Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2006 Mar;21 Suppl 3(Suppl 3):S58-64.
doi: 10.1111/j.1525-1497.2006.00376.x.

Posttraumatic stress disorder screening status is associated with increased VA medical and surgical utilization in women

Dorcas J Dobie  1 , Charles Maynard, Daniel R Kivlahan, Kay M Johnson, Tracy Simpson, Andrew C David, Katharine Bradley
Affiliations

Posttraumatic stress disorder screening status is associated with increased VA medical and surgical utilization in women

Dorcas J Dobie et al. J Gen Intern Med. 2006 Mar.

Abstract

Background: Women with posttraumatic stress disorder (PTSD) report poor health, but associations with health care utilization are understudied.

Objective: To determine associations between medical/surgical utilization and PTSD in female Veterans Affairs (VA) patients.

Design: Prospective comparison of utilization rates between women screening positive or negative for PTSD on a mailed survey.

Subjects: Women receiving care at an urban VA medical center between October 1996 and January 2000.

Measurements: Survey responses, including a validated screen for PTSD (PCL-C), and VA utilization data through September 2002.

Results: Two thousand five hundred and seventy-eight (2,578) women (78% of those eligible) completed the PCL-C; 858 (33%) of them screened positive for PTSD (PTSD+). In unadjusted models, PTSD+ women had higher rates of medical/surgical hospitalizations and surgical inpatient procedures. Among women ages 35 to 49, mean days hospitalized/100 patients/year was 43.4 (95% CI 26 to 61) for PTSD+ women versus 17.0 (16 to 18) for PTSD negative (PTSD-) women. More PTSD+ women underwent surgical procedures (P<.001). Mean annual outpatient visits were significantly higher among PTSD+ women, including: emergency department (ED) (1.1 [1.0 to 1.2] vs 0.6 [0.5 to 0.6]), primary care (3.2 [3.0 to 3.4] vs 2.2 [2.1 to 2.3]), medical/surgical subspecialists (2.1 [1.9 to 2.3] vs 1.5 [1.4 to 1.6]), ancillary services (4.1 [3.7 to 4.5] vs 2.4 [2.2 to 2.6]), and diagnostic tests (5.6 [5.1 to 6.1] vs 3.7 [3.4 to 4.0]). In multivariate models adjusted for demographics, smoking, service access, and medical comorbidities, PTSD+ women had greater likelihood of medical/surgical hospitalization (OR=1.37 [1.04 to 1.79]) and of being among the top quartile of patients for visits to the ED, primary care, ancillary services, and diagnostic testing.

Conclusions: Female veterans who screen PTSD+ receive more VA medical/surgical services. Appropriateness of that care deserves further study.

PubMed Disclaimer

References

    1. Breslau N, Kessler RC, Shilcoat HD, Schultz LR, Davis GC, Andreski PM. Trauma and posttraumatic stress disorder in the community: the 1996 Detroit area survey of trauma. Arch Gen Psychiatry. 1998;55:626–32. - PubMed
    1. Felitti VAR, Nordenberg D, Williamson DF, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults: the adverse childhood experience (ACE) study. Am Prev Med. 1998;14:245–58. - PubMed
    1. Shalev A, Freedman S, Peri T, et al. Prospective study of posttraumatic stress disorder and comorbid major depression following trauma. Am J Psychiatry. 1998;155:630–7. - PubMed
    1. Walker EA, Unutzer J, Rutter C, et al. Costs of health care use by women HMO members with a history of childhood abuse and neglect. Arch Gen Psychiatry. 1999;56:609–13. - PubMed
    1. Sibai AM, Armenian HK, Alam S. Wartime determinants of arteriographically confirmed coronary artery disease in Beirut. Am J Epidemiol. 1989;130:623–31. - PubMed

Publication types