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Publication Briefs

Study Examines Factors Associated with VA and Non-VA Mental Health Service Use among National Guard Soldiers

National Guard soldiers who were activated during OEF/OIF are eligible for five years of free VA healthcare following deployment. Studies suggest that Guard soldiers are at increased risk for PTSD and depression compared to their active-duty counterparts. Moreover, those with PTSD have high levels of comorbid major depressive disorder and alcohol-use disorder, and are at increased risk of suicide. Given the high level of need of these returning Veterans and possible barriers to care, it is important to understand correlates of overall mental health service use, as well as use of VA versus community mental health services. These data will inform both VA and community systems who are attempting to treat Veterans in need. This study sought to determine the associations between mental health need, enabling, and predisposing factors and mental health service use among National Guard soldiers in the first year following a combat deployment to Iraq or Afghanistan. Investigators collected survey data from 1,426 OEF/OIF National Guard Veterans from one Midwestern state between August 2011 and December 2013, approximately 12 months following their return home. Survey questions targeted mental health service use in VA or non-VA settings during the past year. Investigators also assessed: needs factors, including PTSD, depression, and anxiety symptoms, suicide risk, and combat exposure; predisposing factors, including demographics and service rank; and enabling factors, such as income, insurance status, location, and work status.


  • Overall mental health service use was strongly associated with need, including higher number of mental health conditions and worse physical health. Among those using services, predisposing factors (middle age and female gender) and enabling factors (employment, income greater than $50,000, and private insurance) were associated with greater non-VA service use.
  • Among the 405 survey respondents reporting mental health treatment in the prior 12 months, 81% (n=327) received any VA treatment and 19% (n=78) received only non-VA treatment. Approximately 30% of those receiving VA treatment also had received treatment from a non-VA source.


  • The use of self-report and study cross-sectional design limits investigators' ability to identify whether either VA or non-VA community mental health treatment improved symptoms.


  • The Veterans Choice Program is expected to expand healthcare access to thousands of Veterans by alowing them to receive care from non-VA healthcare providers. This new program will cover VA-approved health needs, and further study is needed to determine whether it increases use of overall mental health treatment for National Guard soldiers, or simply shifts mental health service use from VA to non-VA treatment settings.

This study was funded through VA HSR&D's Quality Enhancement Research Initiative (RRP 09-240 and SDP 10-047). Dr. Bohnert is supported by an HSR&D Career Development Award. Drs. Sripada, Ganoczy, Walters, Bohnert, and Valenstein are part of HSR&D's Center for Clinical Management Research (CCMR) in Ann Arbor, MI.

PubMed Logo Gorman L, Sripada R, Ganoczy D, Walters H, Bohnert K, Dalack G, and Valenstein M. Determinants of National Guard Mental Health Service Utilization in VA versus Non-VA Settings. Health Services Research. February 3, 2016;e-pub ahead of print.

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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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