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Age Differences in Posttraumatic Stress Disorder, Psychiatric Disorders, and Healthcare Service Use Among Veterans in Veterans Affairs Primary Care Clinics

From the Department of Psychology, University of Hawaii at Hilo, Hilo, HI (BCF); the Veterans Affairs Medical Center, Charleston, SC (ALG, KMM); the Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC (ALG, RA, GC, KMM); and the Disaster Mental Health Institute, The University of South Dakota, Vermillion, SD (JDE).

Objective: To expand our understanding of posttraumatic stress disorder (PTSD) prevalence, its psychiatric characteristics, and service use among elderly veterans in Veterans Affairs (VA) primary care clinics.

Methods: A cross-sectional, epidemiological design (N = 745) incorporating self-report measures, structured interviews, and chart reviews was used to obtain relevant information for analyses.

Results: The oldest group of veterans (65 years; N = 318) had lower prevalence of most psychiatric diagnoses than the youngest (18–44 years; N = 69) and middle-aged (45–64 years; N = 358) groups. Despite having higher rates of combat exposure, veterans in the oldest group (6.3%) had one-third the prevalence of PTSD than those in the middle-aged group (18.6%). A similar pattern was found across other psychiatric diagnoses. For example, those in the oldest group (7.5%) had one-third the prevalence of major depression as those in the two younger groups (21.7% and 22.9%). These differences were maintained after controlling for relevant demographic covariates (race, sex). Results from examination of VA health care service use across the three groups were consistent with the findings that the oldest veteran group is functioning significantly better across mental health domains.

Conclusion: Elderly veterans who use VA primary care services evidence lower rates of PTSD and other psychiatric disorders, and they use significantly less VA mental health services. They also do not appear to show evidence of worse physical health functioning or use VA health care services or disability benefits at a meaningfully higher rate than their younger counterparts.

Key Words: Posttraumatic stress disorder • geriatric • elderly • Veterans Affairs • service use • veterans • health care

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