Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions
Open accessAbstract
Background Compared to those with depression alone, depressed patients with posttraumatic stress disorder (PTSD) experience more severe psychiatric symptomatology and factors that complicate treatment. Objective To estimate PTSD prevalence among depressed military veteran primary care patients and compare demographic/illness characteristics of PTSD screen-positive depressed patients (MDD-PTSD+) to those with depression alone (MDD). Design Cross-sectional comparison of MDD patients versus MDD-PTSD+ patients. Participants Six hundred seventy-seven randomly sampled depressed patients with at least 1 primary care visit in the previous 12 months. Participants composed the baseline sample of a group randomized trial of collaborative care for depression in 10 VA primary care practices in 5 states. Measurements The Patient Health Questionnaire-9 assessed MDD. Probable PTSD was defined as a Primary Care PTSD Screen > or = 3. Regression-based techniques compared MDD and MDD-PTSD+ patients on demographic/illness characteristics. Results Thirty-six percent of depressed patients screened positive for PTSD. Adjusting for sociodemographic differences and physical illness comorbidity, MDD-PTSD+ patients reported more severe depression (P < .001), lower social support (P < .001), more frequent outpatient health care visits (P < .001), and were more likely to report suicidal ideation (P < .001) than MDD patients. No differences were observed in alcohol consumption, self-reported general health, and physical illness comorbidity. Conclusions PTSD is more common among depressed primary care patients than previously thought. Comorbid PTSD among depressed patients is associated with increased illness burden, poorer prognosis, and delayed response to depression treatment. Providers should consider recommending psychotherapeutic interventions for depressed patients with PTSD.
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The comorbidity between PTSD and depression is supported by many studies.
“The comorbidity between PTSD and depression is supported by many studies (Bleich et al., 1997; Campbell et al., 2007; O’Donnell et al., 2014), so we assume that depression-related rumination is positively associated with PTSD.”
From Coexistence and different determinants of posttraumatic stress disorder and posttraumatic growth among Chinese survivors after earthquake: role of resilience and rumination (2015) · cites this paper as Campbell et al., 2007
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“A limitation of the model is the comorbidity between MDD and PTSD (e.g. Campbell et al., 2007).”
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“and several findings in the literature that confirmed these co-morbidities [8], [23], we decided to combine the three measures using factor analysis to that of general distress.”
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“…traumaexposed individuals still experience residual posttraumatic stress symptoms that negatively impact their quality of life (Thomas et al., 2010) and increased risk for other mental health conditions such as depression and problematic substance use (Campbell et al., 2007; Thomas et al., 2010).”
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BackgroundMental Health Care For Iraq And Afghanistan War Veterans
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“It operates 877 hospitals and clinics and, within these, nearly 200 specialized outpatient and day treatment programs for PTSD, as well as inpatient units dedicated to PTSD. Care for depression within the VHA is delivered largely within the primary care outpatient setting.10 All veterans with combat service after 11 N…”
InfluentialScherer, S. J., Lucas, G., Gratch, J. S., Rizzo, A., & Morency, L. (2015) · IEEE Transactions on Affective Computing · doi:10.1109/taffc.2015.2440264 · Cited by 122 · see citing works
“This fnding is aligned with prior work reporting high comorbidity between PTSD as well as suicidality and depression [21], [75].”
BackgroundResultPrevalence and predictors of PTSD among a college sample
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“use disorders, anxiety disorders, and suicidal ideation.(19,20,21) The use of longitudinal data to further examine these relationships will contribute to a more comprehensive understanding of how PTE exposure and”
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“That dysregulation is also commonly seen in MDD (Rive et al., 2013; Heller et al., 2013), and the two disorders are often comorbid (Regier et al., 2013; Bleich et al., 1997; Campbell et al., 2007).”
Automatic audiovisual behavior descriptors for psychological disorder analysis
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“Based on this analysis, and several findings in theliterature that confirmed these co-morbidities [52,42], we decided to combine the three measures using principal component analysis to that of general distress.”
