A Qualitative Evaluation of Barriers to Care for Trauma-Related Mental Health Problems Among Low-Income Minorities in Primary Care
Open accessAbstract
This study aimed to identify barriers and facilitators of mental health care for patients with trauma histories via qualitative methods with clinicians and administrators from primary care clinics for the underserved. Individual interviews were conducted, followed by a combined focus group with administrators from three jurisdictions; there were three focus groups with clinicians from each clinic system. Common themes were identified, and responses from groups were compared. Administrators and clinicians report extensive trauma histories among patients. Clinician barriers include lack of time, patient resistance, and inadequate referral options; administrators cite reimbursement issues, staff training, and lack of clarity about the term trauma. A key facilitator is doctor-patient relationship. There were differences in perceived barriers and facilitators at the institutional and clinical levels for mental health care for patients with trauma. Importantly, there is agreement about better access to and development of trauma-specific interventions. Findings will aid the development and implementation of trauma-focused interventions embedded in primary care.
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Barriers to an accurate and timely PTSD diagnosis may be attributable to the lack of disclosure of trauma history by patients and to limited awareness and knowledge of trauma-associated symptoms among physicians within a civilian context, including limited training and resources in trauma care.
“The barriers to an accurate and timely PTSD diagnosis may also be attributable to the lack of disclosure of trauma history by patients [19] and the limited awareness and knowledge of trauma-associated symptoms among physicians within a civilian context, including limited training and resources in trauma care [20,33].”
From Patient journey before and after a formal post-traumatic stress disorder diagnosis in adults in the United States-a retrospective claims study (2023) · cites this paper as [20]
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- Authors
- Chung, J. Y., Frank, L., Subramanian, A., Galen, S., Leonhard, S., & Green, B. L.
- Affiliations
- National Institute of Mental Health (US)
- Patient-Centered Outcomes Research Institute (US)
- Georgetown University (US)
- Primary Care Coalition of Montgomery County (US)
- Greater Baden Medical Services (US)
- Corresponding author
- Chung, Joyce Y.
- Venue
- Journal of Nervous & Mental Disease
- Published
- 2012-05
- Volume
- 200
- Issue
- 5
- Pages
- 438-443
- ISSN
- 0022-3018 (ISSN-L)
- PMC
- PMC3478235
- OpenAlex
- W1969255448
- Cited by
- 21
- References
- 25
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 3 · 2023: 2 · 2022: 2 · 2021: 2 · 2020: 4 · 2019: 1 · 2018: 1 · 2017: 1 · 2016: 2 · 2014: 1
- FWCI
- 0.48
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Journal of Nervous and Mental Disease (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institutes of Health (Z99 MH999999)
- National Institute of Mental Health (P20MH068450)
- Topics
- Social Sciences › Psychology › Social Psychology › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Migration, Health and Trauma
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Keywords
- barriers to mental health care, primary care, underserved populations, trauma history, trauma-focused interventions, physician-patient relationship, employee training, trauma definition, clinician perspectives, administrator perspectives
- MeSH terms
- Adult, Aged, Mental Disorders, Female, Health Personnel, Health Services Accessibility, Humans, Life Change Events, Male, Mental Health Services, Middle Aged, Minority Groups, Physician-Patient Relations, Poverty, Primary Health Care, Focus Groups
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