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73. Service Utilization and Outcomes in Medically Ill Veterans with Post-Traumatic Stress Disorder and Depression

TL Kramer, UAMS/Center for Outcomes Research and Effectiveness/North Little Rock VA; BM Booth, UAMS/Center for Mental Health Care Research/North Little Rock VA; FC Blow, Ann Arbor VA Medical Center

Objectives: This presentation highlights the importance of early detection and effective treatment of medically ill veterans with depression or post-traumatic stress disorder due to their significant risk for higher service utilization and poorer outcomes.

Methods: Patients admitted to acute medical and surgical wards at three university-affiliated VA Medical Centers were randomly invited to participate in a larger study examining service utilization and outcomes in male veterans. Patients who met inclusion criteria completed the Quick Diagnostic Interview Schedule (Q-DIS), the SF-36 and the SCL-90 at baseline and three- and twelve-month follow-ups (n=1,007).

Results: At baseline, almost half (46.6%) of the patients met criteria for a lifetime psychiatric diagnosis and almost 1 in 5 (17.8%) met criteria for a recent (in the past twelve months) psychiatric diagnosis: 6.2% were diagnosed with recent PTSD only, 4.8% were diagnosed with recent depression only, and 4.4% were diagnosed with comorbid PTSD and depression. Patients diagnosed with comorbid PTSD and a depressive disorder (24.2%) were more likely to be readmitted for mental health or substance abuse treatment than patients with only a depressive disorder (2.3%), PTSD only (8.7%), or patients with neither disorder (2.1%). Patients with PTSD and a depressive disorder also had higher lengths of stay on psychiatric or substance abuse units (8.0 days) than patients with PTSD only (.96), depression only (.61) or neither diagnosis (.44). Similarly, those with comorbid PTSD and a depressive disorder were more likely to seek outpatient mental health or substance abuse treatment (69.7%), compared with depressive disorder only (33.3%), PTSD only (17.4%), or neither (13.4%). Significant differences were also found in the four groups on all eight subscales of the SF-36. More specifically, patients with comorbid depression and PTSD typically reported more impairment compared to other patients. Furthermore, patients with comorbid depression and PTSD reported significantly more problems on the SCL-90 subscales of depression and anxiety and the Global Severity Index.

Conclusions: Psychological symptoms and functioning worsened over time for all patients, despite efforts to control for confounding variables. However, as anticipated, patients with comorbid PTSD and depression reported more psychological distress on the SCL-90 than patientw with only PTSD, only depression or neither diagnosis. Although patients with comorbid PTSD and depression consistently scored lower on all scales of the SF-36 -- indicating more impairment -- these differences were not statistically significant when compared to patients with depression only.

Impact: This study provides further evidence of the deleterious effects of depression or PTSD in medically ill patients and emphasizes the importance of careful screening for psychiatric symptoms in medically ill patients, with careful follow-up if symptoms persist. Future work should focus on development of interventions to improve identification of individuals with PTSD and depression in primary care and hospital settings and treatment of symptoms of both disorders through multifaceted therapeutic approaches.