Health service use predictors among trauma survivors: A critical review.

Summary of Service Use DeterminantsAmong Trauma Survivors and PTSDPatients Although numerous instances of inconclusiveÞndings exist, several general conclusions canbe drawn across studies (with at least a ratio of3:1 studies supporting a given conclusion and atleast three studies examining the given vari-able). Increased MH service use was found forwomen, people with previous or lifetime traumahistories, and people with a PTSD diagnosis.Increased medical service use was found forpeople with a PTSD diagnosis.However,theseconclusionsareinsuencedbythe fact that some studies may not possess ad-equate statistical power to reveal signiÞcant ef-fects. Therefore, we reassessed our general con-clusions after removing from consideration theseven small-sample ( N 100) studies. As aresult, the only modiÞcation to our conclusions(across studies) would be the addition of PTSDseverity as a variable associated with increasedMH service use. Caveat One particular limitation of this reviewshould be emphasized. We included studies thatsampled very different types of trauma survi-vors, an approach we acknowledge as particu-larly inclusive. Traumatic experiences reportedby war soldiers, for example (being both vic-tims and trained agents of insicting trauma), arevery different from those experienced by disas-ter survivors (being unexpected victims of nat-ural or man-made disasters). Additionally, theresulting psychopathology from different typesof traumatic events can vary widely; for exam-ple, combat exposure and sexual assault areassociated with much higher PTSD rates than isdisaster (Kessler et al., 1995).Additionally, the services available to differ-enttypesoftraumasurvivorscanvary.Veteransof war trauma can qualify for services withinthe VA Medical Center, a relatively closedhealth care system, which is inexpensive to vet-erans but can yield relatively long wait times.Conversely, civilian trauma survivors must seekservices in the community, perhaps throughtheir health insurance plans (and in the case ofcriminal victimization, they may have access tocrime victim compensation).