Symptom severity and lifetime and prospective health service use among military veterans evaluated for PTSD (original) (raw)
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The Journal of Rehabilitation Research and Development, 2008
This study used structural equation modeling (SEM) to evaluate the relative strength of associations between combat exposure, four posttraumatic stress disorder (PTSD) symptom factors, and functional impairment as indexed by Global Assessment of Functioning (GAF) scores in a sample of 315 veterans assessed at a Department of Veterans Affairs PTSD clinic. Results showed that the association between combat exposure and GAF scores was fully mediated by PTSD severity. The bestfitting model included direct paths from combat exposure to reexperiencing symptoms and from avoidance and numbing symptoms to GAF. However, only 17% of variance in GAF was accounted for by PTSD. The results raise concern about the use of the GAF score as a benchmark for quantifying combat PTSDrelated functional impairment.
Posttraumatic Stress Disorder and the Use of Health Services
Psychosomatic Medicine, 2001
Prior research has demonstrated increased use of medical services among persons with anxiety and depression. This investigation examined the possible association of posttraumatic stress disorder (PTSD) with the use of nonmental health services. Method: A case-comparison design enrolled 102 high users of health services and 54 low users who were assessed for PTSD diagnosis and severity of PTSD symptoms. Subjects were male veterans receiving services from the primary care clinics of the VA Boston Healthcare System during an 18-month period. Data were collected by interview by use of standardized instruments including the Clinician Administered PTSD Scale for DSM-IV, the Life Events Checklist, and the Beck Depression Inventory. Data analysis employed odds ratios, linear and logistic regression, and path analyses. Results: High users of health care were almost twice as likely as low users (27.5% vs. 14.8%) to meet diagnostic criteria for current PTSD. The two groups differed significantly on both symptom frequency and intensity. Path analyses showed an indirect positive association between PTSD and health services use, with physician-diagnosed health conditions as a mediating variable. Auxiliary analysis demonstrated that the combined mental health burden of PTSD and depression symptoms also is positively associated with number of health conditions. Conclusions: The findings indicate that PTSD, alone and in combination with depression, has a direct negative relationship with physical health that, in turn, is associated with more frequent use of primary health care services. These results do not suggest that PTSD leads to inappropriate (eg, distress-motivated) use of services.
Longitudinal patterns of care for patients with posttraumatic stress disorder
Journal of traumatic …, 1996
This study assessed patterns of mental health service use over time by patients with posttraumatic stress disorder (PTSD) --as compared with patients with schizophrenia and major depression --with emphasis on the persistence and episodic versus continuous nature of use. Data on utilization were extracted from Veterans Health Administration (VA) administrative data bases. Temporal patterns of use were categorized into intervals of inpatient, outpatient, and no use. PTSD patients used substantial amounts of mental health services, but averaged 2.2 nonuse intervals lasting more than 100 days each, implying that use was episodic. Use of mental health services by patients with PTSD is substantia~ persistent, and quite episodic. To the extent that use of services reflects the course of the disorder, the results suggest that remissions are usually followed by relapse, and that absence of symptoms does not mean that the disorder has run its course.
Background: Critics fear that some Veterans use Department of Veterans Affairs (VA) mental health services solely to establish eligibility for posttraumatic stress disorder (PTSD) disability benefits, then drop out of treatment once their claim is approved. Objective: To examine the long-term effects of receiving VA disability benefits for PTSD on health care in the VA system. Methods: Using VA administrative data, we examined the health care utilization of a nationally representative cohort of former PTSD disability claimants. Veterans filed PTSD disability claims between 1994 and 1998. They returned mailed surveys between 1998 and 2000 (Time 1) and between 2004 and 2006 (Time 2). We examined their health care utilization for the 6 months before and after they received their surveys, comparing the health care use of successful claimants (SC+) to unsuccessful claimants (SC-). Results: Of the 3,337 Veterans in the cohort, 3,090 had at least one episode of care at a VA facility during...
