Blog

Chicago’s Cook County Hospital has one of the busiest trauma centers in the nation, treating about 2,000 patients a year for gunshots, stabbings and other violent injuries.

So when researchers started screening patients there for post-traumatic stress disorder in 2011, they assumed they would find cases.

They just didn’t know how many: Fully 43 percent of the patients they examined – and more than half of gunshot-wound victims – had signs of PTSD.

“We knew these people were going to have PTSD symptoms,” said Kimberly Joseph, a trauma surgeon at the hospital. “We didn’t know it was going to be as extensive.”

What the work showed, Joseph said, is, “This is a much more urgent problem than you think.”

Joseph proposed spending about $200,000 a year to add staffers to screen all at-risk patients for PTSD and connect them with treatment. The taxpayer-subsidized hospital has an annual budget of roughly $450 million. But Joseph said hospital administrators turned her down and suggested she look for outside funding.

“Right now, we don’t have institutional support,” said Joseph, who is now applying for outside grants.

A hospital spokeswoman would not comment on why the hospital decided not to pay for regular screening. The hospital is part of a pilot program with other area hospitals to help “pediatrics patients identified with PTSD,” said the spokeswoman, Marisa Kollias.“The Cook County Health and Hospitals System is committed to treating all patients with high quality care.”

Right now, social workers try to identify patients with the most severe PTSD symptoms, said Carol Reese, the trauma center’s violence prevention coordinator and an Episcopal priest.

“I’m not going to tell you we have everything we need in place right now, because we don’t,” Reese said. “We have a chaplain and a social worker and a couple of social work interns trying to see 5,000 people. We’re not staffed to do it.” 

A growing body of research shows that Americans with traumatic injuries develop PTSD at rates comparable to veterans of war. Just like veterans, civilians can suffer flashbacks, nightmares, paranoia, and social withdrawal. While the United States has been slow to provide adequate treatment to troops affected by post-traumatic stress, the military has made substantial progress in recent years. It now regularly screens for PTSD, works to fight the stigma associated with mental health treatment and educates military families about potential symptoms.

Few similar efforts exist for civilian trauma victims. Americans wounded in their own neighborhoods are not getting treatment for PTSD. They’re not even getting diagnosed.

Studies show that, overall, about 8 percent of Americans suffer from PTSD at some point in their lives. But the rates appear to be much higher in communities – such as poor, largely African-American pockets of Detroit, Atlanta, Chicago and Philadelphia – where high rates of violent crime have persisted despite a national decline.

Researchers in Atlanta interviewed more than 8,000 inner-city residents and found that about two-thirds said they had been violently attacked and that half knew someone who had been murdered. At least 1 in 3 of those interviewed experienced symptoms consistent with PTSD at some point in their lives – and that’s a “conservative estimate,” said Dr. Kerry Ressler, the lead investigator on the project.

“The rates of PTSD we see are as high or higher than Iraq, Afghanistan or Vietnam veterans,” Ressler said. “We have a whole population who is traumatized.”

 “The rates of PTSD we see are as high or higher than Iraq, Afghanistan, or Vietnam veterans.”
– Dr. Kerry Ressler, researcher on inner-city residents exposed to violencePost-traumatic stress can be a serious burden: It can take a toll on relationships and parenting, lead to family conflict and interfere with jobs. A national study of patients with traumatic injuries found that those who developed post-traumatic stress were less likely to have returned to work a year after their injuries.

It may also have a broader social cost.  “Neglect of civilian PTSD as a public health concern may be compromising public safety,” Ressler and his co-authors concluded in a 2012 paper.

For most people, untreated PTSD will not lead to violence. But   “there’s a subgroup of people who are at risk, in the wrong place, at the wrong time, of reacting in a violent way or an aggressive way, that they might not have if they had had their PTSD treated,” Ressler said.

Click Here: camiseta rosario central

Research on military veterans has found that the symptom of “chronic hyperarousal” – the distorted sense of always being under extreme threat – can lead to increased aggression and violent behavior.

“Very minor threats can be experienced, by what the signals in your body tell you, as, ‘You’re in acute danger,’ ” said Sandra Bloom, a psychiatrist and former president of the International Society for Traumatic Stress Studies.

Another issue, wrote researchers at Drexel University, is that people with symptoms of PTSD may be more likely to carry a weapon in order to “restore feelings of safety.”

Hospital trauma centers, which work on the front lines of neighborhood violence, could help address the lack of treatment. Indeed, the American College of Surgeons, which sets standards for the care of patients with traumatic injuries, is set to recommend that trauma centers“evaluate, support and treat” patients for post-traumatic stress.

But it’s not a requirement, and few hospitals appear to be doing it.

ProPublica surveyed a top-level trauma center in each of the 22 cities with the nation’s highest homicide rates. Just one, the Spirit of Charity Trauma Center in New Orleans, currently screens all seriously injured patients for PTSD. At another, Detroit Receiving Hospital, psychologists talk with injured crime victims about PTSD.  

Other hospitals have a patchwork of resources or none at all. At two hospitals, in Birmingham, Alabama and St. Louis, Missouri, trauma center staff said they hope to institute routine PTSD screening by the end of the year.

Doctors in Baltimore, Newark, Memphis, and Jackson, Miss., said they wanted to do more to address PTSD, but they do not have the money.  

They said adding even small amounts to hospital budgets is a hard sell in a tough economic climate. That’s especially true at often-cash-strapped public hospitals.

In order to add a staff member to screen and follow up on PTSD, “Do I lay someone else off in another area?” asked Carnell Cooper, a trauma surgeon at Maryland Shock Trauma in Baltimore.

Many public hospitals rely on state Medicaid programs to cover treatment of low-income patients. But several surgeons across the country said they did not know of any way they could bill Medicaid for screenings.

The federal government often provides guidance to state Medicaid programs on best practices for patient care and how to fund them. But a spokeswoman for the Centers for Medicare and Medicaid Services said the agency has given states no guidance on whether or how hospitals could be reimbursed for PTSD screenings.