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War Zone Veterans Returning to Treatment: Effects of Social Functioning and Psychopathology

Fontana, Alan PhD*†; Rosenheck, Robert MD†‡

The Journal of Nervous and Mental Disease: October 2010 - Volume 198 - Issue 10 - p 699-707
doi: 10.1097/NMD.0b013e3181f4ac88
Original Articles

Patients with mental illness often return for further treatment after an initial episode of care. Two processes that may contribute to the return for further treatment are the severity of patients' initial social and clinical status; and/or deterioration in their status over time, regardless of their initial status. This study examined these processes in an administrative database of war zone veterans who had received outpatient treatment from a Veterans Affairs specialized posttraumatic stress disorder program. The results suggest that both initial severity and deterioration of status contribute to return to treatment and involve changes in both social functioning and psychopathology. Determination of the direction of effects between social functioning and psychopathology showed that psychopathology in the form of PTSD, other Axis I disorder or violent behavior generally affected subsequent social functioning, but not vice versa. Psychopathology in the form of alcohol or drug abuse/dependence, however, showed reciprocal effects with social functioning. These results point to the importance of emphasizing interventions that address social dysfunction and that address psychopathology, from the beginning of treatment as a way of maximizing the benefits and minimizing the need for recurrent care.

*Northeast Program Evaluation Center, VA Healthcare System, West Haven, CT; †Mental Illness Research Education and Clinical Center, VA Healthcare System, West Haven, CT; and ‡Department of Public Health and Child Study Center, Yale University School of Medicine, West Haven, CT.

Work performed as part of US government employment.

Send reprint requests to Alan Fontana, PhD, Northeast Program Evaluation Center, VA Healthcare System, 950 Campbell Avenue, West Haven, CT 06516. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.