Publication year
2013
Citation Title
Predictors of Operation Enduring Freedom/Operation Iraqi Freedom veterans' engagement in mental health treatment.
Journal Name
Military Medicine
Journal Volume
178
Issue Number
11
Page Numbers
1183-1187
DOI
10.7205/MILMED-D-13-00245
Summary
Medical records of 429 Veterans were examined to determine predictors of initial engagement and treatment retention in mental health services at a southwestern VA medical center. The data were obtained from post-deployment intake surveys of Veterans of Operation Iraqi Freedom and Operation Enduring Freedom (OIF/OEF) between September 2007 and January 2010. Results showed the best predictor for initial engagement and retention in mental health services was the number of diagnoses; the higher the number of diagnoses, the more likely Service members were to engage and stay in treatment.
Key Findings
Based on the chart review, 72% of the sample (429 out of 600 Veterans) was diagnosed with some psychiatric disorder.
Of those with a diagnosis, 53% of the Veterans attended at least one appointment within the year. However, only 26% of the Veterans attended eight or more appointments within the year.
Factors which strongly predicted initial engagement include multiple psychiatric diagnoses, higher poly-trauma exposure, and longer length of time since military separation.
Treatment retention was positively associated with Veteran age and number of psychiatric diagnoses.
Implications for Program Leaders
Facilitate outreach efforts to ensure Service members and their families are aware of potentially useful services
Offer pre- and post-deployment support groups for deployed Service members and their families
Engage Service members and their partners in classes that aim to increase communication and conflict-resolution skills prior to and after deployment
Implications for Policy Makers
Continue to support the development and evaluation of novel treatment engagement and retention strategies
Continue to support programs that address the unique challenges faced by military families with a deployed Service member
Recommend training for community providers to educate them about unique factors that contribute to marital strain for military couples
Methods
Electronic medical records of 429 OIF/OEF Veterans were reviewed from a large southwest VA medical center.
The Mental Health Assessment and a semi structured interview was used to measure Veterans’ psychiatric medical history.
Statistical analyses were used to determine predictors of initial engagement and to analyze variables to predict sustainability of engagement.
Participants
Four hundred twenty-nine Veterans from OIF/OEF who completed the post-deployment intake between September 2007 and January 2010 participated in the study.
Ninety percent of the sample were male. The following was the race/ethnicity of the sample: 44% Latino, 39% White, 10% Native American, 4% Black, 2% Asian-American, and 1% Other.
No information was presented about specific military branches or military ranks.
Limitations
Results should be interpreted with caution because the rate of mental health diagnosis in the sample was twice that of the national OIF/OEF Veteran populations.
Ability to generalize the data was limited because participants were already authorized to receive treatment at the VA and agreed to attend the intake clinic.
Veterans not included in the sample (those not seeking care at the VA, unwilling to engage in treatment, etc.) may be significantly different than those who did participate in the study and this potential difference was not accounted for in the analyses.
Avenues for Future Research
Examine factors that improve initial engagement and retention across a broader range of Service members and in different settings, both the VA and the private sector
Replicate this study using different subgroups of Service members, such as women, Service members from different military branches, etc.
Gather qualitative data (e.g., interviews) that explores Service members' reasons for engaging or not engaging in mental health services
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
Although the prevalence of mental health disorders in troops serving in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) is high, many OEF/OIF veterans appear to refuse or delay mental health treatment. To examine psychological and psychosocial predictors of engagement, this pilot study examined eight factors: age, ethnicity, gender, polytrauma status, time since military separation, alcohol use, substance use, and psychiatric comorbidity. Structured clinical interviews given to all OEF/OIF veterans enrolling at a large Veterans Affairs health care center from 2007 to 2010 were examined, as were all psychiatric visits for the next year. Surprisingly, 72% of the sample (N = 600) was diagnosed with a psychiatric disorder. Of those (n = 429), the majority agreed to an initial mental health referral and attended at least one appointment within the year (n = 229, 53%), but only a quarter ( n = 113, 26%) attended eight or more appointments. Multinomial regression analysis indicated that psychiatric comorbidity, polytrauma exposure, and time since military separation were the best predictors of initial engagement in needed mental health treatment, and psychiatric comorbidity and age were the best predictors of treatment retention. Findings suggest that Veterans Affairs may further improve engagement by attending to time since separation.
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