title: Surveying treatment preferences in U.S. Iraq-Afghanistan Veterans with PTSD symptoms: a step toward veteran-centered care.
abstract: This study examined health care barriers and preferences among a self-selected sample of returning U.S. veterans drawn from a representative, randomly selected frame surveyed about posttraumatic stress disorder (PTSD) symptomatology and mental health utilization in the prior year. Comparisons between treated (n = 160) and untreated (n = 119) veterans reporting PTSD symptoms were conducted for measures of barriers and preferences, along with logistic models regressing mental health utilization on clusters derived from these measures. Reported barriers corroborated prior research findings as negative beliefs about treatment and stigma were strongly endorsed, but only privacy concerns were associated with lower service utilization (B = -0.408, SE = 0.142; p = .004). The most endorsed preference (91.0%) was for assistance with benefits, trailed by help for physical problems, and particular PTSD symptoms. Help-seeking veterans reported stronger preferences for multiple interventions, and desire for services for families (B = 0.468, SE = 0.219; p = .033) and specific PTSD symptoms (B = 0.659, SE = 0.302; p = .029) were associated with increased utilization. Outcomes of the study suggested PTSD severity drove help-seeking in this cohort. Results also support the integration of medical and mental health services, as well as coordination of health and benefits services. Finally, the study suggested that outreach about privacy protections and treatment options could well improve engagement in treatment.
authors.affiliation: VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, Durham, North Carolina, USA; Duke University Medical Center, Department of Psychiatry & Behavioral Sciences, Durham, North Carolina, USA.
authors.forename: Eric F
authors.initials: EF
authors.lastname: Crawford
authors.forename: Eric B
authors.initials: EB
authors.lastname: Elbogen
authors.forename: H Ryan
authors.initials: HR
authors.lastname: Wagner
authors.forename: Harold
authors.initials: H
authors.lastname: Kudler
authors.forename: Patrick S
authors.initials: PS
authors.lastname: Calhoun
authors.forename: Mira
authors.initials: M
authors.lastname: Brancu
authors.forename: Kristy A
authors.initials: KA
authors.lastname: Straits-Troster
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D005196:Family Therapy; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D057240:Patient Preference; D018802:Patient-Centered Care; D018907:Privacy; D012720:Severity of Illness Index; D057545:Social Stigma; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy*; D014481:United States; D014728:Veterans / Q000523:psychology*