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Publication Briefs

Study Suggests Many OEF/OIF Veterans Delay Initiating Mental Health Care and Completing Effective Mental Health Treatment

While several studies have examined rates of mental health and primary care services use among OEF/OIF/OND Veterans, to date no known study has investigated correlates of length of time to engagement in primary care and mental health outpatient treatment, including "minimally adequate" mental health treatment (defined for this study as >8 sessions within 12 months from first mental health visit). This retrospective study sought to describe time to initiation (and predictors of time to initiation) of first primary care visit, mental health outpatient visit, and minimally adequate mental healthcare among Veterans with mental health diagnoses seeking VA healthcare post-deployment. Using VA data, investigators identified 314,717 OEF/OIF/OND Veterans who received a mental health diagnosis and used either VA primary or mental health outpatient care between 10/7/01 and 9/30/11. Mental health diagnoses included depression, PTSD, other anxiety disorders, adjustment disorders, alcohol use disorders, and drug use disorders. Number of comorbid mental health diagnoses also was assessed.


  • Findings indicate delays in initiating and completing minimally adequate mental healthcare among OEF/OIF/OND Veterans using VA services. Among these Veterans, the median time to engagement in mental healthcare was more than two years from the end of the last deployment. Further, after more than three years post-deployment, 75% of Veterans with mental health diagnoses — who were in the VA healthcare system for at least one year — had still not engaged in minimally adequate mental healthcare.
  • There was a median lag time of 7.5 years between coming in for an initial mental health treatment session and beginning a course of minimally adequate mental healthcare.
  • All of the mental health diagnoses, as well as number of comorbid mental health diagnoses, were associated with an increased chance of initiating minimally adequate mental health outpatient care sooner. PTSD had the strongest association with early initiation.
  • Male Veterans waited nearly two years longer to initiate minimally adequate mental healthcare compared to female Veterans.
  • Younger Veterans (<25 years of age) took longer to initiate and seek minimally adequate care; racial/ethnic minorities also took longer than their White counterparts.


  • Diagnostic codes were acquired from administrative data and were not verified with standard diagnostic measures.
  • Given recent increased attention to mental health problems among Veterans and programs to increase access to mental health care, these findings over the past decade may not reflect current practice in initiating and completing care.

Dr. Maguen was supported by an HSR&D Career Development Award (RCD 06-042). Drs. Maguen and Seal are part of HSR&D's Program to Improve Care for Veterans with Complex Comorbid Conditions, San Francisco, CA.

PubMed Logo Maguen S, Madden E, Cohen B, Bertenthal D, and Seal K. Time to Treatment among Iraq and Afghanistan Veterans with Metal Health Diagnoses. Psychiatric Services December 2012;63(12):1206-1212.

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HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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