Patient factors relating to detection of posttraumatic stress disorder in Department of Veterans Affairs primary care settings

We examined the impact of patient-level factors on provider recognition of posttraumatic stress disorder (PTSD). Analyses were based on a random sample of 1,079 consenting patients who had an outpatient visit at any of four southeastern Department of Veterans Affairs hospitals in 1999. We collected data on PTSD symptoms, sociodemographics, functional status, medical record diagnoses, and independent PTSD diagnostic assessments for 888 patients. Complete and usable data were available for 819 patients. A total of 98 patients (12%) met criteria for PTSD, and of these, 42 (43%) were correctly classified as such by their provider. Results indicate that age (50-64), war-zone service, worse functioning on the 36-Item Short Form Health Survey role emotional subscale, a diagnosis of musculoskeletal pain, a greater percentage of persistent reexperiencing or avoidance/numbing symptoms, and a previously diagnosed substance use disorder were all independently related to provider recognition of PTSD. Knowledge of these factors may help inform providers and direct improved screening and case finding.