: The primary aim of the proposed study is to evaluate whether a written emotional disclosure (ED) intervention delivered via the Internet reduces healthcare utilization in veterans with chronic multi-symptom illness (CMI). Prior research has demonstrated the efficacy of in-person disclosure for reducing medical utilization in healthy populations and individuals with known medical illness. The current sample will consist of veterans evaluated at the War-Related Illness and Injury Center (WRIISC) who meet criteria for CMI. They reside throughout the U.S. and often lack access to effective interventions. Consistent with """"""""Healthy People 2010"""""""" which identifies access to health care as a leading health indicator, providing Internet ED has the potential to decrease structural barriers that prevent patients from receiving specialized treatment. Participants with multi-symptom illness will be recruited from the WRIISC and randomized to receive either usual WRIISC care or On-line ED+WRIISC care. The primary study outcome variable is number of outpatient visits. Physical functioning, symptom reporting, psychological distress, and satisfaction with services will also be assessed at enrollment and at 6 and 12 months post-intervention. Potential mediation by symptom attribution will be explored. The effect of treatment on utilization will be determined by analysis of ? co-variance, controlling for pre-intervention scores, medical co-morbidity and demographic characteristics. If effective, the Internet ED will provide a brief, low-cost, and accessible intervention for individuals with CMI. ? ?