MethodMental Health Characteristics of Sexual Minority Veterans
Cochran, B. N., Balsam, K. F., Flentje, A., Malte, C., & Simpson, T. L. (2013) · Journal of Homosexuality · doi:10.1080/00918369.2013.744932 · Cited by 124 · see citing works
“Comorbidity, or presence of multiple diagnoses, is also quite common, with one study finding that 36% of depressed patients receiving care through the Veterans Affairs (VA) system also screened positive for PTSD (Campbell et al., 2007).”
BackgroundDepression subtyping based on evolutionary psychiatry: Proximate mechanisms and ultimate functions
Rantala, M. J., Luoto, S., Krams, I. A., & Karlsson, H. (2017) · Brain Behavior and Immunity · doi:10.1016/j.bbi.2017.10.012 · Cited by 121 · see citing works
Wahbeh, H., Svalina, M. N., & Oken, B. S. (2014) · Open Medicine Journal · doi:10.2174/1874220301401010066 · Cited by 116 · see citing works
Rubenstein, L. V., Chaney, E. F., Ober, S. K., Felker, B. L., Sherman, S. E., Lanto, A. B., & Vivell, S. (2010) · Families Systems & Health · doi:10.1037/a0020302 · Cited by 114 · see citing works
“, 2004); posttraumatic stress disorder (PTSD) using the PTSD Check List (PCL) (Campbell et al., 2007); past history of bipolar disorder or use of mood stabilizers; and dysthymia from the 1 International Diagnostic Instrument (CIDI) short form (Composite International Diagnostic Interview (CIDI) Core Version 2.”
MethodInfluentialSelf-citationTheory of mind performance in women with posttraumatic stress disorder related to childhood abuse
Nazarov, A., Frewen, P., Parlar, M., Oremus, C., MacQueen, G., McKinnon, M., & Lanius, R. (2014) · Acta Psychiatrica Scandinavica · doi:10.1111/acps.12142 · Cited by 111 · see citing works
Delahanty, D. L., Gabert-Quillen, C., Ostrowski, S. A., Nugent, N. R., Fischer, B., Morris, A., Pitman, R. K., Bon, J., & Fallon, W. (2013) · CNS Spectrums · doi:10.1017/s1092852913000096 · Cited by 115 · see citing works
Nichter, B., Norman, S. B., Haller, M. M., & Pietrzak, R. H. (2019) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2019.109744 · Cited by 110 · see citing works
Schulze, L., Schulze, A., Renneberg, B., Schmahl, C., & Niedtfeld, I. (2019) · Biological Psychiatry: Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2018.11.004 · Cited by 102 · see citing works
Dennis, E. L., Disner, S. G., Fani, N., Salminen, L. E., Logue, M. W., Clarke‐Rubright, E. K., Haswell, C. C., Averill, C. L., Baugh, L. A., Bomyea, J. A., et al. (2019) · Molecular Psychiatry · doi:10.1038/s41380-019-0631-x · Cited by 108 · see citing works
Post‐traumatic stress disorder and risk of dementia among members of a health care delivery system
Flatt, J. D., Gilsanz, P., Quesenberry, C. P., Albers, K. B., & Whitmer, R. A. (2017) · Alzheimer s & Dementia · doi:10.1016/j.jalz.2017.04.014 · Cited by 105 · see citing works
“For example, depression is associated with a 2- to 3-fold increased risk of dementia [18,19]; and comorbid depression among individuals with PTSD is very common, with estimates of co-occurrence ranging from 30% to 50% [20,21].”
BackgroundZhou, X., & Wu, X. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.12.076 · Cited by 102 · see citing works
Health Care Utilization and Its Costs for Depressed Veterans With and Without Comorbid PTSD Symptoms
Chan, D., Cheadle, A. D., Reiber, G. E., Unützer, J., & Chaney, E. F. (2009) · Psychiatric Services · doi:10.1176/ps.2009.60.12.1612 · Cited by 103 · see citing works
Self-citationPharmacotherapy for posttraumatic stress disorder: Review with clinical applications
Jeffreys, M., Capehart, B. P., & Friedman, M. J. (2012) · The Journal of Rehabilitation Research and Development · doi:10.1682/jrrd.2011.09.0183 · Cited by 98 · see citing works
Targeting opioid dysregulation in depression for the development of novel therapeutics
Browne, C. A., & Lucki, I. (2019) · Pharmacology & Therapeutics · doi:10.1016/j.pharmthera.2019.04.009 · Cited by 97 · see citing works
Neuropeptide Y (NPY) and posttraumatic stress disorder (PTSD): A translational update
Schmeltzer, S. N., Herman, J. P., & Sah, R. (2016) · Experimental Neurology · doi:10.1016/j.expneurol.2016.06.020 · Cited by 99 · see citing works
“Significant comorbidity is observed between depression and PTSD, with about 36–43% of traumatized subjects expressing comorbid PTSD and depressive symptomology (Campbell et al., 2007; Stein and Kennedy, 2001).”
