Biomedical subjects

L Kazis

Publications and source records attributed to L Kazis.

At least 19 recordsLinked to original sources

PubMed2005

Adjunctive use of atypical antipsychotics and anticholinergic drugs among patients with schizophrenia.

BACKGROUND: Treatment of schizophrenia with antipsychotics is often associated with extrapyramidal symptoms (EPS), a disorder involving involuntary muscle movement. Because EPS are often associated with the use of antipsychotics, anticholinergic agents are often indicated. OBJECTIVE: In this observational, retrospective study, we examined whether the initiation of olanzapine or risperidone, the two most widely prescribed atypical antipsychotics, is related to the adjunctive use of anticholinergic agents. METHOD: We identified patients with schizophrenia from outpatient clinics in the Veterans Health Administration (VA) and defined initiation of olanzapine or risperidone as patients who were not on any antipsychotics for 6 months and subsequently initiated on the target drug between 1/4/1999 and 31/3/2000. The data were analysed using tests of means or chi-square tests. RESULTS: The study yielded two major findings. First, compared with risperidone initiators, there were significantly fewer olanzapine initiators who used at least one anticholinergic agent adjunctively. Secondly, among olanzapine or risperidone initiators, patients who used at least one anticholinergic agent adjunctively tended to stay on the target drug significantly longer than those who did not use any anticholinergic agent adjunctively with the target drug. CONCLUSION: As the use of anticholinergics is a proxy for the presence of EPS, these findings suggest that risperidone may be more associated with EPS than olanzapine. However, to assess the benefits and side effects associated with olanzapine or risperidone, future research needs to examine various patient outcomes resulting from the initiation of each drug.

Antipsychotic Agents↗

PubMed2003

The relative health related quality of life of veterans with Parkinson's disease.

OBJECTIVES: To use databases of the US Veterans Health Administration (VHA) to describe the impact of Parkinson's disease on health related quality of life (HRQoL) of veterans; to compare the HRQoL of veterans with Parkinson's disease with that of veterans reporting eight other neurological or chronic conditions; and to estimate the unique effect of Parkinson's disease on HRQoL. METHODS: Respondents to the VHA 1999 large national health survey of veteran enrollees with a diagnosis of Parkinson's disease in VHA treatment files for the fiscal years 1997-1999 were identified by merging databases. The survey incorporated the Veterans SF-36, a well validated generic measure of HRQoL and functional status. This was used to compare patient groups. Mean physical (PCS) and mental (MCS) component summary scores were calculated for Parkinson's disease and eight other diseases by multivariable regressions that adjusted for age, sex, race, education, and 15 mental and physical co-morbid conditions that were self reported in the survey. RESULTS: Of 887 775 survey respondents, 14 530 (1.64%) had a Parkinson's disease diagnosis. Controlling for sociodemographic factors and co-morbidities, veterans with Parkinson's disease had PCS and MCS below veterans with angina/coronary heart disease, arthritis, chronic low back pain, congestive heart failure, diabetes, and stroke. Veterans with spinal cord injury reported slightly lower PCS than veterans with Parkinson's disease (32.38 v 32.72; 0.03 of 1 SD). Veterans with depression reported markedly lower MCS than veterans with Parkinson's disease (35.94 v 41.48; 0.55 of 1 SD). The unique effect of having Parkinson's disease on HRQoL was to lower PCS and MCS by 4.10 and 3.42 points (0.41 and 0.34 of 1 SD), respectively. CONCLUSIONS: The analysis quantifies the negative impact of Parkinson's disease on HRQoL, after controlling for sociodemographic factors and co-morbidities. Compared with eight other chronic conditions, Parkinson's disease imposes a relatively heavy burden on US veterans in the VHA health care system.

Aged↗

PubMed2001

Racial differences in the use of lumbar spine radiographs: results from the Veterans Health Study.

