Study: Enlisted Troops Get Less Consistent Care for Depression

Enlisted troops sometimes get less consistent care for depression than officers, according to a new Rand Corporation study.

For example, after being prescribed anti-depressants, only about two-thirds of junior enlisted troops in the ranks of E-1 through E-4 fill the medication for at least two months; by comparison, more than eight in 10 officers do, the research shows.

Kimberly Hepner, lead author of the study, said enlisted troops were less likely to receive adequate duration of medication -- that is, for a long enough time for it to be most helpful for them.

"Where we did see some differences more frequently, but not across the board ... is that enlisted service members, when we compared them with officers, at times did receive less consistent care, particularly when we looked at care for depression," she said.

The enlisted also were less likely to get the adequate initial treatment following a diagnosis, Hepner said.

The study found that officers were more likely than enlisted members to receive the recommended four psychotherapy visits and four evaluation and management visits within the first eight weeks of discharge from hospital.

In general, the study found that the military health care system performs well when it comes to initiating psychotherapy and follow-up after troops are hospitalized with PTSD or depression but weaker in terms of medication management and ongoing care.

Within that broader picture, researchers discovered some differences in the quality of care, though Hepner said none of the data suggested race or gender played a part in the care received.

"We did not find systematic differences that are telling us, for example, that women are getting worse care or that minorities are getting worse care" because they are women or minorities, she said.

According to the study, the percentage of service members with at least 12 weeks of newly prescribed antidepressant medication was highest among white, non-Hispanic service member (68 percent), followed by Hispanic (60 percent) and black, non-Hispanic service members (53 percent).

The percentage of service members with at least six months of newly prescribed antidepressant for continuation treatment was also highest among white, non-Hispanic service members, followed by Hispanic and black, non-Hispanic service members, at 47, 41 and 33, respectively, the study found.

In looking at the treatments among men and women such as medication durations, post-hospital visits and care, the study found none to be statistically significant.

For a PTSD diagnoses and treatment, for example, both were prescribed up to 60 says of a new medication at about the same rate (70 percent). Forty percent of women were given a follow-up visit within 30 days and 46 percent of men.

Hepner said the study did not explore the causes of the differences but it does recommend they be explored, both by demographic groups, service branches and Tricare facilities.

"Understanding differences can also help inform how health care can be improved as well," she said.

None of the four Tricare regions showed to be a consistently better provider than any other, the study concluded, but there are significant differences noted in four areas measured.

Tricare West had a higher rate than the South region of having at least 60 days of antidepressant medications prescribed, 73 percent versus 65 percent.

Meanwhile, follow-ups within 30 days of a new prescription of antidepressant was significantly higher for the North and Overseas regions, 51 and 49 percent, respectively, than Tricare South, where it was 40 percent.

There were also differences among Tricare regions in follow-up rates -- after mental health hospitalization were observed -- with Tricare North having lower rates than the West and South regions at both seven-day and 30-day periods.

The differences among the groups and regions aside, Hepner said the military health care system functions well, Hepner said.

"We were particularly surprised and pleased to find the military health care system really outperforms other health care systems in providing timely outpatient follow-up. It's a real bright spot," she said.

Where it needs to improve is in its follow-up care to members dealing with PTSD and depression, especially in the growing percentage of people who get the four psychological visits or two medication management visits following release.

The study found that roughly a third -- 34 percent -- of those covered in the study with PTSD received these visits and only a quarter -- 25 percent -- with depression.

Hepner said a second part of the study will be released in a year. It will include analysis of the data covered in the current report, as well as an assessment of suicide in the ranks and of the psychotherapy troops receive.

"We'll also be looking at service member treatment outcomes to evaluate if [those] who are treated are actually getting better," she said.

--Bryant Jordan can be reached at bryant.jordan@military.com. Follow him on Twitter at @bryantjordan.