Cited by 458Posttraumatic Stress Disorder ResearchMigration, Health and TraumaMental Health Treatment and Access

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Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions

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Campbell, Duncan G., Felker, Bradford L., Liu, Chuan-Fen, Yano, Elizabeth M., Kirchner, JoAnn E., Chan, Domin, Rubenstein, Lisa V., Chaney, Edmund F.·2007·Journal of General Internal Medicine

DOI 10.1007/s11606-006-0101-4PMC PMC2219856

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Abstract

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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Mendoza-Alvarez, M., Balthasar, Y., Verbraecken, J. A., Claes, L., Someren, E. J. W. V., van Marle, H. J. F., Vandekerckhove, M. M. P., & Picker, L. D. (2024) · Sleep Medicine · doi:10.1016/j.sleep.2024.12.037 · Cited by 29
Exploring the association between depression and shenjing shuairuo in a population representative epidemiological study of Chinese adults in Guangzhou, China
Hall, B. J., Chang, K., Chen, W. L., Sou, K. L., Latkin, C. A., & Yeung, A. (2018) · Transcultural Psychiatry · doi:10.1177/1363461518778670 · Cited by 27
“The association between depression and stressful life events is commonly supported in the literature and a high comorbidity between depression and posttraumatic stress disorder is often reported (Campbell et al., 2007).”
Background
Focus on: Comorbid mental health disorders.
Anthenelli, R. M. (2010) · Europe PMC (PubMed Central) · Cited by 27
Psychiatric Disorder Incidence Among Adolescents and Young Adults Aged 15-39 With Cancer: Population-Based Cohort
Rosgen, B. K., Moss, S. J., Fiest, K. M., McKillop, S., Diaz, R. L., Barr, R. D., Patten, S. B., Deleemans, J., & Fidler-Benaoudia, M. M. (2022) · JNCI Cancer Spectrum · doi:10.1093/jncics/pkac077 · Cited by 27
“Sex Male 2406 (32) 543 (33) 582 (33) 549 (32) 505 (31) 227 (33) Female 5020 (68) 1120 (67) 1198 (67) 1146 (68) 1102 (69) 454 (67) Type of cancer Leukemias 325 (4) 44 (3) 53 (3) 88 (5) 106 (7) 34 (5) Lymphomas 893 (12) 199 (12) 237 (13) 203 (12) 182 (11) 72 (11) Tumor of the central nervous system 529 (7) 116 (7) 112 (…”
Background
Identifying individuals with undiagnosed post-traumatic stress disorder in a large United States civilian population – a machine learning approach
Gagnon-Sanschagrin, P., Schein, J., Urganus, A., Serra, E., Liang, Y., Musingarimi, P., Cloutier, M., Guérin, A., & Davis, L. L. (2022) · BMC Psychiatry · doi:10.1186/s12888-022-04267-6 · Cited by 28
A Preliminary Investigation of Depression in People with Pathological Dissociation
Fung, H. W., Chan, C., Ross, C. A., & Choi, T. M. (2020) · Journal of Trauma & Dissociation · doi:10.1080/15299732.2020.1760168 · Cited by 27
A Cross-sectional Study of the Mental Health Symptoms of Latin American, US Hispanic, and Spanish College Students Amid the COVID-19 Pandemic
Torres, A., Palomin, A., Morales, F. R., Sevilla-Matos, M. T., Colunga-Rodríguez, C., Ángel-González, M., Sarabia-López, L. E., Dávalos-Picazo, G., Delgado-García, D. D., Bastías, D. M. D., et al. (2022) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-022-00827-9 · Cited by 41
“…higher symptoms of depression, perceived stress, loneliness, and COVID-19 anxiety predicted higher levels of PTSS. Depression was the highest predictor of PTSS, supporting previous findings that identified comorbidity between PTSD and depression (Angelakis & Nixon, 2015; Campbell et al., 2007).”
