GAO Report: VA Provides Inconsistent Treatment to Veterans with Depression

By Rosner, Cara | New Haven Register (New Haven, CT), December 19, 2014 | Go to article overview

GAO Report: VA Provides Inconsistent Treatment to Veterans with Depression


Rosner, Cara, New Haven Register (New Haven, CT)


The U.S. Department of Veterans Affairs provides inconsistent treatment to veterans with depression and may be underestimating the number of vets who suffer from the condition, according to a government watchdog agency.

The VA also needs to do a better job monitoring veterans who are prescribed antidepressants and in tracking suicides, according to a new report by the U.S. Government Accountability Office.

The GAO analyzed VA data from fiscal years 2009-13 and found inconsistencies in the way veterans were treated and medical records were kept. It also found that the VA's own clinical guidelines were not always followed.

VA officials did not respond to requests for comment about the report. The GAO is an independent, nonpartisan watchdog agency that works for Congress and investigates how the federal government spends taxpayer dollars.

According to the GAO, from 2009 through 2013, about 10 percent of veterans -- or 532,222 individuals -- who sought health care services through the VA were diagnosed with major depressive disorder. Symptoms include depressed mood, loss of interest or other conditions that last for two weeks or more and affect the patient's ability to function.

But those figures may not accurately reflect the prevalence of depression among veterans, according to the GAO, because a sample of veterans' medical records found diagnostic coding discrepancies in more than one-third of the cases.

The GAO reviewed 30 individuals' records and found coding errors in 11 cases. In each of those cases, there was at least one time a doctor documented a veteran having major depressive disorder in the record but did not code it properly. Instead, the doctor coded it as a less-specific depression, meaning those individuals were not flagged as having major depressive disorder.

Since VA data collection is tied to the diagnostic codes assigned by clinicians, improper coding can skew figures, according to the GAO.

Of those diagnosed with major depressive disorder, the vast majority -- 94 percent, or 499,000 veterans -- were prescribed at least one antidepressant, according to the GAO report.

But the GAO examined the records of 30 veterans who were given antidepressants and found that almost none were treated in accordance with the VA's clinical guidelines for major depressive disorder.

In 26 of the 30 cases the GAO examined, veterans were not assessed using a standardized assessment tool, which guidelines stipulate should be used four to six weeks after a patient begins treatment. Also, guidelines say all veterans should be taught how to take their medication, but the GAO found no documentation of patient education in six of the 30 cases it examined.

The report also says "VA Central Office mental health officials were unable to tell us what it means to provide care that is consistent with the (guidelines). …

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