Key Takeaways
Extended Takeaways
- Primary VHA use was reported by 20.5% (95% CI, 18.9–22.3%) of veterans in this nationally representative sample, up from 16.9% in 2011, suggesting that VA care is serving a growing share of veterans as their main health system.
- Income appears to be a major driver of reliance on VHA care: annual household income ≤$60,000 accounted for 23% relative variance explained in the model, and only 13.8% of primary VHA users had employer-based insurance versus 48.5% of non-VA users.
- When veterans rely on VHA as their main system, clinicians should anticipate cognitive and social support needs as well as symptom burden, because lower self-reported cognitive functioning accounted for 14% RVE and unmarried/unpartnered status for 10% RVE.
- Among medical comorbidities, chronic pain (odds ratio [OR]=1.45; 95% CI, 1.18–1.78), sleep disorders (OR =1.38; 95% CI, 1.13–1.70), and respiratory disorders (OR =1.31; 95% CI, 1.01–1.71) were the specific conditions independently linked to primary VHA use.
- Primary VHA users endorsed more perceived stigma and practical barriers to mental health care, including concerns that others would see them as weak, transportation and scheduling problems, and distrust of mental health professionals, so engagement strategies may need to address both attitudinal and logistical obstacles.
- Because the regression model explained a modest proportion of utilization variance (Nagelkerke R2 = 0.23), decisions about outreach and care planning should not rely on any single characteristic but rather on the combined profile of financial, psychiatric, medical, cognitive, and social risk.
