title: The effect of medical comorbidities on male and female Veterans' use of psychotherapy for PTSD.
abstract: BACKGROUND
  Posttraumatic stress disorder (PTSD) is associated with an increased risk for medical comorbidities that may prevent participation in psychotherapy. The present study investigated whether medical comorbidities were associated with lower initiation rates and fewer psychotherapy visits for PTSD. Because women are more likely to initiate psychotherapy after traumatic events, we also assessed whether relationships were weaker among women.
  
  
  METHODS
  Veterans (N=482, 47% women) recently diagnosed with PTSD completed a survey assessing demographics, mood, functional status, and interest in treatment. Data on medical comorbidities, psychotherapy visits, antidepressant prescriptions, and service connection were assessed longitudinally through administrative files. Logistic and negative binomial regressions assessed associations between number of medical comorbidities in the 2 years before the survey and the initiation and number of psychotherapy visits for PTSD in the year after the survey. All analyses were stratified by sex and controlled for survey and administrative variables.
  
  
  RESULTS
  The relationship between medical comorbidities and number of psychotherapy visits was stronger among women than among men. A greater number of medical comorbidities was associated with significantly fewer psychotherapy visits in the total sample [incidence rate ratio: 0.91; 95% confidence interval (CI): 0.83, 1.00] and among women (incidence rate ratio: 0.87; 95% CI: 0.77, 0.99), but not among men (95% CI: 0.75, 1.01). Medical comorbidities were not associated with the initiation of psychotherapy among men or women.
  
  
  CONCLUSIONS
  Addressing medical comorbidities may help individuals remain in psychotherapy for PTSD. Medical comorbidities may play a larger role in the number of psychotherapy visits among women than men.
authors.affiliation: *Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park †Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford ‡VA Sierra-Pacific Mental Illness Research, Education and Clinical Center, VA Palo Alto Healthcare System, Menlo Park §Division of General Medical Disciplines, Stanford University School of Medicine, Stanford ∥National Center for PTSD, VA Palo Alto Healthcare System, Menlo Park, CA.
authors.forename: Jessica Y
authors.initials: JY
authors.lastname: Breland
authors.forename: Mark A
authors.initials: MA
authors.lastname: Greenbaum
authors.forename: Donna M
authors.initials: DM
authors.lastname: Zulman
authors.forename: Craig S
authors.initials: CS
authors.lastname: Rosen
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D006306:Health Surveys; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D011613:Psychotherapy; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology / Q000628:therapy*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology*