Personal characteristics affecting veterans' use of services for posttraumatic stress disorder.
OBJECTIVE
Posttraumatic stress disorder (PTSD) is widespread among veterans, but many veterans with PTSD use few health services. This study examined how individual characteristics influenced use of outpatient visits by veterans with PTSD.


METHODS
The study assessed number of annual visits by 414,748 veterans with PTSD who sought care from October 2007 through September 2008 at U.S. Department of Veteran Affairs (VA) facilities. Negative binomial regression and adjusted risk ratios assessed the relationship of number of visits and demographic characteristics as well as place of residence, era of service, extent to which disability was connected to service history, and having comorbid illnesses.


RESULTS
Veterans from rural or highly rural areas had 19% (confidence interval [CI]=.80-.82) and 25% (CI=.72-.79), respectively, fewer visits than urban-dwelling veterans. Iraq and Afghanistan veterans had 21% fewer visits than veterans of prior eras (CI=.78-.81). Veterans with comorbid conditions had 64% more visits than veterans with only PTSD (CI=1.62-1.66). Veterans from rural or highly rural areas had 22% (CI=.87-.89) and 33% (CI=.64-.71), respectively, fewer visits to PTSD specialty clinics than veterans from urban areas.


CONCLUSIONS
Service use by veterans is lower in rural areas. The VA should build on existing efforts to provide more outreach and care opportunities, including telemental health and specialized PTSD services, in rural areas and for veterans of the current service era. Future research should investigate the impact of fewer visits on aspects of functioning, such as interpersonal factors, and the impact of system-level variables on service utilization.
Centers for American Indian and Alaska Native Health, University of Colorado Denver, PO Box 6508, Mail Stop F800, Aurora, CO 80045, USA. elizabeth.brooks@ucdenver.edu
Elizabeth
E
Brooks
Douglas K
DK
Novins
Deborah
D
Thomas
Luohua
L
Jiang
Herbert T
HT
Nagamoto
Nancy
N
Dailey
Byron
B
Bair
Jay H
JH
Shore
D055826:Afghan Campaign 2001-; D016001:Confidence Intervals; D016208:Databases, Factual; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008889:Military Personnel / Q000523:psychology*; D012044:Regression Analysis; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy*; D014728:Veterans / Q000523:psychology*