Structural brain abnormalities common to posttraumatic stress disorder and depression
Kroes, M. C. W., Rugg, M. D., Whalley, M. G., & Brewin, C. R. (2011) · Journal of Psychiatry and Neuroscience · doi:10.1503/jpn.100077 · Cited by 95 · see citing works
“This overlap is hard to interpret since PTSD and depression have a number of symptoms in common and are frequently comorbid.(4) For example, in one study, reduced hippocampal size was found only in depressed individuals if they also reported early childhood trauma, but two-thirds of this group had comorbid PTSD.”
Sabri, B., Bolyard, R., McFadgion, A. L., Stockman, J. K., Lucea, M. B., Callwood, G. B., Coverston, C. R., & Campbell, J. C. (2013) · Social Work in Health Care · doi:10.1080/00981389.2012.745461 · Cited by 89 · see citing works
“Co-occurrence of PTSD and depression increases illness burden, delays response to treatment of one type of problem, and impairs women’s ability to fully utilize personal and social resources (Campbell et al., 2006; Gorde, Helfrich, & Finalyson, 2004; Green et al., 2006; Sullivan & Bybee, 1999).”
BackgroundChaney, E. F., Rubenstein, L. V., Liu, C., Yano, E. M., Bolkan, C. R., Lee, M., Simon, B. F., Lanto, A. B., Felker, B. L., & Uman, J. E. (2011) · Implementation Science · doi:10.1186/1748-5908-6-121 · Cited by 88 · see citing works
“Campbell DG, et al: Prevalence of depression-PTSD comorbidity: implications for clinical practice guidelines and primary care-based interventions.”
BackgroundSelf-citationAndersen, J. P., Wade, M. J., Possemato, K., & Ouimette, P. C. (2010) · Psychosomatic Medicine · doi:10.1097/psy.0b013e3181d969a1 · Cited by 87 · see citing works
Trauma, depression, and comorbid PTSD/depression in a community sample of Latina immigrants.
Kaltman, S. I., Green, B. L., Méte, M., Shara, N. M., & Miranda, J. M. (2010) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0018952 · Cited by 87 · see citing works
Puetz, T. W., Youngstedt, S. D., & Herring, M. P. (2015) · PLoS ONE · doi:10.1371/journal.pone.0126529 · Cited by 86 · see citing works
“For example, higher depressive symptom severity was found among patients with PTSD and comorbid panic disorder compared to patients without the comorbidity [45].”
Post-traumatic stress disorder, depression, and health-related quality of life in OEF/OIF veterans
Pittman, J. O. E., Goldsmith, A. A., Lemmer, J. A., Kilmer, M. T., & Baker, D. G. (2011) · Quality of Life Research · doi:10.1007/s11136-011-9918-3 · Cited by 85 · see citing works
“negative effects on health status [6], understanding that the unique impact of PTSD and depression is important.”
BackgroundStecker, T. A., Fortney, J. C., Owen, R. R., McGovern, M. P., & Williams, S. (2010) · Psychosomatics · doi:10.1176/appi.psy.51.6.503 · Cited by 83 · see citing works
for the Millennium Cohort Study Team, Armenta, R. F., Walter, K. H., Geronimo-Hara, T. R., Porter, B., Stander, V. A., & LeardMann, C. A. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2375-1 · Cited by 87 · see citing works
Zandvakili, A., Philip, N. S., Jones, S. R., Tyrka, A. R., Greenberg, B. D., & Carpenter, L. L. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2019.03.077 · Cited by 83 · see citing works
“Their symptoms overlap, and they are notably comorbid: up to half of those with PTSD also have MDD (Campbell et al., 2007; Franklin and Zimmerman, 2001).”
