BACKGROUND: Little is known about the health needs of Indiana’s 469,000 veterans, approximately 60% of whom are not enrolled in the Veterans Administration (VA) health care system. Sixty-five percent (65%) of Indiana’s 92 counties have designated health professional and behavioral health professional shortage areas.
METHODS: To identify potential needs of Indiana veterans regarding chronic disease management and behavioral health, we examined data collected through the 2014 Indiana Behavioral Risk Factor Survey. Respondents who ever served on active duty in the United States Armed Forces or National Guard were asked if they had ever received a diagnosis of depression, anxiety, or post-traumatic stress disorder (PTSD) or traumatic brain injury (TBI). Among these respondents, we examined characteristics of access to care and self-reported prevalence of chronic diseases.
RESULTS: Of the 1,442 respondents who ever served on active duty, 38% reported having served in a combat or war zone. The majority were aged 55 years or older (59.3%), male (91.8%), white/non-Hispanic (89.5%), married (63.2%), and 23.7% were current smokers. Approximately 5% reported a history of TBI and 17% reported history of PTSD. The prevalence of coronary artery disease, myocardial infarction, chronic obstructive pulmonary disease, stroke, asthma, and arthritis were all significantly higher among those with PTSD than those without. Only prevalence of stroke was significantly higher among those with TBI than those without. Prevalence of depression, receiving psychologic counseling and experiencing thoughts of suicide in the last 12 months were also higher among PTSD and TBI respondents. Although 46% of PTSD and 63% of TBI respondents reported their primary source of healthcare as the VA or other military-based system, a significantly higher proportion of PTSD and TBI respondents reported delays obtaining needed medical care or being unable to see a doctor due to cost. The most frequently reported reasons for delayed care were lack of available appointments, long wait times, and lack of transportation.
CONCLUSIONS: Our findings suggest that Indiana veterans may have unmet healthcare needs related to chronic conditions and behavioral health. Because of question wording we were unable to distinguish respondents reporting PTSD from depression, or distinguish between VA health care and TRICARE enrollees. Limited data regarding the health status of veterans highlights the need for strong partnerships between state health departments and the Department of Veterans Affairs to fully evaluate and address localized gaps in care.