Mental health and satisfaction with primary health care in female patients

      Purpose and objectives

      Patient satisfaction is an important outcome in patient care and is increasingly being used as an indicator of quality of care within large health systems. This study examined whether consideration of specific mental health factors, including posttraumatic stress disorder (PTSD), can improve our understanding of patient satisfaction in primary care settings.


      Questionnaires were mailed to all women who used the VA San Diego Healthcare System primary care clinic in 1998. Two hundred twenty-one (56%) women who were invited to participate in this study completed questionnaires. Participants provided information about physical and mental health and satisfaction with their primary medical care.


      Age and general mental health were negatively associated and PTSD was positively associated with overall satisfaction with care and satisfaction with the provider. General mental health was significantly related to satisfaction with the clinic.


      These findings support the importance of specific mental health symptoms, and trauma-related symptoms in specific, in determining satisfaction.
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        • American Psychiatric Association
        Diagnostic and statistical manual of mental disorders. (4th ed.). Author, Washington, DC1994
        • Ballenger J.C.
        • Davidson J.R.T.
        • Lecrubier Y.
        • Nutt D.J.
        • Goldberg D.
        • Magruder K.M.
        • et al.
        Consensus statement on the primary care management of depression from the International Consensus Group on Depression and Anxiety.
        Journal of Clinical Psychiatry. 1999; 60: 54-61
        • Breslau N.
        • Davis G.C.
        • Andreski P.
        • Peterson E.
        Traumatic events and posttraumatic stress disorder in an urban population of young adults.
        Archives of General Psychiatry. 1991; 48: 216-222
        • Breslau N.
        • Kessler R.C.
        • Chilcoat H.D.
        • Schultz L.R.
        • Davis G.C.
        • Andreski P.
        Trauma and posttraumatic stress disorder in the community.
        Archives of General Psychiatry. 1998; 55: 626-632
        • Calhoun P.S.
        • Bosworth H.B.
        • Grambow S.C.
        • Dudley T.K.
        • Beckham J.C.
        Medical service utilization by veterans seeking help for posttraumatic stress disorder.
        American Journal of Psychiatry. 2002; 159: 2081-2086
        • Calsyn R.J.
        • Morse G.A.
        • Klinkenberg W.D.
        • Yonker R.D.
        • Trusty M.L.
        Moderators and mediators of client satisfaction in case management programs for clients with severe mental illness.
        Mental Health Services Research. 2002; 4: 267-275
        • Coker A.L.
        • Bethea L.
        • Smith P.H.
        • Fadden M.K.
        • Brandt H.M.
        Missed opportunities.
        Preventive Medicine. 2002; 34: 445-454
        • Deykin E.Y.
        • Keane T.M.
        • Kaloupek D.
        • Fincke G.
        • Rothendler J.
        • Siegfried M.
        • et al.
        Posttraumatic stress disorder and the use of health services.
        Psychosomatic Medicine. 2001; 63: 835-841
        • Dobie D.J.
        • Kivlahan D.R.
        • Maynard C.
        • Bush K.R.
        • Davis T.M.
        • Bradley K.A.
        Posttraumatic stress disorder in female veterans.
        Archives of Internal Medicine. 2004; 163: 394-400
        • Dobie D.J.
        • Kivlahan D.R.
        • Maynard C.
        • Bush K.R.
        • McFall M.
        • Epler A.J.
        • et al.
        Screening for post-traumatic stress disorder in female Veteran’s Affairs patients.
        General Hospital Psychiatry. 2002; 24: 367-374
        • Druss B.G.
        • Rosenheck R.A.
        • Stolar M.
        Patient satisfaction and administrative measures as indicators of the quality of mental health care.
        Psychiatric Services. 1999; 50: 1053-1058
        • Engel C.C.
        • Engel A.L.
        • Campbell S.J.
        • McFall M.E.
        • Russo J.
        • Katon W.
        Posttraumatic stress disorder symptoms and precombat sexual and physical abuse in Desert Storm veterans.
