Predictors of Mental Health Care Utilization in Veterans With Post-Traumatic Stress Disorder Symptoms and Hazardous Drinking

Abstract

OBJECTIVES Describe outpatient mental health service use in a sample of recent combat Veterans with PTSD symptoms and hazardous alcohol use and investigate predictors of mental healthcare utilization. METHODS In this prospective study, 126 Veterans with full or subthreshold PTSD and hazardous alcohol use completed a baseline assessment and reported mental health service use through a twelve month follow-up period. Logistic regressions were used to identify factors predicting mental healthcare utilization. RESULTS Veterans who were employed were 63% less likely to use outpatient mental healthcare in the 12 months following baseline. Additionally, for each 1 point increase in negative mental healthcare beliefs, participants were 70% less likely to use outpatient mental healthcare. For each 1 point worsening in social support and leisure functioning, participants were 2.2 times more likely to use outpatient mental healthcare. CONCLUSIONS The current study indicates that negative mental health beliefs are barriers to mental healthcare while unemployment and poor social support/leisure functioning are predictors of mental healthcare utilization for recent combat Veterans with PTSD symptoms and hazardous alcohol use. Patient and system level interventions for these factors are discussed to guide efforts to improve mental healthcare among this high-need population.

Alcohol-related and mental health care for patients with unhealthy alcohol use and posttraumatic stress disorder in a National Veterans Affairs cohort

“…Selection of covariates was guided by Andersen's behavioral model of health service utilization, which includes predisposing (e.g., sociodemographics), enabling (e.g., social support), and need (e.g., symptom severity) factors (Andersen, 1995), as well as by review of the literature to identify variables expected to confound the association between PTSD and receipt of alcohol-related or mental health care (Glass et al, 2010; Johnson et al, 2016; Maguen et al, 2012; Williams et al, 2016).…”

Correlates and predictors of mental health care utilization for veterans with PTSD: A systematic review.

“…Mental Health Beliefs and Stigma, Access and Enabling Resources, Perceived Need, Personal Characteristics and Health Practices, and Satisfaction and Trust were less commonly evaluated. The research on Mental Health Beliefs and Stigma suggests that positive beliefs about mental health care facilitate treatment initiation and retention but also shows that veterans with higher levels of stigma were more likely to initiate treatment (DeViva et al, 2016;Johnson et al, 2016;Spoont et al, 2014Spoont et al, , 2015. Consistent differences in directionality of findings between beliefs and stigma suggests that these are separate constructs with different implications for treatment utilization.…”

Group Psychotherapy with Ethnoracially Diverse OEF/OIF/OND Veterans Presenting with Comorbid Psychopathology: A Transdiagnostic Clinical Forensic Paradigm

“…Expanding a Clinical Forensic "What Works Paradigm for Group Treatment of Co-Morbid Psychopathology" OEF/OIF/OND veterans are more vulnerable to developing PTSD due to repeated exposure to traumatic stressors during a longer period [21]. Several other variables also add to the psychological trauma experienced by veterans and have concomitant symptoms not better described by depression, anxiety, post-traumatic stress, and substance use disorder, as a tendency to selfmedicate [18,22]. There is a growing concern about self-assessed patients who may have rendered their own diagnosis or refused the prescribed treatment.…”

“…As a result, a significant number of veterans with PTSD, depression and anxiety to no surprise also experience interpersonal challenges, unemployment, physical ailments and other instabilities in relationships [27,28]. The barriers to seeking care among veterans are partially influenced by stigma, beliefs about mental health, and it is intensified within the military culture [22]. Most veterans choose to keep their symptoms and challenges to themselves or within the family (PTSD.VA) [18].…”