Transition from military to VHA care

Psychiatric health services for Iraq/Afghanistan combat-wounded

Laurel A. Copeland, John E. Zeber, Mona O. Bingham, Mary Jo Pugh, Polly H Noel, Eric R. Schmacker, Valerie A. Lawrence

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Objective: Veterans from the wars in Afghanistan and Iraq (OEF/OIF) report high rates of mental distress especially affective disorders. Ensuring continuity of care across institutions is a priority for both the Department of Defense (DoD) and the Veterans Health Administration (VHA), yet this process is not monitored nor are medical records integrated. This study assessed transition from DoD to VHA and subsequent psychiatric care of service members traumatically injured in OEF/OIF. Methods: Inpatients at a DoD trauma treatment facility discharged in FY02-FY06 (n = 994) were tracked into the VHA via archival data (n = 216 OEF/OIF veterans). Mental health utilization in both systems was analyzed. Results: VHA users were 9% female, 15% Hispanic; mean age 32 (SD = 10; range 19-59). No DoD inpatients received diagnoses of post-traumatic stress disorder (PTSD); 21% had other mental health diagnoses, primarily drug abuse. In the VHA, 38% sought care within 6 months of DoD discharge; 75% within 1 year. VHA utilization increased over time, with 88-89% of the transition cohort seeking care in FY07-FY09. Most accessed VHA mental health services (81%) and had VHA psychiatric diagnoses (71%); half met criteria for depression (27%) or PTSD (38%). Treatment retention through FY09 was significantly greater for those receiving psychiatric care: 98% vs 62% of those not receiving psychiatric care (x2 = 53.3; p < .001). Limitations: DoD outpatient data were not available. The study relied on administrative data. Conclusions: Although physical trauma led to hospitalization in the DoD, high rates of psychiatric disorders were identified in subsequent VHA care, suggesting delay in development or recognition of psychiatric problems.

Original languageEnglish (US)
Pages (from-to)226-230
Number of pages5
JournalJournal of Affective Disorders
Volume130
Issue number1-2
DOIs
StatePublished - Apr 2011

Fingerprint

Veterans Health
Afghanistan
Iraq
United States Department of Veterans Affairs
Health Services
Psychiatry
Delivery of Health Care
Veterans
Post-Traumatic Stress Disorders
Inpatients
Mental Health
Continuity of Patient Care
Wounds and Injuries
Mental Health Services
Mood Disorders
Hispanic Americans
Mental Disorders
Substance-Related Disorders
Medical Records
Hospitalization

Keywords

  • Combat disorders
  • Health services
  • Iraq War 2003-
  • Mental health services
  • Veterans

ASJC Scopus subject areas

  • Psychiatry and Mental health
  • Clinical Psychology

Cite this

Copeland, L. A., Zeber, J. E., Bingham, M. O., Pugh, M. J., Noel, P. H., Schmacker, E. R., & Lawrence, V. A. (2011). Transition from military to VHA care: Psychiatric health services for Iraq/Afghanistan combat-wounded. Journal of Affective Disorders, 130(1-2), 226-230. https://doi.org/10.1016/j.jad.2010.10.017

Transition from military to VHA care : Psychiatric health services for Iraq/Afghanistan combat-wounded. / Copeland, Laurel A.; Zeber, John E.; Bingham, Mona O.; Pugh, Mary Jo; Noel, Polly H; Schmacker, Eric R.; Lawrence, Valerie A.

In: Journal of Affective Disorders, Vol. 130, No. 1-2, 04.2011, p. 226-230.

