Neuropsychological Services
The study team determined that less than 17% of the 1,686 veterans in the study had a neuropsychological assessment over a five-year period. They also found that specific comorbidities, such as brain injuries, increased the odds of having an assessment, as did mood and sleep disorders.
To reach their conclusions, researchers extracted data from the VHA Corporate Data Warehouse as part of the Women Veterans Cohort Study (WVCS), a longitudinal project with veterans who served during the Iraq and Afghanistan conflicts.
Veterans in the study included those in the WVCS dataset who had three or more VHA MS-related encounters—inpatient, outpatient and/or disease modifying therapy—within one calendar year between fiscal years 2010 and 2015.
The researchers used procedural codes 96118 and 96119 to define neuropsychological assessment, while psychotherapeutic services were defined using codes 90804, 90806, 90808, 96150, 96151 and 96152.
Results indicated that 281 veterans, 16.67% of the study group, participated in a neuropsychological assessment. Although veterans who had an evaluation had higher rates of several co-occurring conditions, the authors reported that no significant relationships emerged between any of the sociodemographic variables and evaluations.
After controlling for age, gender, education and race/ethnicity, two previously diagnosed co-occurring conditions predicted neuropsychological service utilization: traumatic brain injuries (TBIs; OR: 2.33, 95% CI: 1.60, 3.35) and mood disorders (i.e., depressive and bipolar disorders; OR: 1.71, 95% CI: 1.26, 2.31).
Psychotherapeutic Services
On the other hand, psychotherapeutic service usage was nearly three times more common, with more than 45% of the veterans having received some form of psychotherapy.
Several co-occurring conditions, as well as level of education, were associated with service utilization. Focusing on participants who were diagnosed the day of or after the initial encounter, researchers listed five comorbidities that predicted psychotherapeutic service use:
- mood disorders (OR: 1.81, 95% CI: 1.34, 2.46),
- anxiety disorders (OR: 1.38, 95% CI: 1.03, 1.85),
- sleep disorders (OR: 1.55, 95% CI: 1.19, 2.01),
- alcohol-related disorders (OR: 3.29, 95% CI: 1.79, 6.21), and
- cognitive disorders (OR: 3.72, 95% CI: 2.29, 6.16).
“These findings suggest that these services are being utilized by clinicians and veterans to address the clinical complexity related to having MS and one or more of these other conditions,” the authors concluded.
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