Calhoun Patrick S, Bosworth Hayden B, Grambow Steven C, Dudley Tara K, Beckham Jean C
Health Services Research (152), Durham Veterans' Affairs Medical Center, 508 Fulton Street, Durham, NC 27705, USA.
Am J Psychiatry. 2002 Dec;159(12):2081-6. doi: 10.1176/appi.ajp.159.12.2081.
Posttraumatic stress disorder (PTSD) has been associated with higher rates of health complaints and medical conditions diagnosed by physicians, yet research examining the relationship between PTSD and health care utilization has been limited. This study compared the health service use of veterans with PTSD to that of help-seeking veterans without PTSD. The relationship between severity of PTSD and service utilization was also examined.
Data were collected from 996 veterans seeking an evaluation at a Veterans Affairs (VA) Medical Center specialty PTSD clinic in the southeastern United States between March 1992 and September 1998. Data included sociodemographic characteristics, severity of PTSD, and disability status. The outcome variable, VA health service utilization, was prospectively assessed 1 year from the date of the initial PTSD assessment.
Although the use of VA mental health services by patients with PTSD was substantial (a median of seven clinic stops), these patients used more services in general physical health clinics that provided predominantly nonmental health services (a median of 18 clinic stops). Negative binomial regression models revealed that younger veterans with PTSD had greater health care utilization than those without PTSD who also sought services. Greater severity of PTSD was related to higher rates of mental and physical health service use among veterans without a service-connected disability.
PTSD is associated with substantial health service use. The results highlight the importance of increased collaboration between primary care and mental health specialists, given that patients with PTSD are more likely to receive treatment in nonmental health clinics.
创伤后应激障碍（PTSD）与更高的健康投诉率以及医生诊断的医疗状况相关，但研究PTSD与医疗保健利用之间关系的研究一直有限。本研究比较了患有PTSD的退伍军人与寻求帮助但未患PTSD的退伍军人的医疗服务使用情况。还研究了PTSD严重程度与服务利用之间的关系。
数据收集自1992年3月至1998年9月期间在美国东南部一家退伍军人事务（VA）医疗中心的PTSD专科诊所寻求评估的996名退伍军人。数据包括社会人口学特征、PTSD严重程度和残疾状况。从最初的PTSD评估日期起前瞻性评估1年的结果变量，即VA医疗服务利用情况。
尽管患有PTSD的患者大量使用VA心理健康服务（中位数为7次门诊就诊），但这些患者在主要提供非心理健康服务的普通身体健康诊所使用了更多服务（中位数为18次门诊就诊）。负二项回归模型显示，患有PTSD的年轻退伍军人比那些寻求服务但未患PTSD的退伍军人有更高的医疗保健利用率。在没有与服役相关残疾的退伍军人中，PTSD的严重程度越高，其使用心理健康和身体健康服务的比率越高。
PTSD与大量医疗服务使用相关。鉴于患有PTSD的患者更有可能在非心理健康诊所接受治疗，结果凸显了初级保健和心理健康专家加强合作的重要性。
