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VA family service access and utilization in a national sample of veterans

APA Citation:

McKee, G. B., Knopp, K., Glynn, S. M., & McDonald, S. D. (2022). VA family service access and utilization in a national sample of veterans. Psychological Services. Advance online publication. https://doi.org/10.1037/ser0000626

Abstract Created by REACH:

This study used electronic health records of Veterans (N = 22,969) who were referred to couple or family therapy services to examine factors related to whether Veterans initiated services (i.e., attended first appointment) and sustained services (i.e., attended 5 or more sessions). Factors that were examined included demographic characteristics (e.g., gender, race, ethnicity, marital status, rural or urban residence), military characteristics (e.g., service era), mental health diagnoses (e.g., adjustment disorder, depression, substance use), and referral characteristics (e.g., referral source, time from referral to initiation). Race, ethnicity, mental health diagnoses, and referral characteristics were linked to lower rates of therapy initiation and sustainment.


Mental health

Branch of Service:

Multiple branches

Military Affiliation:


Subject Affiliation:



Adulthood (18 yrs & older)
Young adulthood (18 - 29 yrs)
Thirties (30 - 39 yrs)
Middle age (40 - 64 yrs)
Aged (65 yrs & older)


Cross sectional study
Quantitative Study


McKee, Grace B., Knopp, Kayla, Glynn, Shirley M., McDonald, Scott D.


Relationship and family difficulties are common experiences for military veterans, who are able to access family services (i.e., couple and family therapy) through the Veterans Affairs (VA) Healthcare System. This study examines demographic, mental health, military, and referral source variables associated with referral to and utilization of family services using a large national VA dataset of 22,969 veterans who were referred to couple or family therapy from 2016 to 2019. Of those referred, 44.39% had a completed referral; among those who initiated therapy, 31.11% attended five or more sessions. Logistic regression was used to evaluate predictors of completed referrals and of attending five or more sessions of couple or family therapy. Veterans identifying as Black/African American, American Indian or Alaska Native were less likely to have a completed referral than non-Hispanic White veterans; moreover, veterans identifying as Black/African American or Hispanic were less likely to attend five or more sessions. Lower likelihood of a completed referral was also associated with rural county residence, being separated, post-9/11 service era, a substance use disorder diagnosis, and being referred by a psychiatrist, neurologist, physician, or nursing staff rather than a psychologist. Lower likelihood of attending five or more sessions was associated with a delay of 22 or more days to intake, an adjustment disorder diagnosis, and being referred from VA specialty care, or by a psychiatrist or neurologist. These findings may help inform efforts for outreach and service retention within VA family services in order to ensure equity in access to care and healthcare utilization. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Publisher/Sponsoring Organization:

Educational Publishing Foundation

Publication Type:

REACH Publication

Author Affiliation:

Advanced Fellowship Program in Mental Illness Research and Treatment, Mid-Atlantic Mental Illness Research Education and Clinical Center (MIRECC), Central Virginia VA Health Care System, GBM
Department of Psychology, College of Humanities and Sciences, Virginia Commonwealth University, GBM


couples therapy, family relations, family therapy, mental health, military families, military veterans, psychotherapy

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Research Summary

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