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Posttraumatic Stress Disorder in the Primary Care Setting

Summary of Recommended Care

Spottswood, Margaret, MD, MPH; Fortney, John, PhD; Chen, Jessica A., PhD; Davydow, Dimitry, MD, MPH; Huang, Hsiang, MD, MPH

doi: 10.1097/HRP.0000000000000201

Posttraumatic stress disorder (PTSD) occurs following acute threatening events in approximately 12.5% of the primary care population.

Objective The aim of this article is to advance evidence-based clinical practice and collaborative care approaches to PTSD by summarizing targeted-care guidelines.

Method This narrative literature review addresses important aspects of PTSD and management options, in conjunction with expert opinion when indicated. Guidelines were included if they targeted treatment of PTSD in the primary care setting or if the treatments described could be provided in the primary care setting.

Results The implications regarding PTSD, comorbidities, differential diagnosis, screening tools, and treatment are presented.

Conclusion Primary care providers can diagnose and offer initial management of PTSD. Future research should delineate therapies helpful for complex PTSD, including group therapies, those increasing self-compassion, and other optimally effective collaborative care interventions.

From the Community Health Center of Burlington, Burlington, VT (Dr. Spottswood); Department of Psychiatry and Behavioral Sciences, University of Washington (Drs. Fortney and Davydow); VA Health Services Research & Development Center of Innovation for Veteran-Centered and Value-Driven Care, Puget Sound Health Care System Seattle Division, Seattle, WA (Drs. Fortney and Chen); Franciscan Behavioral Health, Tacoma, WA (Dr. Davydow); Institute of Psychiatry & LIM-23, Faculty of Medicine, University of São Paulo R. Dr. Ovidio Pires de Campos (Dr. Huang); Harvard Medical School (Dr. Huang); Department of Psychiatry, Cambridge Health Alliance, Cambridge, MA (Dr. Huang).

Supported, in part, by VA HSR&D Career Scientist Award nos. PCS-1406-19295 and QUE 15-282 (Dr. Fortney) and Postdoctoral Fellowship (Dr. Chen).

Original manuscript received 4 December 2017, accepted for publication subject to revision 4 February 2018; revised manuscript received 4 March 2018.

Correspondence: Margaret Spottswood, MD, MPH, 617 Riverside Ave., Burlington, VT 05401. Email:

© 2019 President and Fellows of Harvard College
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