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*285. Utilization of VA Services Among American Indian Veterans With Psychiatric Disorder in Minnesota

Joseph Westermeyer, Minneapolis VAMC & Univ Minnesota; Jose Canive, Albuquerque VAMC & Univ New Mexico

Objectives: 1. To identify demographic characteristics and diagnoses associated with use of VA care (vs. care in other settings vs. no care)

2. To identify perceived barriers to care in VA settings associated with VA care (vs. care in other settings vs. no care)

Methods: 1. Intensive focused non-probability community-based sample of 669 American Indian (AI) veterans.

2. Demographic characteristics: age, gender, marital status, current employment, type of residence, rural/urban setting.

3. Lifetime & current psychiatric diagnosis based on algorithmic computer-based symptom queries (Quick Diagnostic Interview Schedule).

4. Mental health care received in VA setting; in last year, since discharge from military; other care in medical & traditional settings.

5. Perceived barriers to mental health care in VA based (obtained in open-ended interview).

Results: 1. Demography: 85.6% male, age 47.0 yrs +/- 12.1, 56% high school grad or above, 30% fulltime employed, 51% live c/family, 47.5% rural.

2. Lifetime dx: 45.9% any psychiatric dx. Current dx: 31.8% any psychiatric dx; 21.0% any substance use disorder (w/ 17.6% alcohol abuse/dependence); 17.2% any anxiety disorder (w/ 10.2% PTSD); 6.6% any affective disorder (primarily major depression).

3. VA services, any psychiatric disorder: 68.5% no care in VA ever; 11.6% since military duty but not last year; 19.9% in last year.

4. Self-reports of perceived barriers to VA care: response to open-ended query currently (currently being tabulated).

Conclusions: 1. Current psychiatric disorders among these AI vets was high.

2. AI veterans had a high rate of psychiatric comorbidity. suggesting no treatment, delayed treatment, and/or ineffective treatment.

3. About half of AI veterans who have ever had a substance disorder have not manifested substance disorder in the last year. Only about 20-25% with anxiety or affective disorder have recovered.

4. Early barrier analyses suggest that AI veterans ascribe barriers to themselves, their families and communities, VA staff, and the "VA system." Common categories of perceived barriers will be presented.

Impact: 1. A majority of AI veterans with a current psychiatric disorder have received no care in the last year from any source, whether VA, other medical sources, or traditional/cultural sources.

2. The rate of recovery from substance use disorder is higher than observed in previous studies of AI people, with about half recovered.

3. Recovery from anxiety and affective disorder is much lower than expected, with a high rate of psychiatric comorbidity.

4. Tentative data regarding perceived barriers provide numerous potentail opportunities for interventions that would ameliorate these perceived barriers.