Improving Utilization of and Adherence to Treatment for Post-Traumatic Stress Disorder Among U.S. Servicemembers and Veterans

by Jeremy Kurz

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Post-traumatic stress disorder (PTSD) is a mental health condition which afflicts thousands of current and former U.S. servicemembers. Despite significant advances in treatment options, many servicemembers and veterans suffering from PTSD either do not seek mental healthcare or discontinue treatment before they can receive an adequate dose to reduce their symptoms. This dissertation seeks to find ways in which PTSD treatment utilization and adherence can be improved among servicemembers and veterans. I used a multi-method approach and three data sources to answer five specific research questions. Responses to two separate surveys of servicemembers and veterans were used to examine differences in treatment utilization and adherence between sub-groups of these populations. I interviewed behavioral health specialists to gain insights into administrative practices, use of evidence-based treatments, differences between population sub-groups, and recommendations for improvement. Combined, these two methods provided a picture of what factors contribute to low treatment utilization and adherence and how policies and practices can be changed to better provide for servicemembers and veterans suffering from PTSD.

The results of my analyses indicate that several groups are less likely to utilize and adhere to treatment for PTSD, including men and those with lower levels of combat exposure and/or symptom severity. I also found that attending longer appointments with behavioral health specialists and receiving psychotherapy and/or medications were important predictors of treatment adherence. Several barriers were identified for both utilization and adherence among veterans and servicemembers. However, it was found that servicemembers often experience more barriers to initial treatment entry, whereas veterans have more barriers to continuation. I recommend many policy changes and efforts to improve treatment utilization and adherence, but the most important are establishing standardized practices for provider referrals and appointment scheduling, providing greater support for prolonged exposure therapy, removing negative career consequences for servicemembers seeking care, and providing greater availability of behavioral health specialists.

Table of Contents

  • Chapter One

    Introduction

  • Chapter Two

    Background and Literature Review

  • Chapter Three

    Individual-Level Factors of Servicemembers and Veterans Associated with Treatment Utilization and Adherence

  • Chapter Four

    Behavioral Health Specialist Views on PTSD Treatment Utilization and Adherence by Servicemembers and Veterans

  • Chapter Five

    Conclusions, Policy Recommendations, and Further Research

  • Appendix A

    Predictor Variables from VAOS Data used in Analysis

  • Appendix B

    Predictor Variables from IW Data used in Analysis

  • Appendix C

    Semi-Structured Interview Questions

Research conducted by

This document was submitted as a dissertation in July 2015 in partial fulfillment of the requirements of the doctoral degree in public policy analysis at the Pardee RAND Graduate School. The faculty committee that supervised and approved the dissertation consisted of Lisa S. Meredith (Chair), Terry L. Schell, and Albert "Skip" Rizzo.

This report is part of the RAND Corporation dissertation series. Pardee RAND dissertations are produced by graduate fellows of the Pardee RAND Graduate School, the world's leading producer of Ph.D.'s in policy analysis. The dissertations are supervised, reviewed, and approved by a Pardee RAND faculty committee overseeing each dissertation.

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