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. 2018 Jun;63(6):378-386.
doi: 10.1177/0706743717730826. Epub 2017 Sep 14.

Mental Health Services Use Trends in Canadian Veterans: A Population-Based Retrospective Cohort Study in Ontario

Alyson L Mahar  1   2 , Alice B Aiken  2   3 , Heidi Cramm  2   4 , Marlo Whitehead  5 , Patti Groome  5   6 , Paul Kurdyak  5   7
Affiliations

Mental Health Services Use Trends in Canadian Veterans: A Population-Based Retrospective Cohort Study in Ontario

Alyson L Mahar et al. Can J Psychiatry. 2018 Jun.

Abstract
in English, French

Objective: A substantial evidence base in the peer-reviewed literature exists investigating mental illness in the military, but relatively less is documented about mental illness in veterans. This study uses provincial, administrative data to study the use of mental health services by Canadian veterans in Ontario.

Method: This was a retrospective cohort study of Canadian Armed Forces and Royal Canadian Mounted Police veterans who were released between 1990 and 2013 and resided in Ontario. Mental health-related primary care physician, psychiatrist, emergency department (ED) visits, and psychiatric hospitalisations were counted. Repeated measures were presented in 5-year intervals, stratified by age at release.

Results: The cohort included 23,818 veterans. In the first 5 years following entry into the health care system, 28.9% of veterans had ≥1 mental health-related primary care physician visit, 5.8% visited a psychiatrist at least once, and 2.4% received acute mental health services at an ED. The use of mental health services was consistent over time. Almost 8% of veterans aged 30 to 39 years saw a psychiatrist in the first 5 years after release, compared to 3.5% of veterans aged ≥50 years at release. The youngest veterans at release (<30 years) were the most frequent users of ED services for a mental health-related reason (5.1% had at least 1 ED visit).

Conclusion: Understanding how veterans use the health care system for mental health problems is an important step to ensuring needs are met during the transition to civilian life.

Objectif:: Il y a une recherche substantielle fondée sur des données probantessur la maladie mentale chez les militaires, mais elle est relativement peu documentée dans la littérature révisée par les pairs quand il s’agit de maladie mentale chez les anciens combattants. Cette étude utilise des données provinciales, administratives pour étudier l’utilisation des services de santé mentale par les anciens combattants de l’Ontario.

Méthodologie:: C’était une étude de cohorte rétrospective des anciens combattants des Forces armées canadiennes (FAC) et de la Gendarmerie royale du Canada (GRC) qui ont été libérés entre 1990 et 2013 et résidaient en Ontario. Les visites liées à la santé mentale à un médecin des soins de première ligne, à un psychiatre ou à un service d’urgence (SU) ainsi que les hospitalisations psychiatriques ont été comptées. Les mesures répétées ont été présentées à cinq ans d’intervalle, stratifiées selon l’âge à la libération.

Résultats:: La cohorte comprenait 23818 anciens combattants. Dans les cinq premières années suivant l’entrée dans le système de santé, 28,9% des anciens combattants avaient ≥ 1 visite liée à la santé mentale à un médecin des soins de première ligne, 5,8% avaient vu un psychiatre au moins une fois, et 2,4% avaient reçu des soins actifs de santé mentale à un service d’urgence. L’utilisation des services de santé mentale était constante avec le temps. Presque 8% des anciens combattants de 30 à 39 ans ont vu un psychiatre dans les 5 premières années après la libération, comparé à 3,5% des anciens combattants de ≥ 50 ans à la libération. Les anciens combattants les plus jeunes à la libération (< 30 ans) étaient les utilisateurs les plus fréquents des services d’urgence pour une raison liée à la santé mentale (5,1% avaient au moins une visite au SU).

Conclusion:: Comprendre comment les anciens combattants utilisent le système de santé pour des problèmes de santé mentale est une étape importante pour faire en sorte de répondre à leurs besoins durant la transition à la vie civile.

Keywords: health services; mental disorders; military personnel; veteran; veteran health.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
The proportion of veterans in Ontario who received mental health treatment in primary care, with a psychiatrist, in the emergency department (ED) or during a psychiatric hospitalization at least once, stratified by the time period following release from the Canadian Armed Forces (CAF)/Royal Canadian Mounted Police (RCMP).
Figure 2.
Figure 2.
(a) The proportion of veterans in Ontario with at least 1 visit to primary care for mental health services, stratified by age of the veteran at the time of release from the Canadian Armed Forces (CAF)/Royal Canadian Mounted Police (RCMP). (b) The average number of primary care mental health visits per veteran in Ontario, in those veterans who had at least 1 visit, stratified by age at the time of release from the CAF/RCMP. *The average was calculated for veterans using this service at least once over the time interval.
Figure 3.
Figure 3.
(a) The proportion of veterans in Ontario visiting a psychiatrist, stratified by age at the time of release from the Canadian Armed Forces (CAF)/Royal Canadian Mounted Police (RCMP). (b) The average number of psychiatrist visits by veterans in Ontario, in those who saw a psychiatrist, stratified by age of the veteran at the time of release from the CAF/RCMP. *The average was calculated for veterans using this service at least once over the time interval.
Figure 4.
Figure 4.
(a) The proportion of veterans in Ontario with at least 1 psychiatric emergency department (ED) visit, stratified by age at the time of release from the Canadian Armed Forces (CAF)/Royal Canadian Mounted Police (RCMP). (b) The average number of psychiatric ED visits by veterans in Ontario, in those veterans who had at least 1 visit, stratified by age of the veteran at the time of release from the CAF/RCMP.
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