STUDY DESIGN: We analyzed data from the Veterans Health Study, a longitudinal study of male patients receiving VA ambulatory care. OBJECTIVE: To determine whether clinical differences and/or race account for disparities between white and nonwhite patients in the use of lumbar spine radiographs. SUMMARY AND BACKGROUND DATA: Four hundred one patients with low back pain (LBP) receiving ambulatory care services in four VA outpatient clinics in the greater Boston area were followed for 12 months. METHODS: Participants were mailed the Medical Outcome Study Short Form Health Survey (SF-36) and had scheduled interviews that included the completion of a low back questionnaire, a comorbidity index, and a straight leg raising (SLR) test. Using self-reported racial data, patients were grouped as whites (315 patients) and nonwhites (among whom 22 were black, 4 nonwhite Hispanics, and 1 other race). RESULTS: Nonwhite patients had lumbar spine films more often (13 of 27, 48%) than white patients (87 of 315, 27%)(P = 0.02). Nonwhite patients had higher pain intensity scores than white patients (63 +/- 21 vs. 48 +/- 21, P < 0.01) and were more likely to have radiating leg pain (20 of 27, 76%; compared with 171 of 315, 55%; P = 0.01) than white patients. Nonwhite patients had worse physical functioning (P = 0.01), general health perception (P = 0.05), social functioning (P = 0.02), and role limitations because of emotional problems (P < 0.01). At higher LBP intensity level, nonwhite patients received more lumbar spine films (20 of 27, 74%) than did white patients (155 of 315, 50%)(P < 0.01). Among patients with positive SLR test, nonwhite patients also had lumbar spine films more often (5 of 22, 23%) than white patients (29 of 315, 11%) (P < 0.01). However, after adjusting for multiple clinical characteristics, race was no longer found to be an independent predictor of lumbar spine radiograph use. A positive SLR test remained to be associated with higher radiograph use, whereas better mental health status was associated with lower radiograph use. CONCLUSIONS: There was greater use of lumbar spine radiographs by nonwhite patients compared with white patients. This remained true when patients were subcategorized by severity of LBP or SLR test. However, race had no influence when multiple clinical characteristics of the patients were controlled for simultaneously. This study demonstrates the importance of careful and comprehensive case-mix adjustment when assessing apparent differences in the use of medical services.

Aged↗

PubMed2001

The association of bone marrow lesions with pain in knee osteoarthritis.

BACKGROUND: The cause of pain in osteoarthritis is unknown. Bone has pain fibers, and marrow lesions, which are thought to represent edema, have been noted in osteoarthritis. OBJECTIVE: To determine whether bone marrow lesions on magnetic resonance imaging (MRI) are associated with pain in knee osteoarthritis. DESIGN: Cross-sectional observational study. SETTING: Veterans Affairs Medical Center. PATIENTS: 401 persons (mean age, 66.8 years) with knee osteoarthritis on radiography who were drawn from clinics in the Veterans Administration health care system and from the community. Of these persons, 351 had knee pain and 50 had no knee pain. MEASUREMENTS: Knee radiography and MRI of one knee were performed in all participants. Those with knee pain quantified the severity of their pain. On MRI, coronal T(2)-weighted fat-saturated images were used to score the size of bone marrow lesions, and each knee was characterized as having any lesion or any large lesion. The prevalence of lesions and large lesions in persons with and without knee pain was compared; in participants with knee pain, the presence of lesions was correlated with severity of pain. RESULTS: Bone marrow lesions were found in 272 of 351 (77.5%) persons with painful knees compared with 15 of 50 (30%) persons with no knee pain (P < 0.001). Large lesions were present almost exclusively in persons with knee pain (35.9% vs. 2%; P < 0.001). After adjustment for severity of radiographic disease, effusion, age, and sex, lesions and large lesions remained associated with the occurrence of knee pain. Among persons with knee pain, bone marrow lesions were not associated with pain severity. CONCLUSIONS: Bone marrow lesions on MRI are strongly associated with the presence of pain in knee osteoarthritis.

Adult↗

PubMed2001

Self-reported and clinical oral health in users of VA health care.

BACKGROUND: This article describes the oral health of users of Veterans Administration (VA) health care using both clinical and self-report measures, and models relationships between these measures and self-perceived oral health. METHODS: We conducted a cross-sectional study of 538 male users of VA outpatient care in the Boston area. Questionnaires assessed self-reported oral health, oral-specific health-related quality of life, health behaviors, and sociodemographic information. Clinical data were collected on oral mucosa status, number of teeth and root tips, dental caries, and periodontal treatment need. We report clinical and self-reported oral health status by age group (era of military service). We regressed models of self-perceived oral health on clinical indices and self-reported measures of the impact of oral health on daily life, adjusting for sociodemographic characteristics and health behavior. RESULTS: Among those participants aged 65 to 91 years old, 2.8%, 18.7%, and 41.5% rated their oral health as excellent, very good, or good, respectively. Among 50- to 64-year-old men, the corresponding values were 1.4%, 18.5%, and 40.4%, while among those aged 22 to 49 years old, the values were 2.3%, 17%, and 34.1%. Tooth loss was common among users of VA care; 34% of those aged 65-90 years, 28% of those aged 50-64 years, and 8% of those aged 25-49 years had no teeth. Periodontal treatment needs were uniformly high among persons with teeth; mild mucosal change was common, and 10% had root tips. Regression models showed self-perceived oral health was better in persons with more teeth and recent dental treatment, and worse with tooth mobility, coronal decay, and more medical problems. Measures of the impact of oral conditions on daily life added significantly to the amount of explained variance in self-perceived oral health. CONCLUSIONS: Clinical conditions and the impact of oral health on daily life are important determinants of self-perceived oral health.

