Posttraumatic stress disorder in a psychosomatic outpatient clinic. Gender effects, psychosocial functioning, sense of coherence, and service utilization.

BACKGROUND: The lifetime prevalence of DSM-IV traumatic events and posttraumatic stress disorder (PTSD) was assessed in outpatients of a tertiary referral mental health center; differences in psychopathology and service utilization between PTSD and non-PTSD patients were evaluated.

METHODS: Five hundred eighty-three outpatients (35.3 years, S.D.=12.5; 74.3% women and 25.7% men), who had been initially examined by clinically experienced medical and psychological psychotherapists, were investigated by means of standardized trauma-specific questionnaires.

RESULTS: Of the patients, 61.1% reported at least one traumatic event during their lifetime, but only 34.3% of the total sample met the DSM-IV (A1 and A2) criteria. The lifetime prevalence of PTSD-positive screening was 10.1%. In 2.7% of these patients, PTSD had been diagnosed in clinical routine (ICD-10: F43.1); 6.6% of the men and 11.3% of the women met the diagnostic criteria for lifetime prevalence of PTSD. All in all, patients with PTSD had higher levels of depression and anxiety and lower levels of sense of coherence (P < .001) than did patients without PTSD (all P < .001). In addition, PTSD patients reported significantly higher rates of medical consultations (P < .001), psychotropic medication (P < .001), and psychotherapy (P < .001).

CONCLUSIONS: About one third of the outpatients suffered from DSM-IV traumas, and 10%, from PTSD. However, PTSD had been diagnosed only in very few patients within the routine diagnostic procedure. These findings suggest that PTSD is frequently overlooked not only in primary but also in tertiary care settings. Finally, our study supports previous results that PTSD patients use more service utilization and are more affected by psychopathology symptoms.