Social determinants of health associated with initiation of evidence-based psychotherapy for posttraumatic stress disorder in a national sample of veterans.

Although the Veterans Health Administration (VHA) has strived to make posttraumatic stress disorder (PTSD) treatment widely available, the vast majority of veterans do not initiate evidence-based psychotherapy (EBP) for PTSD, which includes Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT). One prominent gap in the literature on PTSD EBP initiation is research on the role of social determinants of health (SDoH). In the current study, we used national survey and VHA data to investigate relationships between SDoH factors and PTSD EBP initiation. We used data collected in 2018 from a national, population-based, VHA-sponsored survey of post-9/11 veterans. We included VHA users with their first PTSD diagnosis in the electronic health record (EHR) from 2015 to 2018 (n = 678). Our outcome was PTSD EBP initiation, defined as at least one visit using a PE or CPT note template from 2015 to 2018 in the EHR. We conducted a logistic regression, with independent variables including demographic variables (age, gender, racial/ethnicity identity, sexual orientation, and marital status), time from PTSD diagnosis to end of 2018, service connection, trauma exposure (military sexual trauma [MST] and combat experience), and SDoH (education, homelessness, discrimination, legal involvement, socioeconomic disadvantage, and rurality). MST and greater time (from diagnosis to the end of the study) were associated with PTSD EBP initiation. Veterans reporting a history of having been to jail (legal involvement) were less likely to initiate a PTSD EBP. More research is needed to better understand why legal involved veterans are less likely to initiate a PTSD EBP.