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Published Online: 2 February 2015

Barriers and Facilitators Related to Mental Health Care Use Among Older Veterans in the United States

Abstract

Objective:

Psychiatric disorders are more prevalent among older veterans compared with their civilian counterparts, but many veterans with symptoms of psychiatric disorders do not utilize mental health services. This study examined barriers and facilitators related to current mental health care utilization in a nationally representative sample of veterans ages 60 and older (N=2,025).

Methods:

Using data from the National Health and Resilience in Veterans Study, the authors evaluated how predisposing, enabling, and need characteristics as well as perceived barriers to care were related to utilization of mental health care among older veterans.

Results:

A minority of veterans (N=130; weighted prevalence, 6%) reported current mental health care utilization. Among veterans (N=144) who screened positive for a current psychiatric disorder, 42 (weighted prevalence, 25%) were currently utilizing services. In the full sample, current utilization was associated with lifetime posttraumatic stress disorder or depression (odds ratio [OR]=5.88, 95% confidence interval [CI]=3.51–9.84), lifetime drug use disorder (OR=2.87, CI=1.59–5.17), severity of current psychiatric symptoms (OR=1.40, CI=1.19–1.65), general medical difficulties (OR=1.28, CI=1.10–1.50), and lower perceptions of stigma (OR=.80, CI=.68–.93). Non-Hispanic veterans were less likely to utilize care (OR=.42, CI=.25–.69). Among psychiatrically distressed veterans, current utilization was associated with younger age (OR=.89, CI=.81–.97), current suicidal ideation (OR=5.60, CI=1.98–15.84), and fewer negative beliefs about mental health care (OR=.23, CI=.09–.56).

Conclusions:

Efforts to identify psychiatrically distressed veterans and to reduce stigma and negative beliefs about mental health care may help increase mental health service utilization among older U.S. veterans.

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Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services

Cover: By the Pond, by Mary Cassatt, circa 1898. Color print with dry point and aquatint, fourth and final state (classmark: MEZAP+). Print collection, Miriam and Ira D. Wallach Division of Art, Prints and Photographs, New York Public Library. Photo credit: The New York Public Library/Art Resource, New York City.

Psychiatric Services
Pages: 500 - 506
PubMed: 25639990

History

Received: 15 October 2013
Revision received: 28 March 2014
Revision received: 11 June 2014
Revision received: 20 August 2014
Accepted: 26 September 2014
Published online: 2 February 2015
Published in print: May 01, 2015

Authors

Details

Rebecca K. Blais, Ph.D.
Dr. Blais is with the Department of Psychology, Utah State University, Logan (e-mail: [email protected]), and was with the Mental Health Service, Seattle Division, U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, when parts of this work were completed. Dr. Tsai, Dr. Southwick, and Dr. Pietrzak are with the VA Connecticut Healthcare System, West Haven, where Dr. Tsai is with the New England Mental Illness Research, Education and Clinical Center, and Dr. Southwick and Dr. Pietrzak are with the National Center for Posttraumatic Stress Disorder. They are also with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
Jack Tsai, Ph.D.
Dr. Blais is with the Department of Psychology, Utah State University, Logan (e-mail: [email protected]), and was with the Mental Health Service, Seattle Division, U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, when parts of this work were completed. Dr. Tsai, Dr. Southwick, and Dr. Pietrzak are with the VA Connecticut Healthcare System, West Haven, where Dr. Tsai is with the New England Mental Illness Research, Education and Clinical Center, and Dr. Southwick and Dr. Pietrzak are with the National Center for Posttraumatic Stress Disorder. They are also with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
Steven M. Southwick, M.D.
Dr. Blais is with the Department of Psychology, Utah State University, Logan (e-mail: [email protected]), and was with the Mental Health Service, Seattle Division, U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, when parts of this work were completed. Dr. Tsai, Dr. Southwick, and Dr. Pietrzak are with the VA Connecticut Healthcare System, West Haven, where Dr. Tsai is with the New England Mental Illness Research, Education and Clinical Center, and Dr. Southwick and Dr. Pietrzak are with the National Center for Posttraumatic Stress Disorder. They are also with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.
Robert H. Pietrzak, Ph.D., M.P.H.
Dr. Blais is with the Department of Psychology, Utah State University, Logan (e-mail: [email protected]), and was with the Mental Health Service, Seattle Division, U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle, Washington, when parts of this work were completed. Dr. Tsai, Dr. Southwick, and Dr. Pietrzak are with the VA Connecticut Healthcare System, West Haven, where Dr. Tsai is with the New England Mental Illness Research, Education and Clinical Center, and Dr. Southwick and Dr. Pietrzak are with the National Center for Posttraumatic Stress Disorder. They are also with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut.

Funding Information

Department of Veterans Affairs, National Center for PTSD:
The National Health and Resilience in Veterans Study was funded by the U.S. Department of Veterans Affairs National Center for Posttraumatic Stress Disorder.Dr. Pietrzak is a scientific consultant to Cogstate, Ltd. The other authors report no financial relationships with commercial interests.

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