Adult↗

PubMed2001

Health status assessments using the Veterans SF-12 and SF-36: methods for evaluating otucomes in the Veterans Health Administration.

This article describes a study in which the administration of two health surveys, the Veterans SF-36 and SF-12, by telephone and mail-out was used to assess the differences in the health surveys' costs and scores by mode of administration and determine which mode was cost-efficient. The study employed a crossover design: after 12 unsuccessful attempts to contact patients by telephone, the patients were administered the survey by mail, and after 2 unsuccessful mail-outs, up to three attempts were made to interview the patients by telephone. The analysis of the data showed that mail administration, with or without crossover to telephone, was more cost-efficient than telephone administration, having both lower average total and variable costs per completed questionnaire. Overall, telephone administration was about 30% more expensive that mail administration, primarily due to the cost of labor. The marginal cost of an additional completed Veterans SF-12 or Veterans SF-36 was also substantially lower for mail administration. Mail administration without crossover to telephone administration was the most cost-efficient strategy for administering both the Veterans SF-12 and SF-36. The results of this study strongly suggest the need to consider the mode of administration if questionnaires like the Veterans SF-12 or SF-36 are to be used to assess health outcomes within and across large health care systems.

Costs and Cost Analysis↗

PubMed2001

Heart murmurs: are older male dental patients aware of their existence?

BACKGROUND: The American Heart Association recommends that patients with certain abnormal and prosthetic heart valves receive antibiotic prophylaxis before undergoing invasive dental treatment, owing to the risk of bacterial endocarditis, or BE. However, it is not known how many patients are aware that they have such conditions and understand such recommendations. METHODS: The authors conducted a study to determine how many male users of three U.S. Department of Veterans' Affairs ambulatory medical care centers denied having a heart murmur, even though a murmur was noted in their medical record. The authors asked 637 potential subjects a series of questions to identify those who had a heart murmur that might place them at risk of developing BE. The authors then reviewed each subject's medical records for documentation of a heart murmur. RESULTS: Four hundred ninety-seven dentate men (mean age: 61.0 years) denied having a heart murmur. Seventy (14.1 percent) of these men had documentation of a heart murmur in their medical records, and 13 (2.6 percent) had murmurs that were likely to be pathological. The failure to accurately report having a heart murmur and having a potentially pathological heart murmur were positively related to age (P = .001). Failure to accurately report having a heart murmur also was related to lower educational levels. CONCLUSIONS: These results indicate that a substantially larger number of older men than younger men were unaware that they had a heart murmur. Since some of these murmurs necessitate administration of antibiotic prophylaxis before dental procedures, this failure to communicate their correct medical status may put them at risk of developing BE. CLINICAL IMPLICATIONS: Dental health care providers should be aware that patient self-report may not be a reliable indicator of cardiac status, particularly in older patients.

Age Factors↗

PubMed2001

Oral health of ambulatory care patients.

OBJECTIVES: This project assessed the clinical oral health status of Veterans Administration (VA) patients and examined the relationship between oral health and both sociodemographic factors and dental care utilization. METHODS: Data were collected on 538 users of VA ambulatory medical care. Oral health was assessed by clinical examinations, and dental use and sociodemographic information are based on self-report. RESULTS: Younger, more educated VA patients with higher incomes had more teeth, fewer untreated and treated root caries, and were less likely to be edentulous or to have dentures. Dental utilization emerged as the most important aspect of veterans' oral health status, even after sociodemographic factors were controlled. Compared with the general population, veterans have poorer oral health with the exception of coronal caries. CONCLUSION: Compared with national studies, VA patients appear to have worse oral health. The importance of sociodemographic factors and dental utilization that has been found in other studies applies to veterans' oral health as well.

Adult↗

PubMed2001

Knee effusions, popliteal cysts, and synovial thickening: association with knee pain in osteoarthritis.

