Detecting and Addressing Trauma-related Sequelae in Primary Care

Objective: The associations between the sequelae of complex trauma symptoms and adult health status, patient engagement in treatment, and the potential impacts on primary care providers are underappreciated despite the potential for adverse outcomes. This study examined the correlations among adult primary care patients' reports of posttraumatic stress symptoms (PTSS), adverse childhood experiences (ACE), and the impacts of social determinants of health (SDH) with provider diagnoses in the electronic health record. Methods: Patients in 3 primary care clinics were surveyed. Self-report measures included demographics, trauma symptoms, ACE, and SDH elements. Participant health status and diagnoses were obtained from their electronic health records. Results: The final sample of 354 participants reported high levels of trauma including PTSS and ACE. Educational attainment, health literacy, material hardship, access to health care, and ACE were all statistically associated with reports of PTSS (P < .05 for all). Despite the prevalence of symptoms and adverse experiences reported by the participants, only 5% were diagnosed with a trauma-related disorder in the electronic health record. Conclusions: Data analyses revealed a significant discrepancy between participants' reports of symptoms with a diagnosis of posttraumatic stress disorder by their primary care doctor. Trauma-impacted patients often present with complicated health problems that may influence the encounter in negative ways, including diminishing the primary care doctor's sense of efficacy and competency if they are not addressed effectively in the encounter. The common nature of ACE, PTSS, and SDH effects indicate that both patients and physicians would benefit from detection and training in strategies for routinely implementing trauma-informed practices.