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Study Finds OEF/OIF Veterans Most in Need of Psychiatric Care are Accessing Mental Health Services, Primarily at VA


BACKGROUND:
Many OEF/OIF Veterans are coping with PTSD, major depression, and alcohol use disorders; however, many who could benefit from mental healthcare often do not seek or receive it. The DoD, VA, and non-VA facilities continue to grapple with how to increase the likelihood that Veterans will seek out and engage in treatment. In this study, investigators conducted the first survey to employ a random sample of U.S. military post-9/11 that examined treatment use and perceived problems with treatment, including both VA and non-VA service users. Using data from the National Post-Deployment Adjustment Survey (NPDAS), investigators identified 1,388 Veterans who had served after 9/11/01 and were either separated from active duty or were in the Reserves/National Guard. The survey was conducted from 7/09 to 4/10. Data gathered included demographics, military branch, deployment information, and military rank. Mental health use included lifetime and past-year use of psychiatric services or receipt of psychotropic medications. Veterans also were asked about how they viewed treatment (e.g., possible effectiveness), stigma related to seeking mental healthcare (e.g., being perceived as weak by others), and external barriers (e.g., getting time off work for treatment). Investigators also assessed probable PTSD, as well as probable major depression and alcohol misuse.

FINDINGS:

  • Of the Veterans in this study, 43% screened positive for PTSD, major depression, or alcohol misuse.
  • Overall, 40% of Veterans had ever received VA inpatient mental health care, 46% had ever received VA outpatient care and 16% had ever received inpatient or outpatient care in both VA and non-VA settings.
  • Nearly 70% of Veterans with probable PTSD or major depression and 45% of Veterans with probable alcohol misuse reported accessing mental health care in the past year. Authors suggest that Veterans who are ambivalent about accessing mental healthcare may be more willing to do so if they are made aware that a substantial number of Veterans are getting the help they need.
  • Veterans with mental health needs who did not access treatment were more likely to believe that they had to solve problems themselves and that medications would not help. Those who had accessed treatment were more likely to express stigma beliefs and concern about being seen as weak. This suggests barriers to accessing care may be distinct from barriers to engaging in care.
  • Veterans with higher PTSD and depression symptoms were more likely to access care. This finding suggests that, above a certain threshold of symptoms, Veterans were significantly more likely to seek mental health services, even if they viewed those services in a negative light.

LIMITATIONS:

  • This study relied on retrospective self-report.
  • Future longitudinal research is needed to discern whether barriers were related to initiating or discontinuing treatment.

AUTHOR/FUNDING INFORMATION: Drs. Elbogen, Wagner, and Beckham are part of VA's Mid-Atlantic Mental Illness Research, Education, and Clinical Center in Durham, NC. Dr. Timko is part of HSR&D's Center for Health Care Evaluation in Palo Alto, CA. Dr. Beckham also is part of HSR&D's Center for Health Services Research in Primary Care, also located in Durham.


Elbogen E, Wagner H, Johnson S, Kinner P, Kang H, Vasterling J, Timko C, and Beckham J. Are Iraq and Afghanistan Veterans Using Mental Health Services? New Data from a National Random-Sample Survey. Psychiatric Services November 15, 2012;e-pub ahead of print.

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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.