title: Determinants of National Guard Mental Health Service Utilization in VA versus Non-VA Settings.
abstract: To determine associations between need, enabling, and predisposing factors with mental health service use among National Guard soldiers in the first year following a combat deployment to Iraq or Afghanistan.
  
  
  
  Primary data were collected between 2011 and 2013 from 1,426 Guard soldiers representing 36 units.
  
  
  
  Associations between Guard soldier factors and any mental health service use were assessed using multivariable logistic regression models in a cross-sectional study. Further analysis among service users (N = 405) assessed VA treatment versus treatment in other settings.
  
  
  
  Fifty-six percent of Guard soldiers meeting cutoffs on symptom scales received mental health services with 81 percent of those reporting care from the VA. Mental health service use was associated with need (mental health screens and physical health) and residing in micropolitan communities. Among service users, predisposing factors (middle age range and female gender) and enabling factors (employment, income above $50,000, and private insurance) were associated with greater non-VA services use.
  
  
  
  Overall service use was strongly associated with need, whereas sector of use (non-VA vs. VA) was insignificantly associated with need but strongly associated with enabling factors. These findings have implications for the recent extension of veteran health coverage to non-VA providers.
authors: Michigan Public Health Institute, Okemos, MI. lgorman@mphi.org.
authors: Lisa A
authors: LA
authors: Gorman
authors: Department of Psychiatry, University of Michigan, Ann Arbor, MI.|VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI.
authors: Rebecca K
authors: RK
authors: Sripada
authors: VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI.
authors: Dara
authors: D
authors: Ganoczy
authors: VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI.
authors: Heather M
authors: HM
authors: Walters
authors: Department of Psychiatry, University of Michigan, Ann Arbor, MI.|VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI.
authors: Kipling M
authors: KM
authors: Bohnert
authors: Department of Psychiatry, University of Michigan, Ann Arbor, MI.|VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI.
authors: Gregory W
authors: GW
authors: Dalack
authors: Department of Psychiatry, University of Michigan, Ann Arbor, MI.|VA Center for Clinical Management Research, Ann Arbor Health Care System, Ann Arbor, MI.
authors: Marcia
authors: M
authors: Valenstein
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008889:Military Personnel / Q000706:statistics & numerical data*; D011331:Private Practice / Q000706:statistics & numerical data*; D014481:United States
keywords: Mental health; VA health care system; access; utilization of services