P3.268: Care Rates for Children With Post-Traumatic Stress Disorder and Other Mental Health Diagnoses Living in a Mental Health Care Desert

Background: Children in military families have increased risk of mental health (MH) disorders. Many military treatment facilities (MTFs) are in MH professional shortage areas (deserts), defined by lower population-to-provider ratios. This study aims to quantify the association between living in a MH care desert and MH visit rates (number of encounters per year) in children with post-traumatic stress disorder (PTSD) or other serious MH diagnoses requiring one or more inpatient admissions.

Methods: This retrospective cohort study utilized the 2005-2015 Military Health System Data Repository electronic health record to identify children aged 2-18 years, and care provided one year post-diagnosis. ICD-9 codes defined PTSD and other MH diagnoses such as bipolar disorder, anxiety, and depression. Provider specialty type defined MH encounters in MTF and civilian facilities. The Defense Medical Information System identified which MTF children were assigned to, and Health Resources and Services Administration defined MTFs in MH deserts. Poisson regression calculated rates of follow-up MH care, adjusting for age, sex, sponsor race, and sponsor rank.

Results: Out of 14,628 children, 5,039 children had PTSD, 9,589 had other MH diagnoses, and 1,264 had both conditions; one quarter lived in MH deserts. For children with PTSD, living in a MH desert was not significantly associated with an overall difference in MH care (IRR 0.92 [95% CI 0.84-1.02]) as compared to those not in MH deserts. Total inpatient and total outpatient care was not significantly different in or out of MH deserts (IRR 0.86 [0.68-1.09]; IRR 0.96 [0.90-1.01]). Inpatient and outpatient MTF care were lower in MH deserts (IRR 0.15 [0.06-0.36]; IRR 0.81 [0.71-0.93]). Civilian inpatient and outpatient care rates did not significantly differ from children who did not live in deserts (IRR 0.86 [0.68-1.10]; IRR 1.03 [0.96-1.09]). Care rates for children with other MH conditions were lower overall and lower for total inpatient in MH deserts (IRR 0.93 [0.87-0.99]; IRR 0.88 [0.78-0.99]) with lower inpatient and outpatient care at MTFs (IRR 0.15 [0.10-0.22]; IRR 0.86 [0.79-0.95])) and lower inpatient care at civilian facilities (IRR 0.89 [0.79-0.99]), and no significant difference in total outpatient and outpatient civilian care as compared to those not living in deserts (IRR 0.97 [0.93-1.00]; IRR 1.01 [0.97-1.05]).

Conclusion: Living in a MH desert was associated with reduced rates of MH care for children with serious MH conditions. MTFs located in a MH desert were most impacted, suggesting that military bases are not able to meet the needs of military-connected children in areas of low civilian resources.