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Posttraumatic Stress Disorder and the Use of Health Services

National Center for PTSD (E.Y.D., T.M.K., D.K., M.S.), and Medical Service (G.F., K.C.), Veterans Administration Boston Healthcare System and Boston University School of Medicine, and Boston University School of Public Health (J.R.), Boston; and Center for Health Quality, Outcomes, and Economic Research, HSR&D Service (J.R.), Bedford Veterans Administration Medical Center, Bedford, Massachusetts.

View larger version (14K): [in a new window]   Fig. 1. Logistic regression examining the association of PTSD and depression with health services utilization status (high vs. low) for the full sample. Solid lines represent statistically significant paths. Indirect effects for PTSD on Medical Conditions are calculated as the product of significant unstandardized ß weights (Direct: = .362 + .364 x .098 (Indirect) = .0356 (total). The total effect between PTSD and Utilization is the sum of two indirect paths. (Indirect: .362 x .373 = .135 + .0356 x .373 = .0133; total = .148).

View larger version (14K): [in a new window]   Fig. 2. Linear regression examining the association of PTSD and depression with number of health care visits for the high-user group. Solid lines represent statistically significant paths. An indirect effect based on the product of two unstandardized ß weights represents the total association between PTSD and number of visits. PTSD to Medical Conditions: (Direct = .392 + (Indirect) 0 = (Total) .392. PTSD to No. of Health Visits: Indirect = .392 x .488 = .191 (Total).

View larger version (14K): [in a new window]   Fig. 3. Linear regression examining the association of PTSD and depression with number of health care visits for the low user group. Solid lines represent statistically significant paths. There are no significant direct or indirect paths of association between PTSD and number of visits.

View larger version (61K): [in a new window]   Fig. 4. Mean number of medical conditions for each user group across quintiles of mental health burden. Medical condition means are indicated by numbers above bars on the graph. The index of mental health burden is calculated as the product of PTSD (CAPS) and depression (BDI) measures. , low user; , high user.