Article

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

Full-text

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 . "

    No preview · Article · Jan 2015 · Traumatology
  • Source
    • "PTSD is an anxiety disorder induced by exposure to a life-threatening traumatic event [67]. Compared with non-traumatized individuals, PTSD patients have a higher utilization of medical services and are at an increased risk for developing cardiovascular and cancer diseases [68] [69]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Neuroinflammation is a common characteristic of many neurodegenerative conditions including Alzheimer's disease (AD), amyotrophic lateral sclerosis (ALS), stroke, and epilepsy. Neuroinflammation is also associated with mental health conditions such as depression, bipolar disorder, posttraumatic stress disorder (PTSD), and schizophrenia. Recent evidence suggests that individuals with these conditions have inflammatory and oxidative processes in the brain, which are susceptible to being alleviated by analgesic, anti-inflammatory, pro-neurogenic, and pro-neurotrophic treatments. The neuroinflammatory process in the brain is characterized by the activation of glial cells, changes in glucose metabolism and perfusion, and the activation of several pro-inflammatory factors. Such factors include the eicosanoids, cRaf-1, nuclear factor kappa B (NF-κB), cycloxygenase-2 (Cox-2), tumor necrosis factor-α (TNF-α), interleukins, and the inducible nitric oxide synthase (iNOS). The activation of individual factors such as NF-κB can further increase the expression of other pro-inflammatory "partners in crime" including interleukins, eicosanoids, and iNOS. For example, the inhibition of the cRaf-1/NF-κB signaling pathway protects neurons against amyloid β peptide (Aβ) toxicity, considered the main cause of neurodegeneration in AD. Moreover, the multikinase and cRaf-1 inhibitor sorafenib restored memory and inhibited the expression of amyloid precursor protein (APP), NF-κB, Cox-2, and iNOS in the brains of transgenic AD mice. In this chapter, we will discuss potential benefits of targeting neuroinflammatory factors for the treatment of psychiatric and neurological disorders.
    Full-text · Article · Oct 2012
  • 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.
    Full-text · Article · Sep 2009 · Journal of General Internal Medicine
Show more