COVID-19 mortality among veterans with serious mental illness in the veterans health administration

Bowersox, Nicholas W.; Browne, Julia; Grau, Peter P.; Merrill, Stephanie; Haderlein, Taona P.; Llorente, Maria D.; Washington, Donna L.

doi:10.1016/j.jpsychires.2023.05.024

Cited by 2 publications

(2 citation statements)

References 38 publications

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“…The mental health diagnostic categories (examined through International Statistical Classification of Diseases and Related Health Problems-10 codes) included in this study were serious mental illness (SMI; schizophrenia spectrum or bipolar spectrum disorder), substance use disorder (SUD), generalized anxiety disorder (GAD), depressive disorders, personality disorders (PDs), eating disorders, and obsessive-compulsive disorder (OCD) diagnosis. These categories are in line with previous administrative data analyses focused on PTSD treatment utilization patterns in VA (e.g., Sripada et al, 2017Sripada et al, , 2019 and were retained due to high levels of cooccurrence with either or both PTSD (Brady et al, 2000) and SMI (Bowersox et al, 2017). The receipt of an electronic marker on veterans' medical charts indicating that they were deemed at acute or high risk of death by suicide or who "present an immediate safety risk for seriously disruptive, threatening, or violent behavior" (U.S. Department of Veterans Affairs and Veterans Health Administration, 2010, p. 2) in the facility were also included, the latter indicated by receipt of a disruptive behavioral flag (BDF) which can be given following patient verbal or physical aggression (Weinberger et al, 2018).…”

Section: Patient Characteristicssupporting

confidence: 78%

“…One potentially important condition that appears to be more common in veterans who have experienced MST as compared to veterans who have not experienced MST is serious mental illness (SMI; i.e., psychotic disorders, bipolar disorder; Bowersox et al, 2017; Sexton et al, 2017). Compared to the general population, individuals with SMI are at greater lifetime risk for exposure to traumatic events, including sexual trauma, as well as subsequent development of trauma-related disorders (Grubaugh et al, 2011; Kessler et al, 2005).…”

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confidence: 99%

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Engagement in posttraumatic stress disorder treatment for veterans who experienced military sexual trauma and are diagnosed with serious mental illness.

Grau,

Browne,

Nelson

et al. 2024

Psychological Services

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It is important to ensure that veterans who have experienced military sexual trauma (MST) and have posttraumatic stress disorder (PTSD) have access to trauma-focused treatment. For veterans with serious mental illness (SMI), prior work documents decreased likelihood to receive trauma-focused care. This study focused on evaluating the engagement of Veterans Health Administration (VHA) patients diagnosed with PTSD and who have experienced MST in PTSD specialty care, as well as how this differs for veterans with SMI. Using VHA administrative data, all VHA patients who screened positive for MST prior to fiscal year 2019 (FY2019) were identified (N = 84,503). Based on information from FY2019, measures of psychiatric diagnosis status and VHA treatment participation were generated for all cohort members. Logistic regressions assessed whether there were differences in the likelihood to initiate PTSD care (1+ VHA PTSD specialty clinic encounter) or receive guideline-concordant levels of PTSD specialty care (8+ VHA PTSD specialty clinic encounter) during FY2019. Several other patient characteristics associated with decreased likelihood to receive VHA PTSD specialty servies were identified, including White race and older age. Patient SMI status was not significantly associated with likelihood to initiate or receive guideline-concordant levels of PTSD specialty care. Overall, PTSD treatment initiation was low (11% of veterans with SMI initiated PTSD specialty treatment, as opposed to 10% of veterans without SMI). Additional work is merited to identify ways that VHA is able to overcome barriers to trauma care participation experienced by persons who have experienced MST and been diagnosed with PTSD. Impact StatementThis study suggests that VHA patients who have experienced MST and have PTSD and a comorbid SMI diagnosis, are not linked to lower rates of PTSD specialty care engagement. However, other factors such as White race and older age were found to be related to lower rates of PTSD specialty care engagement for veterans with a history of MST.

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