BackgroundHeld, P., Klassen, B. J., Brennan, M. B., & Zalta, A. K. (2018) · Cognitive and Behavioral Practice · doi:10.1016/j.cbpra.2017.09.003 · Cited by 82 · see citing works
“Depressive Symptoms—Because depression is highly comorbid with PTSD, especially in veteran populations (Campbell et al., 2007), veterans were also assessed weekly with the Patient Health Questionnaire-9 (PHQ-9; Kroenke, Spitzer, & Williams, 2001), a reliable and valid self-report measure of depressive symptom severity.”
MethodChiu, S., Niles, J. K., Webber, M. P., Zeig-Owens, R., Gustave, J., Lee, R., Rizzotto, L., Kelly, K. J., Cohen, H. W., & Prezant, D. J. (2011) · Public Health Reports · doi:10.1177/003335491112600211 · Cited by 81 · see citing works
“2 Alternative explanations for the observed comorbidity include: (1) both conditions are reactions to traumatic events,7 (2) depression is a reaction to severe or prolonged PTSD,8 and (3) symptom overlap between these conditions accounts for the appearance of their co-occurrence.”
BackgroundAhmadpanah, M., Sabzeiee, P., Hosseini, S. M., Torabian, S., Haghighi, M., Jahangard, L., Bajoghli, H., Holsboer‐Trachsler, E., & Brand, S. (2014) · Neuropsychobiology · doi:10.1159/000362243 · Cited by 80 · see citing works
Maguen, S., Cohen, B. E., Cohen, G. H., Madden, E., Bertenthal, D., & Seal, K. H. (2012) · Journal of Women s Health · doi:10.1089/jwh.2011.3113 · Cited by 80 · see citing works
Darcet, F., Gardier, A. M., Raphaël Gaillard, B., David, D. J. P., & Guilloux, J. (2016) · Pharmaceuticals · doi:10.3390/ph9010009 · Cited by 78 · see citing works
“Although PTSD confers specific significant psychiatric disturbances and functional impairments, depression and PTSD are commonly co-morbid diseases.”
BackgroundInfluentialSchnurr, P. P., Friedman, M. J., Oxman, T. E., Dietrich, A. J., Smith, M. W., Shiner, B. R., Forshay, E., Gui, J., & Thurston, V. (2012) · Journal of General Internal Medicine · doi:10.1007/s11606-012-2166-6 · Cited by 77 · see citing works
Automatic Nonverbal Behavior Indicators of Depression and PTSD: Exploring Gender Differences
Stratou, G., Scherer, S. J., Gratch, J. S., & Morency, L. (2013) · International Conference on Affective Computing and Intelligent Interaction and workshops · doi:10.1109/acii.2013.31 · Cited by 77 · see citing works
The Impact of Specific and Complex Trauma on the Mental Health of Homeless Youth
Wong, C. F., Clark, L. F., & Marlotte, L. (2014) · Journal of Interpersonal Violence · doi:10.1177/0886260514556770 · Cited by 76 · see citing works
“Studies should also consider how complex traumatic experiences may lead to the development of complex mental health symptoms, particularly the comorbidity between depression and PTSD (Campbell et al., 2007).”
BackgroundDavidson, C. L., Babson, K. A., Bonn‐Miller, M. O., Souter, T., & Vannoy, S. (2013) · Suicide and Life-Threatening Behavior · doi:10.1111/sltb.12014 · Cited by 71 · see citing works
“Indeed, although some studies suggest that PTSD is a risk factor for suicide only in the context of co-occurring depression (Campbell et al., 2007; Oquendo et al., 2003; Zivin et al., 2007), the preponderance of evidence seems to point to PTSD as an important independent risk factor for suicide…”
BackgroundMDMA Impairs Both the Encoding and Retrieval of Emotional Recollections
Doss, M. K., Weafer, J. J., Gallo, D. A., & de Wit, H. (2017) · Neuropsychopharmacology · doi:10.1038/npp.2017.171 · Cited by 72 · see citing works
Relations among social support, PTSD symptoms, and substance use in veterans.