        Journal of Nervous and Mental Disease. 1993; 181: 683-688
        • Fraley S.S.
        • Altmaier E.M.
        Correlates of patient satisfaction among menopausal women.
        Journal of Clinical Psychology in Medical Settings. 2002; 9: 235-243
        • Frayne S.M.
        • Skinner K.M.
        • Sullivan L.M.
        • Tripp T.J.
        • Hankin C.S.
        • Kressin N.R.
        • et al.
        Medical profile of women veterans administration outpatients who report a history of sexual assault occurring while in the military.
        Journal of Women’s Health and Gender-Based Medicine. 1999; 8: 835-845
        • Hall J.A.
        • Roter D.L.
        • Milburn M.A.
        Illness and satisfaction with medical care.
        Current Directions in Psychological Science. 1999; 8: 96-99
        • Hargraves J.L.
        • Wilson I.B.
        • Zaslavsky A.
        • James C.
        • Walker J.D.
        • Rogers G.
        • et al.
        Adjusting for patient characteristics when analyzing reports from patients about hospital care.
        Medical Care. 2001; 39: 635-641
        • Hermann R.C.
        • Ettner S.L.
        • Dorwart R.A.
        The influence of psychiatric disorders on patients’ ratings of satisfaction with health care.
        Medical Care. 1998; 36: 720-727
        • Holcomb W.R.
        • Parker J.C.
        • Leong G.B.
        • Thiele J.
        • Higdon J.
        Customer satisfaction and self-reported treatment outcomes among psychiatric inpatients.
        Psychiatric Services. 1998; 49: 929-934
        • Hourani L.L.
        • Yuan H.
        • Bray R.M.
        Psychosocial and health correlates of types of traumatic event exposures among U.S. military personnel.
        Military Medicine. 2003; 168: 736-743
        • Johansson P.
        • Oleni M.
        • Fridlund B.
        Patient satisfaction with nursing care in the context of health care.
        Scandinavian Journal of Caring Sciences. 2002; 16: 337-344
        • Keane T.M.
        • Caddell J.M.
        • Taylor K.L.
        Mississippi Scale for Combat-Related Posttraumatic Stress Disorder.
        Journal of Consulting and Clinical Psychology. 1988; 56: 85-90
        • Kimerling R.
        • Calhoun K.S.
        Somatic symptoms, social support, and treatment seeking among sexual assault victims.
        Journal of Consulting and Clinical Psychology. 1994; 62: 333-340
        • Lang A.J.
        • Laffaye C.
        • Satz L.E.
        • Dresselhaus T.R.
        • Stein M.B.
        Sensitivity and specificity of the PTSD checklist in detecting PTSD in female veterans in primary care.
        Journal of Traumatic Stress. 2003; 16: 257-264
        • May S.
        Patient satisfaction and the detection of psychiatric morbidity in general practice.
        Family Practice. 1992; 9: 76-81
        • Mazor K.M.
        • Clauser B.E.
        • Field T.
        • Yood R.A.
        • Gurwitz J.H.
        A demonstration of the impact of response bias on the results of patient satisfaction surveys.
        Health Services Research. 2002; 37: 1403-1417
        • McHorney C.A.
        • Ware J.E.
        • Lu J.F.
        • Sherbourne C.D.
        The MOS 36-item Short-Form Health Survey (SF-36): II. Tests of data quality, scaling assumptions, and reliability across diverse patient groups.
        Medical Care. 1994; 32: 40-66
        • McHorney C.A.
        • Ware J.E.
        • Raczek A.E.
        The MOS 36-item Short-Form Health Survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs.
        Medical Care. 1993; 31: 247-263
        • Merrill L.L.
        • Newell C.E.
        • Milner J.S.
        • Koss M.P.
        • Hervig L.K.
        • Gold S.R.
        • et al.
        Prevalence of premilitary adult sexual victimization and aggression in a Navy recruit sample.
        Military Medicine. 1998; 163: 209-212
        • Pellegrin K.L.
        • Stuart G.W.
        • Maree B.
        • Frueh B.C.
        • Ballenger J.C.
        A brief scale for assessing patients’ satisfaction with care in outpatient psychiatric services.
        Psychiatric Services. 2001; 52: 816-819
        • Ren X.S.
        • Kazis L.
        • Lee A.
        • Rogers W.
        • Pendergrass S.
        Health status and satisfaction with health care.
