Positive Mental Health Screens in the Veterans Health Administration, 2021 to 2024

Abstract

Importance Prevalence of mental health conditions is rising, but there have been few national reports in recent years. The Veterans Health Administration (VA) is the nation’s largest institution providing mental health services and provides a fertile ground for assessing rates of mental health conditions. Objective To examine the trends in the risk of 4 mental health conditions in the VA using mandated mental health screens. Design, Setting, and Participants In this cohort study, unadjusted and adjusted rates of positive screens from fiscal year (FY) 2021 to FY 2024 were examined for depression, alcohol use disorder (AUD), suicide risk, and posttraumatic stress disorder (PTSD) in a cohort of patients screened and continuously enrolled in primary care. Adjusted rates were computed from logistic regression analyses, controlling for patient, visit, and clinic setting characteristics. Results The cohort included 3 668 361 patients. The mean [SD] age of patients was 61.5 [15.4] years; 3 292 787 patients (89.8%) were male. Both the unadjusted and adjusted rates showed increases in positive screens for depression and PTSD and reductions for suicide risk and AUD. Adjusted rates for depression increased from 8.8% (95% CI, 8.7%-8.7%) to 9.6% (95% CI, 9.1%-10.3%), a 9% increase, and adjusted rates for PTSD increased from 8.1% (95% CI, 8.1%-8.2%) to 10.5% (95% CI, 10.5%-10.6%), a 30% increase. Rates decreased for suicide risk from 0.7% (95% CI, 0.68%-0.70%) to 0.5% (95% CI, 0.51%-0.53%), a 29% decrease, and decreased for AUD from 5.8% (95% CI, 5.8%-5.8%) to 5.4% (95% CI, 5.3%-5.4%), a 7% decrease. Across all mental health conditions, being younger, having higher clinical risk, living far from medical facilities, and being Hispanic increased odds of positive screening. Conclusions and Relevance The findings of this longitudinal cohort study emphasize the ongoing need to manage depression and PTSD among veteran patients. The VA’s substantial investment in suicide prevention efforts and the VA’s uniqueness in conducting routine screens for AUD may have contributed to the reductions in suicide risk and AUD, but this needs to be evaluated. Findings from the VA may signal broad national trends in recent years.