Publication year
2007
Citation Title
Bringing the war back home: Mental health disorders among 103,788 US Veterans returning from Iraq and Afghanistan seen at Department of Veterans Affairs facilities.
Journal Name
Archives of Internal Medicine
Journal Volume
167
Issue Number
5
Page Numbers
476-482
DOI
10.1001/archinte.167.5.476
Summary
It is important to understand mental health concerns among OEF/OIF Veterans in order for the Veterans Affairs (VA) department to better treat these individuals. Prevalence and care for mental health diagnoses were explored among a national sample of OEF/OIF Veterans receiving VA mental health care. One quarter of Veterans received a mental health diagnosis, most commonly posttraumatic stress disorder (PTSD), and a majority were first diagnosed in non-mental health settings.
Key Findings
Of participating Veterans, 25% had at least one mental health diagnosis, the most common of which was PTSD (13%).
The majority of Veterans' mental health diagnoses were made in non-mental health settings (60%), with 42% made in primary care settings; Most Veterans diagnosed in a non-mental health setting went on to have a mental health visit (61%).
Younger Veterans were at increased risk for PTSD and other mental health diagnoses compared to older Veterans.
Implications for Program Leaders
Disseminate information to Service members and their families about VA and community mental health support groups, especially post-deployment
Collaborate with mental health organizations to provide mental health screenings for recently returning Service members
Provide classes for Service members who have received a mental health diagnosis to educate them about symptoms, comorbidity, impacts on functioning, and available resources
Implications for Policy Makers
Continue to support integrated behavioral health programs that incorporate mental health specialists into non-mental health settings
Recommend increased outreach to younger Service members to promote early intervention of mental health problems
Encourage professional education for community primary care providers to learn about PTSD and related disorders so they can facilitate early identification and treatment
Methods
National VA databases were reviewed for Veterans who initiated treatment at the VA from 2001 to 2005.
Mental health diagnostic information associated with outpatient or inpatient clinic visits was obtained from medical records.
Analyses computed the prevalence and relative risks of mental health diagnoses among OEF/OIF Veterans.
Participants
Participants included 103,778 OEF/OIF Veterans (87% male, 76% 18-40 years of age) accesing VA treatment from 2001-2005 nationwide.
Veterans identified as White (69%), Black (18%), Latino (11%), or another race (2%), and they indicated they were 47% never married, 43% married, and 10% seperated, divorced, or widowed.
Participants were 52% Active Duty and 48% National Guard or Reserves members.
Limitations
Several potentially important confounding variables (e.g., military branch, rank, and combat history) were not evaluated.
Since only 29% of OEF/OIF Veterans had accessed VA care at the time of the study, the results may not generalize to all Veterans.
Mental health diagnoses were derived from chart review, and several different providers made diagnoses; however, there was no measure of inter-rater reliability of diagnoses, potentially introducing error.
Avenues for Future Research
Investigate the prevalence and relative risk of mental health diagnoses in Veterans who are not part of the VA system and may be receiving mental health services elsewhere
Examine the role of military characteristics (e.g., branch, rank, combat experience) on the prevalence and relative risk of mental health disorders among Service members
Conduct studies with long-term follow-up to understand how Veterans continue to utilize VA health care over time and whether some Veterans wait long periods of time before seeking treatment
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Background Veterans of Operations Enduring Freedom and Iraqi Freedom (OEF/OIF) have endured high combat stress and are eligible for two years of free military service–related health care through the Department of Veterans Affairs (VA) health care system, yet little is known about the burden and clinical circumstances of mental health diagnoses among OEF/OIF veterans seen at VA facilities. Methods US veterans separated from OEF/OIF military service and first seen at VA health care facilities between September 30, 2001 (US invasion of Afghanistan), and September 30, 2005, were included. Mental health diagnoses and psychosocial problems were assessed using International Classification of Diseases, Ninth Revision, Clinical Modification codes. The prevalence and clinical circumstances of and subgroups at greatest risk for mental health disorders are described herein. Results Of 103,788 OEF/OIF veterans seen at VA health care facilities, 25,658 (25%) received mental health diagnosis(es); 56% of whom had 2 or more distinct mental health diagnoses. Overall, 32,010 (31%) received mental health and/or psychosocial diagnoses. Mental health diagnoses were detected soon after the first VA clinic visit (median of 13 days), and most initial mental health diagnoses (60%) were made in nonmental health clinics, mostly primary care settings. The youngest group of OEF/OIF veterans (age, 18-24 years) were at greatest risk for receiving mental health or posttraumatic stress disorder diagnoses compared with veterans 40 years or older. Conclusions Co-occurring mental health diagnoses and psychosocial problems were detected early and in primary care medical settings in a substantial proportion of OEF/OIF veterans seen at VA facilities. Targeted early detection and intervention beginning in primary care settings are needed to prevent chronic mental illness and disability.
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