Detecting and Addressing Trauma-related Sequelae in Primary Care

Area of Science:

• Primary Care Medicine
• Psychiatry
• Public Health

Background:

• Complex trauma sequelae significantly impact adult health, treatment engagement, and primary care provider (PCP) efficacy.
• Underappreciation of trauma's effects can lead to adverse patient outcomes and provider challenges.
• This study investigates the link between patient-reported trauma, social determinants of health (SDH), and clinical diagnoses.

Purpose of the Study:

• To examine correlations between posttraumatic stress symptoms (PTSS), adverse childhood experiences (ACE), and SDH with provider diagnoses in primary care.
• To identify the prevalence of trauma symptoms and diagnoses within a primary care setting.
• To understand the discrepancy between patient-reported trauma and electronic health record diagnoses.

Main Methods:

• Survey of 354 adult patients across 3 primary care clinics.
• Self-report measures included demographics, PTSS, ACE, and SDH.
• Health status and diagnoses were extracted from electronic health records.

Main Results:

• High prevalence of trauma symptoms (PTSS) and ACE reported.
• Educational attainment, health literacy, material hardship, healthcare access, and ACE were associated with PTSS (P < .05).
• Only 5% of participants with high trauma burden received a trauma-related diagnosis in EHRs.

Conclusions:

• Significant discrepancy exists between reported trauma symptoms and formal diagnoses in primary care.
• Trauma-impacted patients present complex health issues, potentially affecting PCP efficacy.
• Routine screening and trauma-informed care training are beneficial for both patients and providers.