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Psychiatr Serv. 2019 May 1;70(5):358-366. doi: 10.1176/ Epub 2019 Mar 7.

Mental Health Treatment Delay: A Comparison Among Civilians and Veterans of Different Service Eras.

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Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer).



The study compared delay of treatment for posttraumatic stress disorder (PTSD), major depressive disorder, and alcohol use disorder among post-9/11 veterans versus pre-9/11 veterans and civilians.


The 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III), a nationally representative survey of U.S. noninstitutionalized adults, was used. Participants included 13,528 civilians, 1,130 pre-9/11 veterans, and 258 post-9/11 veterans with lifetime diagnoses of PTSD, major depression, or alcohol use disorder. Cox proportional hazard models, controlling for relevant demographic characteristics, were used to estimate differences in treatment delay (i.e., time between diagnosis and treatment).


Post-9/11 veterans were less likely to delay treatment for PTSD and depression than pre-9/11 veterans (adjusted hazard ratios [AHRs]=0.69 and 0.74, respectively) and civilians (AHRs=0.60 and 0.67, respectively). No differences in treatment delay were observed between post-9/11 veterans and pre-9/11 veterans or civilians for alcohol use disorder. In an exploratory analysis, post-9/11 veterans with past-year military health care coverage (e.g., Veterans Health Administration) had shorter delays for depression treatment compared with post-9/11 veterans without military coverage, pre-9/11 veterans regardless of health care coverage, and civilians, although past-year coverage did not predict treatment delay for PTSD or alcohol use disorder.


Post-9/11 veterans were less likely to delay treatment for some common psychiatric conditions compared with pre-9/11 veterans or civilians, which may reflect efforts to engage recent veterans in mental health care. All groups exhibited low initiation of treatment for alcohol use disorder, highlighting the need for further engagement efforts.


Veterans issues, Utilization patterns & review

[Available on 2020-05-01]

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