Gender differences in rates and predictors of individual psychotherapy initiation and completion among Veterans Health Administration users recently diagnosed with PTSD

Abstract

Objective: Most veterans with posttraumatic stress disorder (PTSD) who receive care from the Veterans Health Administration (VHA) do not receive individual psychotherapy. The purpose of this study was to explore gender differences in initiation and completion of a sufficient course (defined as attending 8 or more sessions) of individual psychotherapy among male and female VHA users recently diagnosed with PTSD.

Method: Participants (N = 7,218) were veterans in a prospective national cohort survey of VHA users diagnosed with PTSD; oversampling was used to increase representation of women and minority veterans.

Results: Forty-two percent of the sample (40.1% of men, 52.3% of women) initiated individual psychotherapy within 6 months of their index PTSD diagnosis. Of those who initiated, 12.1% (10.8% of men, 17.7% of women) completed a sufficient course of individual psychotherapy. Women were generally more likely than men to initiate individual psychotherapy. However, we found an interaction between gender and age, such that younger men were more likely to initiate psychotherapy than older men; age was not significantly associated with initiation among women. Regarding completion of individual psychotherapy, an interaction between gender and beliefs about psychotherapy was found, such that men were less likely to complete individual psychotherapy when they held more negative beliefs about psychotherapy; these beliefs did not significantly impact female veterans' likelihood of completing psychotherapy.

Conclusions: Overall, while female veterans are more likely than male veterans with PTSD to initiate individual psychotherapy, rates of initiation and completion of individual psychotherapy for both genders remain relatively low. Interventions are needed to increase engagement in individual psychotherapy, particularly for male veterans with PTSD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Figure 1.. Interaction between gender and age for initiation of individual psychotherapy.

Note. The figure plots model estimated probabilities of receiving psychotherapy calculated at the sample mean value for continuous predictors, white race, combat trauma, index diagnosis in a PTSD clinic, no reported barriers to treatment, agreement that veteran can follow treatment recommendations, and encouragement from spouse or family to seek treatment.

Figure 2.. Interaction between gender and beliefs about psychotherapy for completion of individual psychotherapy.

Note. The figure plots model estimated probabilities of receiving at least 8 psychotherapy sessions calculated at the sample mean value for continuous predictors, white race, combat trauma, index diagnosis in a PTSD clinic, no reported barriers to treatment, agreement that veteran can follow treatment recommendations, and encouragement from spouse or family to seek treatment.