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Brief Reports   |    
Mental Health Service Utilization by Iraq and Afghanistan Veterans After Entry Into PTSD Specialty Treatment
Jennifer M. Aakre, Ph.D.; Seth Himelhoch, M.D., M.P.H.; Eric P. Slade, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300117
View Author and Article Information

The authors are with the Mental Illness Research, Education and Clinical Center, Veterans Integrated Service Network 5, Baltimore, Maryland, and with the Department of Psychiatry, University of Maryland School of Medicine, Baltimore (e-mail: jennifer.aakre@va.gov).

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  Use of care by Iraq and Afghanistan veterans was examined after entry into a U.S. Department of Veterans Affairs (VA) specialty outpatient program for treatment of posttraumatic stress disorder (PTSD). Those who had received mental health care before entry (continuing patients) were compared with those who had not (new patients).

Methods  Regression analyses compared veterans’ retention in PTSD programs in the 180 days after program entry for new patients (N=172) and continuing patients (N=422). Two retention measures, total visits and completion of nine or more visits, were developed from VA administrative data.

Results  New patients completed fewer PTSD visits than did continuing patients (5.2±9.5 versus 8.3±14.3; incidence risk ratio=.91, 95% confidence interval [CI]=.85–.97) and were also less likely to complete nine or more visits (OR=.81, CI=.68–.97).

Conclusions  Contact with providers before entering PTSD specialty care may facilitate veterans’ treatment engagement, suggesting the value of repeated attempts at engaging such veterans in treatment.

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Table 1Regression analyses of predictors of completion of PTSD specialty program visits in the 180 days after program entry among 594 Iraq and Afghanistan veterans
Table Footer Note

a Schizophrenia, schizoaffective disorder, bipolar disorder, and other psychotic conditions

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References

Seal  KH;  Maguen  S;  Cohen  B  et al:  VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses.  Journal of Traumatic Stress 23:5–16, 2010
[PubMed]
 
Rosenheck  RA;  Fontana  AF:  Recent trends in VA treatment of post-traumatic stress disorder and other mental disorders.  Health Affairs 26:1720–1727, 2007
[CrossRef] | [PubMed]
 
Desai  R;  Spencer  H;  Gray  S  et al:  The Long Journey Home: XVIII. Treatment of Posttraumatic Stress Disorder in the Department of Veterans Affairs: Fiscal Year 2009 Service Delivery and Performance .  West Haven, Conn,  US Department of Veterans Affairs, Northeast Program Evaluation Center, 2010
 
Lu  MW;  Duckart  JP;  O’Malley  JP  et al:  Correlates of utilization of PTSD specialty treatment among recently diagnosed veterans at the VA.  Psychiatric Services 62:943–949, 2011
[PubMed]
 
Olfson  M;  Mojtabai  R;  Sampson  NA  et al:  Dropout from outpatient mental health care in the United States.  Psychiatric Services 60:898–907, 2009
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[CrossRef] | [PubMed]
 
Management of Post-Traumatic Stress Working Group:  DoD Clinical Practice Guideline for the Management of Post-traumatic Stress: Guideline Summary, Version 2.0 .  Washington, DC,  US Department of Veterans Affairs and US Department of Defense, 2010
 
 Diagnostic and Statistical Manual of Mental Disorders , 4th ed, Text Revision.  Washington, DC,  American Psychiatric Association, 2000
 
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