OBJECTIVE: To evaluate the association of effusions, popliteal cysts, and synovial thickening with knee symptoms in older persons with and without radiographic (XR) osteoarthritis (OA), using magnetic resonance imaging (MRI). METHODS: Subjects with and without knee symptoms were recruited from Veterans Affairs and community sources. All had weight-bearing knee radiographs. Subjects were divided into 3 groups: Knee pain/XROA group had knee symptoms and radiographic OA; No knee pain/XROA group had no knee symptoms and radiographic OA; and No knee pain/no XROA group had no knee symptoms and a normal radiograph. A single knee was imaged using a 1.5 T MR scanner using T1 and T2 weighted and proton density SE imaging sequences. MRI were read for effusion, popliteal cysts, and synovial thickening. RESULTS: The mean age of subjects was 67.0 years (66.6% male). We studied 381 subjects with Knee pain/XROA, 52 with No knee pain/XROA, and 25 with No knee pain/no XROA. The prevalence of moderate or larger effusions was: Knee pain/XROA 54.6%, No knee pain/XROA 15.6%, and No knee pain/no XROA 11.1%. Popliteal cysts were present in 33.0% of Knee pain/XROA subjects, 28.0% No knee pain/XROA, and 9.1% No knee pain/no XROA. After adjusting for the severity of radiographic OA, there was a difference between those with and without knee pain in prevalence of moderate or larger effusions (p < 0.001) and synovial thickening, independent of effusion (p < 0.001), but not in the prevalence of popliteal cysts. Further, among those in Knee pain/OA group, synovial thickening was associated with the severity of knee pain. CONCLUSION: Effusions and popliteal cysts are common in middle aged and elderly people. After adjusting for the degree of radiographic OA, moderate or large effusions and synovial thickening were more frequent among those with knee pain than those without pain, suggesting these features are associated with the pain of knee OA. In those with knee symptoms, synovial thickening is uniquely associated with the severity of knee pain.

Aged↗

PubMed2000

Clinical factors that influence patients' desire for participation in decisions about illness.

BACKGROUND: Clinical practice often fails to optimize patient participation in decisions about serious illness. Prior studies are unclear about whether the type of decision and prior illness experience affect the patient's preferences for participation in decision making. Most studies of patient decision making have not addressed decisions about serious illness. OBJECTIVE: To determine whether the type of illness and nature of the decision predict the patient's preferences for involvement in making decisions. DESIGN: Study of randomly selected patients' responses to vignettes about cancer, acute myocardial infarction, and diabetes coupled with cross-sectional survey and chart review. SETTING: Outpatient Veterans Affairs medical clinic. PATIENTS: A total of 255 patients with a mean age of 63.2 years (95.2% male; 61.9% married). MAIN RESULTS: Patients wanted to share hypothesized major decisions with their physicians (mean score, 2.9; 1 = only physician, 5 = only patient) but wanted less involvement in hypothesized minor decisions (mean score, 2.5). Patients with recent severe heart disease (myocardial infarction, bypass surgery, angioplasty) wanted more involvement in decisions about acute myocardial infarction than did patients with stable angina or no heart disease; prior experience with diabetes did not affect decisions about diabetes. Factor analysis of the vignette items yielded 3 types of decisions that we consider to reflect major, minor, and patient behavior decisions. Mean scores were 2.9 for major decisions, 2.1 for minor decisions, and 2.7 for patient behavior decisions. CONCLUSIONS: Patients want to share in major decisions with their physicians but prefer to be less involved in minor decisions. For some illnesses, such as myocardial infarction, prior experience with the illness increases the patients' desire for participation in decision making. Arch Intern Med. 2000;160:2991-2996

Critical Care↗

PubMed2000

Patient characteristics and patterns of use for lumbar spine radiographs: results from the Veterans Health Study.

