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

ABSTRACT 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.

Download full-text


Available from: Daniel Kivlahan, Jul 15, 2014
1 Follower
17 Reads
  • Source
    • "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 "
    [Show abstract] [Hide abstract]
    ABSTRACT: Over 35% of returned Iraq and Afghanistan veterans in VA care have received mental health diagnoses; the most prevalent is post-traumatic stress disorder (PTSD). Little is known about these patients' use of non-mental health medical services and the impact of mental disorders on utilization. To compare utilization across three groups of Iraq and Afghanistan veterans: those without mental disorders, those with mental disorders other than PTSD, and those with PTSD. National, descriptive study of 249,440 veterans newly utilizing VA healthcare between October 7, 2001 and March 31, 2007, followed until March 31, 2008. We used ICD9-CM diagnostic codes to classify mental health status. We compared utilization of outpatient non-mental health services, primary care, medical subspecialty, ancillary services, laboratory tests/diagnostic procedures, emergency services, and hospitalizations during veterans' first year in VA care. Results were adjusted for demographics and military service and VA facility characteristics. Veterans with mental disorders had 42-146% greater utilization than those without mental disorders, depending on the service category (all P < 0.001). Those with PTSD had the highest utilization in all categories: 71-170% greater utilization than those without mental disorders (all P < 0.001). In adjusted analyses, compared with veterans without mental disorders, those with mental disorders other than PTSD had 55% higher utilization of all non-mental health outpatient services; those with PTSD had 91% higher utilization. Female sex and lower rank were also independently associated with greater utilization. Veterans with mental health diagnoses, particularly PTSD, utilize significantly more VA non-mental health medical services. As more veterans return home, we must ensure resources are allocated to meet their outpatient, inpatient, and emergency needs.
    Journal of General Internal Medicine 09/2009; 25(1):18-24. DOI:10.1007/s11606-009-1117-3 · 3.42 Impact Factor
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    ABSTRACT: People who have experienced traumatic events have higher rates than the general population of a wide range of serious and life-threatening illnesses including cardiovascular disease, diabetes, gastrointestinal disorders, and cancer. An important question, for both researchers and clinicians, is why this occurs. Researchers have discovered that traumatic events dysregulate the hypothalamic-pituitary-adrenal axis and sympathetic nervous system. More recently, research from the field of psychoneuroimmunology (PNI) suggests that traumatic life events can lead to health problems through dysregulation of another key system: the inflammatory response. Prior trauma “primes” the inflammatory response system so that it reacts more rapidly to subsequent life stressors. Elevated inflammation has an etiologic role in many chronic illnesses. Recent PNI studies also suggest some interventions that can serve as adjuncts to traditional trauma treatment. These treatments include long-chain omega-3 fatty acids, exercise, and sleep interventions. Each of these interventions downregulates inflammation, which will likely halt the progression to chronic disease for some trauma survivors. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
    Psychological Trauma Theory Research Practice and Policy 02/2009; 1(1):35-48. DOI:10.1037/a0015128 · 2.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Assessment of women veterans' health needs and preferences and their care environment have been identified as a priority research need by the national Veterans Affairs (VA) Women's Health research agenda. Our objective was to identify women veterans' health care preferences and perceptions associated with sole or dual VA health care use. This cross-sectional study of 1,002 VA-enrolled Midwestern veterans was performed by computer-assisted telephone interviews. Sole and dual (both VA and non-VA) users of VA care were more likely to have served in a combat area, have a current diagnosis of posttraumatic stress disorder, and poorer physical health scores than non-VA users. Non-VA users were more likely to be married and have private health insurance. Sole VA users were more likely to want a choice of a male or female health care provider. Both sole and dual VA users believed that the VA provides adequate privacy and safety during outpatient examinations compared with non-users. Urban women veterans were more likely to endorse specific environment of care preferences such as gender-specific waiting areas compared with rural veterans. Care preferences were similar regardless of VA use; however, perceptions of VA care varied. Women using VA care solely had the most positive perceptions of VA care, followed by dual users then non-VA users. Rural women were similar to urban veterans, but were less likely to endorse specific care preferences. Considering these differences with regard to need and access can inform VA policy and initiatives on improving access to and use of VA care among women veterans in urban and rural areas.
    Women s Health Issues 07/2011; 21(4 Suppl):S120-9. DOI:10.1016/j.whi.2011.04.021 · 1.61 Impact Factor
Show more