Seal KH (San Francisco VAMC and University of California, San Francisco), Maguen S
(San Francisco VAMC and University of California, San Francisco), Cohen BE
(San Francisco VAMC and University of California, San Francisco), Gima KS
(San Francisco VAMC), Metzler T
(San Francisco VAMC), Bertenthal D
(San Francisco VAMC), Marmar CR
(San Francisco VAMC and University of California, San Francisco)
The VA conducts universal mental health (MH) screening for Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans and has expanded MH services capacity. Post-traumatic stress disorder (PTSD) treatment endorsed by VA and supported by evidence-based research requires a minimum of 12 sessions, yet little is known about VA MH services utilization in OEF/OIF veterans. We conducted an investigation of MH services utilization in OEF/OIF veterans with MH diagnoses, including PTSD, and examined predictors of receiving minimally adequate PTSD treatment.
The VA OEF/OIF Roster and VA National Patient Care Database were used to identify 238,098 OEF/OIF veterans who were new users of VA facilities between April 1, 2002 and March 31, 2008. MH ICD-9 and clinic stop code data were used to describe the timing, frequency and intensity of VA MH services utilization among OEF/OIF veterans in the first year of receiving initial MH diagnoses. Among OEF/OIF veterans with PTSD diagnoses, multivariate logistic regression analyses were used to determine independent predictors of attending > = 12 MH sessions.
Of 84,972/238,098 (36%) OEF/OIF veterans who received > = 1 MH diagnoses, 56,886 (67%) had at least one follow-up MH clinic visit in the year following initial MH diagnosis: 44% had 1-7 visits and 23% had > = 8 visits. The majority with MH diagnoses received PTSD diagnoses (58.2%), and 80% of these had at least 1 MH follow-up visit in the year following diagnosis, yet only 19% attended > = 12 MH sessions. OEF/OIF veterans were independently less likely to attend > = 12 sessions if they had isolated (versus co-morbid) PTSD, were < age 25 years, female, married, lived > 25 miles from a VA facility, or primarily received care from VA community clinics versus medical centers (all p-values < 0.01).
Among OEF/OIF veterans, MH follow-up in the year following initial MH diagnosis, including PTSD, was robust. In contrast, a minority of veterans with PTSD attended > = 12 MH sessions due to competing priorities, logistical and system-level barriers.
Interventions directed at overcoming barriers and improving retention in MH treatment promise to increase the proportion of OEF/OIF veterans that completes adequate, evidence-based PTSD treatment.