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Abstract title: Post-traumatic Stress Disorder in Elderly Veterans: Results from a Multi-site Study (PRISMe)

UNB Durai - VA Chicago Health Care System, west side Division
E Herskovic - VA Chicago Health Care System, west side Division
E Coakley - John Snow Research and Training Institute
WW Van Stone - VA Central Office, Washington, DC
SG Cooley - VA Central Office, Washington, DC
DD Krahn - William S. Middleton Memorial Veterans Hospital
EJ Olsen - Miami VA Medical Center
JE Kirchner - HSR&D Center for Mental Health and Outcomes Research
D Oslin - Philadelphia VA Medical Center

Objectives: To identify elderly primary care patients with hitherto unrecognized symptoms of Post-traumatic Stress Disorder (PTSD) and other comorbid psychiatric disorders, and determine their mental health service utilization.

Methods: PRISMe is the largest collaborative study of mental health service delivery for the elderly to date and is supported by the VA, SAMHSA, HRSA, and CMS. Veterans 65 years or older from selected primary care clinics in six participating VA medical centers were systematically screened for the presence of the target psychiatric / substance use disorders and the data were analyzed by univariate frequency distributions and bivariate comparisons.

Results: Of the 9442 veterans screened, 3289 (34.83%) acknowledged having experienced a significantly traumatic event and 864 (9.15%) of them exhibited current symptoms of PTSD. There was no statistically significant difference in age and racial distribution between the PTSD positive and negative individuals. The PTSD positive individuals differed significantly from the PTSD negative individuals in the following characteristics: Separated or divorced: 20.35% vs. 15.21% Tobacco use: 18.5% vs. 12.97% Perception of their health as generally poor: 58.08% vs. 46.72% Perception as socially isolated: 29.21% vs. 15.37% Significant emotional distress as measured by GHQ-12: 46.06% vs. 13.62% (average GHQ score 3.5 times higher) At risk alcohol consumption: 14% vs. 9.96%. (average amount consumed was 1.66 times higher) Only 17% of the PTSD positive subjects acknowledged ongoing psychiatric care and in spite of a 14% screen positive rate for at risk drinking, only 0.93% acknowledged ongoing treatment.

Conclusions: PTSD is vastly underdiagnosed and consequently undertreated in older veteran population. Individuals with PTSD perceive themselves as socially isolated and in poor health. Tobacco and alcohol use and the level of general emotional distress are higher in PTSD patients, but only a very small proportion seeks any form of mental health or substance abuse care.

Impact statement: Caring for the increasing numbers of elderly veterans is a major policy issue confronting the Department of Veterans Affairs. Routine screening for common mental health problems in the elderly primary care population may improve health outcomes significantly by way of improved case identification and enhanced access to care.