Veterans with PTSD or Major Depression Less Likely to Undergo Four Major Invasive Procedures
BACKGROUND:
Several studies have reported greater incidence of physical health problems among Veterans with PTSD; for example, patients with PTSD are more likely to have coronary heart disease than those without the disorder, and likely have an equal or greater need for coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI). No published study has examined the association of pre-existing PTSD on the likelihood of undergoing invasive procedures. This study examined whether PTSD, after controlling for major depression, was associated with the likelihood of having four common types of major invasive procedures. Using VA data, investigators assessed 501,489 Veterans who had invasive hip/knee, digestive system, CABG/PCI, and vascular procedures from FY2006 through FY2009. Each patient with PTSD only (n=55,239), major depressive disorder (MDD) only (n=83,456) or PTSD and MDD (n=27,466) was randomly matched with two patients of the same age without PTSD or MDD (n=335,328). Demographics and medical comorbidities also were examined.
FINDINGS:
- After adjusting for demographics and medical comorbidity, Veterans with PTSD only and with depression only were less likely to undergo all types of procedures examined in this study. Having both PTSD and MDD was associated with lower odds of hip/knee, CABG/PCI, and vascular procedures, but not digestive procedures.
- Vascular procedures had the strongest effect. The odds of undergoing CABG/PCI or vascular procedures for patients with MDD only were 35% to 40% lower than for patients with neither PTSD nor MDD, while patients with PTSD only were about 25% less likely to receive the procedures.
- African American and women at-risk patients (those with a pre-existing condition likely to be alleviated by a procedure) were less likely to undergo hip/knee, vascular, and CABG/PCI procedures. Given that African-Americans are more likely than non-Hispanic whites to die of heart disease, their reduced odds of receiving CABG/PCI or vascular procedures could be problematic.
LIMITATIONS:
- This study relied on administrative data. Severity ratings of psychiatric illnesses or indicators of the relative need for major procedures were not available. Also, diagnoses of PTSD and MDD were dependent on administrative coding, which may misclassify some cases.
- Major procedures and/or mental health treatment conducted outside VA were not included.
- The study couldn't determine the reason patients with PTSD or MDD got fewer procedures.
IMPLICATIONS:
There are various reasons patients with underlying psychological disorders may be less likely to get surgical procedures: they may be less likely to bring their symptoms to the attention of their clinician, clinicians may be more focused on patients' psychological symptoms or less likely to recommend the procedures, or patients may be less willing to accept recommendations for invasive procedures. Research to separate out these possible causes may lead to interventions to make sure that patients with PTSD or MDD get appropriate care for their medical conditions.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (IIR 09-335). Drs. Copeland and Zeber and Ms. Sun are part of the Central Texas Veterans Health Care System.
Greenawalt D, Copeland L, MacCarthy A, Sun F, and Zeber J. Post-traumatic Stress Disorder and Odds of Major Invasive Procedures among U.S. Veterans Affairs Patients. Journal of Psychosomatic Research October 2013;75(4):386-93.