Result
Complexity of the Relationships of Pain, Posttraumatic Stress, and Depression in Combat‐Injured Populations: An Integrative Review to Inform Evidence‐Based Practice
Giordano, N. A., Bader, C. E., Richmond, T. S., & Polomano, R. C. (2018) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12274 · Cited by 26
“In civilian populations, individuals with comorbid PTSD and depression may experience more severe depression, increased healthcare cost, and lower physical functioning than individuals with either condition alone (Campbell et al., 2007).”
Background
Invisible Wounds: Predicting the Immediate and Long-Term Consequences of Mental Health Problems in Veterans of Operation Enduring Freedom and Operation Iraqi Freedom
Karney, B. R., Ramchand, R., Osilla, K. C., Caldarone, L. B., & Burns, R. M. (2008) · RAND Corporation eBooks · doi:10.7249/wr546 · Cited by 26
Adaptation and Initial Validation of Minimum Data Set (MDS) Mortality Risk Index to MDS Version 3.0
Niznik, J. D., Zhang, S., Mor, M. K., Zhao, X., Ersek, M. T., Aspinall, S. L., Gellad, W. F., Thorpe, J. M., Hanlon, J. T., Schleiden, L. J., et al. (2018) · Journal of the American Geriatrics Society · doi:10.1111/jgs.15579 · Cited by 25
“Veterans also tend to have higher comorbidity burden.(28,29) Thus, it is possible that the MMRI-v3 is not accurate for nonveteran NH residents, although sensitivity analyses revealed that the original scoring(10) is valid in different populations, because the use of cohort-specific scores did not substantially affect…”
The neurocognitive profile of post‐traumatic stress disorder (PTSD), major depressive disorder (MDD), and PTSD with comorbid MDD
Koopowitz, S., Maré, K. T., Zar, H. J., Stein, D. J., & Ipser, J. (2021) · Brain and Behavior · doi:10.1002/brb3.1950 · Cited by 25
PTSD and Depression in Healthcare Workers in the Italian Epicenter of the COVID-19 Outbreak
Carmassi, C., Pedrinelli, V., Dell’Oste, V., Bertelloni, C. A., Grossi, C., Gesi, C., Cerveri, G., & Dell’Osso, L. (2021) · Clinical Practice and Epidemiology in Mental Health · doi:10.2174/1745017902117010242 · Cited by 25
Fronto-central resting-state 15-29 Hz transient beta events change with therapeutic transcranial magnetic stimulation for posttraumatic stress disorder and major depressive disorder
Morris, A., Temereanca, S., Zandvakili, A., Thorpe, R. V., Sliva, D. D., Greenberg, B. D., Carpenter, L. L., Philip, N. S., & Jones, S. R. (2023) · Scientific Reports · doi:10.1038/s41598-023-32801-3 · Cited by 24
Longitudinal growth of post-traumatic stress and depressive symptoms following a child maltreatment allegation: An examination of violence exposure, family risk and placement type
Barboza, G. E., & Dómínguez, S. (2017) · Children and Youth Services Review · doi:10.1016/j.childyouth.2017.08.029 · Cited by 25
“For example, research has shown that among youth involved with Child Protective Services (CPS), risk factors for co-morbid PTSD and depression include a history of depression, violence exposure, lower levels of social support and gender (Campbell et al., 2007).”
Background
The Potential Role of a Corticotropin-Releasing Factor Receptor-1 Antagonist in Psychiatric Disorders
Stahl, S. M., & Wise, D. D. (2008) · CNS Spectrums · doi:10.1017/s1092852900016709 · Cited by 25
Military Chronic Musculoskeletal Pain and Psychiatric Comorbidity: Is Better Pain Management the Answer?
McGeary, C. A., McGeary, D. D., Moreno, J., & Gatchel, R. J. (2016) · Healthcare · doi:10.3390/healthcare4030038 · Cited by 24
“For example, a 2007 study of military veterans found that 36% of veterans with depression also screened positive for PTSD [6].”
Trauma types as differential predictors of posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and their comorbidity.
