Serving Those Who Served: Retention of Newly Returning Veterans From Iraq and Afghanistan in Mental Health Treatment

Ilan Harpaz‐Rotem · Robert Alan Rosenheck

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Posttraumatic Stress Disorder Research Migration, Health and Trauma Education and Military Integration

Abstract

OBJECTIVE: There are growing concerns about the mental health status of returning veterans from the recent conflicts in Iraq (Operation Iraq Freedom [OIF]) and Afghanistan (Operation Enduring Freedom [OEF]) and about retention in mental health treatment of veterans with posttraumatic stress disorder (PTSD). This study obtained data from veterans who had a new diagnosis of PTSD from fiscal year (FY) 2004 to FY 2007 and determined whether retention in PTSD treatment and the number of mental health visits were comparable among OIF-OEF veterans and veterans from other service eras. METHODS: Data from the Department of Veterans Affairs and the Department of Defense were combined to identify veterans who were newly diagnosed as having PTSD (N=204,184) and their service era. Survival analysis assessed dropout from mental health treatment within one year from initial diagnosis, and Poisson regression assessed the association between war era and number of mental health visits. RESULTS: Although a smaller proportion of OIF-OEF veterans than Vietnam-era veterans remained in treatment for more than one year (37.6% versus 46.0%), when the analyses adjusted for demographic characteristics and comorbid diagnoses, OIF-OEF veterans were less likely than Vietnam-era veterans to discontinue psychiatric treatment for PTSD within one year. OIF-OEF veterans attended fewer mental health visits than Vietnam-era veterans did (8.15 versus 13.37). However, multivariate analysis indicated that, after the analyses adjusted for confounding factors, OIF-OEF veterans had significantly more visits than Vietnam-era veterans associated with PTSD treatment. CONCLUSIONS: Retention and numbers of visits were found to be lower among OIF-OEF veterans primarily as a function of age and comorbid conditions and not as a function of the particular war era. Interventions should be designed to target specific barriers to care that may interfere with continued engagement in mental health services.

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References

1995Posttraumatic Stress Disorder in the National Comorbidity Survey 1995Revisiting the Behavioral Model and Access to Medical Care: Does it Matter?2004Combat Duty in Iraq and Afghanistan, Mental Health Problems, and Barriers to Care 1988Handbook of Psychotherapy and Behavior Change 1951Client-Centered Therapy: Its Current Practice, Implications and Theory 1952Client-centered therapy; its current practice, implications, and theory.2006Mental Health Problems, Use of Mental Health Services, and Attrition From Military Service After Returning From Deployment to Iraq or Afghanistan 1993A meta-analysis of psychotherapy dropout.

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2014Inclusion and Exclusion Criteria in Randomized Controlled Trials of Psychotherapy for PTSD 2015The role of different stigma perceptions in treatment seeking and dropout among active duty military personnel.2017Psychotherapy Utilization and Retention in a National Sample of Veterans With PTSD 2012A randomized controlled trial of telephone motivational interviewing to enhance mental health treatment engagement in Iraq and Afghanistan veterans

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