title: Mental health utilization of new-to-care Iraq and Afghanistan Veterans following suicidal ideation assessment.
abstract: We evaluated the impact of brief structured suicidal ideation (SI) assessments on mental health care among new-to-care Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) veterans. National datasets provided military, demographic, and clinical information. For all new-to-care OEF/OIF veterans administered depression screens (PHQ-2: Patient Health Questionnaire-2) and structured SI assessments in primary care or ambulatory mental health settings of three Veterans Affairs (VA) Medical Centers between April 2008 and September 2009 (N=465), generalized estimating equations were used to examine associations between SI and number of subsequent-year specialty mental health visits and antidepressant prescriptions. Approximately one-third of the veterans reported SI. In multivariate models, PTSD and anxiety diagnoses, severe depression symptoms, being married, and SI assessment by a mental health clinician were associated with more mental health visits in the subsequent year. Depression, PTSD, and anxiety diagnoses, and SI assessment by a mental health clinician were associated with receiving antidepressants. Presence of SI did not significantly affect subsequent year mental health utilization when adjusting for diagnostic and clinician variables, but inaugural visits involving mental health clinicians were consistently associated with subsequent mental health care.
authors.affiliation: Portland Center to Improve Veteran Involvement in Care (CIVIC), Portland VA Medical Center, Portland, OR, United States; Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States. Electronic address: lauren.denneson@va.gov.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Denneson
authors.affiliation: Portland Center to Improve Veteran Involvement in Care (CIVIC), Portland VA Medical Center, Portland, OR, United States; Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Corson
authors.affiliation: War-Related Illness and Injury Study Center, VA New Jersey Health Care System, East Orange, NJ, United States; Department of Medicine and Dentistry, New Jersey Medical School, Newark, NJ, United States.
authors.forename: Drew A
authors.initials: DA
authors.lastname: Helmer
authors.affiliation: Richard L. Roudebush Veteran Affairs Medical Center, Indianapolis, IN, United States.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Bair
authors.affiliation: Portland Center to Improve Veteran Involvement in Care (CIVIC), Portland VA Medical Center, Portland, OR, United States; Department of Psychiatry, Oregon Health & Science University, Portland, OR, United States.
authors.forename: Steven K
authors.initials: SK
authors.lastname: Dobscha
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D001007:Anxiety / Q000175:diagnosis / Q000523:psychology; D003863:Depression / Q000175:diagnosis / Q000523:psychology; D003866:Depressive Disorder / Q000175:diagnosis / Q000523:psychology; D005260:Female; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D008297:Male; D008403:Mass Screening; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008889:Military Personnel / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology; D059020:Suicidal Ideation; D014728:Veterans / Q000523:psychology*; D055815:Young Adult
keywords: Delivery of health care; Depression; Risk assessment; Suicide