3132 — Same-day integrated mental health services for those who screen positive for PTSD in VHA primary care: Implications for diagnosis and treatment

Bohnert KM, VA Ann Arbor CCMR; SMITREC; Sripada RK, VA Ann Arbor CCMR; SMITREC; Mach J, VA Ann Arbor CCMR; SMITREC; McCarthy JF, VA Ann Arbor CCMR; SMITREC;

Objectives:
We examine whether same-day integrated mental health services are associated with increased diagnosis and treatment initiation among primary care (PC) patients who screen positive for posttraumatic stress disorder (PTSD).

Methods:
A national sample of Veterans Health Administration (VHA) PC patients with a positive PTSD screen were studied (n = 21,259). Patients were assessed for PTSD diagnosis and treatment initiation on the screening day, < = 7 days, < = 12 weeks, < = 6 months, and < = 1 year of screening positive. Setting of services received on screening day was categorized as PC-only, same-day Primary Care-Mental Health Integration (PC-MHI), or same-day specialty mental health. Multivariable generalized estimating equations (GEE) logistic regression modeling was used to estimate associations between category of screening day services and diagnosis and treatment initiation, adjusting for demographic characteristics, prior mental health diagnoses, prior VHA utilization, and PTSD screen score.

Results:
Of the 21,259 patients with positive PTSD screens, 10,715 (50.4%) received a diagnosis within one year. Same-day PC-MHI services were associated with greater odds of PTSD diagnosis, both on the same day (OR = 2.2; 95% CI = 2.0-2.6) and one-year following screening positive (OR = 1.7; CI = 1.5-1.9), as compared with PC-only services. Among those who received a diagnosis on the same day as their positive screen, same-day PC-MHI services were associated with increased odds of initiating PTSD treatment (OR = 3.3; CI = 2.6-4.2) within 12 weeks of diagnosis, as compared with PC-only.

Implications:
Same-day integrated mental health services may help facilitate PTSD diagnosis and treatment initiation following a positive screen.

Impacts:
When patients screen positive for PTSD, PC providers should consider engaging integrated mental health services.