title: Timing of mental health treatment and PTSD Symptom improvement among Iraq and Afghanistan veterans.
abstract: OBJECTIVE
  This study examined demographic, military, temporal, and logistic variables associated with improvement of posttraumatic stress disorder (PTSD) among Iraq and Afghanistan veterans who received mental health outpatient treatment from the U.S. Department of Veterans Affairs (VA) health care system. The authors sought to determine whether time between last deployment and initiating mental health treatment was associated with a lack of improvement in PTSD symptoms.
  
  
  METHODS
  The authors conducted a retrospective analysis of existing medical records of Iraq and Afghanistan veterans who enrolled in VA health care, received a postdeployment PTSD diagnosis, and initiated treatment for one or more mental health problems between October 1, 2007, and December 31, 2011, and whose records contained results of PTSD screening at the start of treatment and approximately one year later (N=39,690).
  
  
  RESULTS
  At the start of treatment, 75% of veterans diagnosed as having PTSD had a positive PTSD screen. At follow-up, 27% of those with a positive screen at baseline had improved, and 43% of those with a negative screen at baseline remained negative. A negative PTSD screen at follow-up was associated with female gender, older age, white race, having never married, officer rank, non-Army service, closer proximity to the nearest VA facility, and earlier initiation of treatment after the end of the last deployment.
  
  
  CONCLUSIONS
  Interventions to reduce delays in initiating mental health treatment may improve veterans' treatment response. Further studies are needed to test interventions for particular veteran subgroups who were less likely than others to improve with treatment.
authors.affiliation: The authors are with the San Francisco VA Medical Center, where Dr. Maguen, Ms. Madden, and Dr. Neylan are with the Department of Mental Health, Dr. Cohen and Dr. Seal are with the Department of Medicine, and Mr. Bertenthal is with the Mental Illness Research, Education and Clinical Centers (e-mail: shira.maguen@va.gov ). Dr. Maguen and Dr. Neylan are also with the Department of Psychiatry, and Dr. Cohen and Dr. Seal are also with the Department of Medicine, University of California, San Francisco.
authors.forename: Shira
authors.initials: S
authors.lastname: Maguen
authors.forename: Erin
authors.initials: E
authors.lastname: Madden
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
authors.forename: Beth E
authors.initials: BE
authors.lastname: Cohen
authors.forename: Daniel
authors.initials: D
authors.lastname: Bertenthal
authors.forename: Karen H
authors.initials: KH
authors.lastname: Seal
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D015897:Comorbidity; D003710:Demography; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008603:Mental Health; D008890:Military Psychiatry / Q000379:methods; D017063:Outcome Assessment, Health Care; D011613:Psychotherapy / Q000379:methods / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000523:psychology / Q000628:therapy; D061665:Time-to-Treatment; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology*