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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3040 — Impact of Rurality on Care for Depression or PTSD among OEF/OIF Veterans

Hudson TJ (VA Center for Mental Healthcare and Outcomes Research), Fortney JC (VA Center for Mental Healthcare and Outcomes Research), Landes RD (UAMS College of Public Health), Austen MA (VA Center for Mental Healthcare and Outcomes Research), Williams JS (VA Center for Mental Healthcare and Outcomes Research)

Objectives:
Among OEF/OIF veterans, rates of screening and diagnosis for PTSD and DEP are high. However, less than half of these veterans receive mental healthcare; recent work suggests that veterans in rural areas are much less likely to receive psychotherapy compared to non-rural veterans. This is particularly troublesome because approximately 40% of veterans, including OEF/OIF veterans, live in rural areas. The VA has made significant efforts to increase availability of mental healthcare to veterans living in rural areas. This study utilized data from the VISN 16 data warehouse to better understand the impact of rurality on care for these disorders among OEF/OIF veterans.

Methods:
We identified a cohort of OEF/OIF veterans whose first outpatient clinic visit occurred in 2008 to present. We used logistic regression models and mediation analyses to examine the impact of living in a rural area on rates of screening, diagnosis and treatment for DEP and PTSD and to determine whether the distance a veteran lived from the nearest VAMC or CBOC mediated the impact of rurality on care for DEP or PTSD.

Results:
A total of 5,302 veterans met our inclusion criteria (mean age was 31.2 years; 88% were male; 68% were Caucasian, 23% were non-Caucasian, and race was missing for 10% of the sample; 49% were married). Screening rates were 94.1% and 85.5% for PTSD and DEP respectively and 36.8% and 26.7% respectively screened positive. Among veterans with a diagnosis of PTSD or DEP, 80% and 76.7% respectively received psychotropic medications and 51.1% and 48.6% received psychotherapy respectively. Living in a rural area did not influence likelihood of screening, diagnosis or treatment of PTSD or DEP; distance to care did not mediate the effect of rurality.

Implications:
Within VISN 16, living in a rural area and distance from care has little impact on the care of OEF/OIF veterans with PTSD or DEP.

Impacts:
These data suggest that efforts by the VA to increase provision of care to veterans in rural areas have been successful in one VISN. Further work is needed to examine these issues on a national basis.


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