Prevalence, Comorbidity, and Prognosis of Mental Health Among US Veterans

Trivedi, Ranak; Post, Edward P.; Sun, Haili; Pomerantz, Andrew S.; Saxon, Andrew J.; Piette, John D.; Maynard, Charles; Arnow, Bruce A.; Curtis, Idamay; Fihn, Stephan D.; Nelson, Karin M.

doi:10.2105/ajph.2015.302836

Cited by 329 publications

(235 citation statements)

References 27 publications

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“…24,25 Moreover, the rate of past-year depression in our sample was 70% higher than that observed among veterans receiving care within a patient-centered medical home. 26 These results highlight the need for mental and physical health integration initiatives to be expanded to include patients with life-limiting physical illnesses. Coordination of mental and physical healthcare and increased mental health staffing are priorities within the Veterans Health Administration (VHA), but integration and staffing initiatives have primarily focused on primary care patients.…”

Section: Discussionmentioning

confidence: 96%

Mental Illness and Mental Healthcare Receipt among Hospitalized Veterans with Serious Physical Illnesses

Garrido

Prigerson²,

Neupane

et al. 2017

Journal of Palliative Medicine

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Section: Discussionmentioning

confidence: 96%

Mental Illness and Mental Healthcare Receipt among Hospitalized Veterans with Serious Physical Illnesses

Garrido

Prigerson²,

Neupane

et al. 2017

Journal of Palliative Medicine

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“…VA patients tend to be older with greater chronic medical diseases and lower household incomes compared with the general population 6 7. Veteran status is an independent risk factor for homelessness,8 and approximately one in four veterans have at least one mental illness 9. The presence of a serious mental illness (eg, schizophrenia, bipolar disorder), substance use disorder, or depression in veterans increases the risk for hospitalization or death 9.…”

Section: Introductionmentioning

confidence: 99%

“…Veteran status is an independent risk factor for homelessness,8 and approximately one in four veterans have at least one mental illness 9. The presence of a serious mental illness (eg, schizophrenia, bipolar disorder), substance use disorder, or depression in veterans increases the risk for hospitalization or death 9. In addition, veteran patients who have surgery at teaching VA hospitals have higher 30-day postoperative morbidity rates when compared with non-teaching VA hospitals 10.…”

Section: Introductionmentioning

confidence: 99%

Peripheral nerve blocks are not associated with increased risk of perioperative peripheral nerve injury in a Veterans Affairs inpatient surgical population

Yajnik

Kou

Mudumbai

et al. 2019

Regional Anesthesia &Amp; Pain Medicine

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Background and objectivesPerioperative peripheral nerve injury (PNI) is a known complication in patients undergoing surgery with or without regional anesthesia. The incidence of new PNI in a Veterans Affairs (VA) inpatient surgical population has not been previously described; therefore, the incidence, risk factors, and clinical course of new PNI in this cohort are unknown. We hypothesized that peripheral nerve blocks do not increase PNI incidence.MethodsWe conducted a 5-year review of a Perioperative Surgical Home database including all consecutive surgical inpatients. The primary outcome was new PNI between groups that did or did not have peripheral nerve blockade. Potential confounders were first examined individually using logistic regression, and then included simultaneously together within a mixed-effects logistic regression model. Electronic records of patients with new PNI were reviewed for up to a year postoperatively.ResultsThe incidence of new PNI was 1.2% (114/9558 cases); 30 of 3380 patients with nerve block experienced new PNI (0.9%) compared with 84 of 6178 non-block patients (1.4%; p=0.053). General anesthesia alone, younger age, and American Society of Anesthesiologists physical status <3 were associated with higher incidence of new PNI. Patients who received transversus abdominis plane blocks had increased odds for PNI (OR, 3.20, 95% CI 1.34 to 7.63), but these cases correlated with minimally invasive general and urologic surgery. One hundred PNI cases had 1-year follow-up: 82% resolved by 3 months and only one patient did not recover in a year.ConclusionsThe incidence of new perioperative PNI for VA surgical inpatients is 1.2% and the use of peripheral nerve blocks is not an independent risk factor.

