Rosen CS (National Center for PTSD), Greenbaum MA
(Sierra-Pacific Mental Illness Research, Education & Clinical Center (MIRECC)), Fitt J
(HSR&D Center for Health Care Evaluation)
To examine changes from fiscal years 2001 through 2006 in the prevalence of diagnosed PTSD cases among all VA outpatients, and changes in PTSD patients’ utilization of outpatient mental health services.
This archival analysis of VA administrative outpatient data examined the number of unique outpatients, the number of unique outpatients who received a PTSD diagnosis, period of service of PTSD outpatients, and the number of mental health visits completed by patients with PTSD diagnosis within each fiscal year 2001 through 2006. Differences across years were tested using chi-square.
The number of VA patients diagnosed with PTSD rose by 76% from 2001 (4.8% prevalence; n = 193,954) to 2006 (6.9% prevalence; n = 341,895), while the total number of VA outpatients increased by only 22%. Vietnam-era veterans diagnosed with PTSD (rose from 132,344 to 223,314) accounted for much of the increase. Combat-eligible OIF/OEF veterans (n = 24,353) accounted for only 7.1% of the PTSD outpatient caseload in FY 2006. The proportion of VA patients diagnosed with PTSD who received no mental health visits rose significantly from 2001 (8%) to 2006 (13%). Among PTSD patients with any mental health visits, the proportion that completed at least 3 visits declined significantly from 2001 (79%) to 2006 (74%). The proportion that completed 9 or more visits (enough for a course of evidence-based psychotherapy) also declined significantly, from 40% to 32%. Combat-eligible PTSD patients were significantly less likely than other PTSD patients to complete 3 or more (68% vs. 74%) and 9 or more (26% vs. 33%) mental health visits in FY 06.
More VA patients are being diagnosed with PTSD, and more are being diagnosed outside of mental health. Declining mental health visits per patient may indicate less treatment and/or more patients being managed by primary care providers. Treatment utilization is lower among combat-eligible patients than among other patients.
The findings support current VA initiatives to expand capacity for PTSD services. Combat-eligible veterans tend to make less use of mental health treatment. Improving access for OIF/OEF veterans must not compromise care for the majority of other veterans who have PTSD.