UC San Diego

Posttraumatic stress disorder (PTSD) and complicated grief (CG) are debilitating disorders associated with numerous negative health concerns. PTSD has been widely studied among Veteran populations, however, few studies have evaluated CG. The current study examined 1122 returning Veterans following enrollment into the VA San Diego Healthcare System (VASDHS). Veterans were classified into four groups based on self-reported symptoms: (1) CG alone (n = 26); (2) PTSD alone (n = 112); (3) both CG and PTSD (n = 99), and (4) neither CG or PTSD (Veteran controls; n = 554). This study aimed to (1) evaluate group differences in baseline demographic, physical, and mental health variables (baseline variables); (2) evaluate group differences in use of physical healthcare, mental healthcare, and emergency services (healthcare services) within the first six months following VASDHS enrollment; and (3) evaluate the predictive utility of baseline variables on use of healthcare services within the first six months following VASDHS enrollment. Regression analyses (multiple, binary logistic, multinomial logistic, and negative binomial) were used. Screening positive for both CG and PTSD was associated with the greatest severity of physical and mental health symptoms, followed by PTSD alone, CG alone, and Veteran controls. Screening positive for both CG and PTSD and PTSD alone was associated with greater use of healthcare services compared to other groups. Baseline variables, including branch of military service, positive TBI screen, greater generalized anxiety symptoms, greater insomnia symptoms, greater physical health symptoms, greater pain interference, worse mental health functioning, less resilience, and better physical health functioning predicted greater use of healthcare services. These findings supplement the growing body of literature documenting the negative health impact of PTSD and add to it the importance of considering CG in the overall health and health-utilization of returning Veterans. Results suggest that Veterans with PTSD are more likely to use healthcare services compared to Veterans without PTSD. Results may also suggest that Veterans with CG may underutilize healthcare services compared to other groups. This highlights the importance of routinely screening for CG in Veteran populations, and is relevant to understanding and improving access to healthcare services for Veterans with CG.