The Quality of Mental Health Care for Veterans of Operation Enduring Freedom/Operation Iraqi Freedom
ABSTRACT BACKGROUND:: Some Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans experience serious mental health (MH) problems. As OEF/OIF soldiers leave active military duty, their growing numbers pose a challenge to the Department of Veterans Affairs (VA) in delivering high-quality mental health/substance-use disorder (MH/SUD) care. OBJECTIVE:: To determine whether the quality of MH/SUD care provided by the VA differs by OEF/OIF veteran status. METHODS:: Veterans with selected MH/SUDs were identified from administrative records using diagnostic codes. OEF/OIF service was determined based on Defense Manpower Data Center separation files. Eleven processes of care and 7 utilization performance indicators were examined. Regression analyses were adjusted for veteran demographic and clinical characteristics to test for differences in care by OEF/OIF status. RESULTS:: Of the 836,699 veterans with selected diagnoses who received MH/SUD treatment in FY2007, 52,870 (6.3%) were OEF/OIF veterans. In unadjusted analyses, OEF/OIF veterans were more likely to receive evidence-based care processes captured by 6 of the 11 dichotomous performance indicators examined; however, among those receiving psychotherapy encounters, OEF/OIF veterans received significantly fewer visits (6.9 vs. 9.7, P<0.0001). In adjusted analyses, only postdischarge follow-up remained meaningfully higher for OEF/OIF veterans. CONCLUSIONS:: Efforts to maintain and/or increase OEF/OIF veteran participation in VA MH/SUD services should be informed by their characteristics, such as younger age and better physical health relative to other veterans.
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ABSTRACT: Depressive disorders are a serious public health concern and treatment priority for the Veterans Health Administration. Computer-based Cognitive Behavioral Therapy (cCBT) is an effective intervention for patients with major depressive disorders; however, rates of program completion are an area of concern, which may be improved through the assistance of peers. This pilot study investigated the feasibility of a Veteran-peer assisted cCBT intervention. Participants were patients diagnosed with depression at an Outpatient Mental Health (OMH) or Primary Care Mental Health (PCMH) clinic at a single VHA facility. Participants were paired with a Veteran-peer and given access to a widely used cCBT program via the Internet. Measures of depressive symptoms were obtained at baseline, 4-, and 8-weeks follow-up. Completion rates and program satisfaction were also assessed. At 8 weeks, symptom reductions and completion rates were comparable to study results of brief individual, group CBT, and staff assisted computerized CBT interventions. Significant reductions in depressive symptoms were observed in patients from both clinics, although ratings of program usefulness, relevance, and ease of use were higher for individuals recruited from the PCMH clinic. Peer-assisted cCBT for depression is feasible but further research is needed to determine the clinical efficacy of this approach.Computers in Human Behavior 02/2014; 31:57–64. DOI:10.1016/j.chb.2013.10.012 · 2.27 Impact Factor