Research output: Contribution to journalArticle

Copeland, LA, Zeber, JE, Bingham, MO, Pugh, MJ, Noel, PH, Schmacker, ER & Lawrence, VA 2011, 'Transition from military to VHA care: Psychiatric health services for Iraq/Afghanistan combat-wounded', Journal of Affective Disorders, vol. 130, no. 1-2, pp. 226-230. https://doi.org/10.1016/j.jad.2010.10.017
Copeland, Laurel A. ; Zeber, John E. ; Bingham, Mona O. ; Pugh, Mary Jo ; Noel, Polly H ; Schmacker, Eric R. ; Lawrence, Valerie A. / Transition from military to VHA care : Psychiatric health services for Iraq/Afghanistan combat-wounded. In: Journal of Affective Disorders. 2011 ; Vol. 130, No. 1-2. pp. 226-230.
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abstract = "Objective: Veterans from the wars in Afghanistan and Iraq (OEF/OIF) report high rates of mental distress especially affective disorders. Ensuring continuity of care across institutions is a priority for both the Department of Defense (DoD) and the Veterans Health Administration (VHA), yet this process is not monitored nor are medical records integrated. This study assessed transition from DoD to VHA and subsequent psychiatric care of service members traumatically injured in OEF/OIF. Methods: Inpatients at a DoD trauma treatment facility discharged in FY02-FY06 (n = 994) were tracked into the VHA via archival data (n = 216 OEF/OIF veterans). Mental health utilization in both systems was analyzed. Results: VHA users were 9{\%} female, 15{\%} Hispanic; mean age 32 (SD = 10; range 19-59). No DoD inpatients received diagnoses of post-traumatic stress disorder (PTSD); 21{\%} had other mental health diagnoses, primarily drug abuse. In the VHA, 38{\%} sought care within 6 months of DoD discharge; 75{\%} within 1 year. VHA utilization increased over time, with 88-89{\%} of the transition cohort seeking care in FY07-FY09. Most accessed VHA mental health services (81{\%}) and had VHA psychiatric diagnoses (71{\%}); half met criteria for depression (27{\%}) or PTSD (38{\%}). Treatment retention through FY09 was significantly greater for those receiving psychiatric care: 98{\%} vs 62{\%} of those not receiving psychiatric care (x2 = 53.3; p < .001). Limitations: DoD outpatient data were not available. The study relied on administrative data. Conclusions: Although physical trauma led to hospitalization in the DoD, high rates of psychiatric disorders were identified in subsequent VHA care, suggesting delay in development or recognition of psychiatric problems.",
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AU - Copeland, Laurel A.

AU - Zeber, John E.

AU - Bingham, Mona O.

AU - Pugh, Mary Jo

AU - Noel, Polly H

AU - Schmacker, Eric R.

AU - Lawrence, Valerie A.

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N2 - Objective: Veterans from the wars in Afghanistan and Iraq (OEF/OIF) report high rates of mental distress especially affective disorders. Ensuring continuity of care across institutions is a priority for both the Department of Defense (DoD) and the Veterans Health Administration (VHA), yet this process is not monitored nor are medical records integrated. This study assessed transition from DoD to VHA and subsequent psychiatric care of service members traumatically injured in OEF/OIF. Methods: Inpatients at a DoD trauma treatment facility discharged in FY02-FY06 (n = 994) were tracked into the VHA via archival data (n = 216 OEF/OIF veterans). Mental health utilization in both systems was analyzed. Results: VHA users were 9% female, 15% Hispanic; mean age 32 (SD = 10; range 19-59). No DoD inpatients received diagnoses of post-traumatic stress disorder (PTSD); 21% had other mental health diagnoses, primarily drug abuse. In the VHA, 38% sought care within 6 months of DoD discharge; 75% within 1 year. VHA utilization increased over time, with 88-89% of the transition cohort seeking care in FY07-FY09. Most accessed VHA mental health services (81%) and had VHA psychiatric diagnoses (71%); half met criteria for depression (27%) or PTSD (38%). Treatment retention through FY09 was significantly greater for those receiving psychiatric care: 98% vs 62% of those not receiving psychiatric care (x2 = 53.3; p < .001). Limitations: DoD outpatient data were not available. The study relied on administrative data. Conclusions: Although physical trauma led to hospitalization in the DoD, high rates of psychiatric disorders were identified in subsequent VHA care, suggesting delay in development or recognition of psychiatric problems.

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