STUDY DESIGN: Longitudinal data from the Veterans Health Study, an observational study of male patients receiving Veterans Administration ambulatory care, were analyzed. OBJECTIVE: To identify patient characteristics that predict different patterns in the use of lumbar spine radiographs. SUMMARY AND BACKGROUND DATA: In this study, 401 patients with low back pain receiving ambulatory care services in four Veterans Administration outpatient clinics in the greater Boston area were followed for 12 months. METHODS: Participants were mailed the Medical Outcome Study Short Form Health Survey and participated in scheduled interviews that included the completion of a low back questionnaire, a comorbidity index, and a straight leg raising test. Four groups of patients were defined according to the patterns of use for lumbar spine radiographs: prior use, repeat use, no use, and new use of lumbar spine radiographs. These groups were compared in terms of sociodemographics, comorbid conditions, low back pain intensity, radiating leg pain, straight leg raising, Medical Outcome Study Short Form Health Survey scores, and low back disability days. RESULTS: The patients with new lumbar spine radiographs showed worse physical and psychological distress than the participants in the other three groups. In contrast, the patients with no lumbar spine radiographs reported minor physical impairment. Compared with patients who had no repeat radiographs, patients with repeat lumbar spine radiographs had similar scores on physical health, but they showed worse scores of mental health. CONCLUSIONS: Both physical and psychological factors contribute to having new radiographic examinations, whereas psychological factors have increased importance in the repeat use of roentgenographic examinations. Repeat radiographs appear to be overused, judging by the severity of physical impairment as measured by low back pain intensity, the Medical OutcomeStudy Short Form Health Survey, and disability days.

Ambulatory Care↗

PubMed2000

Detecting radiographic knee osteoarthritis: what combination of views is optimal?

OBJECTIVE: The failure to image the patellofemoral joint or the posterior knee compartment when evaluating persons for knee osteoarthritis may result in missed cases. While the skyline view has been recommended due to more reproducible assessment of the patellofemoral joint space, the lateral view may be easier to acquire and provides different information. We evaluated the sensitivity of different combinations of X-ray views (anteroposterior and lateral; anteroposterior and skyline; all three views) in 377 persons with knee symptoms who had all three views available and had a definite osteophyte on at least one view. RESULTS: Of the different views, skylines had to be excluded most often because the image of the patellofemoral joint was technically unsatisfactory. In the remaining knees, adding either a lateral or a skyline view to an anteroposterior view yielded roughly equal and high sensitivity (94-97%) when compared with the gold standard of a positive X-ray on any of the three views. CONCLUSION: As long as at least an anteroposterior view and one image of the patellofemoral joint is obtained (either skyline or lateral), few cases with radiographic disease will be missed. For clinical or epidemiological studies the lateral view may be easier to acquire with high quality than the skyline view.

Aged↗

PubMed1999

Decision-making preference and opportunity in VA ambulatory care patients: association with patient satisfaction.

Using data from the Veterans Health Study, associations were examined for decision-making preference, decision-making opportunity, and satisfaction with medical care among a sample of 266 men who use Department of Veterans Affairs (VA) ambulatory health care services. Results indicated that veterans with a high preference for involvement in decision-making and low provider-offered decision-making opportunities had significantly lower satisfaction with medical care compared to veterans with either low preference for decision-making involvement with high or low opportunity, or those with a high decision-making preference and high decision-making opportunity. The findings suggest that health care providers may increase patient satisfaction with medical care by providing opportunities for decision-making to patients who prefer involvement in their health care decision-making. Provider strategies for increasing patient decision-making involvement are discussed.

Adult↗

PubMed1999

Short-form Arthritis Impact Measurement Scales 2: tests of reliability and validity among patients with osteoarthritis.

OBJECTIVE: To validate a short-form Arthritis Impact Measurement Scales 2 (AIMS2-SF) among 147 patients with osteoarthritis (OA). METHODS: We used factor analysis to identify domains of functional health associated with OA. Multitrait scaling analysis was used to evaluate the reliability and validity of the AIMS2-SF. RESULTS: The results suggested that upper body limitations should be distinguished from lower body limitations in the physical function scale. The AIMS2-SF was psychometrically sound, with all 5 scales having high item-discriminant validity and Cronbach's alpha reliability above the 0.70 criterion (except 0.67 for the social function scale). CONCLUSION: The AIMS2-SF is a reliable and valid instrument among patients with OA. Because of its simplicity and ease of application, it may be useful in routine evaluation of health status, in clinical research, and in predicting use of medical services among OA patients.

Activities of Daily Living↗

PubMed1999

Social support, social selection and self-assessed health status: results from the veterans health study in the United States.

This study provided a comprehensive assessment of the association between social support and health using longitudinal data from the Veterans Health Study. Unlike previous studies which examined the relationship between one single domain of social support with either mental or physical health, the present study assessed the effects of three different domains of social support on multiple measures of health. The findings of the study indicated that social support tended to mediate the deleterious effects of non-military traumatic events; whereas the adverse consequences of traumatic events experienced in the military were not affected by social support, suggesting that stressors associated with combat had a long lasting effect on the health status of veterans. The study results revealed that compared with those with better health, respondents with poor health were more likely to have lower levels of social support, suggesting that poor health might be a barrier to a person's ability to participate and/or maintain social relationships. The study also showed that different types of social support had varying beneficial effects on different measures of health. While perceived support had a strong effect on all the measures of health (except alcoholism) included in the study, living arrangement had a significant effect on post-traumatic stress disorder or physical health and participation in group activities had a strong effect only on physical functioning. The results of the study highlight the need for future research to determine whether particular types of social support affect various aspects of health differently. This simultaneous focus on multiple support functions and health outcomes is important because it provides insight into the mechanisms linking social support to health.

