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Comparative Study
. 2010 Jan;25(1):18-24.
doi: 10.1007/s11606-009-1117-3. Epub 2009 Sep 29.

Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans

Beth E Cohen  1 , Kris Gima, Daniel Bertenthal, Sue Kim, Charles R Marmar, Karen H Seal
Affiliations
Comparative Study

Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans

Beth E Cohen et al. J Gen Intern Med. 2010 Jan.

Abstract

Background: Over 35% of returned Iraq and Afghanistan veterans in VA care have received mental health diagnoses; the most prevalent is post-traumatic stress disorder (PTSD). Little is known about these patients' use of non-mental health medical services and the impact of mental disorders on utilization.

Objective: To compare utilization across three groups of Iraq and Afghanistan veterans: those without mental disorders, those with mental disorders other than PTSD, and those with PTSD.

Design and participants: National, descriptive study of 249,440 veterans newly utilizing VA healthcare between October 7, 2001 and March 31, 2007, followed until March 31, 2008.

Measurements: We used ICD9-CM diagnostic codes to classify mental health status. We compared utilization of outpatient non-mental health services, primary care, medical subspecialty, ancillary services, laboratory tests/diagnostic procedures, emergency services, and hospitalizations during veterans' first year in VA care. Results were adjusted for demographics and military service and VA facility characteristics.

Main results: Veterans with mental disorders had 42-146% greater utilization than those without mental disorders, depending on the service category (all P < 0.001). Those with PTSD had the highest utilization in all categories: 71-170% greater utilization than those without mental disorders (all P < 0.001). In adjusted analyses, compared with veterans without mental disorders, those with mental disorders other than PTSD had 55% higher utilization of all non-mental health outpatient services; those with PTSD had 91% higher utilization. Female sex and lower rank were also independently associated with greater utilization.

Conclusions: Veterans with mental health diagnoses, particularly PTSD, utilize significantly more VA non-mental health medical services. As more veterans return home, we must ensure resources are allocated to meet their outpatient, inpatient, and emergency needs.

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Figures

Figure 1
Figure 1
Total outpatient utilization of non-mental health services during the first year of VA care by mental health category. MH Dx = mental health diagnoses. Incidence rate ratio adjusted for age, sex, race, marital status, component type, military rank, military branch, multiple deployments, main VA facility, VA facility type, and distance to nearest VA.
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References

    1. Hoge CW, Auchterlonie JL, Milliken CS. Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA. 2006;295:1023–1032. doi: 10.1001/jama.295.9.1023. - DOI - PubMed
    1. Milliken CS, Auchterlonie JL, Hoge CW. Longitudinal assessment of mental health problems among active and reserve component soldiers returning from the Iraq war. JAMA. 2007;298:2141–2148. doi: 10.1001/jama.298.18.2141. - DOI - PubMed
    1. Seal KH, Bertenthal D, Miner CR, Sen S, Marmar C. Bringing the war back home: mental health disorders among 103,788 US veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities. Arch Intern Med. 2007;167:476–482. doi: 10.1001/archinte.167.5.476. - DOI - PubMed
    1. Seal KH, Metzler T, Gima K, Bertenthal D, Maguen S, Marmar CR. Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs healthcare, 2002–2008. AJPH 2008;99:1651–8. - PMC - PubMed
    1. Friedman MJ. Acknowledging the psychiatric cost of war. N Engl J Med. 2004;351:75–77. doi: 10.1056/NEJMe048129. - DOI - PubMed

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