The prevalence of posttraumatic stress disorder (PTSD) among US Service Members returning from Iraq and Afghanistan is high, yet use of mental health treatment among these individuals is low. Therefore, it is likely that many Veterans of these conflicts receiving their healthcare through the Veterans Health Administration (VHA) have a need for PTSD mental health services. Understanding PTSD screening and subsequent services is essential.
The purpose of this project is to provide critical and timely evidence to fill in the existing gaps regarding treatment initiation and engagement among OEF/OIF/OND Veterans with PTSD in VHA. The specific aims of the research are: (1) to identify patient and provider factors associated with timely treatment initiation and continued engagement among all OEF/OIF/OND Veterans in VHA care who receive positive PTSD screens and are diagnosed with the condition; (2) to further elucidate patient factors associated with timely initiation and continued engagement in PTSD treatment using a qualitative approach with provider and Veteran patient focus groups; (3) to build on the two prior aims by developing and piloting a theory-based intervention to increase initiation and engagement in PTSD treatment among Veterans with PTSD; and (4) to identify important facility factors and variation associated with timely treatment initiation and engagement in order to inform future implementation efforts.
Aims 1 and 4 will be completed via secondary data analyses of existing VHA administrative data. Aim 2 will be completed via qualitative focus group interviews of OEF/OIF/OND patients with PTSD who are and are not engaged in treatment, and with providers who care for them. Aim 3 will be completed via a pilot trial of an intervention developed based on theory and results from the two prior aims.
Not yet available.
Understanding and addressing the factors that play a role in the gap between a positive screen, treatment initiation, and treatment continuation may significantly improve our ability to reduce Veteran suffering and prevent further functional and emotional problems associated with PTSD. Recent findings regarding PC-MHI are especially relevant for VA primary care providers, who may consider engaging integrated mental health professionals to help facilitate PTSD diagnostic assessment and treatment initiation. These important findings are often cited by Central Office, and are especially relevant to the My VA Access Initiative.
Additionally, longitudinal findings from recent work among OEF/OIF NG service members have potential treatment implications, including that individuals in classes characterized by higher levels of symptoms at 6 months may have more variable outcomes and may require more intensive interventions as well as vigorous treatment of co-occurring mental health conditions to prevent movement to more severe symptom classes. Those initially in the most severe class may benefit most from PTSD-focused treatments, especially given their low likelihood of transitioning to either mild or asymptomatic classes over time.
Furthermore, emerging initial themes from qualitative work indicate that patients' attitudes regarding stigma associated with PTSD, and their PTSD screening and the care processes (including communication and treatment offerings), may play important roles in why some Veterans do or do not initiate more specialized treatment.
External Links for this Project
Grant Number: IK2HX000970-01A2
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- Hale AC, Bohnert KM, Spencer RJ, Ganoczy D, Pfeiffer PN. The Prevalence and Incidence of Attention-deficit/Hyperactivity Disorder in the Veterans Health Administration From 2009 to 2016. Medical care. 2020 Mar 1; 58(3):273-279. [view]
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- Cornwell BL, Szymanski BR, Bohnert KM, McCarthy JF. Treatment Initiation Following Positive Depression Screens in Primary Care: a Propensity Score-Weighted Analysis of Integrated Mental Health Services. Journal of general internal medicine. 2021 Feb 1; 36(2):561-563. [view]
- Bohnert KM, Walton MA, Ranney M, Bonar EE, Blow FC, Zimmerman MA, Booth BM, Cunningham RM. Understanding the service needs of assault-injured, drug-using youth presenting for care in an urban Emergency Department. Addictive Behaviors. 2015 Feb 1; 41:97-105. [view]
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- Sripada RK, Bohnert KM, Ganoczy D, Blow FC, Valenstein MT, Pfeiffer PN. Initial Group versus Individual therapy for Posttraumatic Stress Disorder and Subsequent Follow-Up Treatment Adequacy. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA. [view]
- Bohnert KM, Sripada RK, Mach J, McCarthy JF. Same-day integrated mental health services for those who screen positive for PTSD in VHA primary Care: Implications for diagnosis and treatment. Poster session presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 8; Philadelphia, PA. [view]
Mental, Cognitive and Behavioral Disorders, Substance Use Disorders, Health Systems
Treatment - Observational, Prevention, Technology Development and Assessment, Treatment - Efficacy/Effectiveness Clinical Trial