title: Medical service utilization by veterans seeking help for posttraumatic stress disorder.
abstract: OBJECTIVE
  Posttraumatic stress disorder (PTSD) has been associated with higher rates of health complaints and medical conditions diagnosed by physicians, yet research examining the relationship between PTSD and health care utilization has been limited. This study compared the health service use of veterans with PTSD to that of help-seeking veterans without PTSD. The relationship between severity of PTSD and service utilization was also examined.
  
  
  METHODS
  Data were collected from 996 veterans seeking an evaluation at a Veterans Affairs (VA) Medical Center specialty PTSD clinic in the southeastern United States between March 1992 and September 1998. Data included sociodemographic characteristics, severity of PTSD, and disability status. The outcome variable, VA health service utilization, was prospectively assessed 1 year from the date of the initial PTSD assessment.
  
  
  RESULTS
  Although the use of VA mental health services by patients with PTSD was substantial (a median of seven clinic stops), these patients used more services in general physical health clinics that provided predominantly nonmental health services (a median of 18 clinic stops). Negative binomial regression models revealed that younger veterans with PTSD had greater health care utilization than those without PTSD who also sought services. Greater severity of PTSD was related to higher rates of mental and physical health service use among veterans without a service-connected disability.
  
  
  CONCLUSIONS
  PTSD is associated with substantial health service use. The results highlight the importance of increased collaboration between primary care and mental health specialists, given that patients with PTSD are more likely to receive treatment in nonmental health clinics.
authors.affiliation: Health Services Research (152), Durham Veterans' Affairs Medical Center, 508 Fulton Street, Durham, NC 27705, USA. calho002@mc.duke.edu
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Calhoun
authors.forename: Hayden B
authors.initials: HB
authors.lastname: Bosworth
authors.forename: Steven C
authors.initials: SC
authors.lastname: Grambow
authors.forename: Tara K
authors.initials: TK
authors.lastname: Dudley
authors.forename: Jean C
authors.initials: JC
authors.lastname: Beckham
mesh_terms: D017677:Age Distribution; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002391:Catchment Area, Health; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D012044:Regression Analysis; D012720:Severity of Illness Index; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*