title: Utilization of VA mental health and primary care services among Iraq and Afghanistan veterans with depression: the influence of gender and ethnicity status.
abstract: The objective of this study is to examine gender and ethnic differences in Veterans Affairs (VA) health services utilization among Iraq and Afghanistan military Veterans diagnosed with depression. With VA administrative data, sociodemographics, utilization of outpatient primary care, specialty mental health and mental health treatment modalities (psychotherapy and antidepressant prescriptions) were collected from electronic medical records of 1,556 depressed Veterans treated in one VA regional network from January 2008 to March 2009. Health care utilization patterns were examined 90 days following being diagnosed with depression. χ(2) and t-tests were used to evaluate unadjusted differences in VA service use by gender and ethnicity. Logistic regression was used to fit study models predicting VA service utilization. Study results indicate no ethnic or gender differences in the use of specialty mental health services or in the use of mental health treatments. However, women Veterans, especially those from ethnic minority groups, were less likely to use primary care than white and nonwhite male Veterans. Collectively, these findings signal a decrease in historically documented disparities within VA health care, especially in the use of mental health services.
authors.affiliation: Mental Illness Research, Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, 2200 Fort Roots, Building 58, Little Rock, AR 72114.
authors.forename: Teri D
authors.initials: TD
authors.lastname: Davis
authors.affiliation: Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham, #554, Little Rock, AR 72205.
authors.forename: Tisha L
authors.initials: TL
authors.lastname: Deen
authors.affiliation: Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham, #554, Little Rock, AR 72205.
authors.forename: John C
authors.initials: JC
authors.lastname: Fortney
authors.affiliation: Mental Illness Research, Education and Clinical Center (MIRECC), Central Arkansas Veterans Healthcare System, 2200 Fort Roots, Building 58, Little Rock, AR 72114.
authors.forename: Greer
authors.initials: G
authors.lastname: Sullivan
authors.affiliation: Psychiatric Research Institute, University of Arkansas for Medical Sciences, 4301 West Markham, #554, Little Rock, AR 72205.
authors.forename: Teresa J
authors.initials: TJ
authors.lastname: Hudson
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D003863:Depression / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012737:Sex Factors; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data*; D055815:Young Adult