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VHA Whole Health Services and Complementary and Integrative Health Therapies: a Gateway to Evidence-Based Mental Health Treatment

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Abstract

Background

Engagement in evidence-based psychotherapy (EBP) among veterans with behavioral health conditions is often low. The Veterans Health Administration (VHA) is implementing a “Whole Health (WH)” system of care, to identify veteran personal health goals, align care with those goals, and offer services designed to engage and empower veterans to achieve well-being.

Objective

To examine the relationship between veteran WH utilization and subsequent engagement in EBP.

Design

Retrospective analysis of VHA administrative records from 18 facilities implementing WH.

Subjects

Veterans (n = 265,364) with a diagnosis of depression, post-traumatic stress disorder (PTSD), and/or anxiety who had a mental healthcare encounter but no EBP use in fiscal year (FY) 2018. Among this cohort, 33,146 (12.5%) began using WH in FY2019.

Main Measures

We examined use of an EBP for depression, anxiety, and/or PTSD within 1 year of the index date of WH use compared to use of an EBP anytime during FY2019 for veterans not identified as using WH. We used multiple logistic regression to examine the association between veteran WH use and EBP engagement.

Key Results

Approximately 3.0% (n = 7,860) of the veterans in our overall cohort engaged in an EBP in the year following their index date. Controlling for key demographic, health, and utilization variables, WH users had 2.4 (95% CI: 2.2–2.5) times higher odds of engaging in an EBP the following year than those with no WH utilization. Associations between utilization of specific WH services (vs. no utilization of that service) and engagement in an EBP in the subsequent year ranged from 1.6 (95% CI: 1.0–2.6) to 3.5 (95% CI: 3.2–3.9) across the different types of WH services used.

Conclusions

WH use was associated with increased engagement in EBPs among veterans with depression, anxiety, and/or PTSD. Future interventions intended to promote veteran engagement in EBPs may benefit from leveraging WH services and therapies.

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Funding

This work was supported by the Department of Veterans Affairs (VA) Office of Patient-Centered Care and Cultural Transformation (OPCC&CT) and the Quality Enhancement Research Initiative (QUERI) (PEC 13–001; PI: Bokhour).

Author information

Authors and Affiliations

  1. Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA

    Bella Etingen PhD & Bridget M. Smith PhD

  2. Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Bridget M. Smith PhD

  3. Seattle-Denver Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA

    Steven B. Zeliadt PhD & David E. Reed II PhD

  4. University of Washington School of Public Health, Seattle, WA, USA

    Steven B. Zeliadt PhD

  5. Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA, USA

    Jenesse E. Kaitz PhD, Anna M. Barker MS, Justeen K. Hyde PhD, Gemmae M. Fix PhD, Ekaterina Anderson PhD, Timothy P. Hogan PhD & Barbara G. Bokhour PhD

  6. Boston University School of Medicine, Boston, MA, USA

    Justeen K. Hyde PhD & Gemmae M. Fix PhD

  7. Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA

    Ekaterina Anderson PhD & Barbara G. Bokhour PhD

  8. Peter O’Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA

    Timothy P. Hogan PhD

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  1. Bella Etingen PhD
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  11. Barbara G. Bokhour PhD
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Corresponding author

Correspondence to Bella Etingen PhD.

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Conflict of Interest

None of the authors report a conflict of interest, financial or otherwise.

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The views expressed in this article are those of the authors and do not necessarily reflect the position and/or policy of the Department of Veterans Affairs or the United States Government.

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Prior Presentations

A poster based on the results of the present manuscript was presented at the AcademyHealth meeting in June of 2022, and a podium presentation was completed at the VHA HSR&D/QUERI national meeting in February of 2023.

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Etingen, B., Smith, B.M., Zeliadt, S.B. et al. VHA Whole Health Services and Complementary and Integrative Health Therapies: a Gateway to Evidence-Based Mental Health Treatment. J GEN INTERN MED 38, 3144–3151 (2023). https://doi.org/10.1007/s11606-023-08296-z

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  • DOI: https://doi.org/10.1007/s11606-023-08296-z

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