Time to treatment among veterans of conflicts in Iraq and Afghanistan with psychiatric diagnoses.
OBJECTIVE
Early mental health treatment after military deployment may reduce chronic mental health problems. The authors described time to, and predictors of time to, initiation of a first primary care visit, a first mental health outpatient visit, and minimally adequate mental health care (eight or more outpatient visits within 12 months) among veterans with psychiatric diagnoses.


METHODS
The authors conducted a retrospective cohort analysis of medical records of veterans of the conflicts in Iraq and Afghanistan who enrolled in Veterans Affairs (VA) health care, had a psychiatric diagnosis, and had used primary or mental health outpatient care between October 7, 2001, and September 30, 2011 (N=314,717).


RESULTS
The median time from the end of the last deployment to engagement in mental health care was over two years. More than three years postdeployment, 75% of the veterans in the VA system for at least one year had not engaged in minimally adequate mental health care. There was a median lag of nearly 7.5 years between initial mental health treatment session and initiation of minimally adequate mental health care. Men waited nearly two years longer than women to initiate minimally adequate mental health care. Younger age and minority racial or ethnic status were also associated with greater time to initial mental health outpatient visit and to minimally adequate mental health care.


CONCLUSIONS
Delays in initiating and completing minimally adequate mental health care by veterans using VA services highlight the importance of attending to the timing of care, particularly among newly returning veterans.
San Francisco Veterans Affairs Medical Center, Mental Health Service, 4150 Clement St., 116-P, San Francisco, CA 94121, USA. shira.maguen@va.gov
Shira
S
Maguen
Erin
E
Madden
Beth Ellen
BE
Cohen
Daniel
D
Bertenthal
Karen Hope
KH
Seal
D000328:Adult; D055826:Afghan Campaign 2001-; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008485:Medical Audit; D001523:Mental Disorders / Q000628:therapy*; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012737:Sex Factors; D013997:Time Factors; D061665:Time-to-Treatment; D014728:Veterans / Q000523:psychology*; D055815:Young Adult