title: Association of PTSD and depression with medical and specialist care utilization in modern peacekeeping veterans in Canada with health-related disabilities.
abstract: OBJECTIVE
  We examined the relative associations between posttraumatic stress disorder (PTSD) and depression severity with medical and specialist care use in modern peacekeeping veterans with health-related disabilities.
  
  
  METHODS
  The participants consisted of 1016 male veterans who served in the Canadian Forces from 1990 to 1999, selected from a larger random sample of 1968 veterans who voluntarily completed an anonymous general health survey conducted by Veterans Affairs Canada in 1999. Survey instruments included the PTSD Checklist-Military Version (PCL-M), Center for Epidemiological Studies-Depression Scale, and questionnaires of health problems and service use, sociodemographic characteristics, and military history.
  
  
  RESULTS
  Among peacekeeping veterans with health disabilities, "probable" PTSD (PCL-M score > or = 50) was associated with significantly more medical service use (primary and specialty care combined), with a mean of 16.4 times (SD = 17.4) compared with 6.0 times (SD = 6.6), p < .001, for veterans without PTSD. We found that in multivariate analyses, general medical care intensity (i.e., number of visits) was related to increased health problems, greater probable PTSD diagnosis, and greater depression symptom severity. We also found that depression severity accounted for health care use intensity and that PTSD only added a small amount of incremental variance above that.
  
  
  CONCLUSIONS
  The observed association between PTSD (diagnosis and severity) and medical care utilization stresses the importance of PTSD screening in primary care settings, especially in patients with a history of military service. This association is also useful for clinicians and hospital administrators in understanding potential medical and psychiatric needs for military veterans.
authors.affiliation: Operational Stress Injury Clinic, St. Joseph's Health Care London, Parkwood Hospital, London, Ontario, Canada. Don.Richardson@sjhc.london.on.ca
authors.forename: J Don
authors.initials: JD
authors.lastname: Richardson
authors.forename: Jon D
authors.initials: JD
authors.lastname: Elhai
authors.forename: David J
authors.initials: DJ
authors.lastname: Pedlar
mesh_terms: D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D003866:Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D006233:Persons with Disabilities / Q000523:psychology / Q000706:statistics & numerical data; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D008889:Military Personnel / Q000523:psychology / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D010555:Personality Inventory; D011320:Primary Health Care; D011569:Psychiatric Status Rating Scales; D012494:Sampling Studies; D012720:Severity of Illness Index; D013038:Specialization; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*