Receipt of psychotherapy following posttraumatic stress disorder diagnosis in veterans affairs and community settings.

The likelihood of receiving psychotherapy following a posttraumatic stress disorder (PTSD) diagnosis has been linked to patient and diagnosing clinician characteristics. This study sought to assess how the probability of receiving psychotherapy following an incident diagnosis of PTSD is influenced by patient rurality, location of diagnosis (Department of Veterans Affairs [VA] or community care), and clinician type. We examined a cohort of veterans (n = 663,256) who received an incident diagnosis of PTSD at a VA or community health care facility between 2019 and 2023. Patients were stratified by rurality, location of diagnosis, and clinician type. Covariates included patient demographics, psychiatric and medical comorbidities, prior VA service use, and prior psychiatric treatment. Probabilities of receiving psychotherapy following PTSD diagnosis were calculated using logistic regression with a three-way interaction of patient rurality, diagnosing clinician, and location of diagnosis. Compared with those diagnosed in the VA, patients diagnosed in the community were more frequently rural, less frequently diagnosed in an outpatient setting, and less frequently diagnosed by social workers, psychologists, psychiatrists, and nonphysician prescribing clinicians. Across all rurality strata, patients diagnosed by mental health clinicians had a high probability of receiving psychotherapy regardless of the location of diagnosis. By contrast, across all rurality strata, patients diagnosed by nonmental health providers had a significantly lower probability of receiving psychotherapy when diagnosed in the community instead of the VA. PTSD diagnoses inside the VA are given by different clinician types than those given in the community, and, in some cases, this is associated with lower initiation of psychotherapy following diagnosis. (PsycInfo Database Record (c) 2026 APA, all rights reserved).