Improvements Needed in Treating Veterans With PTSD, Depression

The number and timing of follow-up psychotherapy visits may be inadequate to deliver evidence-based psychotherapy.

While the US military health care system performs well in following up with patients with post-traumatic stress disorder (PTSD) and depression after they are discharged from mental health hospitalization, there is a need for improvement in medication management and ongoing care, according to findings by the nonprofit research organization RAND Corporation.

These findings are some of the first results of the RAND study, the largest, most comprehensive independent investigation of how the US military health system treats service members with PTSD and depression.

Areas where the US military health care system was found to be performing well included following up with patients with PTSD or depression after discharge from mental health hospitalization, a critical time for follow-up because of patients’ vulnerability during this time.

Researchers also found that the vast majority of patients with a PTSD or depression diagnosis received at least one psychotherapy visit, suggesting that service members with these diagnoses have access to at least some mental health care.

“Regardless of where they serve, where they live, or who they are, all members of the US armed forces should receive high-quality mental health care,” said Kimberly A. Hepner, PhD, lead author of the study and a clinical psychologist at RAND, in a statement. “Developing transparent assessments of care that can be routinely reviewed both internally and externally are essential to ensuring excellent care for all service members and their families.”

However, according to Dr Hepner, although most patients received at least 1 psychotherapy visit, the number and timing of following visits may be inadequate to deliver evidence-based psychotherapy.

This is an area of US military health care that could be improved: patients newly diagnosed with PTSD or depression should receive at least four psychotherapy or two medication management visits within eight weeks of their diagnosis, and only one-third of those diagnosed with PTSD and less than one-fourth of those diagnosed with depression met these established standards.

In order to assess the US military health care system’s performance in treating service members with PTSD or depression, Dr Hepner and colleagues reviewed administrative data and medical records of 14 576 active-duty service members diagnosed with PTSD and 30 541 diagnosed with depression between January 2012 and June 2012. The researchers examined whether the service members were receiving evidence-based care in the year after their diagnosis.

They also examined variations in the quality of care by service branch (Army, Navy, Air Force, and Marine Corps), across service member characteristics, and by TRICARE region (North, South, West, and Overseas). TRICARE is a health care program for members of the military and their families.

The researchers found that while there was variation in the quality of care provided to those with PTSD or depression, no military service branch or region consistently outperformed or underperformed compared with the others. The researchers also found no consistent variation in care provided to patients with different characteristics, such as age, gender, pay grade, race-ethnicity, or deployment history.

The researchers recommend that the Department of Defense investigate the reasons for the significant variation in quality measure rates in order to ensure that service members receive consistent, high-quality care.

A strategy for improving care should be based in quality measures that can be routinely assessed across the military health system, and the results should be shared broadly internally and among service members who use the system.


Hepner KA, Sloss EM, Roth CP, et al. Quality of Care for PTSD and Depression in the Military Health System: Phase I Report. RAND Corporation. 2016; doi:10.7249/RR978.