Grös, D. F., Flanagan, J. C., Korte, K. J., Mills, A. C., Brady, K. T., & Back, S. E. (2016) · Psychology of Addictive Behaviors · doi:10.1037/adb0000205 · Cited by 72 · see citing works
“Individuals with PTSD and cooccurring SUD are more likely than individuals without SUD to have numerous health and psychosocial complications and lower social support has been documented in those with PTSD and co-occurring disorders than individuals with a single diagnosis (Campbell et al., 2007).”
Simblett, S. K., Birch, J., Matcham, F., Yágüez, L., & Morris, R. G. (2017) · JMIR Mental Health · doi:10.2196/mental.5558 · Cited by 72 · see citing works
“Other mental health problems such as poor anger control, drug and alcohol problems, and depression can develop alongside symptoms of PTSD, which can delay access to treatment and increase the burden of illness for individuals [1,2].”
BackgroundPilot randomized controlled trial of exercise training for older veterans with PTSD
Hall, K. S. M., Morey, M. C., Bosworth, H. B., Beckham, J. C., Pebole, M. M., Sloane, R. J., & Pieper, C. F. (2019) · Journal of Behavioral Medicine · doi:10.1007/s10865-019-00073-w · Cited by 73 · see citing works
Wu, X., Zhou, X., Wu, Y., & An, Y. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.01335 · Cited by 71 · see citing works
“Posttraumatic stress disorder (PTSD) is the most common negative outcome after traumatic events (Campbell et al., 2007; Bal, 2008; Wang et al., 2012).”
BackgroundWu, K., Zhang, Y., Liu, Z., Zhou, P., & Wei, C. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.01043 · Cited by 69 · see citing works
“…between PTSD and Frontiers in Psychology | www.frontiersin.org 2 August 2015 | Volume 6 | Article 1043 depression is supported by many studies (Bleich et al., 1997; Campbell et al., 2007; O’Donnell et al., 2014), so we assume that depression-related rumination is positively associated with”
BackgroundAssociation of Posttraumatic Stress and Depressive Symptoms With Mortality in Women
Roberts, A. L., Kubzansky, L. D., Chibnik, L. B., Rimm, E. B., & Koenen, K. C. (2020) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.27935 · Cited by 69 · see citing works
“3 (43-64) years at study baseline in 2008.”
BackgroundHoogsteder, L. M., Thije, L. T., Schippers, E. E., & Stams, G. J. J. M. (2021) · International Journal of Offender Therapy and Comparative Criminology · doi:10.1177/0306624x211010290 · Cited by 70 · see citing works
“These developmental areas often relate to internalizing behavior problems, such as mood disorder symptoms, anxiety symptoms, or a negative self-image (Campbell et al., 2007; Green et al., 2010; McLaughlin et al., 2012).”
BackgroundPosttraumatic stress disorder and depressive symptoms: Joined or independent sequelae of trauma?
Dekel, S., Solomon, Z., Horesh, D., & Ein‐Dor, T. (2014) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2014.03.003 · Cited by 67 · see citing works
Carpenter, L. L., Conelea, C. A., Tyrka, A. R., Welch, E. S., Greenberg, B. D., Price, L. H., Niedzwiecki, M. J., Yip, A. G., Barnes, J. L., & Philip, N. S. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.04.009 · Cited by 62 · see citing works
“Patients with comorbid MDD and PTSD symptoms have poorer treatment outcomes for both pharmacotherapy and psychotherapy (Holtzheimer et al., 2005; Campbell et al., 2007) and as such are well represented among those with treatment-resistant major depression referred for rTMS therapy.”
Influence of Multiple Traumatic Event Types on Mental Health Outcomes: Does Count Matter?
Gerber, M. M., Frankfurt, S. B., Contractor, A. A., Oudshoorn, K., Dranger, P., & Brown, L. A. (2018) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-018-9682-6 · Cited by 62 · see citing works
“2011), negative cognitive appraisals (Whiting and Bryant 2007), and physiological changes (Campbell et al. 2007; Cicerone and Fraser 1999) including interruptions in neurological development (Heim et al.”
