INFORMATION ON PTSD IN PRIMARY CARE

PTSD is a consequence of extreme psychological trauma including assault, rape, abuse, motor vehicle accidents, natural and human-caused disasters, and combat. Most people exposed to an extreme traumatic event do not develop PTSD, but the condition has been observed in military populations from most countries and after every major conflict since it was first officially defined in 1980. In the US, some veterans of Vietnam, the Gulf, Bosnia/Kosovo, Afghanistan, and Iraq Wars have developed PTSD. Prior to that, PTSD-like syndromes have been recognized since the US Civil War and gone by names like Soldier’s Heart, Shell Shock, Neurasthenia, and Effort Syndrome. In addition to war veterans, PTSD is relatively common among occupations at high risk of encountering destruction and violence, including fire fighters, police, and other community crisis responders. UN peacekeeping forces deployed to international war zones have also developed PTSD.

The diagnosis of PTSD involves experiencing extreme reactions to a highly traumatic event resulting in three symptom types (intrusion, numbing-avoidance, and physiologic arousal). To meet criteria for PTSD, the symptoms must last at least a month and result in clinically significant distress or diminished functioning.

The process of care for Soldiers with PTSD begins much the same way as those with depression; there is a brief routine screening form and a longer diagnostic and severity assessment form called a PCL (PTSD Checklist). This self-administered questionnaire helps make a PTSD diagnosis, determine symptom severity, and screen for suicidal thoughts. The Primary Care Clinician assesses suicide risk in those who report suicidal thoughts on this form. Once a diagnosis is made the Primary Care Clinician works with the Soldier on a course of treatment. This could be medication, psychological counseling with a Behavioral Health Specialist, or a combination of the two. Obtaining remission for PTSD often takes longer than with depression.

Soldiers in RESPECT-Mil follow-up are provided regular telephone support from a Care Facilitator who has received rigorous training. The Care Facilitator helps coordinate care recommendations from a Behavioral Health Specialist to Primary Care Clinicians, creating a supportive care partnership for the Soldier. Care Facilitators also monitor Soldiers’ response to treatment. Primary Care Clinicians, armed with the recommendations of the Behavioral Health Specialist and the enhanced continuity of care provided by Care Facilitator support, can make timely adjustments to the level of care, to the care setting, and to both medical and psychosocial treatments. These treatment adjustments are often unlikely to occur without this extra level of Primary Care Clinician support.