title: The Impact of Couple Therapy on Service Utilization among Military Veterans: The Moderating Roles of Pretreatment Service Utilization and Premature Termination.
abstract: Couple therapy reduces relational and individual distress and may affect utilization of other health services, particularly among higher service utilizers. Although average decreases in service utilization are predicted among recipients of couple therapy, low utilizers of services may appropriately increase use. The relationship between couple therapy and service utilization was examined among a sample of 179 U.S. military veterans who received treatment in Veterans Affairs (VA) specialty couple therapy clinics. Consistent with hypotheses, overall mental and physical health visits decreased from the 12 months preceding couple therapy to the 12 months following treatment. Moderator analyses showed that decreases were greatest among individuals who were rated by their therapist as having completed a full course of couple therapy, suggesting that change was attributable to intervention. Pretreatment service utilization also moderated observed change-higher utilizers' use of services decreased substantially, whereas lower utilizers' slightly increased. Cost analyses revealed that the estimated per person mean cost in our sample decreased by $930.33 in the year following compared to the year prior to couple therapy, as per 2008 VA cost data. As service utilization data were only available for one partner and only for 1 year posttherapy, the true magnitude of this effect may be underestimated. Our findings are relevant to policy makers as they demonstrate that couple therapy reduces average service utilization and associated costs and addresses calls for analyses of cost effectiveness of systemic interventions.
authors.affiliation: Department of Psychology, University of Calgary, Calgary, AB, Canada.
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Madsen
authors.affiliation: Departments of Psychology and Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
authors.forename: Lianne M
authors.initials: LM
authors.lastname: Tomfohr-Madsen
authors.affiliation: Department of Psychology, University of Miami, Coral Gables, FL.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Doss
mesh_terms: D000328:Adult; D019546:Couples Therapy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D057566:Self Report; D016896:Treatment Outcome; D014481:United States; D014728:Veterans / Q000523:psychology*
keywords: Cost Effectiveness; Couple Therapy; Medical Offset; Military Veterans; Service Utilization; compensación médica; costo-efectividad; terapia de pareja; utilización de servicios; veteranos de las fuerzas armadas; 伴侣心理治疗; 医务抵消; 成本效益; 服务使用; 退役老兵