Positive Depression Screening in OEF-OIF Veterans is Associated with Mental Healthcare Engagement within 30 Days

Background: Operations Enduring and Iraqi Freedom(OEF-OIF) Veterans experience high rates of mental health concerns. Screening for depression increases access to treatment and may improve health outcomes, but requires time and resources. We describe the association between screening result and mental healthcare engagement among OEF-OIF Veterans with established care at a Veterans Affairs Medical Center(VAMC). Methods: Depression screen data for OEF-OIF veterans were identified from the medical record between February and July2009, and merged with administrative data. Veterans with one or more encounters at the VAMC in the 365 days prior to screening were selected. Logistic regression models tested the relationship between depression screen result(positive vs. negative) and primary care, face-to-face mental health(MHFtoF), and telephone encounters(any vs. none) in the 30 days after screening. Covariates included coded mental health, substance abuse, and pain diagnoses; Charlson comorbidity score; disability compensation rating; age; gender; race; and previous MHFtoF. Results: 789 veterans had established care, of whom 114(14%) screened positive for depression. Bivariate analysis revealed those who completed a MHFtoF in the follow up period were more likely to be younger, male, Caucasian, have diagnosed substance abuse and mental disorders, previous mental healthcare, and positive depression screen than those who did not complete a MHFtoF(all p<0.05). Positive depression screen was associated with MHFtoF(OR=5.62[CI:3.45,9.02]) and telephone (OR=1.73[CI:1.03,2.90]), but not primary care(OR=0.83[CI:0.48,4.43]) encounters. Conclusions: In OEF-OIF VAMC users, positive depression screening is associated with increased engagement with mental healthcare independent of previous MHFtoF. The impact of such use on OEF-OIF veteran health should be explored further.