Transition from military to VHA care: Psychiatric health services for Iraq/Afghanistan combat-wounded

Abstract

ObjectiveVeterans 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. MethodsInpatients 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. ResultsVHA 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 6months of DoD discharge; 75% within 1year. 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). LimitationsDoD outpatient data were not available. The study relied on administrative data. ConclusionsAlthough 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.