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Health Services Research & Development

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2005 HSR&D National Meeting Abstract


3030 — Comorbid PTSD and VA Health Service Utilization in Patients with Primary Psychotic Disorders

Author List:
Calhoun PS (Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center)
Stechuchak KM (Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center)
Bosworth HB (Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center)
Butterfield MI (Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center)

Objectives:
PTSD has been linked with increased health complaints, medical morbidity and health service utilization. Co-morbid PTSD may complicate clinical course and lead to poor outcomes among patients with severe mental illness (SMI). This study examined the impact of co-morbid PTSD on objective measures of health service utilization in patients with primary psychotic disorder.

Methods:
Data were collected from a sample of male veterans (N=165) with a primary diagnosis of schizophrenia or schizoaffective disorder, hospitalized on a VAMC psychiatric unit. PTSD diagnosis was based on the PTSD Checklist. Severity of psychotic symptoms was assessed with the Brief Psychiatric Rating Scale. Health service utilization data were extracted from centralized VA databases for the one-year period after initial hospital discharge. Analyses, controlling for age, race, and presence of alcohol and drug use disorders, compared patients with psychosis and co-morbid PTSD to those with psychosis only on the number of outpatient clinic visits, hospitalizations and length of stay over the 12 months following initial discharge.

Results:
Overall, 64% of the sample had at least one inpatient admission in the study period. The median number of outpatient mental health visits was 7 compared to 10 physical health visits. Among the 165 patients, 78 (47%) met criteria for PTSD. Patients with co-morbid PTSD did not differ from those without PTSD in age, race, marital status or severity of psychotic symptoms. Compared to those without PTSD, patients with PTSD were significantly more likely to have a VA psychiatric hospitalization in the year following initial discharge (OR=3.2, 95% CI, 1.64-6.25). PTSD was not associated with having a medical hospitalization, length of hospital stay, or the number of outpatient mental health visits. Results of adjusted negative binomial regression analyses indicated that co-morbid PTSD was associated with increased number of outpatient physical health visits (IRR=1.48, 95% CI, 1.03-2.15).

Implications:
The presence of co-morbid PTSD is associated with increased psychiatric hospitalization and outpatient physical health visits among patients with primary psychotic disorder.

Impacts:
Patients with SMI should be screened for PTSD. Co-morbid PTSD increases the risk of psychiatric hospitalization and is associated with increased outpatient service utilization in this vulnerable population.


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