BackgroundZammit, S., Lewis, C., Dawson, S., Colley, H., McCann, H. M., Piekarski, A., Rockliff, H., & Bisson, J. I. (2018) · The British Journal of Psychiatry · doi:10.1192/bjp.2017.8 · Cited by 61 · see citing works
Kirkpatrick, M. G., Goldenson, N. I., Kapadia, N., Kahler, C. W., de Wit, H., Swift, R. M., McGeary, J. E., Sussman, S. Y., & Leventhal, A. M. (2015) · Psychopharmacology · doi:10.1007/s00213-015-4091-y · Cited by 59 · see citing works
“Anxiety-related general distress is implicated in forms of anxiety that are highly comorbid with depression, such as generalized anxiety and PTSD (Campbell et al. 2007; Rector et al. 2007).”
Brignone, E., Fargo, J. D., Blais, R. K., Carter, M. E., Samore, M. H., & Gundlapalli, A. V. (2017) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2016.11.015 · Cited by 59 · see citing works
Bryan, C. J., Clemans, T. A., Hernandez, A. M., & Rudd, M. D. (2013) · Journal of Head Trauma Rehabilitation · doi:10.1097/htr.0b013e31826c73cc · Cited by 76 · see citing works
The mental health needs of military service members and veterans.
Lazar, S. (2014) · Psychodynamic Psychiatry · doi:10.1521/pdps.2014.42.3.459 · Cited by 56 · see citing works
Investigation of telomere length and psychological stress in rape victims
Malan‐Müller, S., Hemmings, S. M. J., Kidd, M., Martin, L. I., & Seedat, S. (2011) · Depression and Anxiety · doi:10.1002/da.20903 · Cited by 60 · see citing works
“[36] Data from other countries suggest strong associations between rape and MDD, PTSD, and other anxiety disorders.[37,38] Coid et al.”
BackgroundAutomatic nonverbal behavior indicators of depression and PTSD: the effect of gender
Stratou, G., Scherer, S. J., Gratch, J. S., & Morency, L. (2014) · Journal on Multimodal User Interfaces · doi:10.1007/s12193-014-0161-4 · Cited by 57 · see citing works
“Others argue that it is highly meaningful to differentially distinguish between these conditions and recommend distinct treatments depending on whether one or both conditions are present [42].”
BackgroundFarhood, L., Fares, S. A., Sabbagh, R., & Hamady, C. (2016) · European Journal of Psychotraumatology · doi:10.3402/ejpt.v7.31509 · Cited by 56 · see citing works
“Patients who exhibited this comorbidity often showed exacerbated symptoms, thereby corroborating the increasingly complex necessitation for treatment (Campbell et al., 2007).”
BackgroundBruijniks, S. J. E., DeRubeis, R. J., Hollon, S. D., & Huibers, M. J. H. (2019) · Clinical Psychological Science · doi:10.1177/2167702619830391 · Cited by 54 · see citing works
Paparrigopoulos, T. J., Melissaki, A., Tzavellas, E., Karaiskos, D., Ilias, Ι., & Kokras, N. (2013) · International Journal of Psychiatry in Clinical Practice · doi:10.3109/13651501.2013.855793 · Cited by 52 · see citing works
“Indeed, the co-occurrence of PTSD and depression, as revealed in the present study, is in agreement with previous observations advocating the high co-morbidity between these two conditions (Ginzburg 2006; Campbell et al. 2007).”
ResultCo-Occurrence of Major Depressive Episode and Posttraumatic Stress Disorder Among Survivors of War
Nexhmedin Morina, B., Ajduković, D., Bogić, M., Frančišković, T., Kučukalić, A., Lečić‐Toševski, D., Morina, L., Popovski, M., & Priebe, S. (2013) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.12m07844 · Cited by 53 · see citing works
Jain, S., Ortigo, K. M., Gimeno, J., Baldor, D. A., Weiss, B. J., & Cloître, M. (2020) · Journal of Traumatic Stress · doi:10.1002/jts.22523 · Cited by 51 · see citing works
Brancu, M., Thompson, N. L., Beckham, J. C., Green, K. T., Calhoun, P. S., Elbogen, E. B., Robbins, A. T., Fairbank, J. A., & Wagner, H. R. (2014) · Psychiatry Research · doi:10.1016/j.psychres.2014.02.025 · Cited by 50 · see citing works
“Considering comorbidity in veterans is associated with lower social support (Campbell et al., 2007) and increased distress and impairment (Ikin et al.”
