Background
Post Traumatic Stress Disorder (PTSD) is a disorder characterized by exposure to some traumatic event leaving the individual with a variety of symptoms that can result in debilitating disability. Treatment has historically been centered around Cognitive Processing Therapy (CPT) and literature has shown a significant risk of suicide in those left untreated. Thus, the importance of appropriate healthcare utilization is important for addressing morbidity and mortality of PTSD. Determining appropriate utilization is not well recorded in the literature though some studies show increased utilization with increased symptom severity. The aim of
this study is to replicate these findings and determine if there exists any range of symptom severity that over or under-utilizes the healthcare system.

Methods
Data was collected by Rosen et al. 2012 through Project VALOR, a longitudinal registry of PTSD in combat exposed veterans of Afghanistan and Iraqi military theaters. PTSD checklist (PCL) scores and data regarding number of healthcare utilizations for PTSD treatment year to year were recorded over a five-year period. Utilization of healthcare services for PTSD were stratified by this study into categories and compared against PCL scores using an ordinal logistical regression model to predict probability of being placed in a higher utilization category. Quadratic analysis was conducted on the PCL scores to determine linear relationship of findings.

Results
Ordinal logistical regression of mean centered PCL value was 1.042 (p=0.000). Quadratic effect of ordinal logistical regression of mean centered PCL2 was determined to be 0.99 (p=0.061).

Conclusion
Self-reported PCL scores are positively predictive of healthcare utilization. For every 1 increase in PCL score, there is a predicted 4.29% increased chance of being placed into the next highest utilization category (p=0.000). In addition, the relationship between PCL score and healthcare utilization was determined to be log-linear due to quadratic effect being found not significant 0.99 (p=0.061). This indicates no PCL score is correlated with increased probability of increased or decreased healthcare utilization. This likely represents healthcare services are appropriately being administered based on symptom severity and no group is over or under-utilizing resources. Ultimately, this study replicates previous literature that increased severity is associated with increased healthcare utilization while also quantifying the predictive value of increasing PCL scores. Currently the healthcare system is correctly identifying and capturing individuals who would in theory benefit from increased healthcare utilization. Additional research into capture strength would be beneficial in determining impact of hospital system capture rate of at risk patients.

Increasing PTSD Symptom Severity Predicts Increasing Healthcare Utilization Among OEF/OIF Veterans.

 Psychiatry

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