VA Healthcare Benefits May Reduce Racial/Ethnic Disparities in Seeking Mental Health Treatment among Veterans vs. Civilians
Since 9/11, VA and other Veteran service organizations have conducted intensive outreach and public health campaigns seeking to engage Veterans in mental healthcare; however, concerns regarding racial/ethnic disparities in treatment engagement and outcomes among Veterans persist. This study assessed whether racial/ethnic disparities in mental health treatment seeking for psychiatric conditions common in the Veteran population (PTSD, major depressive disorder, alcohol-use disorder or AUD) were attenuated for military Veterans compared to civilians, and whether attenuation was more pronounced among Veterans who had VA healthcare coverage in the past 12 months. Investigators utilized data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a nationally representative survey of the general US population, including a representative sample of residents who were not active duty military during 2012–2013. The full cohort for this study included all individuals who had a lifetime diagnosis of PTSD (n=2,335), major depressive disorder – MDD (n=7,407), and/or alcohol use disorder (n=9,942) and comprised 13,528 civilians and 1,392 Veterans. The primary variables examined were racial/ ethnic minority status, Veteran status, and access to VA healthcare. Investigators also assessed demographics and comorbidities.
- Among Veterans in this study (unlike civilians), racial/ethnic minorities did not differ from whites in time to initiate treatment for PTSD and depression, and showed a shorter time to initiate treatment for AUD.
- Racial/ethnic minority Veterans with past year VA healthcare coverage were the most likely to seek treatment for all three disorders (83%, 80%, and 38%, for PTSD, MDD, and AUD, respectively); whereas, racial/ethnic minority civilians were the least likely to seek treatment for all three disorders (47%, 54%, and 17%, for PTSD, MDD, and AUD, respectively).
- Among racial/ethnic minority patients, shortened time to treatment initiation for Veterans relative to civilians remained significant after adjusting for additional demographic and clinical covariates for PTSD and major depressive disorder, but not alcohol use disorder.
- Findings suggest that military service and benefits available to Veterans may reduce racial/ethnic disparities in seeking mental health treatment seen in the civilian population.
- There could be potential recall bias in retrospectively assessing symptom onset as well as treatment seeking.
- VA healthcare coverage was only assessed for the past year.
Drs. Fortney, Chen, Young, and Lehavot are part of HSR&D’s Center for Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA. Dr. Fortney was supported by an HSR&D Research Career Scientist Award.
Goldberg S, Fortney J, Chen J, Young B, Lehavot K, and Simpson T. Military Service and Military Health Care Coverage are Associated with Reduced Racial Disparities in Time to Mental Health Treatment Initiation. Administration and Policy in Mental Health and Mental Health Services Research. January 27, 2020; Epub ahead of print.