2012 APA - IPS: Implications for Primary Care in Associations between Somatization-like Illness, PTSD, and Depression

Study indicates that nonspecific physical symptoms such as pain, weakness, and shortness of breath may indicate PTSD or depression.

New York, NY — Researchers uncovered novel findings in a study to determine if there is an association between somatization-like illness and post-traumatic stress disorder (PTSD) in patients presenting to primary care. Their results were presented in a poster at the American Psychiatric Association 64th Institute on Psychiatric Services.

Based on recent studies showing that frequent reporting of nonspecific illness and PTSD are common in the primary care setting, researchers set out to examine factors that might mediate or moderate this association.

“When patients come to the doctor complaining of nonspecific physical symptoms such as pain, weakness, and shortness of breath, the primary care physician should screen for PTSD,” said study author Jagadeesh Batana, MD.

To take this screening further, the researchers enrolled 400 English-speaking volunteers in an urban primary care clinic at the University of Medicine and Dentistry of New Jersey medical school in a 12-month study. Participants were administered psychiatric screening questionnaires to identify PTSD (Post-traumatic Stress Disorder Checklist), somatization-like illness and depression (Patient Health Questionnaire), and alcoholism.

Participants were evenly balanced by gender: females (51.7%) and males (51.1%). Approximately half were of African American descent (53.1% females, 56.6% males). Based on the questionnaires, the prevalence of somatization-like illness in females with and without PTSD was 63.8% and 23.3%, respectively. The prevalence of males with and without PTSD was 61.2 % and 9.7%, respectively. Similarly, the prevalence of females with and without depression was 69.7% and 25.4%, respectively, while for males the prevalence with and without depression was 65.7% and 13.0%.

Results of the first phase of the ongoing 12-month study replicated earlier research showing an association between somatization-like symptoms and PTSD. Among primary care patients, individual differences in reporting of nonspecific symptoms may be due to PTSD, depression, or both. It also yielded a novel finding concerning the presence or absence of these disorders in symptom reporting. Women with PTSD or depression do not report more nonspecific symptoms than men, but women without PTSD or depression do report a higher prevalence of somatization-like symptoms. These results suggest the utility of psychiatric screening in primary care to identify individuals with untreated mental illness.

“The significance or our findings for the primary care clinician is that when a patient comes in with nonspecific physical complaints, instead of running an expensive battery of tests, it may be wise to administer a more cost-effective depression screening first,” Batana said.