Barriers to receiving early care for PTSD: results from the Jerusalem trauma outreach and prevention study.

OBJECTIVES: Preventing posttraumatic stress disorder (PTSD) is a pressing public health need. Studies have shown significant barriers to obtaining early care. This study prospectively evaluated the acceptance of early assessment and treatment, the accuracy of recommending care, and the consequences of declining it.

METHODS: Researchers undertook systematic outreach to survivors of traumatic events consecutively seen in a general hospital emergency department. Structured telephone interviews were conducted 9.5±3.2 days after the emergency visit. Persons with acute stress disorder symptoms were invited for clinical assessment. Those clinically assessed as having acute PTSD symptoms were offered treatment. Telephone interviews, conducted 224.9±39.1 days from the traumatic event, evaluated those included in the initial assessment and a random sample of 10% of those not included because they were deemed not to have experienced a traumatic event.

RESULTS: Telephone calls were made to 5,286 individuals, and 5,053 were reached (96%). Of these, 4,743 (94%) agreed to a telephone interview, 1,502 were invited for a clinical assessment, 756 (50%) attended the assessment, 397 were eligible for treatment, and 296 (75%) started treatment. Declining clinical assessments and treatment were associated with less symptom reduction over time. The prevalence of PTSD among those deemed not to have experienced a traumatic event, not to need clinical assessment, and not to need treatment were, respectively, 4%, 11%, and 3%.

CONCLUSIONS: Despite successful outreach, many symptomatic participants declined clinical care and subsequently recovered less well. Screening for DSM-IV PTSD criterion A effectively identified survivors at low risk for PTSD. Systematic outreach is costly and might be reserved for exceptionally traumatic events.