Association of PTSD and Depression With Medical and Specialist Care Utilization in Modern Peacekeeping Veterans in Canada With Health-Related Disabilities
J Clin Psychiatry 2006;67(8):1240-1245
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: We examined the relative associations
between posttraumatic stress disorder (PTSD) and depression
severity with medical and specialist care use in modern
peacekeeping veterans with health-related disabilities.
Method: The participants consisted of 1016 male
veterans who served in the Canadian Forces from 1990 to 1999,
selected from a larger random sample of 1968 veterans who
voluntarily completed an anonymous general health survey
conducted by Veterans Affairs Canada in 1999. Survey instruments
included the PTSD Checklist-Military Version (PCL-M), Center for
Epidemiological Studies-Depression Scale, and questionnaires of
health problems and service use, sociodemographic
characteristics, and military history.
Results: Among peacekeeping veterans with health
disabilities, "probable" PTSD (PCL-M score 50) was
associated with significantly more medical service use (primary
and specialty care combined), with a mean of 16.4 times (SD = 17.4)
compared with 6.0 times (SD = 6.6), p < .001, for veterans without PTSD. We found that in multivariate analyses, general medical
care intensity (i.e., number of visits) was related to increased
health problems, greater probable PTSD diagnosis, and greater
depression symptom severity. We also found that depression
severity accounted for health care use intensity and that PTSD
only added a small amount of incremental variance above that.
Conclusions: The observed association between
PTSD (diagnosis and severity) and medical care utilization
stresses the importance of PTSD screening in primary care
settings, especially in patients with a history of military
service. This association is also useful for clinicians and
hospital administrators in understanding potential medical and
psychiatric needs for military veterans.