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Articles   |    
Impact of Treatment Beliefs and Social Network Encouragement on Initiation of Care by VA Service Users With PTSD
Michele R. Spoont, Ph.D.; David B. Nelson, Ph.D.; Maureen Murdoch, M.D., M.P.H.; Thomas Rector, Pharm.D., Ph.D.; Nina A. Sayer, Ph.D.; Sean Nugent, B.S.; Joseph Westermeyer, M.D., Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201200324
View Author and Article Information

The authors are with the Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs (VA) Medical Center, Minneapolis, Minnesota (e-mail: michele.spoont@med.va.gov). Dr. Spoont, Dr. Murdoch, and Dr. Sayer are also with the Department of Medicine, Dr. Nelson is also with the Department of Biostatistics, and Dr. Rector is also with the School of Pharmacy, all at the University of Minnesota, Minneapolis. A portion of this research was presented at the VA Health Services Research and Development Service National Conference, July 16–19, 2012, National Harbor, Maryland.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objectives  Despite the U.S. Department of Veterans Affairs’ (VA) expansion of mental health services to treat VA service users with posttraumatic stress disorder (PTSD), many with PTSD do not engage in treatment. Numerous studies suggest that beliefs about treatment and social network factors, such as encouragement to seek treatment by others, affect engagement; however, prospective studies examining these factors are largely absent in this population. This study sought to understand social and attitudinal factors influencing treatment initiation, which may help to inform outreach interventions for VA service users with PTSD.

Methods  A prospective, national cohort study of mental health care use among veterans recently diagnosed as having PTSD (N=7,645) was undertaken. Data from self-administered surveys and administrative databases were analyzed to assess contributions of treatment-related beliefs and social network encouragement to subsequent mental health care use, after facility, demographic, need, and access factors were controlled.

Results  After the analysis controlled for treatment need and accessibility, the odds of initiating mental health care were greater for veterans who believed that they needed help for PTSD or other emotional problems and those who were encouraged to seek help by friends and family. Beliefs about the effectiveness of PTSD treatments were associated with the type of treatment received. Negative illness identity was not a barrier to treatment initiation.

Conclusions  VA service users’ social networks, veterans’ perceptions of their need for mental health care, and their beliefs about PTSD treatment effectiveness may be fruitful targets for future treatment engagement interventions.

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Table 1Characteristics at baseline and outcomes of 7,645 veterans with PTSDa
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a Totals vary across variables because of missing data. The total was 7,632 for outcomes, because 13 veterans died before the end of the six-month follow-up period.

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b Percentages may not add up to 100 because of rounding.

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c Data from administrative database

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d Possible scores range from 17 to 85 with higher scores indicating more severe PTSD symptoms.

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e Possible scores range from 0 to 100, with higher scores indicating better mental health quality of life.

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f Possible scores range from 5 to 20, with higher scores indicating more negative perceptions.

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g Possible scores range from 5 to 20, with higher scores indicating more positive beliefs.

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h SSRIs, selective serotonin reuptake inhibitors; SNRIs, serotonin-norepinephrine reuptake inhibitors

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Table 2Multivariate models predicting receipt of psychotherapy or pharmacotherapy among 7,645 veterans with posttraumatic stress disorder (PTSD)
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a Included the demographic, need, and access factors

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b Included model 1 variables plus belief measures

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c Included model 2 variables plus the social encouragement variable

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d For each one-half standard deviation change in the predictor, the outcome changed by the magnitude of the predictor's odds ratio when all other factors were controlled.

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Table 3Multivariate models predicting receipt of psychotherapy among 7,645 veterans with posttraumatic stress disorder (PTSD)
Table Footer Note

a Included the demographic, need, and access factors

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b Included model 1 variables plus belief measures

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c Included model 2 variables plus the social encouragement variable

Table Footer Note

d For each one-half standard deviation change in the predictor, the outcome changed by the magnitude of the predictor's odds ratio when all other factors were controlled.

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Table 4Multivariate models predicting receipt of pharmacotherapy among 7,645 veterans with posttraumatic stress disorder (PTSD)
Table Footer Note

a Included the demographic, need, and access factors

Table Footer Note

b Included model 1 variables plus belief measures

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c Included model 2 variables plus the social encouragement variable

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d For each one-half standard deviation change in the predictor, the outcome changed by the magnitude of the predictor's odds ratio when all other factors were controlled.

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