Skip to main content Accessibility help
×
×
Home

Undetected post-traumatic stress disorder in secondary-care mental health services: systematic review

  • Stan Zammit (a1), Catrin Lewis (a2), Sarah Dawson (a3), Hannah Colley (a2), Hannah McCann (a2), Alice Piekarski (a2), Helen Rockliff (a3) and Jonathan Bisson (a4)...
Abstract
Background

Comorbid post-traumatic stress disorder (PTSD) is associated with poorer outcomes of other disorders, but is treatable.

Aims

To estimate the frequency of clinically undetected PTSD in secondary care.

Method

A systematic review of studies that screened for PTSD and reported on PTSD documentation in clinical records. Frequency of undetected PTSD was estimated, and reasons for heterogeneity explored.

Results

The median proportion of participants with undetected PTSD (29 studies) was 28.6% (interquartile range 18.2–38.6%). There was substantial heterogeneity, with studies conducted in the USA and those with the highest proportions of in-patients and patients with psychotic disorder reporting higher frequencies of undetected PTSD.

Conclusions

Undetected PTSD is common in secondary care, even if the true value is at the lower limit of the estimates reported here. Trials examining the impact of routine screening for PTSD are required to determine whether such programmes should be standard procedure for all mental health services.

Declaration of interest

None.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Undetected post-traumatic stress disorder in secondary-care mental health services: systematic review
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Undetected post-traumatic stress disorder in secondary-care mental health services: systematic review
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Undetected post-traumatic stress disorder in secondary-care mental health services: systematic review
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence: Stan Zammit, MRC Centre for Neuropsychiatric Genetics and Genomics, Hadyn Ellis building, Maindy Road, Cardiff CF24 4HQ. Email: zammits@cardiff.ac.uk
References
Hide All
1Campbell, DG, Felker, BL, Liu, CF, Yano, EM, Kirchner, JE, Chan, D, et al. Prevalence of depression-PTSD comorbidity: implications for clinical practice guidelines and primary care-based interventions. J Gen Intern Med 2007; 22: 711–8.
2Holtzheimer, PE 3rd, Russo, J, Zatzick, D, Bundy, C, Roy-Byrne, PP. The impact of comorbid posttraumatic stress disorder on short-term clinical outcome in hospitalized patients with depression. Am J Psychiatry 2005; 162: 970–6.
3Quarantini, LC, Miranda-Scippa, A, Nery-Fernandes, F, Andrade-Nascimento, M, Galvão-de-Almeida, A, Guimarães, JL, et al. The impact of comorbid posttraumatic stress disorder on bipolar disorder patients. J Affective Disord 2010; 123: 71–6.
4Seow, LS, Ong, C, Mahesh, MV, Sagayadevan, V, Shafie, S, Chong, SA, et al. A systematic review on comorbid post-traumatic stress disorder in schizophrenia. Schizophr Res 2016; 176: 441–51.
5National Institute for Health and Clinical Excellence. Post-traumatic Stress Disorder (PTSD): The Management of PTSD in Adults and Children in Primary and Secondary Care. NICE, 2005.
6Kilcommons, AM, Morrison, AP. Relationships between trauma and psychosis: an exploration of cognitive and dissociative factors. Acta Psychiatr Scand 2005; 112: 351–9.
7Kimerling, R, Trafton, JA, Nguyen, B. Validation of a brief screen for post-traumatic stress disorder with substance use disorder patients. Addict Behav 2006; 31: 2074–9.
8Mueser, KT, Goodman, LB, Trumbetta, SL, Rosenberg, SD, Osher, FC, Vidaver, R, et al. Trauma and posttraumatic stress disorder in severe mental illness. J Consult Clin Psychol 1998; 66: 493–9.
9Wang, B, Vivek, S. Survey of posttraumatic stress disorder (PTSD) with PTSD Checklist – Civilian (PCL-C) Questionnaire on outpatients at two mental health clinics in New York City. J Depress Anxiety 2013; S4: 007.
