Transition from military to VHA care: psychiatric health services for Iraq/Afghanistan combat-wounded.
OBJECTIVE
Veterans from the wars in Afghanistan and Iraq (OEF/OIF) report high rates of mental distress especially affective disorders. Ensuring continuity of care across institutions is a priority for both the Department of Defense (DoD) and the Veterans Health Administration (VHA), yet this process is not monitored nor are medical records integrated. This study assessed transition from DoD to VHA and subsequent psychiatric care of service members traumatically injured in OEF/OIF.


METHODS
Inpatients at a DoD trauma treatment facility discharged in FY02-FY06 (n=994) were tracked into the VHA via archival data (n=216 OEF/OIF veterans). Mental health utilization in both systems was analyzed.


RESULTS
VHA users were 9% female, 15% Hispanic; mean age 32 (SD=10; range 19-59). No DoD inpatients received diagnoses of post-traumatic stress disorder (PTSD); 21% had other mental health diagnoses, primarily drug abuse. In the VHA, 38% sought care within 6 months of DoD discharge; 75% within 1 year. VHA utilization increased over time, with 88-89% of the transition cohort seeking care in FY07-FY09. Most accessed VHA mental health services (81%) and had VHA psychiatric diagnoses (71%); half met criteria for depression (27%) or PTSD (38%). Treatment retention through FY09 was significantly greater for those receiving psychiatric care: 98% vs 62% of those not receiving psychiatric care (x(2)=53.3; p<.001).


CONCLUSIONS
DoD outpatient data were not available. The study relied on administrative data.


CONCLUSIONS
Although physical trauma led to hospitalization in the DoD, high rates of psychiatric disorders were identified in subsequent VHA care, suggesting delay in development or recognition of psychiatric problems.
Veterans Affairs: Central Texas Veterans Health Care System Temple, TX, United States. LaurelACopeland@gmail.com
Laurel A
LA
Copeland
John E
JE
Zeber
Mona O
MO
Bingham
Mary Jo
MJ
Pugh
Polly Hitchcock
PH
Noël
Eric R
ER
Schmacker
Valerie A
VA
Lawrence
D000328:Adult; D055826:Afghan Campaign 2001-; D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D008889:Military Personnel; D008890:Military Psychiatry / Q000458:organization & administration; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration; D014728:Veterans / Q000523:psychology; D014947:Wounds and Injuries / Q000523:psychology*; D055815:Young Adult