title: Do veterans with posttraumatic stress disorder receive first-line pharmacotherapy? Results from the longitudinal veterans health survey.
abstract: OBJECTIVE
  Guidelines addressing the treatment of veterans with posttraumatic stress disorder (PTSD) strongly recommend a therapeutic trial of selective serotonin reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs). This study examined veteran characteristics associated with receiving such first-line pharmacotherapy, as well as how being a veteran of the recent conflicts in Afghanistan and Iraq impact receipt of pharmacotherapy for PTSD.
  
  
  METHODS
  This was a national study of 482 Veterans Affairs (VA) outpatients between the ages of 18 and 69 years who had been newly diagnosed with PTSD (DSM-IV criteria: 309.81) during a VA outpatient visit between May 31, 2006, and December 7, 2007. Participants completed a mailed survey between August 11, 2006, and April 6, 2008. Veterans from the Afghanistan and Iraq conflicts and female veterans were intentionally oversampled. Logistic regression models were developed to predict 2 dependent variables: odds of initiating an SSRI/SNRI and, among veterans who initiated an SSRI/SNRI, odds of receiving an adequate therapeutic trial. Each dependent variable was regressed on a variety of sociodemographic and survey characteristics.
  
  
  RESULTS
  Of the 377 veterans prescribed a psychotropic medication, 73% (n = 276) received an SSRI/SNRI, of whom 61% (n = 168) received a therapeutic trial. Afghanistan and Iraq veterans were less likely to receive a therapeutic trial (odds ratio [OR] = 0.45; 95% CI, 0.27-0.75; P < .01), with presence of a comorbid depression diagnosis in the year after the index episode moderating this relationship, which further decreased the odds of completing a therapeutic trial (OR = 0.29; 95% CI, 0.09-0.95; P < .05).
  
  
  CONCLUSIONS
  Reduced levels of receipt of first-line pharmacotherapy among recent veteran returnees parallel previous findings of less mental health treatment utilization in this population and warrant investigation.
authors.affiliation: National Center for Posttraumatic Stress Disorder, VA Palo Alto Health Care System, Palo Alto and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford (Drs Jain and Rosen); and VA Sierra-Pacific Mental Illness Research, Education and Clinical Center, Palo Alto (Mr Greenbaum and Dr Rosen), California.
authors.forename: Shaili
authors.initials: S
authors.lastname: Jain
authors.forename: Mark A
authors.initials: MA
authors.lastname: Greenbaum
authors.forename: Craig S
authors.initials: CS
authors.lastname: Rosen