Mental Health Treatment Delay: A Comparison Among Civilians and Veterans of Different Service Eras

Abstract

The study compared delay of treatment for posttraumatic stress disorder (PTSD), major depressive disorder, and alcohol use disorder among post-9/11 veterans versus pre-9/11 veterans and civilians. Methods: The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a nationally representative survey of U.S. noninstitutionalized adults, was used. Participants included 13,528 civilians, 1,130 pre-9/11 veterans, and 258 post-9/11 veterans with lifetime diagnoses of PTSD, major depression, or alcohol use disorder. Cox proportional hazard models, controlling for relevant demographic characteristics, were used to estimate differences in treatment delay (i.e., time between diagnosis and treatment). Results: Post-9/11 veterans were less likely to delay treatment for PTSD and depression than pre-9/11 veterans (adjusted hazard ratios [AHRs]=0.69 and 0.74, respectively) and civilians (AHRs=0.60 and 0.67, respectively). No differences in treatment delay were observed between post-9/11 veterans and pre-9/11 veterans or civilians for alcohol use disorder. In an exploratory analysis, post-9/11 veterans with past-year military health care coverage (e.g., Veterans Health Administration) had shorter delays for depression treatment compared with post-9/11 veterans without military coverage, pre-9/11 veterans regardless of health care coverage, and civilians, although past-year coverage did not predict treatment delay for PTSD or alcohol use disorder. Conclusions: Post-9/11 veterans were less likely to delay treatment for some common psychiatric conditions compared with pre-9/11 veterans or civilians, which may reflect efforts to engage recent veterans in mental health care. All groups exhibited low initiation of treatment for alcohol use disorder, highlighting the need for further engagement efforts.

Differential effects of prior stress on conditioned inhibition of fear and fear extinction

“…One obvious difference between the clinical data and ours is the age of the trauma/stress memory. Individuals diagnosed with PTSD often do not receive treatment until many weeks after the trauma, sometimes years [23]. Perhaps our conditioned inhibition results would differ if we increased the time between the stress exposure and the beginning of reward training.…”

Moral injury and substance use disorders among US combat veterans: results from the 2019–2020 National Health and Resilience in Veterans Study

“…In concert, these complex reactions may create a foundation for coping through drug use in an attempt to numb emotions or memories of the PMIEs (Norman, Wilkins, Myers, & Allard, 2014). It may lead some to believe they do not deserve to get better, which may contribute to low rates of engagement in substance use treatment among symptomatic veterans (Goldberg et al, 2019). Researchers have not yet explored relationships between exposure to PMIEs and DUDs, likely due to the challenges of assessing for these issues, stigma, as well as ramifications of revealing drug use problems while military personnel are still in the service.…”

Usability and Acceptability of a Mobile App for the Self-Management of Alcohol Misuse Among Veterans (Step Away): Pilot Cohort Study

“…Previous reports suggest the rate of alcohol misuse among OEF and OIF veterans is 2 times the rate observed for similarly aged veterans who did not serve in OEF and OIF and much higher among men (22%) than women (5%) [5]. Despite high rates of use, many OEF and OIF veterans with alcohol-related problems do not receive alcohol-related care or only receive care after significant delay [6][7][8]. The large gap between those who need and those who receive treatment is thought to be due in part to barriers to using available services [9].…”