title: Medical illness burden is associated with greater PTSD service utilization in a nationally representative survey.
abstract: OBJECTIVE
  Posttraumatic stress disorder (PTSD) is associated with higher rates of many medical conditions and higher use of medical health care services. Growing evidence suggests that comorbid medical illness in PTSD may in turn be associated with greater use of mental health treatment. However, no study to date has examined the impact of cumulative medical illness burden on PTSD service utilization.
  
  
  METHODS
  Data come from the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions. PTSD was assessed via structured interview, and cumulative medical illness burden was assessed via a survey of medical conditions. Logistic regression modeling examined associations between cumulative medical illness burden and odds of receiving PTSD treatment.
  
  
  RESULTS
  In the final sample of 1599 individuals with current PTSD, controlling for demographic characteristics, insurance status, psychiatric comorbidity and PTSD symptom count, higher levels of past-year medical illness were associated with increased odds of receiving past-year treatment for PTSD (odds ratio = 1.10, 95% confidence interval = 1.01-1.20, P = .029).
  
  
  CONCLUSIONS
  Greater levels of medical illness are associated with increased odds of PTSD service utilization. Greater medical comorbidity may increase the need for PTSD care by exacerbating symptoms or increase contact with medical services promoting PTSD detection and treatment.
authors.affiliation: VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC); VA Ann Arbor Health Care System; University of Michigan Department of Psychiatry. Electronic address: rekaufma@umich.edu.
authors.forename: Rebecca K
authors.initials: RK
authors.lastname: Sripada
authors.affiliation: VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC); VA Ann Arbor Health Care System; University of Michigan Department of Psychiatry.
authors.forename: Paul N
authors.initials: PN
authors.lastname: Pfeiffer
authors.affiliation: VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC); VA Ann Arbor Health Care System; University of Michigan Department of Psychiatry.
authors.forename: Marcia
authors.initials: M
authors.lastname: Valenstein
authors.affiliation: VA Serious Mental Illness Treatment Resource and Evaluation Center (SMITREC); VA Ann Arbor Health Care System; University of Michigan Department of Psychiatry.
authors.forename: Kipling M
authors.initials: KM
authors.lastname: Bohnert
mesh_terms: D000163:Acquired Immunodeficiency Syndrome / Q000453:epidemiology*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001168:Arthritis / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004066:Digestive System Diseases / Q000453:epidemiology*; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology*; D008107:Liver Diseases / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012307:Risk Factors; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000628:therapy*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Comorbidity; NESARC; National Epidemiologic Survey on Alcohol and Related Conditions; Physical illness; Posttraumatic stress disorder