title: 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).
authors.affiliation: Department of Veterans Affairs, Ann Arbor Center of Excellence (COE), Serious Mental Illness Treatment, Research, and Evaluation Center (SMITREC), Ann Arbor, Michigan 48108, USA. Chermack@umich.edu
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Chermack
authors.forename: Kara
authors.initials: K
authors.lastname: Zivin
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
authors.forename: Mark
authors.initials: M
authors.lastname: Ilgen
authors.forename: Karen L
authors.initials: KL
authors.lastname: Austin
authors.forename: John
authors.initials: J
authors.lastname: Wryobeck
authors.forename: Frederic C
authors.initials: FC
authors.lastname: Blow
mesh_terms: D000328:Adult; D000368:Aged; D000928:Antidepressive Agents / Q000627:therapeutic use*; D019985:Benchmarking; D015897:Comorbidity; D003863:Depression / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011613:Psychotherapy; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans
chemical_list: D000928:Antidepressive Agents