        American Journal of Medical Quality. 2001; 16: 166-173
        • Rubin H.R.
        • Gandek B.
        • Rogers W.H.
        • Kosinski M.
        • McHorney C.A.
        • Ware J.E.
        Patients’ ratings of outpatient visits in different practice settings. Results from the Medical Outcomes Study.
        Journal of the American Medical Association. 1993; 270: 835-840
        • Saxe G.
        • Wolfe J.
        Gender and posttraumatic stress disorder.
        in: Saigh P.A. Bremner J.D. Posttraumatic stress disorder a comprehensive text. Allyn and Bacon, Boston1999: 160-179
        • Schnurr P.P.
        • Friedman M.J.
        • Sengupta A.
        • Jankowski M.K.
        • Holmes T.
        PTSD and utilization of medical treatment services among male Vietnam veterans.
        Journal of Nervous and Mental Disease. 2000; 188: 496-504
        • Shi L.
        • Forrest C.B.
        • von Schrader S.
        • Ng J.
        Vulnerability and the patient-practitioner relationship.
        American Journal of Public Health. 2003; 93: 138-144
        • Solomon S.D.
        • Davidson J.R.
        Journal of Clinical Psychiatry. 1997; 58: 5-11
        • Stein M.B.
        • McQuaid J.R.
        • Pedrelli P.
        • Lenox R.
        • McCahill M.E.
        Posttraumatic stress disorder in the primary care medical setting.
        General Hospital Psychiatry. 2000; 22: 261-269
        • Stein M.B.
        • Walker J.R.
        • Forde D.R.
        Gender differences in susceptibility to posttraumatic stress disorder.
        Behaviour Research and Therapy. 2000; 38: 619-628
        • Taubman-Ben-Ari O.
        • Rabinowitz J.
        • Feldman D.
        • Vaturi R.
        Post-traumatic stress disorder in primary-care settings.
        Psychological Medicine. 2001; 31: 555-560
        • Tu H.T.
        • Reschovsky J.D.
        Assessments of medical care by enrollees in for-profit and nonprofit health maintenance organizations.
        New England Journal of Medicine. 2002; 346: 1288-1293
        • Walker E.A.
        • Newman E.
        • Dobie D.J.
        • Ciechanowski P.
        • Katon W.
        Validation of the PTSD checklist in an HMO sample of women.
        General Hospital Psychiatry. 2002; 24: 375-380
        • Ware J.E.
        • Snow K.K.
        • Kosinski M.
        • Gandek B.
        SF-36 Health Survey manual and interpretation guide.
        The Health Institute, New England Medical Center, Boston1993
        • Weathers F.W.
        • Huska J.A.
        • Keane T.M.
        The PTSD Checklist—Civilian Version (PCL-C).
        National Center for PTSD, Boston1991
        • Wells K.B.
        • Stewart A.
        • Hays R.D.
        • Burnam M.A.
        • Rogers W.
        • Daniels M.
        • et al.
        The functioning and well-being of depressed patients.Results from the Medical Outcomes Study.
        Journal of the American Medical Association. 1989; 262: 914-919
        • Wilson P.M.J.
        • Sullivan F.
        • Hussein S.
        • Smith G.D.
        Examination of the effects of emotional disturbance and its detection on general practice patients’ satisfaction with the consultation.
        British Journal of General Practice. 1995; 45: 304-309


      Dr. Lang is a psychologist who specializes in behavioral medicine. Her research interests include assessment and treatment of anxiety and trauma in medical patients.


      Dr. Rodgers is a psychologist who specializes in treating sexual trauma. Her research interests include trauma, disruptive behavior disorders, gender differences in pathology, and women’s health.


      Dr. Moyer is a physician with clinical and research interests in internal medicine and women’s health.


      Ms. Laffaye is a graduate student with interest in patient satisfaction, primary health care, PTSD, and women’s health.


      Ms. Satz is a nurse practitioner with clinical and research interests in primary care, women’s health, and medical impact of trauma and PTSD.


      Dr. Dresselhaus is a physician with interest in quality measurement, activity analysis/random sampling, preventive care, and use of standardized patients.


      Dr. Stein is a psychiatrist with clinical and research interest in anxiety, epidemiology, health services, and public health.