Demographic Characteristics, Mental Health Conditions, and Psychotherapy Use of Veterans in Couples and Family Therapy

The purpose of this descriptive study was to characterize demographic information, military service-connected mental health conditions, and information about the provision of couple and family therapy within the Department of Veterans Affairs (VA) Healthcare System. This study used a population-based cohort design to obtain electronic health record data from 97,302 veterans who attended couple or family therapy in 1,075 VA facilities from 2014 to 2019. More than 59% had a mental health disorder connected with military service, the most common of which was posttraumatic stress disorder (39.92%). Over one-third had evidence of military combat exposure, and 9% reported military sexual trauma. Approximately 90% attended 10 or fewer sessions, and among the 78,028 veterans who initiated therapy after progress note tracking of evidence-based psychotherapy was mandated in 2015, 12% had evidence of receiving an evidence-based psychotherapy for family difficulties, suggesting that many veterans may not receive a full course of conjoint therapy. Exploratory analyses revealed that attending five or more sessions of couple or family therapy was associated with identifying as female, younger age, identifying as non-Hispanic White, combat exposure, military sexual trauma, service connection for any mental health condition, and service connection for posttraumatic stress disorder, major depressive disorder, and chronic adjustment disorder. Further empirical work on understanding veterans' psychiatric and family concerns is necessary to ensure that the VA Healthcare System is able to meet the needs of veterans with complex symptom profiles and to determine whether current therapeutic approaches may be effectively tailored to meet those needs.