Predisposing, enabling, and need factors as predictors of low and high psychotherapy utilization in veterans.
This study used national administrative data from the Veterans Health Administration (VHA) to examine predisposing, enabling, and need factors related to multiple levels of psychotherapy utilization in a sample of veterans with posttraumatic stress disorder (PTSD), depression, or anxiety. The database was queried for all veterans who were newly diagnosed with PTSD, depression, or anxiety during the 2010 fiscal year and received at least 1 outpatient psychotherapy session in the year following diagnosis (N = 130,331). Veterans were classified as low (51.0%; 1-3 sessions), moderate (38.3%; 4-18 sessions), high (8.7%; 19-51 sessions), or very high (1.9%; 52 or more sessions) psychotherapy users based on the total number of psychotherapy visits during the 1-year follow-up period. Multinomial logistic regression was used to examine predictors of utilization level. Predisposing factors of gender and marital status were modestly associated with utilization. Several need factors were strongly associated with utilization; very high users had higher rates of PTSD and substance use disorders, more comorbid psychiatric diagnoses, and more inpatient psychiatric visits. Very high users were also more likely to demonstrate enabling factors, including living closer to a VHA facility and seeking care at more complex facilities. Overall, need factors appeared to be most strongly linked to psychotherapy utilization. These results suggest many patients may not receive a clinically optimal dose of psychotherapy, highlighting the need to enhance retention in therapy for low utilizers and examine whether very high utilizers are benefitting from extensive courses of treatment.
Veterans Affairs Health Services Research & Development, Houston Center of Excellence.
Natalie E
NE
Hundt
Veterans Affairs Health Services Research & Development, Houston Center of Excellence.
Terri L
TL
Barrera
Veterans Affairs Health Services Research & Development, Houston Center of Excellence.
Juliette M
JM
Mott
Veterans Affairs Health Services Research & Development, Houston Center of Excellence.
Joseph
J
Mignogna
Veterans Affairs Health Services Research & Development, Houston Center of Excellence.
Hong-Jen
HJ
Yu
Veterans Affairs Health Services Research & Development, Houston Center of Excellence.
Shubhada
S
Sansgiry
Veterans Affairs Health Services Research & Development, Houston Center of Excellence.
Melinda A
MA
Stanley
Veterans Affairs Health Services Research & Development, Houston Center of Excellence.
Jeffrey A
JA
Cully
D000328:Adult; D000368:Aged; D016208:Databases, Factual; D005260:Female; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011613:Psychotherapy; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*; D058014:Veterans Health