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The Prevalence and Predictors of Mental Health Treatment Services in a National Sample of Depressed Veterans

Chermack, Stephen T. PhD*†; Zivin, Kara PhD*†; Valenstein, Marcia MD, MS*†; Ilgen, Mark PhD*†; Austin, Karen L. MPH*; Wryobeck, John PhD; Blow, Frederic C. PhD*†

doi: 10.1097/MLR.0b013e318178eb08
Original Article

Background: Few studies of acute depression care have examined the provision of psychotherapy or combined treatment in addition to medication management. This study examined acute phase depression treatment in the VA healthcare system, including measures of medication treatment (MT), psychotherapy (PT), and combined treatment (CT = MT plus PT). Both low level care (receipt of any MT, PT, or CT, but all below guideline levels) as well as guideline concordant care (GC MT, PT, and CT) were examined.

Methods: The sample included 41,412 patients with new depression diagnoses. Analyses examined the relationship between demographics and psychiatric comorbidities (eg, substance use disorders, post-traumatic stress disorder, depression with both substance use disorders and post-traumatic stress disorder) and receipt of each type of care (low level and guideline concordant MT, PT, and CT).

Results: The majority (75%) received at least some treatment, with 35% of the sample receiving guideline concordant care (particularly GC MT). Those with psychiatric comorbidities generally were more likely to receive GC care, older veterans were less likely to receive each type of care, and African Americans were less likely to receive GC MT but more likely to receive GC PT and GC CT than whites.

Conclusions: Although it is difficult to benchmark, the VA overall seems similar or better than the private sector in providing guideline concordant acute phase treatment for its depressed patients. The majority of veterans received some acute phase depression treatment, but only a minority seem to receive guideline concordant care (particularly PT and CT).

From the *Department of Veterans Affairs, Ann Arbor Center of Excellence (COE), Serious Mental Illness Treatment, Research, and Evaluation Center (SMITREC), Ann Arbor, Michigan; †Department of Psychiatry, University of Michigan, Ann Arbor, Michigan; and ‡Department of Psychiatry, University of Toledo, Toledo, Ohio.

Supported by Department of Veterans Affairs, Health Services Research and Development Service, RCD 98–350, by the Serious Mental Illness Treatment, Research, and Evaluation Center, Ann Arbor, MI, and by the VA-Mental Health Quality QUERI.

Reprints: Stephen T. Chermack, PhD, Psychiatry (116C), VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48108. E-mail:

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

© 2008 Lippincott Williams & Wilkins, Inc.