Increase in Psychotherapy Since 2004 Corresponds with VA's Efforts to Improve Access to Mental Health
Despite empirical evidence supporting its efficacy, there is substantial underuse of psychotherapy in the U.S.. Recently, initiatives to increase access to psychotherapy have proliferated, including the integration of psychotherapy into primary care settings, such as VA's Primary Care-Mental Health Integration Program that began in 2007. VA guidelines also have encouraged the use of telemental health services, and VA has endorsed several evidence-based psychotherapies (i.e., prolonged exposure for PTSD, cognitive behavioral therapy for depression). This retrospective study examined longitudinal changes in VA psychotherapy use corresponding with widespread programmatic change targeting increased availability and quality of mental healthcare. Using VA administrative data, investigators identified Veterans who received a new diagnosis of depression, anxiety, or PTSD in FY04 (n=424,428), FY07 (n=494,318), and FY10 (n=583,733). Veterans' use of mental health services and treatment delays were assessed during the 12 months following their diagnosis date. Patient demographics and illness burden also were examined.
- The number of Veterans newly diagnosed with depression, anxiety, or PTSD increased by nearly 40% between 2004 and 2010. Rates of PTSD grew most substantially, increasing by more than 2-fold. During this time, the proportion of Veterans with depression, anxiety, or PTSD receiving psychotherapy grew from 21% to 27%. In addition, psychotherapy dose increased - a growing proportion of Veterans received eight or more psychotherapy sessions.
- More Veterans engaged in individual than group psychotherapy across all study years. However, Veterans who engaged in group psychotherapy received more sessions of psychotherapy than those in individual psychotherapy.
- Treatment delays decreased across study time points. The median time between index diagnosis and psychotherapy dropped from 56 days in 2004 to 47 days in 2010. Although Veterans with PTSD consistently had shorter delays than Veterans with depression or anxiety, diagnostic disparities in time until treatment grew smaller across the study time points.
- Consistent with VA expansion efforts, more substantial increases in psychotherapy access, dose, and timeliness occurred between 2007 and 2010 relative to 2004 and 2007.
- This study did not capture the type of psychotherapy provided to Veterans.
- The use of non-VA psychotherapy was not examined, and medication use was not assessed.
- Because study data only extend to 2010, the effects of more recent efforts to hire more mental health providers in VA were not examined.
This study was funded through HSR&D. Drs. Mott, Hundt, Sansgiry, Mignogna, and Cully are part of HSR&D's Center for Innovations in Quality, Effectiveness, and Safety in Houston, and the South Central Mental Illness Research, Education, and Clinical Center.
Mott JM, Hundt NE, Sansgiry S, Mignogna J, Cully J. Changes in Psychotherapy Utilization among Veterans with Depression, Anxiety, and PTSD. Psychiatric Services October 1, 2013;e-pub ahead of print.