The role of coping in depression treatment utilization for VA primary care patients.
OBJECTIVE
To examine the impact of Veterans' coping strategies on mental health treatment engagement following a positive screen for depression.


METHODS
A mixed-methods observational study using a mailed survey and semi-structured interviews. Sample included 271 Veterans who screened positive for depression during a primary care visit at one of three VA medical centers and had not received a diagnosis of depression or prescribed antidepressants 12 months prior to screening. A subsample of 23 Veterans was interviewed.


RESULTS
Logistic regression models showed that Veterans who reported more instrumental support and active coping were more likely to receive depression or other mental health treatment within three months of their positive depression screen. Those who reported emotional support or self-distraction as coping strategies were less likely to receive any treatment in the same time frame. Qualitative analyses revealed that how Veterans use these and other coping strategies can impact treatment engagement in a variety of ways.


CONCLUSIONS
The relationship between Veterans' use of coping strategies and treatment engagement for depression may not be readily apparent without in-depth exploration.


PRACTICE IMPLICATIONS
In VA primary care clinics, nurse care managers and behavioral health providers should explore how Veterans' methods of coping may impact treatment engagement.