title: Serving those who served: retention of newly returning veterans from Iraq and Afghanistan in mental health treatment.
abstract: OBJECTIVE
  There are growing concerns about the mental health status of returning veterans from the recent conflicts in Iraq (Operation Iraq Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]) and about retention in mental health treatment of veterans with posttraumatic stress disorder (PTSD). This study obtained data from veterans who had a new diagnosis of PTSD from fiscal year (FY) 2004 to FY 2007 and determined whether retention in PTSD treatment and the number of mental health visits were comparable among OIF-OEF veterans and veterans from other service eras.
  
  
  METHODS
  Data from the Department of Veterans Affairs and the Department of Defense were combined to identify veterans who were newly diagnosed as having PTSD (N=204,184) and their service era. Survival analysis assessed dropout from mental health treatment within one year from initial diagnosis, and Poisson regression assessed the association between war era and number of mental health visits.
  
  
  RESULTS
  Although a smaller proportion of OIF-OEF veterans than Vietnam-era veterans remained in treatment for more than one year (37.6% versus 46.0%), when the analyses adjusted for demographic characteristics and comorbid diagnoses, OIF-OEF veterans were less likely than Vietnam-era veterans to discontinue psychiatric treatment for PTSD within one year. OIF-OEF veterans attended fewer mental health visits than Vietnam-era veterans did (8.15 versus 13.37). However, multivariate analysis indicated that, after the analyses adjusted for confounding factors, OIF-OEF veterans had significantly more visits than Vietnam-era veterans associated with PTSD treatment.
  
  
  CONCLUSIONS
  Retention and numbers of visits were found to be lower among OIF-OEF veterans primarily as a function of age and comorbid conditions and not as a function of the particular war era. Interventions should be designed to target specific barriers to care that may interfere with continued engagement in mental health services.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, 300 George St., Suite 901, New Haven, CT 06511, USA. ilan.harpaz-rotem@yale.edu
authors.forename: Ilan
authors.initials: I
authors.lastname: Harpaz-Rotem
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
mesh_terms: D055826:Afghan Campaign 2001-; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care; D010352:Patient Dropouts / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000534:rehabilitation*; D016019:Survival Analysis; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*