Posttraumatic stress disorder screening status is associated with increased VA medical and surgical utilization in women

Mental Illness Research, Education and Clinical Center, University of Washington School of Medicine, Seattle, WA, USA.
Journal of General Internal Medicine (Impact Factor: 3.42). 03/2006; 21 Suppl 3(S3):S58-64. DOI: 10.1111/j.1525-1497.2006.00376.x
Source: PubMed


Women with posttraumatic stress disorder (PTSD) report poor health, but associations with health care utilization are understudied.
To determine associations between medical/surgical utilization and PTSD in female Veterans Affairs (VA) patients.
Prospective comparison of utilization rates between women screening positive or negative for PTSD on a mailed survey.
Women receiving care at an urban VA medical center between October 1996 and January 2000.
Survey responses, including a validated screen for PTSD (PCL-C), and VA utilization data through September 2002.
Two thousand five hundred and seventy-eight (2,578) women (78% of those eligible) completed the PCL-C; 858 (33%) of them screened positive for PTSD (PTSD+). In unadjusted models, PTSD+ women had higher rates of medical/surgical hospitalizations and surgical inpatient procedures. Among women ages 35 to 49, mean days hospitalized/100 patients/year was 43.4 (95% CI 26 to 61) for PTSD+ women versus 17.0 (16 to 18) for PTSD negative (PTSD-) women. More PTSD+ women underwent surgical procedures (P<.001). Mean annual outpatient visits were significantly higher among PTSD+ women, including: emergency department (ED) (1.1 [1.0 to 1.2] vs 0.6 [0.5 to 0.6]), primary care (3.2 [3.0 to 3.4] vs 2.2 [2.1 to 2.3]), medical/surgical subspecialists (2.1 [1.9 to 2.3] vs 1.5 [1.4 to 1.6]), ancillary services (4.1 [3.7 to 4.5] vs 2.4 [2.2 to 2.6]), and diagnostic tests (5.6 [5.1 to 6.1] vs 3.7 [3.4 to 4.0]). In multivariate models adjusted for demographics, smoking, service access, and medical comorbidities, PTSD+ women had greater likelihood of medical/surgical hospitalization (OR=1.37 [1.04 to 1.79]) and of being among the top quartile of patients for visits to the ED, primary care, ancillary services, and diagnostic testing.
Female veterans who screen PTSD+ receive more VA medical/surgical services. Appropriateness of that care deserves further study.

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Available from: Daniel Kivlahan, Jul 15, 2014
    • ", 2012 ) . In an earlier study , Dobie and colleagues ( 2006 ) found that women veterans with PTSD had higher inpatient / sur - gical utilization , increased risk of medical / surgical hospitaliza - tions , and greater numbers of outpatient clinic visits . Although the Veterans Health Administration ( VHA ) was ini - tially developed to support the health care needs of returning male veterans , the significant growth of women in the military over the past two decades has warranted much more focused attention to women ' s health care needs . "

    Traumatology 01/2015; DOI:10.1037/trm0000039
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    • "Studies from OEF/OIF and prior wars have demonstrated that mental disorders, particularly PTSD, are associated with higher rates of physical symptoms, chronic physical illness, and overall mortality.6,12–14 This increased burden of physical diseases may translate into greater non-mental health medical service utilization, as suggested by a study showing that PTSD was associated greater self-reported primary care visits in 2,863 OIF veterans 6 and by studies examining utilization in veterans of prior wars.11,15–19 Yet, mental disorders and their associated stigma and risk for social isolation and cognitive impairment may also act as barriers to medical treatment.16,20 "
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    • "Not surprisingly, people with PTSD use more health care services than those without PTSD. In a study of women seeking health care at Veterans' Administration facilities (Dobie et al., 2006), women with PTSD had more outpatient visits to the emergency department, primary care, medical or surgery subspecialities, ancillary services, and diagnostic tests. They had higher rates of hospitalizations and surgical procedures. "
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