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Articles   |    
Screening and Intervention for Comorbid Substance Disorders, PTSD, Depression, and Suicide: A Trauma Center Survey
Jeff Love, B.A.; Douglas Zatzick, M.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300399
View Author and Article Information

The authors are with the Department of Psychiatry and Behavioral Sciences, Harborview Medical Center, University of Washington, Seattle. Send correspondence to Dr. Zatzick (e-mail: dzatzick@u.washington.edu). A preliminary version of this paper was presented at the annual meeting of the American Psychiatric Association, San Francisco, May 18–22, 2013.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Few investigations have examined screening and intervention procedures for comorbid substance use and mental disorders at trauma centers in the United States, although these disorders are endemic among survivors of traumatic injury. In 2006, the American College of Surgeons (ACS) mandated that level I and level II trauma centers screen for alcohol use problems and that level I centers provide brief intervention for those who screen positive. The ACS is expected to recommend best practice policy guidelines for screening for drug use problems and posttraumatic stress disorder (PTSD). This study examined screening and intervention procedures for the full spectrum of comorbid mental and substance use disorders at U.S. trauma centers.

Methods  Respondents at all level I and level II trauma centers (N=518) in the United States were asked to complete a survey describing screening and intervention procedures for alcohol and drug use problems, suicidality, depression, and PTSD.

Results  There were 391 (75%) respondents. Over 80% of trauma centers routinely screened for alcohol and drug use problems. Routine screening and intervention for suicidality, depression, and PTSD were markedly less common; in fact, only 7% of centers reported routine screening for PTSD. Consistent with ACS policy, level I centers were significantly more likely than level II centers to provide alcohol intervention.

Conclusions  Alcohol screening and intervention occurred frequently at U.S. trauma centers and appeared to be responsive to ACS mandates. In the future, efforts to orchestrate clinical investigation and policy could enhance screening and intervention procedures for highly prevalent, comorbid mental disorders.

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Anchor for Jump
Table 1Organizational characteristics of 518 trauma centers, by survey response
Table Footer Note

a ACS, American College of Surgeons

Table Footer Note

b CTH, Council of Teaching Hospitals

Anchor for Jump
Table 2Screening and use of formal consults for alcohol and drug use problems at 172 level 1 and 219 level II trauma centers
Table Footer Note

a Includes motivational interviewing

Anchor for Jump
Table 3Screening and use of formal consults for suicide, depression, and PTSD at 172 level 1 and 219 level II trauma centers
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