Minimally adequate mental health care and latent classes of PTSD symptoms in female Iraq and Afghanistan veterans

Abstract

Female veterans of Operations Enduring and Iraqi Freedom, and Operation New Dawn (OEF/OIF/OND) represent a growing segment of Department of Veterans Affairs (VA) health care users. A retrospective analysis used national VA medical records to identify factors associated with female OEF/OIF/OND veterans' completion of minimally adequate care (MAC) for PTSD, defined as the completion of at least nine mental health outpatient visits within a 15-week period or at least twelve consecutive weeks of medication use. The sample included female OEF/OIF/OND veterans with PTSD who initiated VA health care between 2007-2013, and were seen in outpatient mental health (N=2183). Multivariable logistic regression models examined factors associated with completing MAC for PTSD, including PTSD symptom expression (represented by latent class analysis), sociodemographic, military, clinical, and VA access factors. Within one year of initiating mental health care, 48.3% of female veterans completed MAC. Race/ethnicity, age, PTSD symptom class, additional psychiatric diagnoses, and VA primary care use were significantly associated with completion of MAC for PTSD. Results suggest that veterans presenting for PTSD treatment should be comprehensively evaluated to identify factors associated with inadequate completion of care. Treatments that are tailored to PTSD symptom class may help to address potential barriers.

Usual Course of Treatment and Predictors of Treatment Utilization for Patients With Posttraumatic Stress Disorder

“…These findings are similar to those from a study in the VA healthcare system of 2,183 patients with PTSD by Hebenstreit et al, which found Latino ethnicity to be negatively associated with receiving minimally adequate care for PTSD. 11 This finding is also consistent with several studies that have found high rates of therapy dropout among racial and ethnic minority patients compared to non-Latino white patients. 25, 26 Structural barriers, including language barriers, patient-provider cultural differences, including the importance of family and religious ties, 27 and social inequities likely play a role in lower access to a full course of evidence-based mental health treatment.…”

“…9 Additionally, in a study of 186,240 VA patients with PTSD, Cohen et al found that 80.1% had been prescribed a psychiatric medication. 10 A handful of studies, mostly conducted among veterans, have additionally evaluated predictors of treatment utilization among those diagnosed with PTSD, finding lower treatment utilization among both Latinos and African Americans as compared to non-Latino whites, 11, 12 among those who were married or divorced/separated/widowed, 11 those who were older, 10, 13, 14 and those without a mental health comorbidity. 11, 15, 16 …”

Latent classes of PTSD symptoms in veterans undergoing residential PTSD treatment.

“…Class 2 exhibited higher re-experiencing symptoms, whereas Class 3 exhibited higher emotional numbing symptoms. Veterans with high levels of emotional numbing symptoms and more moderate levels of other PTSD symptoms may be less likely to complete minimally-adequate treatment as compared with Veterans who have symptoms that are relatively moderate with higher re-experiencing (Hebenstreit et al, 2015). Moreover, emotional numbing symptoms may respond more slowly to treatment.…”

Behavioral Health Treatment Receipt Among a Community Sample of Young Adult Veterans

“…30,31,46,47 A strength of the current study is the reliance on the Internet for recruitment and survey assessment, which allows for a broader view of behavioral health problems among veterans both enrolled in the VA and not, as well as allowing for inclusion of those not willing to attend in-person assessments. As approximately 30% of the sample had never used a VA for any reason since discharge, the inclusion of care receipt at other settings (Vet Centers, community providers) is another strength as findings include receipt of care beyond that received solely from the VA.…”

“…For example, VA data indicate that only 27% of the 49,425 OEF/OIF/OND veterans seen for PTSD in the VA between 2002 and 2008 received a minimally adequate dose of care 30 and less than half of 2,183 female veterans with PTSD who were enrolled at the VA received minimally adequate PTSD care at the VA between 2007 and 2013. 31 Much of the data on OEF/OIF/OND veterans come from VA patient records or from Department of Defense records from active-duty service members. However, as noted, many separated veterans do not elect to receive benefits from the VA or have only attended appointments outside of behavioral health clinics, and are therefore not captured in these samples.…”