Age Differences in PTSD Diagnoses and Treatment Seeking among Veterans
PTSD is one of the most common mental health disorders among Veterans and once established, PTSD symptoms may resolve, become chronic, or subside and recur years later. Retirement has been associated with a surge in PTSD symptoms, and older Veterans with PTSD are more likely to report poor physical health. VA has established a system of PTSD screening to identify patients in need of treatment, and most screening takes place in primary care clinics. This retrospective cohort study examined age differences in PTSD screening results and specialty mental health treatment initiation in a large sample of VA primary care patients who were not already receiving mental health services. Investigators also examined age differences in the types of follow-up mental health treatment received. Using VA data, 71,039 Veterans were identified who were administered PTSD screens during primary care encounters in 2007 at one of four Pacific Northwest VAMCs; these Veterans had no mental health clinic visits or PTSD diagnoses during the year before screening.
Findings show that among the 5,556 Veterans in this study sample who screened positive for PTSD, the percentage of positive screens decreased as age increased: 17% for Veterans aged 18-29 years, 13% for Veterans ages 30-44, 13% for Veterans ages 45-59, 6% for Veterans ages 60-74, and 2% for those ages 75 years and older. While older Veterans were less likely to screen positive for PTSD, they also were less likely to initiate specialty mental health treatment when they had positive screens. For example, 66% of Veterans ages 18-29 had mental health visits compared to 19% of Veterans ages 75 years and older. There also were significant differences by age in types of treatment received. Veterans ages 18-29 years received the most diagnostic visits, while Veterans ages 45-59 and 60-74 years received more visits for group psychotherapy than other age groups. Veterans ages 75 years and older received the fewest visits involving psychotherapy and medications or phone contact.
The authors suggest that future research is needed to examine whether alternative approaches to PTSD in primary care settings may improve specialty treatment initiation rates, particularly among older Veterans.
Lu M, Carlson K, Duckart J, and Dobscha S. The effects of age on initiation of mental health treatment after positive PTSD screens among Veterans Affairs primary care patients. General Hospital Psychiatry August 13, 2012;e-pub ahead of print.
This study was funded by HSR&D, and Dr. Carlson was supported by an HSR&D Career Development Award. Drs. Carlson, Duckart, and Dobscha are part of HSR&D's Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders, Portland OR.