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To identify preinjury variables related to mental health treatment utilization at 2 years post-traumatic brain injury (TBI).Veterans Affairs (VA) TBI Model Systems includes 5 VA Polytrauma Rehabilitation Centers.Veterans and service members enrolled in TBI Model Systems who completed the year 2 follow-up assessment and provided mental health information. Sample was largely male (97%) and White (72%), with median age of 30 years.Participants with elevated mental health symptoms were identified by measures of depression, anxiety, and posttraumatic distress; suicide attempt in the past year; or problematic substance use in the past year. Forty-seven percent of participants had elevated mental health symptoms at 2 years postinjury. Among those with elevated symptoms, comparisons were made between those who sought mental health treatment in past year and those who did not.Demographic, historic, environmental, psychological/mental health, and injury/rehabilitation variables.Within the sample, 23% denied utilizing mental health services. Nonutilizers were more likely to deny a preinjury mental health treatment history, to report problematic substance use at year 2, and to report lower levels of internalizing symptoms than the treatment utilizers.Veterans and service members with elevated mental health symptoms may require tailored tactics to promote treatment utilization post-TBI.