The Impact of Trauma Exposure and Post-Traumatic Stress Disorder on Healthcare Utilization Among Primary Care Patients

Post-traumatic stress disorder (PTSD) in an urban primary care population is associated with a doubling of the number of hospitalizations and over twice the utilization of mental health resources. PTSD was not, however, associated with higher emergency department use or outpatient visits.

This study looked at utilization of health care resources by people with diagnoses of PTSD or trauma exposure in an urban civilian population. Although studies examining utilization of resources by people with PTSD or trauma diagnoses have been done before, most of them are done on veterans, and use self-reported data rather than electronic medical record data.

This cross-sectional study hypothesized that urban PTSD patients in a primary care population would have more nonmental health outpatient visits and emergency visits, as well as hospitalizations and mental health outpatient visits. Patients were interviewed at an urban academic safety-net center and 607 agreed to participate. This study is one of very few such studies that did not focus on PTSD related to combat or sexual assault. The study population could be characterized as an 'urban, minority, disenfranchised population' with a high trauma burden.

Key Findings:

  • Subjects with PTSD had greater use of health care resources through hospitalizations and mental health visits. Trauma itself was not associated with increased utilization apart from mental health visits.
  • However, emergency department visits were not higher, and outpatient resource use was not greater.

The authors' research adds to a slim body of work on PTSD in general populations not focusing on combat- or sexual assault-related PTSD. The authors also contribute to the literature by using stricter methodological characterization of the study population to determine PTSD status, and by trying to separate the contribution of depression in adding to utilization of resources. This study also separates effects of trauma exposure from effects of PTSD, and concludes that, in most cases, trauma exposure alone is not causing significant resource use. Limitations of the study include that it was cross-sectional, and thus cannot determine causality of associations, and that the population may not be similar to other populations.