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The PTSD crisis ignored: Americans wounded at home

Lois Beckett | 2/7/2014, 6 a.m.

Hospitals are often unwilling to foot the bill themselves.

Trauma surgeons and their staffs expressed frustration that they know PTSD is having a serious impact on their patients, but they can’t find a way to pay for the help they need.

“We don’t recognize that people have PTSD. We don’t recognize that they’re not doing their job as well, that they’re not doing as well in school, that they’re getting irritable at home with their families,” said John Porter, a trauma surgeon in Jackson, Miss., which has a per-capita homicide rate higher than Chicago’s.

“When you think about it, if someone gets shot, and I save their life, and they can’t go out and function, did I technically save their life? Probably not,” Porter added.

When RAND Corp. researchers began interviewing violently injured young men in Los Angeles in the late 1990s, they faced some skepticism that the men, often connected to gangs, would be susceptible to PTSD.

“We had people tell us that we’d see a lot of people who were gang-bangers, and they wouldn’t develop PTSD, because they were already hardened to that kind of life,” said Grant Marshall, a behavioral scientist who studied patients at a Los Angeles trauma center. “We didn’t find that to be the case at all. People in gangs were just as likely as anyone else to develop PTSD.”

In fact, trauma appears to have a cumulative effect. Young men with violent injuries may be more likely to develop symptoms if they have been attacked before.

The Los Angeles study found that 27 percent of the men interviewed three months after they were injured had symptoms consistent with PTSD.

“Most people still think that all the people who get shot were doing something they didn’t need to be doing,” said Porter, the trauma surgeon from Jackson, Miss. “I’m not saying it’s the racist thing, but everybody thinks it’s a young black men’s disease: They get shot, they’re out selling drugs. We’re not going to spend more time on them.”

While post-traumatic stress often does not show up until several months after an injury, experts say many trauma centers are missing the chance to evaluate patients early for risk of PTSD and to use clinical follow-ups — when patients come back to have their physical wounds examined — to check if patients are developing symptoms.

Doctors say hospitals are unlikely to make significant progress until the American College of Surgeons makes systematic PTSD screening a requirement for all top-level trauma centers.

An ACS requirement would be “a much better hammer to show the administration,” said Michael Foreman, chief of trauma surgery at Baylor University Medical Center in Dallas. Baylor, one of the few trauma centers to have a fulltime psychologist on staff, surveyed 200 patients and found that roughly a quarter experienced post-traumatic stress. But Foreman said the center would not systematically screen all its patients until the ACS mandates it.

It’s not clear when that will happen. The organization’s recognition of PTSD screening as a recommended practice is a first step. Those new guidelines will be released in March 2014, according to Chris Cribari, who chairs the subcommittee that evaluates whether hospitals are meeting ACS standards. Cribari declined to say when PTSD screening might become a requirement. He said the timing will depend on what hurdles hospitals encounter — such as patient privacy — when some of them start screenings.