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Articles   |    
Changes in Psychotherapy Utilization Among Veterans With Depression, Anxiety, and PTSD
Juliette M. Mott, Ph.D.; Natalie E. Hundt, Ph.D.; Shubhada Sansgiry, Ph.D.; Joseph Mignogna, Ph.D.; Jeffrey A. Cully, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300056
View Author and Article Information

The authors are with the Veterans Affairs (VA) Houston Center of Excellence, Health Services Research and Development, and the South Central Mental Illness Research, Education and Clinical Center of the Michael E. DeBakey VA Medical Center, and with the Baylor College of Medicine, Houston, Texas (e-mail: juliette.mott@va.gov).

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Large-scale health care systems such as the Veterans Health Administration (VHA) have recently invested heavily in the expansion of psychotherapy services. This study examined longitudinal changes in use of psychotherapy at the VHA during a period of substantial programmatic change targeting increased availability and quality of mental health care.

Methods  This retrospective cohort study used data from the VHA National Patient Care Database outpatient treatment files to identify patients with a new-onset diagnosis of depression, anxiety, or posttraumatic stress disorder during fiscal years (FYs) 2004 (N=424,428), 2007 (N=494,318), and 2010 (N=583,733). Use of psychotherapy during the 12 months after diagnosis was assessed.

Results  The proportion of patients receiving any psychotherapy increased across the three study time points (FY 2004, 21%; FY 2007, 22%; and FY 2010, 27%). Amount of psychotherapy also increased such that with time a growing proportion of patients received eight or more psychotherapy sessions. The median time between diagnosis and start of psychotherapy decreased from 56 to 47 days from FY 2004 to FY 2010. Consistent with VHA expansion efforts, more substantial increases in psychotherapy reach, amount, and timeliness occurred between FY 2007 and 2010 than between FY 2004 and FY 2007.

Conclusions  These findings highlight recent increases in the use of VHA psychotherapy and correspond to substantial efforts to improve access to mental health services. Despite these advances, most newly diagnosed patients received no psychotherapy or a low-intensity amount of psychotherapy. Additional efforts to promote veteran engagement in needed mental health services appear warranted.

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Figure 1 Rates of exposure to psychotherapy within the Veterans Health Administration, fiscal years 2004, 2007, and 2010
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Table 1Descriptive characteristics of VHA cohorts, by fiscal year (FY)a
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a VHA, Veterans Health Administration

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b An odds ratio representing the predicted health care cost of each veteran compared with the average predicted cost in the general population

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Table 2Psychotherapy exposure among VHA patients by diagnostic group and fiscal year (FY)a
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a Veterans Health Administration (VHA) patients may have received more than one new-onset category diagnosis during the study period; therefore, the total number of diagnoses may exceed the full cohort number.

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Table 3Psychotherapy exposure of VHA patients in fiscal years (FYs) 2004, 2007, and 2010, by individual and group modalitiesa
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a VHA, Veterans Health Administration

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Table 4Time between psychiatric diagnosis and initiation of psychotherapy in the VHA, in fiscal years 2004, 2007, and 2010a
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a VHA, Veterans Health Administration

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b Patients may have received more than one new-onset category diagnosis during the study period; therefore, the total number of diagnoses may exceed the full cohort number.

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