By Lois Beckett, ProPublicaThis piece originally ran on ProPublica.

Undiagnosed post-traumatic stress disorder is having a major impact on injured civilians, particularly those with violent injuries, as we detailed last month. One national study of patients with traumatic injuries found that more than 20 percent of them developed PTSD.

But many hospitals still have no systematic approach to identifying patients with PTSD or helping them get treatment.

We surveyed 21 top-level trauma centers in cities with high rates of violence. The results show that trauma surgeons across the country see PTSD as a serious problem. But only one trauma center, at the Interim LSU Public Hospital in New Orleans, actually screens all acutely injured patients for PTSD. (See the full survey.)

Why don’t hospitals do more to identify PTSD? Here is what surgeons and other trauma experts told us.  

It’s too expensive

Paying for additional hospital staff to screen patients for PTSD and connect them with treatment might only cost $100,000 or $200,000 a year. But cash-strapped hospitals are often reluctant to incur any new expenses.  

 “As much as we’d like to [screen] — we’d really like to be able to do it — we as hospitals are simply trying to find a way to survive, to pay the bills,” said Dr. Carnell Cooper, a trauma surgeon at Baltimore’s Adams Cowley Shock Trauma Center, which doesn’t do routine PTSD screenings.  

At, Chicago’s Cook County Hospital, researchers found that 43 percent of the patients they surveyed had signs of PTSD. A trauma surgeon at the hospital proposed spending about $200,000 a year to add staff focused on PTSD. But the hospital administration suggested that she look for outside funding. The taxpayer-subsidized hospital currently provides no institutional funding for systematic PTSD screening.

Doctors say they don’t screen for PTSD because they don’t know if their patients can get treatment

Another barrier to screening civilian patients for PTSD is a lack of mental health professionals in many communities. 

“Right now, we’re not doing the PTSD screening for everybody because we can’t treat everyone,” said Carol Reese, the violence prevention coordinator at Cook County Hospital in Chicago.

Finding mental health treatment can be challenging even for patients with health insurance, said Cooper, the Baltimore trauma surgeon. And for the uninsured, finding treatment can be an “exercise in frustration,” ending with hospital staff “begging for favors from contacts and friends, to make sure the patient gets the care he or she needs.”

“If we knew that we could find people treatment,” Cooper said, “then we would find a way to screen them.”

Patients and their families often have little awareness of PTSD

One of the researchers who helped demonstrate the high rates of PTSD in civilian trauma patients is Dr. Gregory “Jerry” Jurkovich, who is now the chief of surgery and trauma services at Denver Health in Colorado, which was not part of our survey.

If more patients knew how common PTSD is among civilians, “there might be a demand from the ground level up for something to be done about it” Jurkovich said. So far, he added, “that hasn’t existed.”

Surgeons are just beginning to realize how many civilians get PTSD

At Baylor University Medical Center in Dallas, Texas, researchers recently found that 25 percent of patients screened positive for PTSD six months after their injuries.

Dr. Michael Foreman, the chief of the division of trauma surgery, said the study “dramatically” changed his perspective on PTSD.

Previously, he said, he had assumed that only a small fraction of his patients developed post-traumatic stress. “I don’t know if my patients were trying to be nice to me and didn’t want to, quote, ‘bother’ me, or I just wasn’t asking the right questions,” he said.

“It was quite surprising and humbling to me to recognize that this was happening … to start hearing these disturbing stories, of people’s lives and how profoundly they had been affected, and to realize how I was unaware of it,” he said. 

While the hospital is trying to improve patient awareness of PTSD, the trauma center is still not doing routine screening for all patients.

Dr. Martin Croce is the medical director of the Elvis Presley Memorial Trauma Center at the Regional Medical Center in Memphis, Tenn. A few years ago, Croce said, he was skeptical about whether PTSD was a serious issue in civilian patients.  But the growing research has led him to do “a complete 180.”

Now, Croce said, “The only people that don’t think it’s real are people who have not been keeping up.”

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