title: Barriers and facilitators related to mental health care use among older veterans in the United States.
abstract: OBJECTIVE
  Psychiatric disorders are more prevalent among older veterans compared with their civilian counterparts, but many veterans with symptoms of psychiatric disorders do not utilize mental health services. This study examined barriers and facilitators related to current mental health care utilization in a nationally representative sample of veterans ages 60 and older (N=2,025).
  
  
  METHODS
  Using data from the National Health and Resilience in Veterans Study, the authors evaluated how predisposing, enabling, and need characteristics as well as perceived barriers to care were related to utilization of mental health care among older veterans.
  
  
  RESULTS
  A minority of veterans (N=130; weighted prevalence, 6%) reported current mental health care utilization. Among veterans (N=144) who screened positive for a current psychiatric disorder, 42 (weighted prevalence, 25%) were currently utilizing services. In the full sample, current utilization was associated with lifetime posttraumatic stress disorder or depression (odds ratio [OR]=5.88, 95% confidence interval [CI]=3.51-9.84), lifetime drug use disorder (OR=2.87, CI=1.59-5.17), severity of current psychiatric symptoms (OR=1.40, CI=1.19-1.65), general medical difficulties (OR=1.28, CI=1.10-1.50), and lower perceptions of stigma (OR=.80, CI=.68-.93). Non-Hispanic veterans were less likely to utilize care (OR=.42, CI=.25-.69). Among psychiatrically distressed veterans, current utilization was associated with younger age (OR=.89, CI=.81-.97), current suicidal ideation (OR=5.60, CI=1.98-15.84), and fewer negative beliefs about mental health care (OR=.23, CI=.09-.56).
  
  
  CONCLUSIONS
  Efforts to identify psychiatrically distressed veterans and to reduce stigma and negative beliefs about mental health care may help increase mental health service utilization among older U.S. veterans.
authors: Dr. Blais is with the Department of Psychology, Utah State University, Logan (e-mail: rebecca.blais@usu.edu ), and was with the Mental Health Service, Seattle Division, U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, when parts of this work were completed. Dr. Tsai, Dr. Southwick, and Dr. Pietrzak are with the VA Connecticut Healthcare System, West Haven, where Dr. Tsai is with the New England Mental Illness Research, Education and Clinical Center, and Dr. Southwick and Dr. Pietrzak are with the National Center for Posttraumatic Stress Disorder. They are also with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
authors: Rebecca K
authors: RK
authors: Blais
authors: Jack
authors: J
authors: Tsai
authors: Steven M
authors: SM
authors: Southwick
authors: Robert H
authors: RH
authors: Pietrzak
mesh_terms: D000368:Aged; D001294:Attitude to Health; D005260:Female; D005852:Geriatric Psychiatry / Q000706:statistics & numerical data; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006299:Health Services for the Aged / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D013240:Stereotyping; D014481:United States; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data