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Trauma and Posttraumatic Stress Disorder in an Urban Xhosa Primary Care Population: Prevalence, Comorbidity, and Service Use Patterns

CAREY, PAUL D. M.B. Ch.B., M.Med. (Psych)1; STEIN, DAN J. M.D., Ph.D.1; ZUNGU-DIRWAYI, NOMPUMELELO M.A.1; SEEDAT, SORAYA M.B. Ch.B., M.Med. (Psych), F.C.Psych.1

The Journal of Nervous and Mental Disease: April 2003 - Volume 191 - Issue 4 - p 230-236
doi: 10.1097/01.NMD.0000061143.66146.A8

Despite increased awareness of the prevalence and morbidity of psychiatric illnesses, relatively few studies have been undertaken in primary care settings in the African context. The authors determined the prevalence of trauma exposure and posttraumatic stress disorder (PTSD) in a South African township primary health care clinic and assessed associated demographic factors, comorbidity, service use, service satisfaction, and quality of life. Subjects were directly interviewed using translated, standardized instruments to assess variables described. Retrospective chart analysis assessed clinician case identification and psychotropic drug-prescribing habits. Of the 201 participants, 94% reported exposure to traumatic events (mean, 3.8). Trauma was associated with single status (p = .01), and PTSD was associated with poverty and single status (p = .04). Both sexes were equally likely to develop PTSD. PTSD (current; 19.9%), depression (37%), and somatization disorder (18.4%) were the most common diagnoses. Comorbidity with PTSD was high and included depression (75%, p < .01), somatization (35%, p < .01), and panic disorder (25%, p < .01). Levels of functional impairment were higher for subjects with PTSD, depression, and somatization than for those without (p < .05). PTSD comorbid with depression compounded impairment (p = .04). Levels of trauma, PTSD, and depression did not increase service use or dissatisfaction with services. Clinicians did not identify trauma (0%) or psychopathology (0%), and psychotropic medication was prescribed for only 1% of participants. In this population, trauma and PTSD were highly prevalent and associated with significant unidentified morbidity and comorbidity. Patients remain untreated for years in the current system of primary care consultations.

1 MRC Unit for Stress and Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, PO Box 19063, Tygerberg 7505, Cape Town, South Africa. Send reprint requests to Dr. Carey.

This study was made possible by support from the Medical Research Council of South Africa.

© 2003 Lippincott Williams & Wilkins, Inc.