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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 (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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“…as it is in line with known patterns of comorbidity: major depressive disorder, PTSD, and bipolar all have observed comorbidity (Brady et al., 2000; Campbell et al., 2007; McElroy et al., 2001) while SAD is currently considered a specifier of major depressive disorder or bipolar disorder (American…”
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“Two studies [1,20] were excluded because they reported the same data in more recent articles [21,22].”
Result
Metadata
- 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
- 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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