these treatments show clinically meaningful symptom improvement, the majority of those who begin treatment retain a diagnosis of PTSD post-treatment. Perhaps for this reason, many individuals with PTSD have sought more holistic, mind–body, complementary and integrative health (CIH) interventions. However, there remains a paucity of high-quality, active controlled efficacy studies of CIH interventions for PTSD, which precludes their formal recommendation.Methods and analysesWe present the protocol for an ongoing non-inferiority parallel group randomised controlled trial (RCT) comparing the efficacy of a breathing meditation intervention (Sudarshan Kriya Yoga [SKY]) to a recommended evidence-based psychotherapy (CPT) for PTSD among veterans. Assessors are blinded to treatment group. The primary outcome measure is the PTSD Checklist-Civilian Version and a combination of clinical, self-report, experimental and physiological outcome measures assess treatment-related changes across each of the four PTSD symptom clusters (re-experiencing, avoidance, negative cognitions or mood and hyperarousal/reactivity). Once the RCT is completed, analyses will use both an intent-to-treat (using the ‘last observation carried forward’ for missing data) and a per-protocol or ‘treatment completers’ procedure, which is the most rigorous approach to non-inferiority designs.Ethics and disseminationTo the best of our knowledge, this is this first non-inferiority RCT of SKY versus CPT for PTSD among veterans. The protocol is approved by the Stanford University Institutional Review Board. All participants provided written informed consent prior to participation. Results from this RCT will inform future studies including larger multi-site efficacy RCTs of SKY for PTSD and other mental health conditions, as well as exploration of cost-effectiveness and evaluation of implementation issues. Results will also inform evidence-based formal recommendations regarding CIH interventions for PTSD.Trial registration numberNCT02366403; Pre-results.

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The Prevalence of Posttraumatic Stress Disorder in Primary Care: A Systematic Review

Cited by 88 publications

References 76 publications

Prevalence of acute stress disorder among road traffic accident survivors: a meta-analysis

Prevalence of acute stress disorder among road traffic accident survivors: a meta-analysis

Psychological interventions for posttraumatic stress disorder involving primary care physicians: systematic review and Meta-analysis of randomized controlled trials

Study protocol for a non-inferiority randomised controlled trial of SKY breathing meditation versus cognitive processing therapy for PTSD among veterans

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