This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Deykin, E. Y. Articles by Creamer, K. Search for Related Content PubMed PubMed Citation Articles by Deykin, E. Y. Articles by Creamer, K. Related Collections Other Epidemiology PTSD

Posttraumatic Stress Disorder and the Use of Health Services

National Center for PTSD (E.Y.D., T.M.K., D.K., M.S.), and Medical Service (G.F., K.C.), Veterans Administration Boston Healthcare System and Boston University School of Medicine, and Boston University School of Public Health (J.R.), Boston; and Center for Health Quality, Outcomes, and Economic Research, HSR&D Service (J.R.), Bedford Veterans Administration Medical Center, Bedford, Massachusetts.

Address reprint requests to: Terence M. Keane, PhD, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. Email: terry.keane{at}med.va.gov

OBJECTIVE: Prior research has demonstrated increased use of medical services among persons with anxiety and depression. This investigation examined the possible association of posttraumatic stress disorder (PTSD) with the use of nonmental health services.

METHOD: A case-comparison design enrolled 102 high users of health services and 54 low users who were assessed for PTSD diagnosis and severity of PTSD symptoms. Subjects were male veterans receiving services from the primary care clinics of the VA Boston Healthcare System during an 18-month period. Data were collected by interview by use of standardized instruments including the Clinician Administered PTSD Scale for DSM-IV, the Life Events Checklist, and the Beck Depression Inventory. Data analysis employed odds ratios, linear and logistic regression, and path analyses.

RESULTS: High users of health care were almost twice as likely as low users (27.5% vs. 14.8%) to meet diagnostic criteria for current PTSD. The two groups differed significantly on both symptom frequency and intensity. Path analyses showed an indirect positive association between PTSD and health services use, with physician-diagnosed health conditions as a mediating variable. Auxiliary analysis demonstrated that the combined mental health burden of PTSD and depression symptoms also is positively associated with number of health conditions.

CONCLUSIONS: The findings indicate that PTSD, alone and in combination with depression, has a direct negative relationship with physical health that, in turn, is associated with more frequent use of primary health care services. These results do not suggest that PTSD leads to inappropriate (eg, distress-motivated) use of services.

Key Words: Posttraumatic stress disorder • primary care • health services utilization • veterans • health status

Abbreviations: PTSD = Posttraumatic Stress Disorder; DSM-IV = Diagnostic and Statistical Manual version IV; BDI = Beck Depression Inventory; CAPS-DX = Clinician Administered PTSD Scale for DSM-IV—Current and Lifetime Diagnostic Version; LSD = least significant difference; ANOVA = analysis of variance; SD = standard deviation; SES = Socio-economic status

This article has been cited by other articles:

				B. C. Frueh, A. L. Grubaugh, R. Acierno, J. D. Elhai, G. Cain, and K. M. Magruder Age Differences in Posttraumatic Stress Disorder, Psychiatric Disorders, and Healthcare Service Use Among Veterans in Veterans Affairs Primary Care Clinics Am J Geriatr Psychiatry, August 1, 2007; 15(8): 660 - 672. [Abstract] [Full Text] [PDF]

				M. McFall, A. J. Saxon, S. Thaneemit-Chen, M. W. Smith, A. M. Joseph, T. P. Carmody, J. C. Beckham, C. A. Malte, J. E. Vertrees, K. D. Boardman, et al. Integrating smoking cessation into mental health care for post-traumatic stress disorder Clinical Trials, April 1, 2007; 4(2): 178 - 189. [Abstract] [PDF]

				D. Lauterbach, R. Vora, and M. Rakow The Relationship Between Posttraumatic Stress Disorder and Self-Reported Health Problems Psychosom Med, November 1, 2005; 67(6): 939 - 947. [Abstract] [Full Text] [PDF]

				H. Spindler and S. S. Pedersen Posttraumatic Stress Disorder in the Wake of Heart Disease: Prevalence, Risk Factors, and Future Research Directions Psychosom Med, September 1, 2005; 67(5): 715 - 723. [Abstract] [Full Text] [PDF]

				S. M. Frayne, M. R. Seaver, S. Loveland, C. L. Christiansen, A. Spiro III, V. A. Parker, and K. M. Skinner Burden of Medical Illness in Women With Depression and Posttraumatic Stress Disorder Arch Intern Med, June 28, 2004; 164(12): 1306 - 1312. [Abstract] [Full Text] [PDF]

				D. Mohr, K. Vedantham, T. Neylan, T. J. Metzler, S. Best, and C. R. Marmar The Mediating Effects of Sleep in the Relationship Between Traumatic Stress and Health Symptoms in Urban Police Officers Psychosom Med, May 1, 2003; 65(3): 485 - 489. [Abstract] [Full Text] [PDF]