MIDAS Project
Publication Abstracts
Zimmerman, M., Mattia, J.I. Is posttraumatic stress disorder
underdiagnosed in routine clinical settings? Journal of Nervous and
Mental Disease, 1999, 187, 420-428.
The goal of the present study was to examine whether posttraumatic
stress disorder (PTSD) is underrecognized in routine clinical practice.
One thousand patients were evaluated at the Rhode Island Hospital
Department of Psychiatry outpatient practice. The first 500 patients
completed a psychiatric diagnostic screening questionnaire that included a
PTSD subscale. The next 500 individuals were interviewed with the
Structural Clinical Interview for DSM-IV (SCID). In the first 500
patients, thirty-six (7.2%) patients were diagnosed by their clinicians
with PTSD and nearly one-fifth (18.6%) of the sample screened positive on
the questionnaire but were not diagnosed with PTSD. The patients who were
diagnosed with PTSD and the patients who screened positive but were not
given the diagnosis were significantly younger, had lower GAF scores, and
less frequently graduated from college than the non-PTSD group. The
frequency of suicidal thoughts was identical in the 2 PTSD groups and
twice as high as the frequency in the non-PTSD group. Scores on 9 of the
other 12 psychopathology dimensions assessed by the screening
questionnaire were significantly higher in the 2 PTSD groups than the non-PTSD
group. In the 500 patients interviewed with the SCID the prevalence of
PTSD was two times higher than in the 500 patients diagnosed with an
unstructured clinical interview (14.4% vs. 7.2%). The difference in
prevalence rates of PTSD between the SCID and clinical samples was
significant when considering PTSD as an additional diagnosis; there was no
difference in prevalence rates when restricting the analysis to principal
diagnoses. The results of this study suggest that PTSD is frequently
overlooked in routine clinical practice when symptoms of PTSD are not the
presenting complaint.
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