Appendix A.

Variable definitions

PTSD (baseline/fixed) – Presence of 309.81 at one of five VHA PTSD specialty clinics on ≥2 outpatient visits or one inpatient in FY2008 to FY2012. Index date is the second PTSD date or the second visit date for those without PTSD.

New OAU (time dependent) – new fill for OAU after index date and greater than 90 days prior to study end date

Cardiovascular Disease - ≥1 ICD9 diagnosis code or revascularization CPT/ICD9 procedure codes  a. ICD-9 diagnosis codes for any of the following conditions:   1. hypertensive heart disease: 402x, 403x, 404x, 405x   2. MI: 410x, 411x   3. Ischemic heart disease: 412x, 413x, 414x   4. disease of pulm circulation: 415x, 416x, 417x   5. other heart disease: 420x – 429x  b. CPT codes (outpatient clinic stop files): 35450–35459; 35470–35475; 35480–35495; 92980, 92981, 92984, 92995, 92996; 33510–33536; 33572; 37220–37235; 92920–92944; 0234T-0238T; G0290, G0291; S2211; S2222; S2204-S2209  c. ICD-9 procedure codes (inpatient procedure files): 36.0x – 36.3x All patients with a revascularization code also had an ICD9 code for cardiovascular disease

Study end date - Date of cardiovascular disease or last encounter with VHA system

Depression (time dependent) – (296.2x, 296.3x, 311). Presence of a single inpatient code or ≥2 outpatient codes within a 12 month period prior to OAU/study end date.

Other anxiety (time dependent) –Composite of panic disorder, OCD, social phobia, GAD, anxiety NOS (300.00, 300.01, 300.02, 300.23, 300.3). Presence of a single inpatient code or ≥2 outpatient codes within a 12 month period prior to OAU/study end date.

Alcohol abuse/dependence (time dependent) – (303.9x, 305.0x). At least a single code prior to OAU/study end date

Drug abuse/dependence (time dependent) = composite of any drug abuse/dependence. At least a single code for the following prior to OAU/study end date: sedative (304.1x, 305.4x), cocaine (304.2x, 305.6x), cannabis (304.3x, 305.2x), amphetamine (304.4x, 305.7x), hallucinogens (304.5x, 305.3x), ‘other’ (304.6x, 305.9x), opioid (304.0x, 305.5x), opioid with other SUD (304.7x), other SUD excluding opioid (304.8x), unspecified drug abuse/dependence (304.9x).

Sleep disorder (time dependent) = At least a single code for 307.4x, 327.x, 780.5x, 333.94 prior to OAU/study end date

Smoke status (fixed) –This is indicated as Current, Former, Never. 1. Current – “current smoker” in health factors or ICD9 code for nicotine dependence (V15.82, 305.1) prior to OAU/study end date. 2. Former – never has a “current smoking” indicator and has an indicator for “former smoker” in health factors prior to OAU/study end date. 3. Never = all else.

Obese any (time dependent) – Presence of BMI ≥30 or ICD9 (278.00, 278.01) code for obesity prior to OAU/study end date

Body Mass Index (fixed – descriptive only) - last BMI prior to study end date.

Hypertension (time dependent) - (401.x) At least a single code prior to OAU/study end date.

Hyperlipidemia (time dependent) – (272.0, 272.1, 272.2, 272.4). At least a single code prior to OAU/study end date.

Type 2 Diabetes (time dependent) – (250.x0, 250.x2, 357.2, 362.0x, 366.41) Presence of ≥2 codes in any 24 month period prior to OAU/study end date.

Pain conditions (time dependent) – at least one code for the following prior to OAU/study end date. a) Arthritis (710.0–710.4, 710.8, 710.9, 711x, 713x-717x, 718.0x-718.3x, 718.5x-718.9x, 719x, 720.0, V13.4) b) Back pain (720.1, 720.2, 720.8x, 720.9, 721x, 722x, 723.0–723.3, 723.5–723.7, 723.9, 724x, 756.1x c) Musculoskeletal pain (725x, 726.0x-726.6x, 726.71, 726.72, 726.90, 727.00, 727.03, 727.04, 727.05, 727.06, 727.09, 727.2, 727.3, 727.49, 727.50, 727.51, 727.6x, 727.89, 727.9, 729.0, 729.1, 729.4, 729.5, 729.7x, 729.89, 729.9, 729.91, 729.92, 781.99, 830x-848x, 905.6, 905.7, V43.6x, V43.7, V48.3, V49.6x, V49.7x) d) Headache (307.81, 339x, 346.0x-346.5x, 346.7x-346.9x, 784.0) e) Neuropathy (053.13, 072.12, 337.0x, 337.1, 353x-357x, 377.33, 377.34, 377.41)

Demographic Information (all fixed covariates)

Age – age at initial visit to one of five VHA PTSD specialty clinics

Gender – male vs. female

Race – most commonly occurring in record (white vs. black vs. other)

Marital status – most commonly occurring in record (married vs. other)

VHA only insurance – most commonly occurring in record (yes vs no)

Primary healthcare utilization - number of unique primary care clinic stops per total months in entire VA system. Total months is calculated from first visit date to any VA facility in FY08 to FY15 to the study end date. Primary Care stop codes: 170, 172, 301, 322, 323, 348, 350. From entire sample of 17–80 year olds, quartiled visits/months and top quartile = high.