Adult↗

PubMed1999

Assessment of functional status, low back disability, and use of diagnostic imaging in patients with low back pain and radiating leg pain.

We analyzed data from outpatients with chronic low back pain (LBP) in the Veterans Health Study (n = 563) to examine the relationship between localized LBP intensity and radiating leg pain in assessing patient functional status, low back disability, and use of diagnostic imaging. Based on the localized LBP intensity, the study subjects were divided into tertiles (low, moderate, and high intensity). The study subjects were also stratified by the extent of radiating leg pain. Using analysis of variance and multiple regression analysis, we compared the relative importance of localized LBP intensity and radiating leg pain in explaining the variability in the means of the SF-36 scales and low back disability days, and in the proportion of patients who had used diagnostic imaging. The results of the study indicate that measures of localized LBP intensity and radiating leg pain contribute separately to the assessment of patient functional status, low back disability, and use of diagnostic imaging. These results suggest that localized LBP intensity and radiating leg pain may represent two different approaches in assessing back pain severity. Future epidemiological and health services research should consider both measures in assessing the impact of LBP on patient functional status, low back disability, and use of diagnostic imaging.

Adult↗

PubMed1999

Roles of physicians, attorneys, and illness experience in advance directives.

BACKGROUND: Age, illness severity, functional status, and education are associated with advance directive completion. We examined these patient characteristics and discussions with attorneys and physicians in a predictive model for advance directive completion. METHODS: We did a cross-sectional survey of 255 randomly selected patients in a VA outpatient clinic. RESULTS: Patients were predominantly men (95.2%), married (61.9%), with a mean age of 63.2 years; 17.7% of the patients had an advance directive; 5.0% had only a living will, 6.0% had only a durable power of attorney for health care, and 6.7% had both. Age, marital status, illness severity, previous serious illness in spouse, and physician discussion were all associated with advance directive completion in a multiple logistic regression. Eighty-two patients were asked about discussions with attorneys--15 had advance directives; of these, 13 had talked to an attorney, but only 7 had talked to a physician. CONCLUSIONS: Previous serious spousal illness, marital status, age, illness severity, and patient-physician discussions all predicted completions of an advance directive. Attorney discussions were strongly associated with advance directive completion. Better communication between physicians, patients, and attorneys may increase the usefulness of advance directives.

Adult↗

PubMed1999

Mental disorders and mental health treatment among U.S. Department of Veterans Affairs outpatients: the Veterans Health Study.

OBJECTIVE: The authors examined the self-reported presence and treatment of current depressive disorder, posttraumatic stress disorder (PTSD), and alcohol-related disorder in a group of outpatient veterans. METHOD: Data were obtained from the Veterans Health Study, a longitudinal investigation of male veterans' health. A representative sample of 2,160 outpatients (mean age = 62 years) was drawn from Boston-area U.S. Department of Veterans Affairs (VA) outpatient facilities. The participants completed screening measures for depression, PTSD, and alcohol-related disorder. Mental health treatment was assessed by interviews. RESULTS: The screening criteria for at least one current mental disorder were satisfied by 40% (N = 856) of the patients. Screening rates were 31% (N = 676) for depression, 20% (N = 426) for PTSD, and 12% (N = 264) for alcohol-related disorder. Patients who screened positively for current mental disorders were younger, less likely to be married or employed, and more likely to report traumatic exposure than were those without mental disorders. Of those who met the screening criteria for any of the targeted mental disorders, 68% (N = 579) reported receiving mental health treatment. Younger, Caucasian men and those who reported more traumatic exposure were more likely to report receiving mental health treatment than were others who screened positively for mental disorders. CONCLUSIONS: Screening rates of depression and PTSD and rates of mental health treatment were considerably higher among these VA outpatients than among similar patients in primary care in the private sector. Although the VA is currently meeting the mental health care needs of its patients, future fiscal constraints could affect most adversely the treatment of non-Caucasian and older patients and those with a history of traumatic exposure.

Alcoholism↗