Most Veterans with New PTSD Diagnoses Who Attend PTSD Clinics May Not Receive Minimally Adequate Treatment
VA encourages the use of evidence-based psychotherapies for the treatment of PTSD, which typically consist of 9 or more treatment sessions. However, little is known about the extent to which Veterans recently diagnosed with PTSD receive specialty PTSD treatment. This study sought to assess receipt of PTSD specialty treatment among Veterans newly diagnosed with PTSD – and to identify predictors of receiving minimally adequate specialty treatment (MAST), which is defined as 9 or more visits over 12 months to a VA PTSD specialty clinic. Using VA data, 852 Veterans were identified who screened positive for PTSD between 11/06 and 9/08, received a new PTSD diagnosis, and attended at least one visit at a PTSD specialty clinic at one of four Northwest VA facilities within one year of screening. Investigators also compared outcomes for OEF/OIF Veterans (n=395) with non-OEF/OIF Veterans (n=457).
- Only 33% of Veterans in this study who began VA PTSD specialty care received minimally adequate specialty treatment (MAST).
- OEF/OIF Veterans were less likely to receive MAST (29% vs. 36%) and attended fewer clinic visits (mean 8.2 vs. 9.9) than non-OEF/OIF Veterans. However, they were more likely to have an initial PTSD visit within 30 days of a positive PTSD screen.
- Among OEF/OIF Veterans, predictors of receiving MAST included: non-white race, an initial PTSD clinic visit within 30 days of a positive PTSD screen, living in an urban setting, and comorbid diagnoses of depression, other anxiety disorders, alcohol use disorder, or traumatic brain injury.
- Among non-OEF/OIF Veterans, predictors of receiving MAST included: non-white race, being married, an initial PTSD clinic visit within 30 days of a positive PTSD screen, living in an urban setting, and comorbid diagnoses of depression or other anxiety disorders.
- Only Veterans new to VA mental healthcare were included in this study, which may lower the observed rate for MAST.
- Only Veterans who received at least one PTSD clinic visit were included. Many veterans receive treatment for PTSD in general mental health or primary care settings.
- Information on accuracy of PTSD diagnoses and PTSD severity was not available.
- Any implications about findings related to race are limited by the significant proportion of missing data on race for this particular study.
- Use of evidence-based psychotherapies has continued to increase since the study period; current rates of MAST may be different as a result.
This study was partly supported by HSR&D. Drs. Duckart and Dobscha are part of HSR&D’s Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders.
Lu M, Duckart J, O’Malley J, and Dobscha S. Correlates of VA PTSD Specialty Treatment Utilization among Veterans Recently Diagnosed with PTSD. Psychiatric Services August 2011;62(8):943-949.