Determinants of Mental Health Services Utilization Among Deployed Service Members and Their Families

摘要

The stress associated with extended separations due to military deployment can create significant emotional problems for service members and their families. The current sustained combat operations in Iraq and Afghanistan by the U.S. military requires a continual assessment of the mental health of service members who have deployed to combat and to understand if there is a difference in service use among this population. This study analyzed the determinants of outpatient mental health services utilization at Brooke Army Medical Center (BAMC) within the framework of the Anderson Behavioral Model (ABM), which examines the impact of predisposing (demographic), enabling (socio- economic), and need factors (health status) on health services utilization behavior. Using the Military Health System Data Mart (M2), data covering three fiscal years from 2005 through 2007, were used to analyze 33,860 direct care and 27,300 purchased care outpatient mental health observations or visits at the BAMC Behavioral Health Clinic. The study used hierarchical regression analyses to examine the impact of predisposing, enabling and need factors on outpatient mental health service utilization. The data partially support the hypotheses. The predisposing variables, beneficiary category and branch of service, consistently explained about 1% of the variance in mental health service utilization in direct care settings and up to 13% in purchased care settings. Provider specialty was the only significant enabling variable in both direct and purchased care visits and accounted for 7% and 9% respectively of the shared variance in the models. The adjusted R2 for the direct care model was .071 and for purchased care .158. Although the diagnosis variable of post- traumatic stress disorder was associated with greater mental health service utilization, need factors, as a whole, were neither a consistent predictor in visits where the sponsor deployed to combat nor for those where the sponsor did not deploy.