Comorbidities May Stall Diagnosis of PTSD in the General Population

NEW ORLEANS — Patients with post-traumatic stress disorder (PTSD) are often treated for symptoms of the condition before ever receiving a formal diagnosis, according to a retrospective analysis of U.S. commercial claims data.

In the 6 months prior to PTSD diagnosis, patients often experienced multiple PTSD-related symptoms, such as mental, behavioral, or neurodevelopmental disorders (69.7%), physiological symptoms (58.1%), general health and quality of life issues (23.6%), and problems with cognitive faculties (10.0%), reported Jyoti Aggarwal, MHS, of Otsuka Pharmaceutical Development & Commercialization, during a poster presentation at Psych Congress.

Among these patients, 85.9% had at least one comorbidity, such as depression (50.8%), anxiety (45.0%), sleep disturbances (18.4%), or substance use/abuse (10.7%).

“What we’ve seen is that, actually, PTSD patients are diagnosed about 8 years after their trauma, which is a huge delayed diagnosis and they’re experiencing all these symptoms and they’re diagnosed with all these comorbidities and they’re being treated for all of this stuff for that period of time,” Aggarwal told MedPage Today. “If you’re someone who’s suffering from any type of illness, it’s frustrating if nothing is working.”

After diagnosis of PTSD, 43.6% of patients initiated treatment within 15 days. Of these patients, 67.4% were given a selective serotonin reuptake inhibitor (SSRI) as their first treatment, 60.3% were given an augmenting agent, 23.4% received an atypical antipsychotic, 22.5% received a serotonin-norepinephrine reuptake inhibitor, and 12.2% were given combination therapy.

Of note, 20% of patients were treated with more than three lines of therapy over the 24 months following PTSD diagnosis.

In undertaking this study, Aggarwal and colleagues wanted to to identify trends in PTSD diagnosis and treatment in the general U.S. population. PTSD affects 2.6% of men and 6% of women in the U.S., with the majority of patients in the civilian population (86%).

“One of the things that we’ve noted is that PTSD is very well understood in the VA population in what’s happening before diagnosis of PTSD and after diagnosis of PTSD, but it’s not really understood what’s happening in the civilian population,” Aggarwal said. “So this is really looking at a community population — looking at their claims data — and showing when someone’s diagnosed with PTSD what is leading to that diagnosis and how they’re being treated.”

Aggarwal noted that identifying and managing PTSD can be challenging in clinical practice because of the heterogeneous presentations of the disorder.

For this analysis, the researchers identified 26,306 adult patients in the IBM MarketScan Commercial Subset database who were diagnosed with and treated for PTSD from 2015 to 2020, analyzing data for each patient in the 6 months before and the 24 months after diagnosis.

The patients had a median age of 40, and 73.3% were women. A geographical breakdown showed that 42.1% lived in the South, and 23.7% lived in the Midwest.

The researchers noted that the data in their analysis were limited to information available in the claims database, which lacked some clinical data. In addition, their findings may not be representative of the general PTSD population or those with public or no health insurance.