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OEF/OIF Veterans with Mental Health Diagnoses, Particularly PTSD, Use More Non-Mental Health VA Services


VA has been one of the largest providers of healthcare for returning Veterans and has expanded access to more Veterans of the current conflicts. For example, more than 40% of all OEF/OIF Veterans have obtained outpatient and/or inpatient care at VA facilities. In addition, research has shown that returning OEF/OIF Veterans are at high risk for mental disorders, and a recent analysis of more than 200,000 returning OEF/OIF Veterans seen at VA healthcare facilities found that rates of PTSD and other mental disorders were increasing over time. Studies from OEF/OIF and prior wars also indicate that mental disorders, particularly PTSD, are associated with higher rates of physical symptoms, chronic physical illness, and overall mortality. Using national data from all returning OEF/OIF Veterans (N=249,440) who used VA healthcare between 10/01 and 3/07, this study sought to examine the association of PTSD and other mental disorders with non-mental health outpatient, inpatient, and emergency services utilization. Investigators also assessed whether other factors (e.g., demographics, military service characteristics) independently predicted increased utilization.

Findings show that OEF/OIF Veterans diagnosed with mental health disorders had significantly greater utilization of all types of non-mental health care services than OEF/OIF Veterans with no mental health diagnoses. In adjusted analyses, compared with OEF/OIF Veterans without mental disorders, those with mental disorders other than PTSD had 55% greater utilization of all non-mental health outpatient services; Veterans with PTSD had 91% higher utilization. Results also showed that female gender and lower rank were independently associated with greater utilization. PTSD was the most common mental health diagnosis (21.5%), followed by depression (18.3%), adjustment disorder (11.1%), anxiety disorder (10.6%), substance use disorder (8.4%), and alcohol use disorder (7.3%). The authors suggest that as more Veterans return home, many with mental and physical injuries, evaluating the capacity of VA and other healthcare systems to meet their needs will be increasingly important.

PubMed Logo Cohen B, Gima K, Bertenthal D, et al. Mental Health Diagnoses and Utilization of VA Non-Mental Health Medical Services among Returning Iraq and Afghanistan Veterans. Journal of General Internal Medicine September 29, 2009; e-pub ahead of print.

This study was partly funded by HSR&D. Dr. Cohen and Ms. Gima are part of the San Francisco VAMC, and Mr. Bertenthal is part of HSR&D's Program to Improve Care for Veterans with Complex Comorbid Conditions, also in San Francisco.

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What are HSR&D Publication Briefs?

HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.