BackgroundMartin, C. E., Vujanovic, A. A., Paulus, D. J., Bartlett, B., Gallagher, M. W., & Tran, J. K. (2017) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2017.01.002 · Cited by 49 · see citing works
A Snapshot of Mental Health and Wellness of Engineering Students Across the Western United States
Danowitz, A., & Beddoes, K. (2020) · IEEE Frontiers in Education Conference (FIE) · doi:10.1109/fie44824.2020.9273885 · Cited by 49 · see citing works
“studies have indicated a high-comorbidity of these conditions [26].”
BackgroundDual Use of VA and Non-VA Services Among Primary Care Patients with Depression
Liu, C., Bolkan, C. R., Chan, D., Yano, E. M., Rubenstein, L. V., & Chaney, E. F. (2008) · Journal of General Internal Medicine · doi:10.1007/s11606-008-0867-7 · Cited by 49 · see citing works
Self-citationSu, T., Zhang, L., Chung, M., Chen, Y.-S., Bi, Y.-M., Chou, Y.-H., Barker, J. L., Barrett, J. E., Maric, D., Li, X. X., et al. (2009) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2009.03.010 · Cited by 49 · see citing works
Kothgassner, O. D., Pellegrini, M., Goreis, A., Giordano, V., Edobor, J., Fischer, S., Plener, P. L., & Huscsava, M. (2021) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2021.105168 · Cited by 49 · see citing works
Post-traumatic stress disorder as a comorbidity: impact on disease outcomes
Cavalcanti-Ribeiro, P., Andrade-Nascimento, M., Morais-de-Jesus, M., de Medeiros, G. M., Daltro-Oliveira, R., conceição, J. O., Rocha, M. F. V., Miranda‐Scippa, Â., Koenen, K. C., & Quarantini, L. C. (2012) · Expert Review of Neurotherapeutics · doi:10.1586/ern.12.77 · Cited by 48 · see citing works
A Dynamic Model of Post-Traumatic Stress Disorder for Military Personnel and Veterans
Ghaffarzadegan, N., Ebrahimvandi, A., & Jalali, M. S. (2016) · PLoS ONE · doi:10.1371/journal.pone.0161405 · Cited by 48 · see citing works
“PTSD is highly comorbid with other psychological effects or mental illnesses that can occur following trauma, including depression [7, 8], anger and violence [3], guilt and shame [9, 10], substance abuse [11, 12], and suicidality [13].”
BackgroundInfluentialRoberts, A. L., Koenen, K. C., Chen, Q., Gilsanz, P., Mason, S. M., Prescott, J., Ratanatharathorn, A. D., Rimm, E. B., Sumner, J. A., Winning, A., et al. (2017) · Depression and Anxiety · doi:10.1002/da.22620 · Cited by 48 · see citing works
“Moreover, as depression and PTSD are highly comorbid (Bleich, Koslowsky, Dolev, & Lerer, 1997; Campbell et al., 2007; Gill, Page, Sharps, & Campbell, 2008), and depression is associated with shorter TL in several (Hartmann, Boehner, Groenen, & Kalb, 2010; Schutte & Malouff, 2015; Simon et al.,…”
Fruchtman-Steinbok, T., Keynan, J. N., Cohen, A., Jaljuli, I., Mermelstein, S., Drori, G., Routledge, E., Krasnoshtein, M., Playle, R., Linden, D. E. J., et al. (2021) · NeuroImage: Clinical · doi:10.1016/j.nicl.2021.102859 · Cited by 42 · see citing works
Bolkan, C. R., Bonner, L. M., Campbell, D. G., Lanto, A., Zivin, K., Chaney, E., & Rubenstein, L. V. (2013) · Psychiatric Services · doi:10.1176/appi.ps.201200160 · Cited by 47 · see citing works
Reduced vowel space is a robust indicator of psychological distress: A cross-corpus analysis
Scherer, S. J., Morency, L., Gratch, J. S., & Pestian, J. P. (2015) · IEEE International Conference on Acoustics Speech and Signal Processing · doi:10.1109/icassp.2015.7178880 · Cited by 45 · see citing works
“Indeed the comorbidity between PTSD as well as suicidality and depression has been previously identified in the literature [31, 32] and the observed strong correlation between conditions has been further discussed in our prior work, where we have identified the more generic condition of psychological distress as a com…”
BackgroundVujanovic, A. A., Rathnayaka, N. S., Amador, C. D., & Schmitz, J. M. (2015) · Behavior Modification · doi:10.1177/0145445515621490 · Cited by 47 · see citing works
“54), consistent with extant literature (e.g., Brady et al., 2000; Campbell et al., 2007).”