10Brady, S. Post-traumatic stress disorder in adults with serious mental illness and substance abuse. J Trauma Dissociation 2003; 4: 7790.
11Davidson, J, Smith, R. Traumatic experiences in psychiatric outpatients. J Trauma Stress 1990; 3: 459–75.
12Tagay, S, Herpertz, S, Langkafel, M, Senf, W. Posttraumatic stress disorder in a psychosomatic outpatient clinic: gender effects, psychosocial functioning, sense of coherence, and service utilization. J Psychosom Res 2005; 58: 439–46.
13Stroup, DF, Berlin, JA, Morton, SC, Olkin, I, Williamson, GD, Rennie, D, et al. Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 2000; 283: 2008–12.
14Hoy, D, Brooks, P, Woolf, A, Blyth, F, March, L, Bain, C, et al. Assessing risk of bias in prevalence studies: modification of an existing tool and evidence of interrater agreement. J Clin Epidemiol 2012; 65: 934–9.
15Egger, M, Davey Smith, G, Schneider, M, Minder, C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315: 629–34.
16Higgins, JP, Thompson, SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21: 1539–58.
17Bonn-Miller, MO, Bucossi, MM, Trafton, JA. The underdiagnosis of cannabis use disorders and other Axis-I disorders among military veterans within VHA. Mil Med 2012; 177: 786–8.
18Calhoun, PS, Stechuchak, KM, Strauss, JL, Bosworth, HB, Marx, CE, Butterfield, MI. Interpersonal trauma, war zone exposure, and posttraumatic stress disorder among veterans with schizophrenia. Schizophr Res 2007; 91: 210–6.
19Cascardi, M, Mueser, KT, DeGiralomo, J, Murrin, M. Physical aggression against psychiatric inpatients by family members and partners. Psychiatr Serv 1996; 47: 531–3.
20Craine, LS. Prevalence of a history of sexual abuse among female psychiatric patients in a state hospital system. Hosp Community Psychiatry 1988; 39: 300–4.
21Cusack, KJ, Grubaugh, AL, Knapp, RG, Frueh, B. Unrecognized trauma and PTSD among public mental health consumers with chronic and severe mental illness. Community Ment Health J 2006; 42: 487500.
22Dansky, BS, Roitzsch, JC, Brady, KT, Saladin, ME. Posttraumatic stress disorder and substance abuse: use of research in a clinical setting. J Trauma Stress 1997; 10: 141–8.
23Gosein Varendra, J, Stiffler Jon, D, Frascoia, Alan, Ford Elizabeth, B. Life stressors and posttraumatic stress disorder in a seriously mentally ill jail population. J Forens Sci 2016; 61: 116–21.
24Schwartz, AC, Bradley, RL, Sexton, M, Sherry, A, Ressler, KJ. Posttraumatic stress disorder among African Americans in an inner city mental health clinic. Psychiatr Serv 56: 212–5.
25Switzer, GE, Dew, MA, Thompson, K, Goycoolea, JM, Derricott, T, Mullins, SD. Posttraumatic stress disorder and service utilization among urban mental health center clients. J Trauma Stress 1999; 12: 2539.
26Villano, CL, Rosenblum, A, Magura, S, Fong, C, Cleland, C, Betzler, TF. Prevalence and correlates of posttraumatic stress disorder and chronic severe pain in psychiatric outpatients. J Rehab Res Develop 2007; 44: 167–78.
27Howgego, IM, Owen, C, Meldrum, L, Yellowlees, P, Dark, F, Parslow, R. Posttraumatic stress disorder: an exploratory study examining rates of trauma and PTSD and its effect on client outcomes in community mental health. BMC Psychiatry 2005; 5: 21.
28Komiti Angela, A, Jackson Henry, J, Judd Fiona, K, Cockram, AM, Kyrios, M, Yeatman, R, et al. A comparison of the Composite International Diagnostic Interview (CIDI-Auto) with clinical assessment in diagnosing mood and anxiety disorders. Aust N Z J Psychiatry 2001; 35: 224–30.
29McFarlane, A, Schrader, G, Bookless, C, Browne, D. Prevalence of victimization, posttraumatic stress disorder and violent behaviour in the seriously mentally ill. Aust N Z J Psychiatry 2006; 40: 1010–5.
30Reynolds, M, Mezey, G, Chapman, M, Wheeler, M, Drummond, C, Baldacchino, A. Co-morbid post-traumatic stress disorder in a substance misusing clinical population. Drug Alcohol Depend 2005; 77: 251–8.
31Reynolds, M, Hinchliffe, K, Asamoah, V, Kouimtsidis, C. Trauma and post-traumatic stress disorder in a drug treatment community service. Psychiatrist 2011; 35: 256–60.
