US Veterans Using VA Health Care Have Greater Psychiatric and Medical Needs

Key Takeaways

• Approximately 20.5% of US veterans reported using the US Department of Veterans Affairs (VA) health care system as their primary source of care in a nationally representative survey of 4069 veterans.
• Veterans relying on VA care were more likely to have depression, post-traumatic stress disorder (PTSD), chronic pain, sleep disorders, respiratory illness, and greater cumulative trauma exposure than non-VA users.
• Findings suggest that VA primary users represent a clinically and socially vulnerable population, supporting continued investment in integrated, trauma-informed, and multidisciplinary care.

Veterans who rely primarily on the VA health care system have substantially greater psychiatric, medical, and socioeconomic challenges than veterans who receive care elsewhere, according to an analysis of the 2019-2020 National Health and Resilience in Veterans Study (NHRVS). The nationally representative study evaluated demographic and clinical characteristics associated with primary VA health care utilization among US military veterans.

Veterans Who Rely on VA Care Have More Complex Health and Social Needs

Researchers analyzed data from 4069 US military veterans representing all major service eras. Overall, 20.5% (95% CI, 18.9%-22.3%) reported that the Veterans Health Administration (VHA) was their primary source of health care.

Compared with veterans who primarily received care outside the VA, primary VA users were more likely to be younger, Black/African American, unmarried or unpartnered, and have annual household incomes of $60 000 or less. They were also less likely to have employer-sponsored health insurance and more likely to have served in combat roles.

Clinically, VA users reported significantly greater cumulative trauma exposure, including military sexual trauma and adverse childhood experiences. They had higher rates of lifetime and current major depressive disorder, PTSD, generalized anxiety disorder, alcohol and drug use disorders, as well as increased indicators of suicide risk, including suicidal ideation, suicide attempts, and non-suicidal self-injury.

Primary VA users also reported poorer mental, physical, and cognitive functioning and a greater burden of chronic medical conditions. In multivariable analyses, independent predictors of VA utilization included younger age, Black race, unmarried status, lower income, combat exposure, lifetime depression, PTSD, greater cumulative trauma burden, lower cognitive functioning, and multiple medical conditions.

Post hoc analyses identified chronic pain (OR, 1.45; 95% CI, 1.18-1.78), sleep disorders (OR, 1.38; 95% CI, 1.13-1.70), and respiratory disorders (OR, 1.31; 95% CI, 1.01-1.71) as independently associated with primary VA health care use.

A relative importance analysis found that household income of $60 000 or less accounted for the largest proportion of explained variance (23%), followed by lower cognitive functioning (14%), younger age (11%), unmarried status (10%), lifetime depression (9%), chronic pain (9%), PTSD (7%), and sleep disorders (6%).

Integrated VA Care May Be Critical for High-Risk Veteran Populations

The findings indicate that veterans who depend on the US Veterans Health Administration for their care represent a distinct subgroup with complex multimorbidity and substantial social vulnerability. Their higher prevalence of psychiatric disorders, chronic medical illnesses, trauma exposure, and financial insecurity highlights the importance of integrated models that combine primary care, behavioral health, specialty services, and social support.

The study also emphasizes persistent barriers to care among VA users, including perceived stigma surrounding mental health treatment, transportation and scheduling difficulties, concerns about treatment effectiveness, and distrust of mental health professionals. These barriers may complicate engagement even among veterans already connected to the VA system.

For clinicians, the results reinforce the value of comprehensive screening for mental health conditions, trauma history, cognitive impairment, chronic pain, sleep disorders, and respiratory disease when caring for veterans. Coordinated care, trauma-informed approaches, cognitive support, and attention to socioeconomic factors may improve health outcomes for veterans who rely on VA services.

Researchers Highlight Need for Expanded, Trauma-Informed VA Services

The study authors concluded that veterans who primarily use VA health care represent a “unique and vulnerable subgroup of veterans, characterized by more complex health needs and reduced financial and social resources." They noted that these veterans experience higher rates of depression, PTSD, chronic medical conditions, and barriers to mental health care, underscoring the need for continued expansion of integrated, trauma-informed services within the VHA.

Strengthening Care for Vulnerable Veterans

The study demonstrates that 1 in 5 US veterans relies primarily on VA health care and that these individuals have greater psychiatric, medical, and socioeconomic complexity than non-VA users. The findings support ongoing efforts to strengthen integrated, patient-centered services that address both clinical and social determinants of health for veterans.

Reference

Meshberg-Cohen S, Goodwin SR, Fischer IC, Cook JM, Tsai J, Pietrzak RH. Prim Care Companion CNS Disord. 2026;28(3):25m04176. doi:10.4088/PCC.25m04176