title: Psychotherapy in the Veterans Health Administration: Missed Opportunities?
abstract: Informed by data on the dose-response effect, the authors assessed use of psychotherapy in the Veterans Health Administration (VA). The authors identified 410,923 patients with newly diagnosed depression, anxiety, or posttraumatic stress disorder using VA databases (October 2003 through September 2004). Psychotherapy encounters were identified by Current Procedural Terminology codes for the 12 months following patients' initial diagnosis. Psychotherapy was examined for session exposure received within the 12-month follow-up period and time (in days) between diagnosis and treatment. Of the cohort, 22% received at least one session of psychotherapy; 7.9% received four or more sessions; 4.2% received eight or more sessions; and 2.4% received 13 or more sessions. Delays between initial mental health diagnosis and initiation of care averaged 57 days. Patient variables including age, marital status, income, travel distance, psychiatric diagnosis, and medical-illness burden were significantly related to receipt of psychotherapy. Treatment delays and general underuse of psychotherapy services are potential missed opportunities for higher-quality psychotherapeutic care in integrated health care settings.
authors.affiliation: Houston Center for Quality of Care & Utilization Studies, Veterans Affairs Health Services Research and Development Center of Excellence, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, and Veterans Affairs South Central Mental Illness Research, Education, & Clinical Center.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cully
authors.affiliation: Michael E. DeBakey Veterans Affairs Medical Center.
authors.forename: Laura
authors.initials: L
authors.lastname: Tolpin
authors.affiliation: Houston Center for Quality of Care & Utilization Studies, Veterans Affairs Health Services Research and Development Center of Excellence.
authors.forename: Louise
authors.initials: L
authors.lastname: Henderson
authors.affiliation: Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine.
authors.forename: Daniel
authors.initials: D
authors.lastname: Jimenez
authors.affiliation: Houston Center for Quality of Care & Utilization Studies, Veterans Affairs Health Services Research and Development Center of Excellence, Baylor College of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, and Veterans Affairs South Central Mental Illness Research, Education, & Clinical Center.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Kunik
authors.affiliation: Houston Center for Quality of Care & Utilization Studies, Veterans Affairs Health Services Research and Development Center of Excellence, Baylor College of Medicine, and Michael E. DeBakey Veterans Affairs Medical Center.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Petersen
keywords: anxiety; depression; mental health; posttraumatic stress disorder; psychotherapy