Association of PTSD and Depression With Medical and Specialist Care Utilization in Modern Peacekeeping Veterans in Canada With Health-Related Disabilities

Objective: We examined the relative associationsbetween posttraumatic stress disorder (PTSD) and depressionseverity with medical and specialist care use in modernpeacekeeping veterans with health-related disabilities.

Method: The participants consisted of 1016 maleveterans who served in the Canadian Forces from 1990 to 1999,selected from a larger random sample of 1968 veterans whovoluntarily completed an anonymous general health surveyconducted by Veterans Affairs Canada in 1999. Survey instrumentsincluded the PTSD Checklist-Military Version (PCL-M), Center forEpidemiological Studies-Depression Scale, and questionnaires ofhealth problems and service use, sociodemographiccharacteristics, and military history.

Results: Among peacekeeping veterans with healthdisabilities, “probable” PTSD (PCL-M score 50) wasassociated with significantly more medical service use (primaryand specialty care combined), with a mean of 16.4 times (SD = 17.4)compared with 6.0 times (SD = 6.6), p < .001, for veterans without PTSD. We found that in multivariate analyses, general medicalcare intensity (i.e., number of visits) was related to increasedhealth problems, greater probable PTSD diagnosis, and greaterdepression symptom severity. We also found that depressionseverity accounted for health care use intensity and that PTSDonly added a small amount of incremental variance above that.

Conclusions: The observed association betweenPTSD (diagnosis and severity) and medical care utilizationstresses the importance of PTSD screening in primary caresettings, especially in patients with a history of militaryservice. This association is also useful for clinicians andhospital administrators in understanding potential medical andpsychiatric needs for military veterans.