Journal of General Internal Medicine

, Volume 21, Supplement 3, pp S58–S64 | Cite as

Posttraumatic stress disorder screening status is associated with increased VA medical and surgical utilization in women

  • Dorcas J. DobieEmail author
  • Charles Maynard
  • Daniel R. Kivlahan
  • Kay M. Johnson
  • Tracy Simpson
  • Andrew C. David
  • Katharine Bradley
Original Articles


BACKGROUND: Women with posttraumatic stress disorder (PTSD) report poor health, but associations with health care utilization are understudied.

OBJECTIVE: To determine associations between medical/surgical utilization and PTSD in female Veterans Affairs (VA) patients.

DESIGN: Prospective comparison of utilization rates between women screening positive or negative for PTSD on a mailed survey.

SUBJECTS: Women receiving care at an urban VA medical center between October 1996 and January 2000.

MEASUREMENTS: Survey responses, including a validated screen for PTSD (PCL-C), and VA utilization data through September 2002.

RESULTS: Two thousand five hundred and seventy-eight (2,578) women (78% of those eligible) completed the PCL-C; 858 (33%) of them screened positive for PTSD (PTSD+). In unadjusted models, PTSD+ women had higher rates of medical/surgical hospitalizations and surgical inpatient procedures. Among women ages 35 to 49, mean days hospitalized/100 patients/year was 43.4 (95% CI 26 to 61) for PTSD+ women versus 17.0 (16 to 18) for PTSD negative (PTSD−) women. More PTSD+ women underwent surgical procedures (P<.001). Mean annual outpatient visits were significantly higher among PTSD+ women, including: emergency department (ED) (1.1 [1.0 to 1.2] vs 0.6 [0.5 to 0.6]), primary care (3.2 [3.0 to 3.4] vs 2.2 [2.1 to 2.3]), medical/surgical subspecialists (2.1 [1.9 to 2.3] vs 1.5 [1.4 to 1.6]), ancillary services (4.1 [3.7 to 4.5] vs 2.4 [2.2 to 2.6]), and diagnostic tests (5.6 [5.1 to 6.1] vs 3.7 [3.4 to 4.0]). In multivariate models adjusted for demographics, smoking, service access, and medical comorbidities, PTSD+ women had greater likelihood of medical/surgical hospitalization (OR=1.37 [1.04 to 1.79]) and of being among the top quartile of patients for visits to the ED, primary care, ancillary services, and diagnostic testing.

CONCLUSIONS: Female veterans who screen PTSD+ receive more VA medical/surgical services. Appropriateness of that care deserves further study.

Key words

mental health survey research utilization veterans women’s health 


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Copyright information

© Society of General Internal Medicine 2006

Authors and Affiliations

  • Dorcas J. Dobie
    • 1
    • 2
    • 3
    Email author
  • Charles Maynard
    • 2
    • 4
    • 5
  • Daniel R. Kivlahan
    • 1
    • 2
    • 3
    • 6
  • Kay M. Johnson
    • 2
    • 7
  • Tracy Simpson
    • 2
    • 3
    • 8
  • Andrew C. David
    • 1
    • 2
    • 3
  • Katharine Bradley
    • 2
    • 4
    • 7
  1. 1.Mental Illness Research, Education and Clinical CenterUniversity of Washington School of MedicineSeattleUSA
  2. 2.Veterans Affairs Puget Sound Health Care SystemUniversity of Washington School of MedicineSeattleUSA
  3. 3.Departments of Psychiatry and Behavioral SciencesUniversity of Washington School of MedicineSeattleUSA
  4. 4.Health Services Research and DevelopmentUniversity of Washington School of MedicineSeattleUSA
  5. 5.Epidemiology Research and Information CenterUniversity of Washington School of MedicineSeattleUSA
  6. 6.Center of Excellence in Substance Abuse Treatment and EducationUniversity of Washington School of MedicineSeattleUSA
  7. 7.Department of MedicineUniversity of Washington School of MedicineSeattleUSA
  8. 8.Women’s Trauma Recovery ProgramUniversity of Washington School of MedicineSeattleUSA

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