Trauma Exposure in Anxious Primary Care Patients

The present study examined rates of trauma exposure, clinical characteristics associated with trauma exposure, and the effect of trauma exposure on treatment outcome in a large sample of primary care patients without posttraumatic stress disorder (PTSD). Individuals without PTSD (N = 1263) treated as part of the CALM program (Roy-Byrne et al., 2010) were assessed for presence of trauma exposure. Those with and without trauma exposure were compared on baseline demographic and diagnostic information, symptom severity, and responder status six months after beginning treatment. Trauma-exposed individuals (N = 662, 53%) were more likely to meet diagnostic criteria for Obsessive Compulsive Disorder and had higher levels of somatic symptoms at baseline. Individuals with and without trauma exposure did not differ significantly on severity of anxiety, depression, or mental health functioning at baseline. Trauma exposure did not significantly impact treatment response. Findings suggest that adverse effects of trauma exposure in those without PTSD may include OCD and somatic anxiety symptoms. Treatment did not appear to be adversely impacted by trauma exposure. Thus, although trauma exposure is prevalent in primary care samples, results suggest that treatment of the presenting anxiety disorder is effective irrespective of trauma history.

A review of the literature on the epidemiology of parasuicide in the general population

OBJECTIVE

The author reviewed recent literature on the epidemiology of parasuicide in the general population. Major risk factors are also discussed.

METHODS

Parasuicide was defined as suicide attempts and deliberate self-harm inflicted with no intent to die. Articles in English on rates of parasuicide in the general population from 1970 through June 2000 were identified by keyword searches of the PsycINFO and MEDLINE databases. Studies that provided data from a representative population sample and provided incidence or prevalence rates were included in the review. Articles focusing on subsamples such as adolescents or psychiatric patients were excluded.

RESULTS AND CONCLUSIONS

Twenty studies were analyzed. Although methodological problems constitute a major limitation in interpretation of the results, the literature indicates that parasuicide is a serious public health problem. Reported annual rates of parasuicide in recent decades range from 2.6 to 1,100 per 100,000, and lifetime prevalence rates range from 720 to 5,930 per 100,000. The most important risk factors identified were younger age and female gender. Others included being single or divorced, being unemployed, having a recent change in living situation, having a mental disorder, and having a previous parasuicide incident.