Online Program

Examining the Effectiveness of the Military Mental Healthcare System and Ways to Reduce Costs

Monday, November 2, 2015

Kartavya Vyas, MA, Department of Sociology, Anthropology, and Social Work, Creighton University, Omaha, NE
Eileen Delaney, PhD, Naval Center for Combat & Operational Stress Control, San Diego, CA
Nicholas Boyd, MA, Naval Center for Combat & Operational Stress Control, San Diego, CA
Susan Fesperman, MPH, Naval Center for Combat & Operational Stress Control, San Diego, CA
Jennifer Webb-Murphy, PhD, Naval Center for Combat & Operational Stress Control, San Diego, CA
Scott Johnston, PhD, Naval Center for Combat & Operational Stress Control, San Diego, CA
Purpose: Retrospective analyses of data from the Psychological Health Pathways program were conducted to evaluate the effectiveness of the military mental healthcare system, as well as the role of resilience in reducing healthcare costs.

Methods: Mental healthcare-seeking patients completed assessments at T1 and T2 (median=63 days, 56 days IQR). Self-reported outcomes included PTSD (PCL-M), depression (PHQ-9), sleep quality (PSQI), impairment (SDS), and resilience (RSES). Paired sample t-tests were conducted to examine changes from T1 to T2. Logistic regression models determined the predictive value of resilience for a number of outcomes.

Findings: The overall sample (n=2,887) exhibited significant improvements (p <.001) on all variables from T1 to T2. Depression showed the greatest improvement (effect size [ES]=-.39), followed by resilience (ES=.36), PTSD (ES=-.31), impairment (ES=-.28), and sleep (ES=-.14). At T1, patients with low resilience were at greater odds (adjusted odds ratio, 95% confidence intervals) for depression (2.89, 2.34-3.57), sleep problems (2.60, 1.81-3.73), and PTSD (1.68, 1.36-2.07). At T2, a 5-point increase in the RSES score was associated with decreased odds for depression (25.6%), sleep problems (19.8%), and PTSD (25.2%). Moreover, a 5-point increase in resilience across services is estimated to decrease the incidence rates of PTSD and depression by approximately 6%, saving the military nearly $120 million/year.

Implications: These findings demonstrate that service members’ mental health symptoms are improving. Bolstering service members’ resilience, either as a preventative approach through resilience training or as part of treatment, shows promise in increasing individual wellbeing and mission readiness, as well as reducing overall healthcare costs.

Learning Areas:

Administration, management, leadership
Implementation of health education strategies, interventions and programs
Provision of health care to the public
Public health or related laws, regulations, standards, or guidelines
Public health or related organizational policy, standards, or other guidelines

Learning Objectives:
Describe how effective the military mental healthcare system is in reducing symptoms and improving quality of life for service members; Define the role of resilience in preventing mental health disorders and ultimately reducing mental healthcare costs for the Department of Defense; Demonstrate quantitatively how resilience is directly associated with reduced mental healthcare costs.

Keyword(s): Mental Health System, Federal Policy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I will receive my master's degree in medical anthropology from Creighton University in a few months. I have worked in the fields of HIV and mental health clinical research, both in academia and in the military, for nearly 10 years. I have presented numerous abstracts at international and national conferences and have published several first-author, peer-reviewed articles.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.