title: Use of psychotherapy by rural and urban veterans.
abstract: OBJECTIVE
  To examine whether differences exist between rural and urban veterans in terms of initiation of psychotherapy, delay in time from diagnosis to treatment, and dose of psychotherapy sessions.
  
  
  METHODS
  Using a longitudinal cohort of veterans obtained from national Veterans Affairs databases (October 2003 through September 2004), we extracted veterans with a new diagnosis of depression, anxiety, or posttraumatic stress disorder (PTSD) (n = 410,923). Veterans were classified as rural (categories 6-9; n = 65,044) or urban (category 1; n = 149,747), using the US Department of Agriculture Rural-Urban Continuum Codes. Psychotherapy encounters were identified using Current Procedural Terminology codes for the 12 months following patients' initial diagnosis.
  
  
  RESULTS
  Newly diagnosed rural veterans were significantly less likely (P < .0001) to receive psychotherapy (both individual and group). Urban veterans were roughly twice as likely as rural veterans to receive 4 or more (9.46% vs 5.08%) and 8 or more (5.59% vs 2.35%) psychotherapy sessions (P < .001).
  
  
  CONCLUSIONS
  Rural veterans are significantly less likely to receive psychotherapy services, and the dose of the psychotherapy services provided for rural veterans is limited relative to their urban counterparts. Focused efforts are needed to increase access to psychotherapy services provided to rural veterans with depression, anxiety, and PTSD.
authors.affiliation: Houston Center for Quality of Care & Utilization Studies, Veterans Affairs Health Services Research and Development Center (HSR&D) of Excellence, Houston, Texas 77030, USA. Jeffrey.Cully@va.gov
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cully
authors.forename: John P
authors.initials: JP
authors.lastname: Jameson
authors.forename: Laura L
authors.initials: LL
authors.lastname: Phillips
authors.forename: Mark E
authors.initials: ME
authors.lastname: Kunik
authors.forename: John C
authors.initials: JC
authors.lastname: Fortney
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000628:therapy; D015331:Cohort Studies; D016208:Databases, Factual; D003863:Depression / Q000628:therapy*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D011613:Psychotherapy / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012306:Risk; D019035:Rural Health Services / Q000706:statistics & numerical data*; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D019037:Urban Health Services / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*