32de Bont, PA, van den Berg, DP, van der Vleugel, BM, de Roos, C, de Jongh, A, van der Gaag, M, et al. Predictive validity of the Trauma Screening Questionnaire in detecting post-traumatic stress disorder in patients with psychotic disorders. Br J Psychiatry 2015; 206: 408–16.
33Gielen, N, Havermans, RC, Tekelenburg, M, Jansen, A. Prevalence of post-traumatic stress disorder among patients with substance use disorder: it is higher than clinicians think it is. Eur J Psychotraumatol 2012; 3: 10.
34Lommen, MJ, Restifo, K. Trauma and posttraumatic stress disorder (PTSD) in patients with schizophrenia or schizoaffective disorder. Community Ment Health J 2009; 45: 485–96.
35Tagay, S, Schlegl, S, Senf, W. Traumatic events, posttraumatic stress symptomatology and somatoform symptoms in eating disorder patients. Eur Eating Disord Rev 2010; 18: 124–32.
36Van Zyl, M, Oosthuizen, P, Seedat, S. Post traumatic stress disorder: undiagnosed cases in a tertiary inpatient setting. Afr J Psychiatry 2008; 11: 119–22.
37Alvarez, MJ, Roura, P, Foguet, Q, Oses, A, Sola, J, Arrufat, FX. Posttraumatic stress disorder comorbidity and clinical implications in patients with severe mental illness. J Nervous Mental Dis 2012; 200: 549–52.
38Kavakci, O, Semiz, M, Kartal, A, Dikici, A, Kugu, N. Prevalence of post-traumatic stress disorder among the inpatients in a tertiary clinic and relationship with suicidal attempts. Neurol Psychiatry Brain Res 2013; 19: 76–9.
39Blanchard, EB, Jones-Alexander, J, Buckley, TC, Forneris, CA. Psychometric properties of the PTSD Checklist (PCL). Behav Res Ther 1996; 34: 669–73.
40Brewin, CR, Rose, S, Andrews, B, Green, J, Tata, P, McEvedy, C, et al. Brief screening instrument for post-traumatic stress disorder. Br J Psychiatry 2002; 181: 158–62.
41Sin, GL, Abdin, E, Lee, J. The PSS-SR as a screening tool for PTSD in first-episode psychosis patients. Early Interv Psychiatry 2012; 6: 191–4.
42Hovens, JE, Bramsen, I, van der Ploeg, HM. Self-rating inventory for posttraumatic stress disorder: review of the psychometric properties of a new brief Dutch screening instrument. Percept Mot Skills 2002; 94: 9961008.
43Harrington, T, Newman, E. The psychometric utility of two self-report measures of PTSD among women substance users. Addict Behav 2007; 32: 2788–98.
44Witteveen, AB, Bramsen, I, Hovens, JE, van der Ploeg, HM. Utility of the impact of event scale in screening for posttraumatic stress disorder. Psychol Rep 2005; 97: 297308.
45Coffey, SF, Gudmundsdottir, B, Beck, JG, Palyo, SA, Miller, L. Screening for PTSD in motor vehicle accident survivors using the PSS-SR and IES. J Trauma Stress 2006; 19: 119–28.
46Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, CB. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 1995; 52: 1048–60.
47Alonso, J, Angermeyer, MC, Bernert, S, Bruffaerts, R, Brugha, TS, Bryson, H, et al. Prevalence of mental disorders in Europe: results from the European Study of the Epidemiology of Mental Disorders (ESEMeD) project. Acta Psychiatr Scand Suppl 2004; 420: 21–7.
48Burri, A, Maercker, A. Differences in prevalence rates of PTSD in various European countries explained by war exposure, other trauma and cultural value orientation. BMC Res Notes 2014; 7: 407.
49Duckers, ML, Alisic, E, Brewin, CR. A vulnerability paradox in the cross-national prevalence of post-traumatic stress disorder. Br J Psychiatry 2016; 209: 300–5.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
UNKNOWN
Supplementary materials

Zammit et al supplementary material
Zammit et al supplementary material 1

 Unknown (130 KB)
130 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Undetected post-traumatic stress disorder in secondary-care mental health services: systematic review

  • Stan Zammit (a1), Catrin Lewis (a2), Sarah Dawson (a3), Hannah Colley (a2), Hannah McCann (a2), Alice Piekarski (a2), Helen Rockliff (a3) and Jonathan Bisson (a4)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *