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PTSD worsens symptoms in patients with depression

Among patients with depression, a diagnosis of coexisting PTSD was associated with worse depression symptoms when managed in collaborative care management in primary care, according to data published in the Journal of Primary Care and Community Health.

“Major depressive disorder is frequently a comorbid condition in patients with PTSD,” Kurt Angstman, MD, of the Mayo Clinic in Rochester, Minnesota, and colleagues wrote. “Primary care management of patients with depression has focused on enhancing care and improving outcomes with collaborative care management.”

According to the researchers, collaborative care management is a team-based model that identifies comorbid psychiatric disorders, and provides appropriate intervention and follow-up to measure improvement using patient self-assessment scales.

To analyze data on the clinical impact of PTSD on depression outcomes in collaborative care management, the researchers used a retrospective cohort design to evaluate 2,121 adult patients in collaborative care management in a primary care setting. Patients used standardized self-reporting measures, and the researchers evaluated baseline depression and 6-month outcome scores. Of the patients, 76 had a PTSD diagnosis in the electronic medical record.

According to the researchers, patients with PTSD reported more severe depressive symptoms at baseline, with a Patient Health Questionnaire-9 score of 17.9, compared with a score of 15.4 among those who without PTSD (P < .001). Controlling for sociodemographic and clinical characteristics, PTSD was associated with lower odds of remission at 6 months (aOR = 0.457, 95% CI, 0.274-0.76, P = .003), and also with higher odds of persistent depressive symptoms after 6 months in collaborative care management (aOR = 3.112, 95% CI, 1.921-5.041, P < .001).

“When coexisting with depression, a diagnosis of PTSD was associated with worse depression outcomes, when managed with [collaborative care management] in primary care,” Angstman and colleagues wrote. “Screening for PTSD in depressed patients with persist depressive symptoms, increased attention to engaging patients in care coordination, and adaptations of care coordination approaches for those patients comorbid with PTSD are all considerations based on our findings. Opportunities still exist for more aggressive management of depression in these patients to help improve remission as well as reduce persistent depressive symptoms.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.