The Prevalence and Predictors of Mental Health Treatment Services in a National Sample of Depressed Veterans

Abstract

Background Few studies of acute depression care have examined the provision of psychotherapy or combined treatment in addition to medication management. This study examined acute phase depression treatment in the VA healthcare system, including measures of medication treatment (MT), psychotherapy (PT), and combined treatment (CT = MT plus PT). Both low level care (receipt of any MT, PT, or CT, but all below guideline levels) as well as guideline concordant care (GC MT, PT, and CT) were examined. Methods The sample included 41,412 patients with new depression diagnoses. Analyses examined the relationship between demographics and psychiatric comorbidities (eg, substance use disorders, post-traumatic stress disorder, depression with both substance use disorders and post-traumatic stress disorder) and receipt of each type of care (low level and guideline concordant MT, PT, and CT). Results The majority (75%) received at least some treatment, with 35% of the sample receiving guideline concordant care (particularly GC MT). Those with psychiatric comorbidities generally were more likely to receive GC care, older veterans were less likely to receive each type of care, and African Americans were less likely to receive GC MT but more likely to receive GC PT and GC CT than whites. Conclusions Although it is difficult to benchmark, the VA overall seems similar or better than the private sector in providing guideline concordant acute phase treatment for its depressed patients. The majority of veterans received some acute phase depression treatment, but only a minority seem to receive guideline concordant care (particularly PT and CT).

The Effect of Incident Cancer, Depression and Pulmonary Disease Exacerbations on Type 2 Diabetes Control

“…[15][16][17][18] Although we required that cohort members had not received treatment for depression for at least 6 months after the DM index date, it is possible that some cohort members identified through this process may have experienced previous episodes of depression. Including such potentially recurrent 'incident' cases would still be consistent with the aims of the investigation.…”

Mental Illness and Mental Healthcare Receipt among Hospitalized Veterans with Serious Physical Illnesses

“…Following previous VA studies, depression and anxiety, if present, were counted as incident if there were no depression or anxiety diagnosis codes or prescriptions for antidepressants or anxiolytics in the previous 120 days. 14,15 Incident diagnoses were measured during the hospitalization and in the year before hospitalization.…”

Group Intervention for Chronic Depression and PTSD

“…As clinicians working in the Veterans Administration HealthCare System, we have noted that when these disorders co-occur, patients report greater symptom distress, treatment interventions can become highly problematic, and/or patients become treatment refractory [23]. Although first-line PTSD treatments, such as Prolonged Exposure Therapy (PE) and Cognitive Processing Therapy (CPT) for non-comorbid PTSD report a remission of acute depressive symptoms when PTSD symptoms are actively addressed, some chronically depressed patients find it difficult to engage in and complete trauma focused therapies that activate traumatic memories and require adherence to between-session imaginal and in-vivo exposures.…”

“…For instance, over 50% of military veterans diagnosed with PTSD carry a diagnosis of depression lasting for two or more years with no evidence of depressive disorder prior to their military duty [22,9]. This co-morbid PTSD/chronically depressed population has a high treatment refractory rate for both antidepressant medication and psychosocial interventions [23].…”