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

TLDR

Mental illnesses among veterans are linked to poor clinical outcomes, and integrating mental health care into primary care has been suggested to reduce these risks. The study aimed to assess how depression, PTSD, substance use disorder, anxiety, and serious mental illness affect emergency department visits, hospitalizations, and mortality among veterans and to evaluate the impact of Primary Care‑Mental Health Integration. Researchers analyzed data from 4.46 million veterans in Patient Aligned Care Teams, estimating one‑year risks of ED visits, hospitalizations, and death by mental‑illness category and PCMHI participation. Depression, serious mental illness, and substance use disorder increased the risk of hospitalization or death, PTSD was linked to lower odds of ED visits and mortality, and veterans who had at least one PCMHI contact experienced better outcomes.

Abstract

We evaluated the association of mental illnesses with clinical outcomes among US veterans and evaluated the effects of Primary Care-Mental Health Integration (PCMHI).A total of 4 461 208 veterans were seen in the Veterans Health Administration's patient-centered medical homes called Patient Aligned Care Teams (PACT) in 2010 and 2011, of whom 1 147 022 had at least 1 diagnosis of depression, posttraumatic stress disorder (PTSD), substance use disorder (SUD), anxiety disorder, or serious mental illness (SMI; i.e., schizophrenia or bipolar disorder). We estimated 1-year risk of emergency department (ED) visits, hospitalizations, and mortality by mental illness category and by PCMHI involvement.A quarter of all PACT patients reported 1 or more mental illnesses. Depression, SMI, and SUD were associated with increased risk of hospitalization or death. PTSD was associated with lower odds of ED visits and mortality. Having 1 or more contact with PCMHI was associated with better outcomes.Mental illnesses are associated with poor outcomes, but integrating mental health treatment in primary care may be associated with lower risk of those outcomes.