Original Article

PTSD and Substance Use: Unrecognized Sequelae of Bioterrorism in Primary Care Providers

Authors: Jennie C.I. Tsao, PHD, Aram Dobalian, PHD, JD, Brenda A. Wiens, PHD, Julius A. Gylys, PHD, Art Clawson, MS, Robert Brooks, MD

Abstract

Background: Psychological casualties following public health emergencies are likely to significantly outnumber physical casualties. However, postevent psychological disorders may be under-recognized by primary care providers (PCPs).


Methods: Rural PCPs in northern and central Florida were interviewed using a series of open-ended questions to assess knowledge of likely mental disorders, their risk factors, and preferred treatment options following such events (n = 21).


Results: PTSD was identified by 14% and substance abuse by 10% of the sample. Physicians were significantly more likely to identify posttraumatic stress disorder (PTSD) as an expected postevent psychological disorder than nonphysician providers. PCPs were significantly more likely to endorse counseling (86%) than medications (43%) as a preferred treatment option.


Conclusions: Our findings support the need for increased education and training regarding the mental health consequences of bioterrorism in rural PCPs, particularly for nursing-level and other nonphysician providers. Improvements in knowledge may enhance preparedness for such emergencies.


Key Points


* Respondents in this sample of rural primary care providers (PCPs) revealed low levels of awareness that posttraumatic stress disorder (PTSD) (14%) and substance abuse (10%) constitute likely mental health consequences of bioterrorism.


* PCPs in the present study were significantly more likely to endorse counseling, (86%) rather than medications, (43%) as a preferred treatment option for postevent mental disorders, and one-third of the sample endorsed both medications and counseling.


* Our findings support the need for increased education and training regarding the mental and behavioral health consequences of bioterrorism and other public health emergencies in rural PCPs, particularly for nursing-level and other nonphysician providers.


* Improvements in knowledge of expected mental disorders and their risk factors may enhance preparedness for bioterrorism and other such emergencies by assisting rural PCPs in the identification and triage of immediate postevent psychological casualties, as well as the care of postacute and chronic mental health needs after such events.


* Increased efforts should be directed toward facilitating referrals to mental health professionals and increasing the availability of such professionals in rural communities throughout the U.S.

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