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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3014 — Predictors of Mental Health Treatment Engagement: A Prospective Cohort Study of Veterans Recently Diagnosed with PTSD

Spoont MRMurdoch MRector TSayer NNelson DBNugent S, and Westermeyer J, CCDOR;

Chronic posttraumatic stress disorder (PTSD) can result in significant social and physical impairments. Despite the Department of Veterans Affairs’ (VA) expansion of mental health services to treat increasing numbers of Veterans with this disorder, many Veterans do not receive timely treatment. The goal of this study was to identify risk factors for and sources of variation in mental health treatment non-initiation or premature treatment drop-out.

Prospective, national cohort study of a national sample of VA enrollees who were newly diagnosed with PTSD (n = 7,645). Self-administered surveys and VA administrative databases examined predisposing, need, and enabling factors associated with mental health care treatment initiation and treatment persistence.

Veterans whose PTSD diagnosis occurred in a primary care clinic were one-third as likely to receive any mental health care in the subsequent six months, even after controlling for predisposing, need, and enabling factors, including beliefs about mental health treatment. Older Veterans were less likely to receive any treatment, particularly psychotherapy, and African American Veterans were less likely to receive a minimal trial of treatment. Beliefs about mental health care were important determinants of treatment engagement.

The odds of mental health treatment receipt and persistence vary among demographic groups, and this variation cannot be solely attributed to differences in treatment needs or attitudes.

VA should continue its efforts to expand treatment access, particularly into primary care clinics. Providers need to be aware that some subgroups of Veterans are at greater risk for falling through the cracks, and that they may need to make additional efforts to engage them in treatment. Treatment participation may improve if providers incorporate patient beliefs about treatment into the treatment plan.

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