ResultSuicidal or Self‐Harming Ideation in Military Personnel Transitioning to Civilian Life
Mansfield, A. J., Bender, R. H., Hourani, L. L., & Larson, G. E. (2011) · Suicide and Life-Threatening Behavior · doi:10.1111/j.1943-278x.2011.00039.x · Cited by 47 · see citing works
Depression in post-traumatic stress disorder
Radell, M. L., Hamza, E. A., & Moustafa, A. A. (2020) · Reviews in the Neurosciences · doi:10.1515/revneuro-2020-0006 · Cited by 47 · see citing works
The Effectiveness of Emotionally Focused Couples Therapy With Veterans With PTSD: A Pilot Study
Weissman, N. J., Batten, S. V., Rheem, K. D., Wiebe, S. A., Pasillas, R. M., Potts, W., Barone, M. D., Brown, C. H., & Dixon, L. B. (2017) · Journal of Couple & Relationship Therapy · doi:10.1080/15332691.2017.1285261 · Cited by 45 · see citing works
“Further, there is evidence that EFT may contribute to a reduction in depressive symptoms (Denton, Wittenborn, & Golden, 2012; Dessaulles, Johnson, & Denton, 2003), a common comorbidity with PTSD (Campbell et al., 2007).”
BackgroundLee, C. J., Wu, H.-F., Chu, M.-C., Chung, Y.-J., Mao, W.-C., Li, C., & Lin, H. (2020) · Cerebral Cortex · doi:10.1093/cercor/bhaa244 · Cited by 43 · see citing works
- Authors
- Campbell, D. G., Felker, B. L., Liu, C.-F., Yano, E. M., Kirchner, J. E., Chan, D., Rubenstein, L. V., & Chaney, E. F.
- Affiliations
- Health Services Research & Development (US)
- University of Washington (US)
- University of California, Los Angeles (US)
- Central Arkansas Veterans Healthcare System (US)
- RAND Corporation (US)
- Corresponding author
- Campbell, Duncan G.
- ORCID
- Venue
- Journal of General Internal Medicine
- Published
- 2007-01-24
- Volume
- 22
- Issue
- 6
- Pages
- 711-718
- ISSN
- 0884-8734 (ISSN-L)
- 1525-1497
- PMC
- PMC2219856
- OpenAlex
- W2030974975
- Cited by
- 458
- References
- 57
- Citations by year
- 2026: 15 · 2025: 24 · 2024: 14 · 2023: 19 · 2022: 25 · 2021: 29 · 2020: 34 · 2019: 39 · 2018: 34 · 2017: 37 · 2016: 36 · 2015: 31 · 2014: 26 · 2013: 30 · 2012: 14
- FWCI
- 10.57
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Journal of General Internal Medicine (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- U.S. Department of Veterans Affairs
- Pfizer
- RAND Corporation
- Health Services Research and Development
- University of Washington
- University of Montana
- University of California, Los Angeles
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Keywords
- depression, post-traumatic stress disorder, PTSD prevalence, comorbidities, military veterans, primary care, collaborative care, suicidal ideation, social support, PHQ-9, PTSD screening, treatment response
- MeSH terms
- Aged, Cross-Sectional Studies, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Primary Health Care, Stress Disorders, Post-Traumatic, Veterans, Comorbidity, Prevalence, Practice Guidelines as Topic
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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