Prior research has demonstrated increased use of medical services among persons with anxiety and depression. This investigation examined the possible association of posttraumatic stress disorder (PTSD) with the use of nonmental health services.
A case-comparison design enrolled 102 high users of health services and 54 low users who were assessed for PTSD diagnosis and severity of PTSD symptoms. Subjects were male veterans receiving services from the primary care clinics of the VA Boston Healthcare System during an 18-month period. Data were collected by interview by use of standardized instruments including the Clinician Administered PTSD Scale for DSM-IV, the Life Events Checklist, and the Beck Depression Inventory. Data analysis employed odds ratios, linear and logistic regression, and path analyses.
High users of health care were almost twice as likely as low users (27.5% vs. 14.8%) to meet diagnostic criteria for current PTSD. The two groups differed significantly on both symptom frequency and intensity. Path analyses showed an indirect positive association between PTSD and health services use, with physician-diagnosed health conditions as a mediating variable. Auxiliary analysis demonstrated that the combined mental health burden of PTSD and depression symptoms also is positively associated with number of health conditions.
The findings indicate that PTSD, alone and in combination with depression, has a direct negative relationship with physical health that, in turn, is associated with more frequent use of primary health care services. These results do not suggest that PTSD leads to inappropriate (eg, distress-motivated) use of services.
National Center for PTSD (E.Y.D., T.M.K., D.K., M.S.), and Medical Service (G.F., K.C.), Veterans Administration Boston Healthcare System and Boston University School of Medicine, and Boston University School of Public Health (J.R.), Boston; and Center for Health Quality, Outcomes, and Economic Research, HSR&D Service (J.R.), Bedford Veterans Administration Medical Center, Bedford, Massachusetts.
Received for publication June 23, 2000;
revision receivedDecember 8, 2000.
Address reprint requests to: Terence M. Keane, PhD, VA Boston Healthcare System, 150 S. Huntington Avenue, Boston, MA 02130. Email: firstname.lastname@example.org