Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1064 — Racial and Ethnic Differences in PTSD Treatment Participation

Spoont MR (CCDOR/U of Minnesota) , Murdoch M (CCDOR/U of Minnesota), Hodges J (CCDOR/U of Minnesota), Nugent S (CCDOR)

Objectives:
Military-related PTSD is a debilitating, chronic condition. While treatment can help to alleviate the attendant suffering and disability, it is unclear how many veterans with PTSD participate in mental health (MH) treatment and whether treatment participation varies by race and ethnicity, as found in other mental illnesses. This study evaluated whether veterans with PTSD initiate MH treatment and, if they do, receive adequate treatment trials.

Methods:
Demographic and visit information were extracted from the National Patient Center Database on all veterans seen in the VA between April 2004 and March 2005 who were diagnosed with PTSD but who had no MH care in the prior year (n=20,284). Pharmacy data were extracted from the Decision Support Services database. Visit information and psychiatric medication prescriptions were examined for 6 months after receipt of a PTSD diagnosis. Outcomes were: 1)receipt of antidepressants, 2)receipt of counseling-related visits; and, if in treatment, 1) at least 4 months of antidepressants, and 2) at least 8 counseling visits. To determine if treatment participation varied by race or ethnicity, these variables were entered first into a logistic regression equation, followed by blocks of demographic, health, and access factors (e.g., distance from VA, co-pay status). All OR’s compared to Whites.

Results:
About 42% (n=8,505) received no MH care 6 months after a PTSD diagnosis. Native Americans were less likely than all but Asian Americans to receive antidepressants (OR=0.48, CI=0.34,0.68). Hawaiians (OR=0.57, CI=0.36,0.89) and Blacks (OR=0.61, CI=0.54, 0.68) were less likely than Whites to receive medication for at least 4 months, as were Hispanics (OR=0.83, CI=0.67,1.04). In contrast, Blacks (OR=1.11, CI=1.02, 1.22) and Hawaiians (OR=1.37, CI=1.18, 1.6) were more likely than Whites to receive any counseling, and Blacks were also more likely to receive at least 8 counseling visits (OR=1.39, CI=1.01,1.9).

Implications:
As with other mental illnesses, participation in MH treatment for PTSD varies by race and ethnicity, even after controlling for other demographic, health, and access factors.

Impacts:
Many veterans with PTSD do not receive MH care. To engage all veterans with PTSD in MH treatment, differences in treatment participation by race and ethnicity need to be understood.