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Publication Briefs

Study Shows Increasing VA Rates of Psychotherapy among Rural- and Urban-Dwelling Veterans with Mental Illness

Psychotherapy is consistently endorsed as a first-line treatment for the most common mental health conditions among Veterans; however, the disparity in access to care between rural- and urban-dwelling Veterans is particularly apparent for psychotherapy services. In recent years, VA has dedicated substantial attention and resources toward increasing rural Veterans' access to high-quality mental health services, including significant expansion of community-based outpatient clinics, as well as telehealth services. This retrospective study evaluated changes in rural-dwelling Veterans' use of psychotherapy during this period of widespread organizational efforts to engage this patient population in mental health service use – and compared their use of psychotherapy with urban-dwelling Veterans. Using VA data, investigators identified Veterans who received a new diagnosis of depression, anxiety, or PTSD in FY07 and FY10. Using the US Department of Agriculture Rural-Urban Continuum Codes, they also identified these Veterans' urban- and rural-dwelling status. The final cohort included 265,270 VA patients from FY07 (rural n=72,923; urban n=192,347) and 313,376 patients from FY10 (rural n=81,905; urban n=231,471). Investigators then examined patients' mental health service use during the 12 months following the index diagnosis, including the number of patients who received at least 1 session, 4 sessions, or 8 sessions (minimum length of traditional, evidence-based psychotherapies for depressive and anxiety disorders) of psychotherapy.


  • VA psychotherapy use is increasing among both urban- and rural-dwelling Veterans with a new diagnosis of depression, anxiety, or PTSD. Over the four-year study period, the proportion of Veterans receiving any psychotherapy increased from 17% to 22% for rural Veterans and 24% to 28% for urban Veterans.
  • With respect to psychotherapy dose, the proportion of both rural- and urban-dwelling Veterans receiving 4+ and 8+ psychotherapy sessions increased from 2007 to 2010. And although rural-dwelling Veterans received, on average, fewer psychotherapy sessions than urban-dwelling Veterans, this gap decreased over time. By 2010, the mean number of sessions attended by rural Veterans (5 sessions) was only 1 session less than their urban counterparts (6 sessions).
  • Rates of PTSD diagnosis were higher among urban-dwelling Veterans, whereas rates of depression and anxiety were higher among rural-dwelling Veterans.


  • Healthcare received outside the VA system was not included in this study.
    • Service use was measured according to CPT codes, which are determined by the clinician and are not independently verified.

    This study was partly funded by HSR&D. Drs. Mott, Sansgiry, and Cully are part of HSR&D's Center for Innovations in Quality, Effectiveness and Safety in Houston, TX. Dr. Mott also is affiliated with the National Center for PTSD in White River Junction, VT. Dr. Grubbs is part of HSR&D's Center for Mental Healthcare and Outcomes Research in North Little Rock, AR, and Dr. Fortney is part of HSR&D's Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA.

    PubMed Logo Mott J, Grubbs K, Sansgiry S, Fortney J, and Cully J. Psychotherapy Utilization among Rural and Urban Veterans from 2007 to 2010. The Journal of Rural Health. December 3, 2014;e-pub ahead of print.

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