Psychiatric Services, 2010
Despite the high prevalence of posttraumatic stress disorder (PTSD) among veterans treated at Department of Veterans Affairs (VA) facilities, rates of initiation of mental health treatment and persistence in treatment are unknown. This study examined outpatient treatment participation among veterans with a recent PTSD diagnosis and treatment differences according to the VA sector in which they received the diagnosis (PTSD specialty treatment program, general mental health clinic, and general medical clinic). Methods: Administrative data for 20,284 veterans who had received a diagnosis of PTSD at VA facilities were analyzed to determine rates of treatment initiation (any psychotropic prescription, an antidepressant prescription, behavioral counseling, and either a prescription or counseling) and maintenance of pharmacotherapy (at least four 30-day supplies), and counseling (at least eight visits) for the six months after diagnosis. Results: Approximately two-thirds of the sample initiated treatment: 50% received a psychotropic medication and 39% received some counseling; 64% received either medication or counseling. About half of those given medication (54%) received at least a four-month supply, and 24% of those given counseling had at least eight sessions. Overall, 33% received minimally adequate treatment. Initiation, type, and duration varied by treatment sector: receipt of a diagnosis in a PTSD specialty program or a mental health clinic conferred small but significant benefits over receipt in a general medical clinic. Conclusions: Greater availability of mental health specialty services, particularly PTSD services, may be needed to ensure that veterans receive minimally adequate treatment after a PTSD diagnosis. (Psychiatric Services 61:58-63, 2010)
Journal of traumatic stress, 2016
We examined the longitudinal course of primary care patients in the active duty Army with posttraumatic stress disorder (PTSD) and identified prognostic indicators of PTSD severity. Data were drawn from a 6-site randomized trial of collaborative primary care for PTSD and dpression in the military. Subjects were 474 soldiers with PTSD (scores ≥ 50 on the PTSD Checklist -Civilian Version). Four assessments were completed at U.S. Army installations: baseline, and follow-ups at 3 months (92.8% response rate [RR]), 6 months (90.1% RR), and 12 months (87.1% RR). Combat exposure and 7 validated indicators of baseline clinical status (alcohol misuse, depression, pain, somatic symptoms, low mental health functioning, low physical health functioning, mild traumatic brain injury) were used to predict PTSD symptom severity on the Posttraumatic Diagnostic Scale (Cronbach's α = .87, .92, .95, .95, at assessments 1-4, respectively). Growth mixture modeling identified 2 PTSD symptom trajectorie...
Journal of Psychiatric Research, 2019
The current study examined the nature and correlates of seven-year posttraumatic stress disorder (PTSD) symptom courses in a nationally representative, prospective cohort of U.S. military veterans. Data were analyzed from 2,307 trauma-exposed veterans who completed at least one follow-up assessment over a 7-year period, a subsample of n = 3,157 veterans who participated in the first wave of the National Health and Resilience in Veterans Study. Latent growth mixture modeling (LGMM) was used to identify PTSD symptom courses over four survey waves conducted in 2011, 2013, 2015, and 2018. Sociodemographic, health, and psychosocial variables were examined as potential correlates of symptomatic trajectories. PTSD symptoms were best characterized by three courses: No/Low (89.2%), Moderate Symptom (7.6%), and High Symptom (3.2%). Relative to the No/Low Symptom course, symptomatic courses were positively associated with a greater number of lifetime traumatic events, higher scores on measures of physical health difficulties and lifetime psychiatric history (relative risk ratio [RRR] range = 1.19-2.74), and were negatively associated with time since index trauma, household income, and social connectedness (RRR range = 0.14-0.97). Veterans in the Moderate Symptom course additionally had lower scores on a measure of protective psychosocial characteristics (RRR = 0.78) and were more likely to have received mental health treatment (RRR = 1.62), while those in the High PTSD Symptom course were more likely to be exposed to combat and to more traumas since Wave 1 (RRR range = 1.23-4.63). Three PTSD symptom courses in U.S. veterans were identified, with more than 10% of veterans exhibiting a moderate or high symptom course. Prevention and treatment efforts targeting modifiable correlates, such as social connectedness, may help mitigate symptomatic PTSD symptom courses in this population.
Prevalence of PTSD symptoms in combat veterans seeking medical treatment
Journal of Traumatic Stress, 1990
Results from recent research point to the need to screen and assess for PTSD in medical as well as psychiatric patients, and to broaden the scope of assessment to include combat veterans of other recent wars, e.g., World War H and Korea. The present study was designed to obtain the following information: (1) the degree to which PTSD symptomatology is present in veterans who are inpatients on medical units, (2) the respective rates of PTSD symptoms and psychological distress of combat veterans from Korea, and Vietnam, and (3) the extent and nature of psychological disturbance, as measured by the paper and pencil tests, across the three military time periods. One hundred and sixty-one nonpsychiatric combat and former PO W veteran patients served as subjects, with 70.2 % having served in World War II, 13.1% having served in Korea, and 16.8% having served in Vietnam. All subjects completed a questionnaire packet which included a demographic data sheet, the Mississippi Scale for Combat-related PTSD, the Symptom Checklist-90-Revised, and the Combat Exposure Scale. Resuits of the study showed a 24% overall PTSD rate, as determined by subjects" scores on the Mississippi scale. While no differences in combat exposure were found among three war groups, psychiatric disturbance was most apparent among Vietnam veterans. A combination of demographic and psychological factors was found to accurately predict PTSD status. These