Iraq and Afghanistan veterans with mental health diagnoses use more VA medical services

In a study of nearly 250,000 veterans of the wars in Iraq and Afghanistan, those who were diagnosed with mental health disorders used non-mental health medical services provided by the Department of Veterans Affairs at significantly higher rates than those without mental health disorders.

Veterans whose mental health diagnosis was post-traumatic stress syndrome used VA medical services at almost twice the rate of those whose mental health diagnosis was another disorder, such as depression.

The study, conducted by researchers at the San Francisco VA Medical Center and the University of California, San Francisco, analyzed medical records of veterans who were first-time users of VA medical services. It appears in the “Online First” section of the website of the “Journal of General Internal Medicine.

“This information is important right now, because the VA is preparing to care for a large number of returning veterans,” says lead author Beth E. Cohen, MD, MAS, a staff physician at SFVAMC. She notes that approximately 1.6 million men and women have served in Iraq and Afghanistan, “so we need to think about how we can best meet their needs as they return home.”

The results are consistent with studies of veterans from earlier wars, says Cohen, who is also an assistant professor of medicine at UCSF. “What we don’t know from this data,” she observes, “is whether these veterans are using medical care more often because they simply have more medical diseases, or because they need help with mental health concerns but seek care in other medical settings” because of the stigma associated with mental health treatment.

The study authors analyzed the medical records of 249,400 Iraq and Afghanistan veterans who used VA health care for the first time between October 7, 2001 – the beginning of the conflict in Afghanistan – and March 31, 2007. The veterans were followed until March 31, 2008.

The authors found that veterans with PTSD used non-mental health medical services, including primary care, emergency care, and visits to other medical specialists at a 91 percent higher rate overall than those without mental health diagnoses. Veterans with a mental health diagnosis other than PTSD had a 55 percent higher utilization rate than those without mental health diagnoses.

To explore the factors driving the veterans’ use of non-mental health medical care, Cohen and her fellow researchers plan to evaluate the effects of different models of care delivery on utilization. One such model, says Cohen, is the OEF/OIF (Afghanistan/Iraq) Integrated Care Clinic at SFVAMC, where all patients, whether or not they screen positive for a mental health concern, are seen by primary care, mental health, and social work providers, potentially reducing the stigma of seeking mental health care.

“Integrated care is a priority for the VA nationally,” notes Cohen. “It may be that when a veteran sees a primary care provider and a mental health care provider who work together as a team, we can deliver care more efficiently.”

The study authors also found that female gender and lower rank were independently associated with greater health care utilization. “Again, we can’t determine why from this type of study, but there are clues,” says Cohen. “For example, lower rank is associated with more combat exposure, which may lead to a greater burden of both mental and physical health problems. This is another area where looking at individual veterans might give us some answers.”

Co-authors of the study are Kris Gima, BA, of UCSF, and Daniel Bertenthal, MPH, Sue Kim, PhD, Charles Marmar, MD, and senior author Karen Seal, MD, MPH, of SFVAMC and UCSF.

The study was supported by funds from the Department of Veterans Affairs and the National Institutes of Health, some of which were administered by the Northern California Institute for Research and Education.

NCIRE - The Veterans Health Research Institute is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.

SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care.