Wanklyn, S. G., Pukay‐Martin, N. D., Belus, J. M., Cyr, K. S., Girard, T. A., & Monson, C. M. (2016) · Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement · doi:10.1037/cbs0000056 · Cited by 33
Posttraumatic stress disorder's role in integrated substance dependence and depression treatment outcomes
Norman, S. B., Tate, S. R., Wilkins, K. C., Cummins, K. M., & Brown, S. A. (2010) · Journal of Substance Abuse Treatment · doi:10.1016/j.jsat.2010.01.013 · Cited by 24
Characteristics of U.S. Veteran Patients with Major Depressive Disorder who require “next-step” treatments: A VAST-D report
Zisook, S., Tal, I., Weingart, K. R., Hicks, P. B., Davis, L. L., Chen, P., Yoon, J., Johnson, G. R., Vertrees, J. E., Rao, S. D., et al. (2016) · Journal of Affective Disorders · doi:10.1016/j.jad.2016.07.023 · Cited by 25
Exploring Rural Disparities in Medical Diagnoses Among Veterans With Transgender-related Diagnoses Utilizing Veterans Health Administration Care
Bukowski, L. A., Blosnich, J. R., Shipherd, J. C., Kauth, M. R., Brown, G. R., & Gordon, A. J. (2017) · Medical Care · doi:10.1097/mlr.0000000000000745 · Cited by 26
“Finally, rural/urban differences in prevalence of posttraumatic stress disorder (PTSD) should be explored as PTSD is common among veterans.(24) Although veterans with transgender-related diagnoses are a relatively newly identified vulnerable population to VA health equity research,(7) achieving equity in health and he…”
Background
The Role of Personality and Subjective Exposure Experiences in Posttraumatic Stress Disorder and Depression Symptoms among Children Following Wenchuan Earthquake
Chen, X., Xu, J., Li, B., Li, N., Guo, W., Ran, M., Zhang, J., Yang, Y., & Hu, J. (2017) · Scientific Reports · doi:10.1038/s41598-017-17440-9 · Cited by 29
The Social Psychology of Trauma
Muldoon, O. T. (2024) · Cambridge University Press eBooks · doi:10.1017/9781009306997 · Cited by 23
Psychometric Properties of the Expanded Version of the Inventory of Depression and Anxiety Symptoms in a Turkish Population
Irak, M., & Albayrak, E. O. (2018) · Psychological Reports · doi:10.1177/0033294118813844 · Cited by 23
“One possible explanation for this result could be the high comorbidity rate between PTSD depression and anxiety disorders (Campbell et al., 2007; Sadock & Sadock, 2007).”
Background
Brief behavioral treatment for insomnia in older adults with late-life treatment-resistant depression and insomnia: a pilot study
Gebara, M. A., DiNapoli, E. A., Lederer, L. G., Bramoweth, A. D., Germain, A., Kasckow, J., & Karp, J. F. (2019) · Sleep and Biological Rhythms · doi:10.1007/s41105-019-00211-6 · Cited by 24
Comorbid PTSD and Depression Diagnoses Mediate the Association of Military Sexual Trauma and Suicide and Intentional Self-Inflicted Injury in VHA-Enrolled Iraq/Afghanistan Veterans, 2004-2014
Livingston, W. S., Fargo, J. D., Gundlapalli, A. V., Brignone, E., & Blais, R. K. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.05.024 · Cited by 27
Efficacy of amisulpride for depressive symptoms in individuals with mental disorders: A systematic review and meta‐analysis
Zangani, C., Giordano, B., Stein, H., Bonora, S., D’Agostino, A., & Ostinelli, E. G. (2021) · Human Psychopharmacology Clinical and Experimental · doi:10.1002/hup.2801 · Cited by 23
“…to be very common in other psychiatric disorders, such as anxiety disorders (Nordahl et al., 2018; Ratnani et al., 2017), post‐traumatic stress disorder (PTSD; Armenta et al., 2019; Campbell et al., 2007), and schizophrenia (SCZ), especially during the first psychotic episode (Häfner et al., 2015).”
