Correlates and Predictors of Mental Health Care Utilization for Veterans With PTSD: A Systematic Review

Objective: Treatment utilization among veterans with posttraumatic stress disorder (PTSD) is low. Understanding correlates and predictors of mental health care for veterans with PTSD is critical to facilitating treatment utilization. However, given the size of the literature base and disparate findings, it is difficult to interpret available research. Correlates and predictors of mental health care for veterans with PTSD published between 2012 and 2016 were examined to (a) define the scope of recent literature and (b) summarize predictive evidence. Method: This 2-phase systematic review conducted scientific database searches. Phase 1 defined the scope of recent literature (n = 51) and tabulated types of correlates, outcomes, and sources of bias. Phase 2 summarized results from prospective studies (n = 17) evaluating mental health care utilization (PROSPERO ID No. CRD42017082686). Results: Demographics- social network characteristics (61%) and evaluated need (61%) were the most common correlates of mental health utilization. Facilitators with the strongest evidence for predicting utilization (both initiation and retention) were characteristics of the episode of care (e.g., mental health in primary care) and greater PTSD symptom severity. Study biases favoring Department of Veterans Affairs (VA) enrollees (92%) and excluding outside VA care outcomes (86%) limit generalizability of results. Conclusions: Efforts focused on providing mental health in primary care, interventions to address mental health beliefs, and outreach to racial-ethnic minority veterans and those with mild to moderate PTSD could increase mental health care utilization.