VHA Whole Health Services and Complementary and Integrative Health Therapies: a Gateway to Evidence-Based Mental Health Treatment

• Published in: Journal of general internal medicine : JGIM 2023-11, Vol.38 (14), p.3144-3151
• Main Authors: Etingen, Bella, Smith, Bridget M., Zeliadt, Steven B., Kaitz, Jenesse E., Barker, Anna M., Hyde, Justeen K., Fix, Gemmae M., Reed, David E., Anderson, Ekaterina, Hogan, Timothy P., Bokhour, Barbara G.
• Format: Article
• Language: English
• Subjects: Anxiety; Demographic variables; Health services; Humans; Internal Medicine; Medicine; Medicine & Public Health; Mental depression; Mental disorders; Mental Health; Original Research; Personal health; Post traumatic stress disorder; Psychological stress; Psychotherapy; Retrospective Studies; Stress Disorders, Post-Traumatic - diagnosis; Stress Disorders, Post-Traumatic - epidemiology; Stress Disorders, Post-Traumatic - therapy; United States - epidemiology; United States Department of Veterans Affairs; Utilization; Veterans; Veterans - psychology; Veterans Health Services; Well being
• ISSN: 0884-8734; 1525-1497; 1525-1497
• DOI: 10.1007/s11606-023-08296-z

Background Engagement in evidence-based psychotherapy (EBP) among veterans with behavioral health conditions is often low. The Veterans Health Administration (VHA) is implementing a “Whole Health (WH)” system of care, to identify veteran personal health goals, align care with those goals, and offer services designed to engage and empower veterans to achieve well-being. Objective To examine the relationship between veteran WH utilization and subsequent engagement in EBP. Design Retrospective analysis of VHA administrative records from 18 facilities implementing WH. Subjects Veterans ( n  = 265,364) with a diagnosis of depression, post-traumatic stress disorder (PTSD), and/or anxiety who had a mental healthcare encounter but no EBP use in fiscal year (FY) 2018. Among this cohort, 33,146 (12.5%) began using WH in FY2019. Main Measures We examined use of an EBP for depression, anxiety, and/or PTSD within 1 year of the index date of WH use compared to use of an EBP anytime during FY2019 for veterans not identified as using WH. We used multiple logistic regression to examine the association between veteran WH use and EBP engagement. Key Results Approximately 3.0% ( n  = 7,860) of the veterans in our overall cohort engaged in an EBP in the year following their index date. Controlling for key demographic, health, and utilization variables, WH users had 2.4 (95% CI: 2.2–2.5) times higher odds of engaging in an EBP the following year than those with no WH utilization. Associations between utilization of specific WH services (vs. no utilization of that service) and engagement in an EBP in the subsequent year ranged from 1.6 (95% CI: 1.0–2.6) to 3.5 (95% CI: 3.2–3.9) across the different types of WH services used. Conclusions WH use was associated with increased engagement in EBPs among veterans with depression, anxiety, and/or PTSD. Future interventions intended to promote veteran engagement in EBPs may benefit from leveraging WH services and therapies.