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Use of Psychotherapy by Rural and Urban Veterans |
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| Authors: | Jeffrey A. Cully PhD John P. Jameson PhD Laura L. Phillips PhD Mark E. Kunik MD MPH John C. Fortney PhD |
| Affiliation: | 1. Houston Center for Quality of Care & Utilization Studies, Veterans Affairs Health Services Research and Development Center (HSR&D) of Excellence, Houston, Texas Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas Section of Health Services Research, Department of Medicine, Baylor College of Medicine, Houston, Texas Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Veterans Affairs South Central Mental Illness Research, Education, & Clinical Center, Houston, Texas;2. Houston Center for Quality of Care & Utilization Studies, Veterans Affairs Health Services Research and Development Center (HSR&D) of Excellence, Houston, Texas Veterans Affairs South Central Mental Illness Research, Education, & Clinical Center, Houston, Texas Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas;3. Mental Health & Behavioral Medicine, Central Texas Veterans Health Care System, Temple, Texas;4. South Central Mental Illness Education and Clinical Center (MIRECC) and Health Services Research and Development, (HSR&D), Center for Mental Health and Outcomes Research, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas Division of Health Services Research, Department of Psychiatry, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas Department of Health Policy and Management, College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas |
| Abstract: | Purpose: To examine whether differences exist between rural and urban veterans in terms of initiation of psychotherapy, delay in time from diagnosis to treatment, and dose of psychotherapy sessions. Methods: Using a longitudinal cohort of veterans obtained from national Veterans Affairs databases (October 2003 through September 2004), we extracted veterans with a new diagnosis of depression, anxiety, or posttraumatic stress disorder (PTSD) (n = 410,923). Veterans were classified as rural (categories 6-9; n = 65,044) or urban (category 1; n = 149,747), using the US Department of Agriculture Rural-Urban Continuum Codes. Psychotherapy encounters were identified using Current Procedural Terminology codes for the 12 months following patients’ initial diagnosis. Findings: Newly diagnosed rural veterans were significantly less likely (P < .0001) to receive psychotherapy (both individual and group). Urban veterans were roughly twice as likely as rural veterans to receive 4 or more (9.46% vs 5.08%) and 8 or more (5.59% vs 2.35%) psychotherapy sessions (P < .001). Conclusions: Rural veterans are significantly less likely to receive psychotherapy services, and the dose of the psychotherapy services provided for rural veterans is limited relative to their urban counterparts. Focused efforts are needed to increase access to psychotherapy services provided to rural veterans with depression, anxiety, and PTSD. |
| Keywords: | anxiety depression posttraumatic stress disorder psychotherapy rural veterans |