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Postdeployment Behavioral Health Screens and Linkage to the Veterans Health Administration for Army Reserve Component
Megan E Vanneman1, Alex H S Harris1, Cheng Chen1
1Dr. Vanneman is with the Informatics, Decision-Enhancement and Analytic Sciences Center, Department of Veterans Affairs (VA) Salt Lake City Health Care System, and with the Department of Internal Medicine, Division of Epidemiology, University of Utah School of Medicine, Salt Lake City. Dr. Harris and Ms. Chen are with the Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California. Dr. Harris is also with the Department of Surgery, Stanford University School of Medicine, Stanford, California. Dr. Adams and Dr. Larson are with the Heller School for Social Policy and Management, Brandeis University, Waltham, Massachusetts. Dr. Williams is with the Defense Health Agency, U.S. Department of Defense (DoD), Falls Church, Virginia.
Objective:
Approximately three to six months after returning from deployment, military service members complete the Post-Deployment Health Reassessment (PDHRA), which includes screens for alcohol misuse, depression, and posttraumatic stress disorder (PTSD). To determine whether Army Reserve Component (RC) members (Army National Guard and Army Reserve) with positive screening scores on the PDHRA receive needed care, the investigators examined the association between positive scores and enrollment and utilization of care ("linkage") in the Veterans Health Administration (VHA), as well as rescreening scores, diagnosis, and behavioral treatment in VHA.
Methods:
Mixed-effects regression models were used to predict linkage to VHA within six months after RC members (N=73,164) completed the PDHRA, with alcohol misuse, depression, and PTSD screen scores as key independent variables. Regression models were stratified by gender and National Guard versus Reserve status. Among those who linked to VHA (N=25,168), screening scores and subsequent diagnosis and treatment in VHA were also examined.
Results:
Army RC members with positive PTSD and depression screening scores were more likely than those with negative screens to link to VHA, and most (54%-84%) received VHA treatment once diagnosed. Positive screens for alcohol misuse were associated with linkage to VHA for men but not for women, and treatment rates for alcohol use disorders were relatively low (0%-25%) for both men and women diagnosed as having an alcohol use disorder.
Conclusions:
The finding that Army RC members with greater indications of behavioral health problems linked to VHA is encouraging. However, more outreach and treatment engagement strategies could be directed to those with alcohol use disorder, particularly women.