In this article, the authors examine patterns of medical services use among the Department of Veterans Affairs (VA)
ambulatory care patients who screened positive for posttraumatic stress, depression, or
alcohol-related disorders. On the basis of research linking
mental disorders with increased use of medical services, the authors hypothesize that even after controlling for age and medical disease comorbidity, patients in VA
ambulatory care who screen positive for targeted
mental disorders would be more likely to use VA medical services and have higher rates of such use than those who did not screen positive. Baseline data were obtained from the Veterans Health Study, a longitudinal investigation of veterans' health. Four Boston-area VA ambulatory care facilities were used as study sites. A random sample of 2425 participants (mean age = 62) was drawn from male VA
ambulatory care patients screened for eligibility during specified periods. Screening measures were Center for Epidemiological Studies-Depression Scale for depression,
Posttraumatic Stress Disorder Checklist for
posttraumatic stress disorder, and CAGE Questionnaire for
alcohol-related disorders with endorsement of prior year consumption for
alcohol-related disorders. Prior medical services use was assessed by self-report. Although unadjusted analyses of medical services use revealed clear effects of the screening presence of
mental disorders on most outcomes, after adjusting for age and medical comorbidity, almost all these effects were reduced, and some previously nonsignificant results became significant. Findings suggest that healthcare policy and risk adjustment predicated upon the presumed relationship between
mental disorders in the aggregate and medical services use should reconsider the important contributions of age, comorbid medical disorders, and specific
mental disorder diagnoses.