Background
Long-term mental health outcome in post-conflict settings: Similarities and differences between Kosovo and Rwanda
Eytan, A., Munyandamutsa, N., Nkubamugisha, P. M., & Gex‐Fabry, M. (2014) · International Journal of Social Psychiatry · doi:10.1177/0020764014547062 · Cited by 23
“, 2012) and high frequency of health-care visits (Campbell et al., 2007) in different populations and settings.”
Background
Rates and consequences of posttraumatic distress among American Indian adults with type 2 diabetes
Aronson, B. D., Palombi, L. C., & Walls, M. L. (2016) · Journal of Behavioral Medicine · doi:10.1007/s10865-016-9733-y · Cited by 22
“…personnel in service during the 2003 Iraq War (Iversen et al., 2009), 10 % for newly diagnosed breast cancer patients (Hegel et al., 2006), 13 % for US soldiers returning from Operation Iraqi Freedom (Maguen et al., 2010), and 36 % for a sample of depressed patients (Campbell et al., 2007).”
Background
Occupational functioning and employment services use among VA primary care patients with posttraumatic stress disorder.
Sripada, R. K., Henry, J., Yosef, M., Levine, D. S., Bohnert, K. M., Miller, E., & Zivin, K. (2016) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000241 · Cited by 23
Anger as an underlying dimension of posttraumatic stress disorder
Durham, T. A., Byllesby, B. M., Lv, X., Elhai, J. D., & Wang, L. (2018) · Psychiatry Research · doi:10.1016/j.psychres.2018.06.011 · Cited by 23
Psychiatric morbidity and predisposing factors in a primary care population in Madrid
Reneses, B., Garrido, S., Navalón, A., Martín, O., Ramos, I., Fuentes, M. E., Moreno, J., & López-Ibor, J. J. (2014) · International Journal of Social Psychiatry · doi:10.1177/0020764014542815 · Cited by 22
“High comorbidities of PTSD with other psychiatric disorders, especially depressive disorder, have been found in most studies of the subject, including ours (Campbell et al., 2007).”
Result
Interpersonal Trauma, and PTSD Symptomology among Lesbian, Gay, and Bisexual Individuals: A Closer Look at Gender, Minority Stress, and Help-Seeking Behaviors
Stenersen, M. R., Ovrebo, E., Emery, H. E., Brown, E. L., New, C. M., Brasfield, C., & Turner, L. (2019) · Journal of LGBTQ Issues in Counseling · doi:10.1080/15538605.2019.1627976 · Cited by 29
“Experiences of PTSD symptomology have also been linked to increased risk for additional life stressors including substance abuse, low self-confidence, and other mental health issues (Campbell et al., 2007; Hedtke et al., 2008; Kilpatrick et al., 2003).”
Background
Implementation research for public sector mental health care scale-up (SMART-DAPPER): a sequential multiple, assignment randomized trial (SMART) of non-specialist-delivered psychotherapy and/or medication for major depressive disorder and posttraumatic stress disorder (DAPPER) integrated with outpatient care clinics at a county hospital in Kenya
Levy, R., Mathai, M., Chatterjee, P., Ongeri, L., Njuguna, S., Onyango, D., Akena, D. H., Rota, G., Otieno, A., Neylan, T. C., et al. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2395-x · Cited by 24
Investigating post-traumatic stress disorder (PTSD) and complex PTSD among people with self-reported depressive symptoms
Fung, H. W., Chien, W. T., Lam, S. K. K., & Ross, C. A. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.953001 · Cited by 24
Contribution of the opioid system to depression and to the therapeutic effects of classical antidepressants and ketamine
Adžić, M., Lukić, I., Mitić, M., Glavonic, E., Dragicevic-Curic, N., & Ivković, S. (2023) · Life Sciences · doi:10.1016/j.lfs.2023.121803 · Cited by 22
Comparison of behavioral activation-enhanced cognitive processing therapy and cognitive processing therapy among U.S. service members: A randomized clinical trial
Walter, K. H., Hunt, W. M., Otis, N. P., Kline, A. C., Miggantz, E. L., Thomsen, C. J., & Glassman, L. H. (2023) · Psychiatry Research · doi:10.1016/j.psychres.2023.115330 · Cited by 23
“, 2006) and mental health care visits (Campbell et al., 2007).”
