title: Posttraumatic stress disorder and odds of major invasive procedures among U.S. Veterans Affairs patients.
abstract: OBJECTIVE
  Although individuals with posttraumatic stress disorder (PTSD) are at heightened risk for several serious health conditions, research has not examined how having PTSD impacts receipt of invasive procedures that may alleviate these problems. We examined whether PTSD, after controlling for major depression, was associated with odds of receiving common types of major invasive procedures, and whether race, ethnicity, and gender was associated with odds of procedures.
  
  
  METHODS
  Veterans Health Administration patients with PTSD and/or depression were age-matched with patients without these disorders. The odds of invasive hip/knee, digestive system, coronary artery bypass graft/percutaneous coronary intervention (CABG/PCI), and vascular procedures during FY2006-2009 were modeled for the full sample of 501,489 patients and for at-risk subsamples with medical conditions alleviated by the procedures examined.
  
  
  RESULTS
  Adjusting for demographic covariates and medical comorbidity, PTSD without depression was associated with decreased odds of all types of procedures (odds ratios [OR] range 0.74-0.82), as was depression without PTSD (OR range 0.59-0.77). In analyses of at-risk patients, those with PTSD only were less likely to undergo hip/knee (OR=0.78) and vascular procedures (OR=0.73) but not CABG/PCI. African-Americans and women at-risk patients were less likely to undergo hip/knee, vascular, and CABG/PCI procedures (OR range 0.31-0.82).
  
  
  CONCLUSIONS
  With the exception of CABG/PCI among at-risk patients, Veterans with PTSD and/or depression were less likely to undergo all types of procedures examined. Future studies should examine the reasons for this disparity and whether it is associated with subsequent adverse outcomes.
authors.affiliation: VISN 17 Center of Excellence for Research on Returning War Veterans, 4800 Memorial Drive, Waco, TX 76711, USA. Electronic address: mycapemaypoint@yahoo.com.
authors.forename: David Sloan
authors.initials: DS
authors.lastname: Greenawalt
authors.forename: Laurel Anne
authors.initials: LA
authors.lastname: Copeland
authors.forename: Andrea A
authors.initials: AA
authors.lastname: MacCarthy
authors.forename: Fangfang F
authors.initials: FF
authors.lastname: Sun
authors.forename: John Edward
authors.initials: JE
authors.lastname: Zeber
mesh_terms: D000368:Aged; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology*; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D044469:Racial Groups / Q000706:statistics & numerical data; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology*; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Depression; Invasive procedures; Posttraumatic stress disorder; Surgery; Veterans