This study aimed to investigate associations between social determinants of health (SDoH, the conditions in which people live) and receipt of psychotherapy among Veterans with posttraumatic stress disorder (PTSD) engaged in care at the Veterans Health Administration. Past research has identified disparities in receipt of PTSD care related to demographics, but there is a lack of research on disparities related to SDoH. This study investigated three SDoH: homelessness, socioeconomic disadvantage, and rurality. Using VHA electronic health records, we included Veterans with a PTSD diagnosis from 2015 to 2018, a total of 435,381 Veterans, and reviewed receipt of PTSD psychotherapy through 2019. In regression models accounting for demographics, trauma exposure, and mental and physical health factors, we found that Veterans who had experienced lifetime homelessness were more likely to receive any PTSD psychotherapy and a minimally adequate dose of PTSD psychotherapy (eight sessions within a 24-week period). We found that Veterans with greater socioeconomic disadvantage and Veterans who resided in rural areas were less likely to receive a minimally adequate dose of PTSD psychotherapy. These findings suggest that efforts are needed to promote engagement with mental healthcare for rural Veterans and those with greater socioeconomic disadvantage.
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