November 2017

VA HSR&D researchers conduct an extensive number of investigations designed to improve clinical decision-making and care, inform patients, evaluate changes in the healthcare system, and inform VA policymaking. In Progress is a quarterly publication that highlights ongoing HSR&D research on various topics.

In This Issue: Improving Care of Mental Health Conditions

A series of three reports published in JAMA Psychiatry (2014) found that many soldiers suffer from some form of mental illness, with rates much higher than among civilians. For example, nearly 25% of almost 5,500 active-duty, non-deployed Army soldiers tested positive for a mental disorder (i.e., major depressive disorder, PTSD, bipolar disorder), and 11% within that subgroup had more than one mental illness.¹ The lifetime prevalence of PTSD among adults living in the U.S. is 10% for women and 4% for men, but among male combat Veterans, lifetime PTSD rates are as high as 39%. Moreover, 28% of OEF/OIF/OND Veterans have a PTSD diagnosis in their VA medical record.²

PTSD is also a risk factor for suicide, as are depression and other forms of serious mental illness (i.e., bipolar disorder). Recently, VA conducted the most comprehensive analyses of suicide rates among Veterans in the United States, examining more than 55 million records from 1979 to 2014 from all 50 states, Puerto Rico, and the District of Columbia. Results showed that an average of 20 Veterans died by suicide each day. After adjusting for differences in age and sex, the risk of suicide was 22% higher among Veterans compared to U.S. civilian adults.³ Since these results were published, VA has aggressively undertaken new measures to prevent suicide, including:

• Expanding the Veterans Crisis Line (1-800-273-8255),
• Launching a new national campaign to encourage everyone to “be there” for Veterans in crisis,
• Using predictive analytics to identify those at risk and intervene early,
• Bolstering mental health services for women,
• Expanding telemental health services,
• Offering free mobile apps to help Veterans and their families,
• Leveraging VA Vet Centers and readjustment counselors,
• Providing telephone coaching for families of Veterans,
• Fostering innovative public-private partnerships to reach Veterans, and
• Facilitating proactive outreach to contact Veterans needing care.³

In addition, VA HSR&D researchers conduct an extensive number of investigations designed to improve mental health for Veterans. These include studies of enhanced clinical decision-making and outreach, examinations of Veteran perspectives and social supports, and rigorous evaluations of novel, data-driven clinical practices to inform VA policymaking. This issue of In Progress features several articles regarding these efforts:

• Overview of HSR&D Mental Health Research
  • REACH-Vet national evaluation

Individual Research Studies on VA Mental Healthcare

An estimated 28% of more than 230 active HSR&D projects address some aspect of the care of mental health conditions. Below we highlight some important new and recent projects that have informed the care for mental health conditions in Veterans.

• Motivational Coaching to Enhance Mental Health Engagement in Rural Veterans
• Optimizing Benefits for Mental Health Open Notes
• Yoga for Women Veterans with PTSD and Military Sexual Trauma
• PACT to Improve Healthcare for People with Serious Mental Illness
• Primary Care-Based PTSD Intervention
• PRIME Care: PRecision medicine In Mental health Care

References

1. Kessler R, Heeringa S, and Stein M. Thirty-day prevalence of DSM-IV mental disorders among non-deployed soldiers in the US Army. JAMA Psychiatry. 2014;71(5):504-513.
2. CREATE: Evidence-Based Therapies for PTSD.
3. Facts about Veteran Suicide: August 2017. VA Office of Mental Health and Suicide Prevention.
4. VA Mental Health Care. Fact Sheet. VA Office of Public Affairs, Media Relations. April 2016.