AJN, American Journal of Nursing:
As the daughter of a retired Vietnam veteran and the wife of an Iraq war veteran, I enthusiastically read the recent Viewpoint about our vets ("Coming Home with Posttraumatic Stress Disorder," May). It's important that we nurses—particularly those in the primary care setting—understand the issues facing these patients and recognize the varied presentations of PTSD.
The invaluable Web addresses provided by author Elizabethe Westgard contain an enormous number of screening tools, including one very simple, four-item questionnaire for use in the primary care setting. Hoge and colleagues recommend that "... veterans who have served in combat and are seen with significant physical symptoms should be evaluated for PTSD. . . ."1
The author mentions several obstacles veterans face when trying to obtain care, but one of the biggest reasons they go untreated is that health professionals often fail to recognize the illness. These patients might not present in the way we expect. In one study, "A total of 98 patients (12%) met criteria for PTSD, and of these 42 [43%] were correctly classified as such by their provider"2; that means 57% were not correctly identified as having the condition. In addition, because many veterans will be in the chronic phase of PTSD by the time they seek treatment from primary care providers, we need to be aware that PTSD and depression usually occur together.
After all our veterans have been through, it would be an injustice not to identify this condition in the primary care setting.
Dawn Cissell-Browne, RN
1. Hoge CW, et al. Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. Am J Psychiatry
2. Magruder KM, Yeager DE. Patient factors relating to detection of posttraumatic stress disorder in Department of Veterans Affairs primary care settings. J Rehabil Res Dev