Mental health treatment delay: A comparison among civilians and veterans of different service eras

Simon B. Goldberg, Tracy L. Simpson, Keren Lehavot, Jodie G. Katon, Jessica A. Chen, Joseph E. Glass, Paula P. Schnurr, Nina A. Sayer, John C. Fortney

Research output: Contribution to journalArticlepeer-review

16 Scopus citations


Objective: The study compared delay of treatment for posttraumatic stress disorder (PTSD), major depressive disorder, and alcohol use disorder among post-9/11 veterans versus pre-9/11 veterans and civilians. Methods: The 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions–III (NESARC-III), a nationally representative survey of U.S. noninstitutionalized adults, was used. Participants included 13,528 civilians, 1,130 pre-9/11 veterans, and 258 post-9/11 veterans with lifetime diagnoses of PTSD, major depression, or alcohol use disorder. Cox proportional hazard models, controlling for relevant demographic characteristics, were used to estimate differences in treatment delay (i.e., time between diagnosis and treatment). Results: Post-9/11 veterans were less likely to delay treatment for PTSD and depression than pre-9/11 veterans (adjusted hazard ratios [AHRs]=0.69 and 0.74, respectively) and civilians (AHRs=0.60 and 0.67, respectively). No differences in treatment delay were observed between post-9/11 veterans and pre-9/11 veterans or civilians for alcohol use disorder. In an exploratory analysis, post-9/11 veterans with past-year military health care coverage (e.g., Veterans Health Administration) had shorter delays for depression treatment compared with post-9/11 veterans without military coverage, pre-9/11 veterans regardless of health care coverage, and civilians, although past-year coverage did not predict treatment delay for PTSD or alcohol use disorder. Conclusions: Post-9/11 veterans were less likely to delay treatment for some common psychiatric conditions compared with pre-9/11 veterans or civilians, which may reflect efforts to engage recent veterans in mental health care. All groups exhibited low initiation of treatment for alcohol use disorder, highlighting the need for further engagement efforts.

Original languageEnglish (US)
Pages (from-to)358-366
Number of pages9
JournalPsychiatric Services
Issue number5
StatePublished - May 2019

Bibliographical note

Funding Information:
Department of Counseling Psychology, University of Wisconsin– Madison, Madison, Wisconsin (Goldberg); Health Services Research & Development (HSR&D) Center of Innovation (Goldberg, Lehavot, Katon, Chen, Fortney) and Center of Excellence in Substance Abuse Treatment and Education (CESATE) (Simpson), U.S. Department of Veterans Affairs (VA) Puget Sound Health Care System, Seattle; Department of Psychiatry and Behavioral Sciences (Lehavot, Fortney, Simpson) and Department of Health Services (Katon, Chen), University of Washington, Seattle; Kaiser Permanente Washington Health Research Institute, Seattle (Glass); National Center for PTSD, White River Junction, Vermont, and Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (Schnurr); Center for Care Delivery and Outcomes Research, Minneapolis VA Health Care System, Minneapolis, and Department of Medicine and Psychiatry, University of Minnesota, Minneapolis (Sayer). Send correspondence to Dr. Goldberg ( Dr. Goldberg and Dr. Chen were supported by a VA Office of Academic Affiliations Advanced Fellowship in HSR&D (TPH 61-000-24 and TPH 61-000-14, respectively). Dr. Simpson was supported by CESATE. Dr. Lehavot and Dr. Katon were supported by Career Development Awards (CDAs) from VA Clinical Science Research & Development (CX000867) and HSR&D (CDA 13-266), respectively. Dr. Glass was supported by the National Institutes of Health Extramural Loan Repayment Program for Health Disparities Research (L60 MD009373) and a Mentored Research Scientist Development Award (K01 AA023859). Dr. Fortney was supported by a grant (PCS-1406-19295) from the Patient-Centered Outcomes Research Institute and by a VA HSR&D Research Career Scientist Award. The views expressed in this article are solely those of the authors and do not reflect an endorsement by or the official policy or position of the VA. Dr. Schnurr is a member of the scientific advisory board for Noblis Therapeutics. The other authors report no financial relationships with commercial interests. Received September 27, 2018; revision received December 7, 2018; accepted January 9, 2019; published online March 7, 2019.

Publisher Copyright:
© 2019 American Psychiatric Association. All rights reserved.

PubMed: MeSH publication types

  • Journal Article
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Research Support, N.I.H., Extramural
  • Comparative Study


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