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Publication Briefs

Post 9/11 Veterans Less Likely to Delay Mental Health Treatment

Three of the most common mental health conditions among post-9/11 Veterans who served in Iraq and/or Afghanistan are PTSD, major depressive disorder (MDD), and alcohol-use disorder (AUD). As a result, VA and other organizations have made concerted efforts in the past decade to increase Veterans' engagement in mental health treatment. Nonetheless, recent evaluations indicate there remain substantial unmet mental health needs among post-9/11 Veterans. This study compared delay of treatment for PTSD, MDD, and/or AUD among post-9/11 Veterans relative to pre-9/11 Veterans and civilians. Using data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), investigators identified a national sample of the general US population who were not on active military duty during 2012-2013. The sample included 14,916 unique survey respondents, including those with a lifetime diagnosis of PTSD (n=2,335), MDD (n=7,406), and/or AUD (n=9,943). The majority were civilians (n=13,528), but 1,130 pre-9/11 Veterans and 258 post-9/11 Veterans were also included in the sample. Controlling for relevant demographics, investigators estimated differences in treatment delay (i.e., time between symptom onset and treatment).


  • Post-9/11 Veterans were less likely than both pre-9/11 Veterans and civilians to delay mental health treatment for PTSD and depression.
    • Median time to PTSD treatment was 2.5 years for post-9/11 Veterans compared to 16 years and 15 years, for pre-9/11 Veterans and civilians, respectively.
    • Median time to depression treatment was 1 year for post-9/11 Veterans compared to 7 years and 5 years, for pre-9/11 Veterans and civilians, respectively.
  • No differences in treatment delay were observed between post-9/11 Veterans and pre-9/11 Veterans or civilians for alcohol-use disorder. However, a considerably smaller percentage of respondents with AUD received treatment (18% to 26%).
  • Post-9/11 Veterans with past year VHA/TRICARE coverage showed shorter delays to treatment for depression relative to post-9/11 Veterans without past year VHA/TRICARE coverage.


  • Increased engagement in PTSD and depression treatment for post- vs. pre-9/11 Veterans could be attributable to a host of recent historic, cultural, and policy changes, including: DoD's universal post-deployment mental health screening; educational public health initiatives; enhanced eligibility for VA benefits for post-9/11 Veterans; VA's suicide prevention hotline; VA mobile health resources (e.g., PTSD Coach); and VA's integration of mental health services into primary care settings.


  • This study lacked information regarding where treatment was received, limiting the ability to draw conclusions regarding which engagement efforts are responsible for reduced treatment delay.

Dr. Goldberg was supported by the HSR&D postdoctoral fellowship program. Dr. Fortney is supported by an HSR&D Research Career Scientist Award. Drs. Goldberg, Lehavot, Katon, and Fortney are part of HSR&D's Center of Innovation for Veteran-Centered and Value-Driven Care.

PubMed Logo Goldberg S, Simpson T, Lehavot K, Katon J, Chen J, Glass J, Schnurr P, Sayer N, and Fortney J. Mental Health Treatment Delay: A Comparison among Civilians and Veterans of Different Service Areas. Psychiatric Services. March 7, 2019; Epub 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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