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“…11 Individual contact with PC-MHI programs has also been associated with improved outcomes, such as increased completion of mental health specialty (MHS) referral 12 , increased odds of PTSD diagnosis and treatment initiation 13 , and lower risk of having an emergency department (ED) visit, hospitalization, or death. 14 Supported by additional primary care staffing through the VA patient-centered medical home initiative (ie, Patient Aligned Care Teams [PACT]) in 2010 15 , the aim has been to provide the bulk of mental health care for primary care patients with low-to-moderate-complexity mental health conditions within the medical home. 8 Recently, researchers have observed reductions in MHS visits and total VA costs and have attributed this to PACT.…”

mentioning

confidence: 99%

Changing Patterns of Mental Health Care Use: The Role of Integrated Mental Health Services in Veteran Affairs Primary Care

et al. 2018

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Objective: Aiming to foster timely, high-quality mental health care for Veterans, VA's Primary CareMental Health Integration (PC-MHI) embeds mental health specialists in primary care and promotes care management for depression. PC-MHI and patient-centered medical home providers work together to provide the bulk of mental health care for primary care patients with low-to-moderate-complexity mental health conditions. This study examines whether increasing primary care clinic engagement in PC-MHI services is associated with changes in patient health care utilization and costs.Methods: We performed a retrospective longitudinal cohort study of primary care patients with identified mental health needs in 29 Southern California VA clinics from October 1, 2008 to September 30, 2013, using electronic administrative data (n ‫؍‬ 66,638). We calculated clinic PC-MHI engagement as the proportion of patients receiving PC-MHI services among all primary care clinic patients in each year. Capitalizing on variation in PC-MHI engagement across clinics, our multivariable regression models predicted annual patient use of 1) non-primary care based mental health specialty (MHS) visits, 2) total mental health visits (ie, the sum of MHS and PC-MHI visits), and 3) health care utilization and costs. We controlled for year-and clinic-fixed effects, other clinic interventions, and patient characteristics.Results: Median clinic PC-MHI engagement increased by 8.2 percentage points over 5 years. At any given year, patients treated at a clinic with 1 percentage-point higher PC-MHI engagement was associated with 0.5% more total mental health visits (CI, 0.18% to 0.90%; P ‫؍‬ .003) and 1.0% fewer MHS visits (CI, ؊1.6% to ؊0.3%; P ‫؍‬ .002); this is a substitution rate, at the mean, of 1.5 PC-MHI visits for each MHS visit. There was no PC-MHI effect on other health care utilization and costs.Conclusions: As intended, greater clinic engagement in PC-MHI services seems to increase realized accessibility to mental health care for primary care patients, substituting PC-MHI for MHS visits, without increasing acute care use or total costs. Thus, PC-MHI services within primary care clinics may improve mental health care value at the patient population level. More research is needed to understand the relationship between clinic PC-MHI engagement and clinical quality of mental health care. (J Am Board Fam Med 2018;31:38 -48.)

show abstract

Prevalence, Comorbidity, and Prognosis of Mental Health Among US Veterans

Abstract: Mental illnesses are associated with poor outcomes, but integrating mental health treatment in primary care may be associated with lower risk of those outcomes.

Cited by 329 publications

References 27 publications

Mental Illness and Mental Healthcare Receipt among Hospitalized Veterans with Serious Physical Illnesses

Mental Illness and Mental Healthcare Receipt among Hospitalized Veterans with Serious Physical Illnesses

Peripheral nerve blocks are not associated with increased risk of perioperative peripheral nerve injury in a Veterans Affairs inpatient surgical population

Changing Patterns of Mental Health Care Use: The Role of Integrated Mental Health Services in Veteran Affairs Primary Care

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