3094 — VA Mental Health Services Utilization among Iraq and Afghanistan Veterans in the First Year of Receiving Mental Health Diagnoses

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)

Objectives:
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.

Methods:
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.

Results:
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).

Implications:
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.

Impacts:
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.