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The Burden of Mental Illness Among Veterans: Use of VHA Health Care Services by Those With Service-connected Conditions

Maynard, Charles PhD*,†; Batten, Adam BA; Liu, Chuan-Fen PhD*,†; Nelson, Karin MD, MSHS*,§; Fihn, Stephan D MD, MPH*,‡,§

doi: 10.1097/MLR.0000000000000806
Brief Report

Background: Little is known about how Veterans with service-connected conditions use health care provided by the Veterans Health Administration (VHA).

Objectives: To ascertain what proportion of Veterans with service-connected conditions used VHA health care and whether it varied according to type of condition, combined disability rating, age, sex, military rank, or other characteristics and whether there were differences in receipt of inpatient and outpatient care.

Research Design: Cross-sectional analysis of administrative benefits and claims data for 2015 and 2016.

Subjects: In total, 4,029,672 Veterans who had an active award status for service-connected conditions in October 2016.

Measures: Independent variables included age, sex, military rank, service branch, combined disability rating, Agent Orange exposure, and type of service-connected condition. The key-dependent variable was VHA health care use including specific types of health care utilization such as inpatient and outpatient services.

Results: In total, 52% of those with service-connected conditions used VHA health care. Type of condition and disability rating were associated with use. Over 65% of those with major depression, posttraumatic stress disorder (PTSD), Agent Orange exposure, or diabetes used VHA health care, as did 76% of those with a 100% rating. Almost one third of users of VHA health care were compensated for PTSD. In general, both inpatient and outpatient mental health services were frequently used by Veterans with service-connected mental health conditions.

Conclusions: Veterans with service-connected conditions, particularly those with diabetes or mental illness such as depression or PTSD, depend heavily upon VHA for health care, including mental health services.

Departments of *Veterans Affairs Puget Sound Health Care System

Health Services

Veterans Affairs Office of Clinical System Development and Evaluation

§Medicine, University of Washington, Seattle, WA

The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

Supported by the Department of Veterans Affairs, Clinical System Development and Evaluation.

The authors declare no conflict of interest.

Reprints: Charles Maynard, PhD, Department of Veterans Affairs, 1660 S Columbian Way, Seattle, WA 98108. E-mail:

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