title: The quality of mental health care for veterans of Operation Enduring Freedom/Operation Iraqi Freedom.
abstract: BACKGROUND
  Some Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans experience serious mental health (MH) problems. As OEF/OIF soldiers leave active military duty, their growing numbers pose a challenge to the Department of Veterans Affairs (VA) in delivering high-quality mental health/substance-use disorder (MH/SUD) care.
  
  
  OBJECTIVE
  To determine whether the quality of MH/SUD care provided by the VA differs by OEF/OIF veteran status.
  
  
  METHODS
  Veterans with selected MH/SUDs were identified from administrative records using diagnostic codes. OEF/OIF service was determined based on Defense Manpower Data Center separation files. Eleven processes of care and 7 utilization performance indicators were examined. Regression analyses were adjusted for veteran demographic and clinical characteristics to test for differences in care by OEF/OIF status.
  
  
  RESULTS
  Of the 836,699 veterans with selected diagnoses who received MH/SUD treatment in FY2007, 52,870 (6.3%) were OEF/OIF veterans. In unadjusted analyses, OEF/OIF veterans were more likely to receive evidence-based care processes captured by 6 of the 11 dichotomous performance indicators examined; however, among those receiving psychotherapy encounters, OEF/OIF veterans received significantly fewer visits (6.9 vs. 9.7, P<0.0001). In adjusted analyses, only postdischarge follow-up remained meaningfully higher for OEF/OIF veterans.
  
  
  CONCLUSIONS
  Efforts to maintain and/or increase OEF/OIF veteran participation in VA MH/SUD services should be informed by their characteristics, such as younger age and better physical health relative to other veterans.
authors.affiliation: RAND Corporation, Santa Monica, CA 90407, USA. paddock@rand.org
authors.forename: Susan M
authors.initials: SM
authors.lastname: Paddock
authors.forename: Abigail
authors.initials: A
authors.lastname: Woodroffe
authors.forename: Katherine E
authors.initials: KE
authors.lastname: Watkins
authors.forename: Melony E
authors.initials: ME
authors.lastname: Sorbero
authors.forename: Brad
authors.initials: B
authors.lastname: Smith
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Mannle
authors.forename: Jacob
authors.initials: J
authors.lastname: Solomon
authors.forename: Harold A
authors.initials: HA
authors.lastname: Pincus
mesh_terms: D000293:Adolescent; D000328:Adult; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D001523:Mental Disorders / Q000628:therapy; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards*; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards*; D014728:Veterans / Q000523:psychology*; D055815:Young Adult