PTSD Prevalent, Underrecognized in the Inpatient Psychiatric Setting

Comorbid PTSD and other psychiatric illness has been linked to increased rates of suicidal ideation and substance use disorders.
Comorbid PTSD and other psychiatric illness has been linked to increased rates of suicidal ideation and substance use disorders.

ATLANTA, Georgia — At least 50% of the population can be expected to experience a traumatic event in their lifetime, with a majority reported to experience more than one event.1 Trauma in the presence of a psychiatric diagnosis occurs even more frequently, with 1 study identifying 91% of patients in a psychiatric hospital being exposed to at least 1 trauma.2 The national 12-month prevalence of posttraumatic stress disorder (PTSD) in the United States is 3.5%.3 Although research on PTSD in the inpatient psychiatric setting is limited, comorbid PTSD and other psychiatric illness is common and linked to increased rates of suicidal ideation and substance use disorders.

To study this further, a team of investigators from the University of Texas Health Science Center, McGovern Medical School, in Houston, undertook an assessment of all psychiatric patients admitted to an inpatient psychiatric unit over a 6-month period with a goal of determining the prevalence of PTSD in this setting.4

The results of their study were presented at the 2016 Annual Meeting of the American Psychiatric Association (APA), in Atlanta, Georgia.

A total of 115 patients with a primary diagnosis of bipolar, depressive, or psychotic disorder were included in the study.  Patients with a primary diagnosis of either substance-induced mood/psychotic disorder or adjustment disorder were excluded from participation. All patients were asked to complete the PTSD Checklist for DSM-5 (PCL-5), which is a self-reported measure used to assess the 20 symptoms of PTSD as indicated in the DSM-5.  Patients are instructed to describe their symptoms as “not at all,” “a little bit,” “moderately,” “quite a bit,” or “extreme.”

A provisional diagnosis of PTSD was made in 48 (41.74%) patients, as determined by a cut-off score of >33 (out of 80) on the PCL-5.  There was no difference between groups based on gender, race, or primary diagnosis; however, patients with PTSD were older than those without (36.85 years vs 32.55 years; P<.05).

The authors concluded that the prevalence of PTSD in the psychiatric inpatient setting is much higher than the national average.  As PTSD in this setting may be underrecognized and undertreated, “clinicians should explore a diagnosis of PTSD more frequently in the inpatient population.”

Click here for more research from the 2016 Annual Meeting of the American Psychiatric Association.

References

1. Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52:1048-1060.

2. Floen SK, Elklit A. Psychiatric diagnoses, trauma, and suicidality. Ann Gen Psychiatry. 2007;6:12.

3. Kessler RC, Chiu WT, Demler O, Walters EE. Prevalence, severity, and comorbidity of twelve-month DSM-IV disorders in the National Comorbidity Survey Replication (NCS-R). Arch Gen Psychiatry. 2005;62(6):617-627.

4. James C, Desai P, Allen M, Pigott T. PTSD symptoms in acute psychiatric inpatients: prevalence and impact on comorbid diagnoses, demographics, and length of stay. Poster presentation at: 2016 Annual Meeting of the American Psychiatric Association; May 14-18, 2016; Atlanta, GA. P2-056.

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