title: Prevalence, Comorbidity, and Prognosis of Mental Health Among US Veterans.
abstract: OBJECTIVE
  We evaluated the association of mental illnesses with clinical outcomes among US veterans and evaluated the effects of Primary Care-Mental Health Integration (PCMHI).
  
  
  METHODS
  A total of 4 461 208 veterans were seen in the Veterans Health Administration's patient-centered medical homes called Patient Aligned Care Teams (PACT) in 2010 and 2011, of whom 1 147 022 had at least 1 diagnosis of depression, posttraumatic stress disorder (PTSD), substance use disorder (SUD), anxiety disorder, or serious mental illness (SMI; i.e., schizophrenia or bipolar disorder). We estimated 1-year risk of emergency department (ED) visits, hospitalizations, and mortality by mental illness category and by PCMHI involvement.
  
  
  RESULTS
  A quarter of all PACT patients reported 1 or more mental illnesses. Depression, SMI, and SUD were associated with increased risk of hospitalization or death. PTSD was associated with lower odds of ED visits and mortality. Having 1 or more contact with PCMHI was associated with better outcomes.
  
  
  CONCLUSIONS
  Mental illnesses are associated with poor outcomes, but integrating mental health treatment in primary care may be associated with lower risk of those outcomes.
authors.affiliation: Ranak B. Trivedi is with the Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA. Haili Sun, Andrew J. Saxon, Charles Maynard, Idamay Curtis, and Karin Nelson are with the VA Puget Sound Health Care System, Seattle, WA. Edward P. Post and John D. Piette are with the Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI. Andrew Pomerantz is with the VA Mental Health Services, Washington, DC. Bruce Arnow is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA. Stephan D. Fihn is with the Office of Analytics and Business Informatics, Seattle.
authors.forename: Ranak B
authors.initials: RB
authors.lastname: Trivedi
authors.affiliation: Ranak B. Trivedi is with the Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA. Haili Sun, Andrew J. Saxon, Charles Maynard, Idamay Curtis, and Karin Nelson are with the VA Puget Sound Health Care System, Seattle, WA. Edward P. Post and John D. Piette are with the Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI. Andrew Pomerantz is with the VA Mental Health Services, Washington, DC. Bruce Arnow is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA. Stephan D. Fihn is with the Office of Analytics and Business Informatics, Seattle.
authors.forename: Edward P
authors.initials: EP
authors.lastname: Post
authors.affiliation: Ranak B. Trivedi is with the Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA. Haili Sun, Andrew J. Saxon, Charles Maynard, Idamay Curtis, and Karin Nelson are with the VA Puget Sound Health Care System, Seattle, WA. Edward P. Post and John D. Piette are with the Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI. Andrew Pomerantz is with the VA Mental Health Services, Washington, DC. Bruce Arnow is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA. Stephan D. Fihn is with the Office of Analytics and Business Informatics, Seattle.
authors.forename: Haili
authors.initials: H
authors.lastname: Sun
authors.affiliation: Ranak B. Trivedi is with the Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA. Haili Sun, Andrew J. Saxon, Charles Maynard, Idamay Curtis, and Karin Nelson are with the VA Puget Sound Health Care System, Seattle, WA. Edward P. Post and John D. Piette are with the Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI. Andrew Pomerantz is with the VA Mental Health Services, Washington, DC. Bruce Arnow is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA. Stephan D. Fihn is with the Office of Analytics and Business Informatics, Seattle.
authors.forename: Andrew
authors.initials: A
authors.lastname: Pomerantz
authors.affiliation: Ranak B. Trivedi is with the Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA. Haili Sun, Andrew J. Saxon, Charles Maynard, Idamay Curtis, and Karin Nelson are with the VA Puget Sound Health Care System, Seattle, WA. Edward P. Post and John D. Piette are with the Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI. Andrew Pomerantz is with the VA Mental Health Services, Washington, DC. Bruce Arnow is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA. Stephan D. Fihn is with the Office of Analytics and Business Informatics, Seattle.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Saxon
authors.affiliation: Ranak B. Trivedi is with the Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA. Haili Sun, Andrew J. Saxon, Charles Maynard, Idamay Curtis, and Karin Nelson are with the VA Puget Sound Health Care System, Seattle, WA. Edward P. Post and John D. Piette are with the Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI. Andrew Pomerantz is with the VA Mental Health Services, Washington, DC. Bruce Arnow is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA. Stephan D. Fihn is with the Office of Analytics and Business Informatics, Seattle.
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.affiliation: Ranak B. Trivedi is with the Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA. Haili Sun, Andrew J. Saxon, Charles Maynard, Idamay Curtis, and Karin Nelson are with the VA Puget Sound Health Care System, Seattle, WA. Edward P. Post and John D. Piette are with the Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI. Andrew Pomerantz is with the VA Mental Health Services, Washington, DC. Bruce Arnow is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA. Stephan D. Fihn is with the Office of Analytics and Business Informatics, Seattle.
authors.forename: Charles
authors.initials: C
authors.lastname: Maynard
authors.affiliation: Ranak B. Trivedi is with the Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA. Haili Sun, Andrew J. Saxon, Charles Maynard, Idamay Curtis, and Karin Nelson are with the VA Puget Sound Health Care System, Seattle, WA. Edward P. Post and John D. Piette are with the Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI. Andrew Pomerantz is with the VA Mental Health Services, Washington, DC. Bruce Arnow is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA. Stephan D. Fihn is with the Office of Analytics and Business Informatics, Seattle.
authors.forename: Bruce
authors.initials: B
authors.lastname: Arnow
authors.affiliation: Ranak B. Trivedi is with the Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA. Haili Sun, Andrew J. Saxon, Charles Maynard, Idamay Curtis, and Karin Nelson are with the VA Puget Sound Health Care System, Seattle, WA. Edward P. Post and John D. Piette are with the Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI. Andrew Pomerantz is with the VA Mental Health Services, Washington, DC. Bruce Arnow is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA. Stephan D. Fihn is with the Office of Analytics and Business Informatics, Seattle.
authors.forename: Idamay
authors.initials: I
authors.lastname: Curtis
authors.affiliation: Ranak B. Trivedi is with the Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA. Haili Sun, Andrew J. Saxon, Charles Maynard, Idamay Curtis, and Karin Nelson are with the VA Puget Sound Health Care System, Seattle, WA. Edward P. Post and John D. Piette are with the Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI. Andrew Pomerantz is with the VA Mental Health Services, Washington, DC. Bruce Arnow is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA. Stephan D. Fihn is with the Office of Analytics and Business Informatics, Seattle.
authors.forename: Stephan D
authors.initials: SD
authors.lastname: Fihn
authors.affiliation: Ranak B. Trivedi is with the Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, CA. Haili Sun, Andrew J. Saxon, Charles Maynard, Idamay Curtis, and Karin Nelson are with the VA Puget Sound Health Care System, Seattle, WA. Edward P. Post and John D. Piette are with the Center for Clinical Management Research, VA Ann Arbor Health Care System, Ann Arbor, MI. Andrew Pomerantz is with the VA Mental Health Services, Washington, DC. Bruce Arnow is with the Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA. Stephan D. Fihn is with the Office of Analytics and Business Informatics, Seattle.
authors.forename: Karin
authors.initials: K
authors.lastname: Nelson
mesh_terms: D001008:Anxiety Disorders / Q000453:epidemiology; D001714:Bipolar Disorder / Q000453:epidemiology; D015897:Comorbidity; D003863:Depression / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology*; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D012559:Schizophrenia / Q000453:epidemiology; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*