Session number: 1033
Abstract title: Health Related Quality of Life in Veterans Diagnosed with SMI and PTSD
Author(s):
PS Calhoun - Durham VAMC
KG Meador - Durham VAMC
MI Butterfield - Durham VAMC
Objectives: PTSD is associated with decreased quality of life, increased medical morbidity and increased health service use. Trauma is prevalent among patients with severe mental illness (SMI) and there is some evidence that PTSD is unrecognized and under-diagnosed in persons with SMI. The present study examined the prevalence of PTSD in a SMI population and investigated the impact of co-morbid PTSD on health-related quality of life (QOL) and health service use.
Methods: Data were collected on a sample of male veterans (N=165) with a primary diagnosis of schizophrenia or schizoaffective disorder, who were hospitalized on a VAMC inpatient psychiatric unit between 1998-2000. Severity of psychotic symptoms was assessed with the Brief Psychiatric Rating Scale (BPRS). PTSD diagnosis was based upon chart review and the PTSD Check List (PCL). QOL was assessed with the Medical Outcomes Study Short-Form 12-Item Health Survey (SF-12). Service utilization data were collected via self-report. Analyses examining QOL and health service use compared patients with SMI and co-morbid PTSD to those without PTSD.
Results: Eighty-one patients (49%) met DSM-IV diagnostic criteria for PTSD, however only 9% had a diagnosis of PTSD documented in their medical chart. Patients with co-morbid PTSD did not differ from those without PTSD in age, race, marital status or BPRS scores. Patients with co-morbid PTSD did not differ significantly in the physical health component on the SF-12, but reported significantly lower QOL on the SF-12 mental health component, F(1, 158)=42.7, p<.0001. Patients with co-morbid PTSD reported increased service use including more psychiatric admissions, F(1,163)=4.2, p<.04 and a trend toward more frequent physical health visits, F(1,163)=3.6, p<.06. Results remained unchanged even after controlling for demographic factors and use of alcohol and illicit drugs.
Conclusions: Results suggest that PTSD is highly prevalent and under-diagnosed among patients with primary psychotic disorders hospitalized in a VA psychiatric unit. The presence of co-morbid PTSD is associated with decreased health-related quality of life and increased health service use.
Impact statement: PTSD is both prevalent and under-diagnosed in patients with SMI. There is a need for increased screening and research aimed at developing effective interventions to reduce morbidity in this at-risk population.