Determinants of National Guard Mental Health Service Utilization in VA versus Non‐VA Settings

Abstract

Objective. To determine associations between need, enabling, and predisposing factors with mental health service use among National Guard soldiers in the first year following a combat deployment to Iraq or Afghanistan. Data Sources/Study Setting. Primary data were collected between 2011 and 2013 from 1,426 Guard soldiers representing 36 units. Study Design. Associations between Guard soldier factors and any mental health service use were assessed using multivariable logistic regression models in a cross-sectional study. Further analysis among service users (N = 405) assessed VA treatment versus treatment in other settings. Principal Findings. Fifty-six percent of Guard soldiers meeting cutoffs on symptom scales received mental health services with 81 percent of those reporting care from the VA. Mental health service use was associated with need (mental health screens and physical health) and residing in micropolitan communities. Among service users, predisposing factors (middle age range and female gender) and enabling factors (employment, income above $50,000, and private insurance) were associated with greater non-VA services use. Conclusion. Overall service use was strongly associated with need, whereas sector of use (non-VA vs. VA) was insignificantly associated with need but strongly associated with enabling factors. These findings have implications for the recent extension of veteran health coverage to non-VA providers.

Differences between the Canadian military’s Regular and Reserve Forces in perceived need for care, mental health services use and perceived sufficiency of care: a cross-sectional survey

“…Our findings indicate that even after adjusting for many covariates, including several need-related proxies, ResF personnel’s overall MHSU was 61%; approximately, 11% lower relative to RegF. Others have found that even when controlling for need, MHSU among ResF personnel tends to be lower 12 18 19 39. For example, one US study that assessed a sample of National Guard and Reserve personnel who returned from deployments to Iraq or Afghanistan between 2006 and 2009 identified 60% with a need for mental health services yet only 50% of these individuals reported accessing care in the 12 months following deployment return 39.…”

“…Our analyses were among personnel with a mental disorder, that is, those who would presumably benefit from MHSU and, ideally, perceive a need for these services. Other researchers have observed that need18 19 and psychiatric distress39 largely predict MHSU but this appears to be only one of many influencing factors. Our findings indicate that even after adjusting for many covariates, including several need-related proxies, ResF personnel’s overall MHSU was 61%; approximately, 11% lower relative to RegF.…”

“…Prior research among CAF personnel with a past-year mental disorder identified a failure to perceive a need for care as the most prevalent barrier; reported by 84%–97% of participants depending on the type of care considered 17. Other countries have similarly identified perceived need18 19 as both a predictor and its absence, a barrier to MHSU. In addition to barriers, there are a number of facilitators to mental health care seeking, features that may directly have a positive influence on barriers to care, such as the presence of a supportive organisational climate, social support and educational programmes that provide information on mental health and promote treatment seeking 16…”

Evidence Review—Social Determinants of Health for Veterans

“…We found moderate strength of evidence indicating no or very small differences in the proportion of engaged and non-engaged Veterans who reside in rural areas. Articles including engaged and non-engaged Veterans also employed varying measures of rurality, including MSA, 21,55,138 self-reported rural/urban residence, 70,107,120 RUC codes, 81,137 Rural-Urban Commuting Area (RUCA) codes, 26,47,48 and straight-line distances between participant homes and nearest VHA facility 98 (online Appendix Table 6). More than half of articles reported no difference in rural residence between engaged and non-engaged Veterans (actual estimates 6-26%).…”

“…More than half of articles reported no difference in rural residence between engaged and non-engaged Veterans (actual estimates 6-26%). 47,48,55,70,73,107,120,138 One medium-quality article found slightly higher rurality for engaged Veterans (30 vs 24% of non-engaged). 137 In contrast, another medium-quality article reported lower rural residence in engaged Veterans (18% engaged vs 28% non-engaged), but was limited to Native Americans enrolled in VHA and Indian Health Service.…”