The Veterans Health Administration (VHA) is the branch of the United States Department of Veterans Affairs (VA) that is responsible for providing healthcare services and medical assistance programs to veterans enrolled in VA’s healthcare services.
a continuous line drawing of a therapist consoling a veteran
Key Points
Rationale
This study examined rates of OCD diagnosis and treatment in veterans within the Veterans Health Administration (VHA) system.
OCDis a disabling disorder, yet little was known about OCD among veterans in VHA care (McIngvale, Van Kirk, & Stanley, 2015).
Previous research shows OCD is associated with substantial functional impairment, quality of life reductions, and occupational disability (Huppert et al., 2009; Macy et al., 2013; Markarian et al., 2010). OCD tends to be chronic without appropriate treatment (Eisen et al., 2013).
The prevalence of OCD may be elevated among veterans compared to the general population. Studies using structured interviews indicate higher 12-month OCD rates among veterans versus civilians (Gros, Magruder, & Frueh, 2013; Jordan et al., 1991; Orsillo et al., 1996; Roszell et al., 1991).
Associations found between OCD and trauma exposure (Cromer, Schmidt, & Murphy, 2007; Kimbrel et al., 2015) suggest OCD could be increased in veterans.
The study provides important data on the recognition and treatment of OCD in VHA to inform efforts to improve diagnostic and treatment services for veterans with OCD.
Enhancing OCD care is critical given the functional impacts of OCD and its likely underestimation and inadequate treatment within VHA.
Method
Thisretrospective studyextracted data on 20,364 veterans with an OCD diagnosis in 2010-2011 from the VHA Corporate Data Warehouse.
A subset of 5,229 veterans newly diagnosed with OCD in 2010-2011 was further analyzed to examine diagnostic and treatment patterns.
Sociodemographic, diagnostic, clinic setting, provider type, and mental health utilization variables were extracted from medical records.
Sample
The majority of the over 20,000 veterans diagnosed with OCD were male (84.0%), with a mean age of 57.4 years. Of those newly diagnosed in 2010-2011, 56.9% were unmarried.
The majority had psychiatric comorbidities, including mood disorders (80.7%), anxiety disorders (64.4%), PTSD (49.7%), and substance use disorders (32.9%).
This complex clinical profile may contribute to the underrecognition of OCD in veterans.
Statistical Analysis
Descriptive analyses examined patient characteristics, settings, providers, and mental health visits associated with an OCD diagnosis.
Results
Insight
The low OCD diagnosis rate suggests underrecognition in VHA. Most patients had psychiatric comorbidities, compounding complex presentations.
Insufficient treatment after diagnosis indicates unmet needs. Better OCD assessment, diagnosis, guidelines, and services are required to address this disabling but overlooked disorder among veterans.
Strengths
Limitations
Implications
The findings indicate gaps in awareness, assessment, and treatment of OCD among veterans in VHA care. Veterans likely do not receive guideline-recommended care likeexposure and response prevention therapy.
Improved OCD clinical practice guidelines, screening, staff training, and services are greatly needed to reduce the burden and disability for veterans with OCD.
References
Primary reference
Barrera, T. L., McIngvale, E., Lindsay, J. A., Walder, A. M., Kauth, M. R., Smith, T. L., Van Kirk, N., Teng, E. J., & Stanley, M. A. (2018). Obsessive-compulsive disorder in the Veterans Health Administration.Psychological Services, 16(4), 605–611.https://doi.org/10.1037/ser0000249
Other references
Cromer, K. R., Schmidt, N. B., & Murphy, D. L. (2007). An investigation of traumatic life events and obsessive–compulsive disorder.Behaviour Research and Therapy, 45(7), 1683-1691.
Eisen, J. L., Sibrava, N. J., Boisseau, C. L., Mancebo, M. C., Stout, R. L., Pinto, A., & Rasmussen, S. A. (2013). Five-year course of obsessive-compulsive disorder: Predictors of remission and relapse.Journal of Clinical Psychiatry, 74(3), 233-239.
Gros, D. F., Magruder, K. M., & Frueh, B. C. (2013). Obsessive compulsive disorder in veterans in primary care: Prevalence and impairment.General Hospital Psychiatry, 35(1), 71-73.
Huppert, J. D., Simpson, H. B., Nissenson, K. J., Liebowitz, M. R., & Foa, E. B. (2009). Quality of life and functional impairment in obsessive–compulsive disorder: A comparison of patients with and without comorbidity, patients in remission, and healthy controls.Depression and Anxiety, 26(1), 39-45.
Jordan, B. K., Schlenger, W. E., Hough, R., Kulka, R. A., Weiss, D., Fairbank, J. A., & Marmar, C. R. (1991). Lifetime and current prevalence of specific psychiatric disorders among Vietnam veterans and controls.Archives of General Psychiatry, 48(3), 207-215.
Kimbrel, N. A., DeBeer, B. B., Meyer, E. C., Silvia, P. J., Beckham, J. C., Young, K. A., & Morissette, S. B. (2015). An examination of the broader effects of warzone experiences on returning Iraq/Afghanistan veterans’ psychiatric health.Psychiatry Research, 226(1), 78-83.
Macy, A. S., Theo, J. N., Kaufmann, S. C., Ghazzaoui, R. B., Pawlowski, P. A., Fakhry, H. I., Cassidy, K. L., & IsHak, W. W. (2013). Quality of life in obsessive compulsive disorder.CNS Spectrums, 18(1), 21-33.
Markarian, Y., Larson, M. J., Aldea, M. A., Baldwin, S. A., Good, D., Berkeljon, A., Murphy, T. K., Storch, E. A., & McKay, D. (2010). Multiple pathways to functional impairment in obsessive-compulsive disorder.Clinical Psychology Review, 30(1), 78-88.
McIngvale, E., Van Kirk, N., & Stanley, M. A. (2015, July).OCD and active duty members/veterans: A review. Poster presented at the 22nd Annual Conference of the International OCD Foundation, Boston, MA.
Orsillo, S. M., Weathers, F. W., Litz, B. T., Steinberg, H. R., Huska, J. A., & Keane, T. M. (1996). Current and lifetime psychiatric disorders among veterans with war zone-related posttraumatic stress disorder.Journal of Nervous and Mental Disease, 184(5), 307-313.
Roszell, D. K., McFall, M. E., & Malas, K. L. (1991). Frequency of symptoms and concurrent psychiatric disorder in Vietnam veterans with chronic PTSD.Hospital & Community Psychiatry, 42(3), 293-296.
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Olivia Guy-Evans, MSc
BSc (Hons) Psychology, MSc Psychology of Education
Olivia Guy-Evans is a writer and associate editor for Simply Psychology. She has previously worked in healthcare and educational sectors.
Saul McLeod, PhD
BSc (Hons) Psychology, MRes, PhD, University of Manchester
Saul McLeod, PhD., is a qualified psychology teacher with over 18 years of experience in further and higher education. He has been published in peer-reviewed journals, including the Journal of Clinical Psychology.