Background
Long‐term effectiveness of collaborative depression care in older primary care patients with and without PTSD symptoms
Chan, D., Fan, M., & Unützer, J. (2010) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.2606 · Cited by 23
“Brief screeners for PTSD have been used in primary care studies and are comparable to other screening tools for mental disorders, such as the PTSD Symptom Checklist (Prins et al., 2003; Campbell et al., 2007).”
BackgroundMethodSelf-citation
Trajectories of Cannabis use Beginning in Adolescence Associated with Symptoms of Posttraumatic stress Disorder in the Mid-Thirties
Lee, J. Y., Brook, J. S., Finch, S. J., & Brook, D. W. (2017) · Substance Abuse · doi:10.1080/08897077.2017.1363121 · Cited by 25
Posttraumatic stress disorder diagnosis and gender are associated with accelerated weight gain trajectories in veterans during the post-deployment period
Buta, E., Masheb, R. M., Gueorguieva, R. V., Bathulapalli, H., Brandt, C., & Goulet, J. L. (2018) · Eating Behaviors · doi:10.1016/j.eatbeh.2018.01.002 · Cited by 22
Comorbidity Patterns of Psychiatric Conditions in Canadian Armed Forces Personnel
Richardson, J. D., Thompson, A., King, L., Ketcheson, F., Shnaider, P., Armour, C., Cyr, K. S., Sareen, J., Elhai, J. D., & Zamorski, M. A. (2019) · The Canadian Journal of Psychiatry · doi:10.1177/0706743718816057 · Cited by 22
Residual Insomnia and Nightmares Postintervention Symptom Reduction Among Veterans Receiving Treatment for Comorbid PTSD and Depressive Symptoms
López, C. M., Lancaster, C. L., Wilkerson, A. K., Grös, D. F., Ruggiero, K. J., & Acierno, R. E. (2019) · Behavior Therapy · doi:10.1016/j.beth.2019.01.006 · Cited by 24
Right temporal pole volume reduction in PTSD
Gosnell, S. N., Oh, H., Schmidt, J., Oldham, J. M., Fowler, J. C., Patriquin, M. A., Ress, D. B., & Salas, R. (2020) · Progress in Neuro-Psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2020.109890 · Cited by 22
The network structure of posttraumatic stress disorder among Filipina migrant domestic workers: comorbidity with depression
Garabiles, M. R., Lao, C. K., Wang, S., & Hall, B. J. (2020) · European Journal of Psychotraumatology · doi:10.1080/20008198.2020.1765544 · Cited by 21
“are at greater risk for suicide than those with only PTSD or only depression (Campbell et al., 2007; Ramsawh et al., 2014).”
Background
Prospective associations between changes in mental health symptoms and health-related quality of life in veterans seeking posttraumatic stress disorder residential treatment
Sofko, C. A., Currier, J. M., & Drescher, K. D. (2016) · Anxiety Stress & Coping · doi:10.1080/10615806.2016.1157171 · Cited by 21
“Along with scheduling more frequent outpatient medical visits, Campbell et al. (2007) also found that veterans with PTSD struggle with more severe depressive symptoms than depressed counterparts who do not have PTSD.”
Background

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: Campbell, Duncan G.
Felker, Bradford L.
Yano, Elizabeth M.
Kirchner, JoAnn E.
Rubenstein, Lisa V.
Chaney, Edmund F.
Venue: Journal of General Internal Medicine
Publisher: Springer Science and Business Media LLC
Published: 2007-01-24
Volume: 22
Issue: 6
Pages: 711-718
ISSN: 0884-8734 (ISSN-L)
1525-1497
DOI: 10.1007/s11606-006-0101-4
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
Health Sciences › Medicine › Psychiatry and Mental health › 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

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Prevalence of Depression–PTSD Comorbidity: Implications for Clinical Practice Guidelines and Primary Care-based Interventions

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