VA Women’s Mental Health Services Research Paula P. Schnurr, Ph.D VA National Center for PTSD Dartmouth Medical School

HSR&D Support for Women’s Health Research Special solicitation focused on WHR since 1996Special solicitation focused on WHR since 1996 Aimed at explaining care and utilization by women Veterans and improving careAimed at explaining care and utilization by women Veterans and improving care Includes Career Development Awards, Center of Excellence funding, and a new Women’s Health Research Consortium/Practice-Based Research NetworkIncludes Career Development Awards, Center of Excellence funding, and a new Women’s Health Research Consortium/Practice-Based Research Network

Areas of HSR&D Research on Women Veterans Delivery, organization, and systems of care for women veteransDelivery, organization, and systems of care for women veterans Gender-specific use of VA and non-VA careGender-specific use of VA and non-VA care Gender-specific issues related to access and barriers to careGender-specific issues related to access and barriers to care Quality of careQuality of care Continuity, comprehensiveness, outcomes and costs of careContinuity, comprehensiveness, outcomes and costs of care Other factors associated with health care for women veterans, their special needs, and potential disparitiesOther factors associated with health care for women veterans, their special needs, and potential disparities

VA is A Natural Translational Research Environment

CSP #494: Cognitive-Behavioral Treatment of PTSD in Women The Science 1 st clinical trial of PTSD treatment in female Veterans and Service Members 12 sites; 284 women Prolonged Exposure (PE) therapy shown to be effective (JAMA, 2007) The Translation National rollout of PE implemented in 2008 –942 clinicians trained 7/1/10 Infrastructure created to sustain implementation Research to enhance efficiency, outcome, and acceptability

HSR&D Women’s Health Research Projects FY $10.9 million 34 projects – 26 mental health – 5 organization & quality of care – 3 other

Why Focus on Mental Health in Women Veterans? VA Health Services Research has Answers

Women Who Use VA have Worse Mental Health Relative to Women in the General Population – Frayne et al., J Gen Intern Med 21:S40 (2006)  Veterans  General population Mental Health Subscales

Among VA Users, Women are More Likely Than Men to have Mental Health Problems From Frayne, VA Women’s Health Evaluation Initiative. Percents are based on presence of at least 2 instances of mental health condition ICD-9 codes in VA outpatient administrative data in FY08; includes veteran patients only. 9 31% of women vs. 20% of men have a diagnosed mental health condition

Mental Health Problems Are Cross- Cutting: A Hidden Variable In women Veterans (male Veterans, civilians), mental health problems are related to:In women Veterans (male Veterans, civilians), mental health problems are related to: –More physical health problems and pain –Greater service utilization –Lower psychosocial and occupational functioning –Poor self-care, e.g., smoking –Reduced quality of life Higher likelihood of mental health problems = More burden

Even in Veterans with Mental Health Problems, the Burden is Greater in Women – Frayne, Kimerling, under review FY06-07, OEF/OIF Veterans (N = 90, 558)

Military Sexual Trauma is Prevalent in Women Veterans VA Users Screened for MST MenWomen Veterans Screened FY 2005 (N = 3,045,000) 1.1%21.8% OEF/OIF Veterans Screened FY (N = 126,729) 0.7%15.1% – Kimerling et al., 2007 & in press

Military Sexual Trauma Increases Risk of Comorbid Problems All AORs significant at p <.05; adjusted for age, race, marital status, health insurance, service connection, prior VHA use, component, branch, and multiple deployments – Kimerling et al., in press Data from 126,729 OEF/OIF Veterans screened for sexual trauma in VA FYs Odds Ratio for MST vs. no MST

And Where are We Headed?

Mental Health Areas of HSR&D ∧ Research on Women Veterans Delivery, organization, and systems of care for women veteransDelivery, organization, and systems of care for women veterans Gender-specific use of VA and non-VA careGender-specific use of VA and non-VA care Gender-specific issues related to access and barriers to careGender-specific issues related to access and barriers to care Quality of careQuality of care Continuity, comprehensiveness, outcomes and costs of careContinuity, comprehensiveness, outcomes and costs of care Other factors associated with health care for women veterans, their special needs, and potential disparitiesOther factors associated with health care for women veterans, their special needs, and potential disparities

CSP #579: Long Term Health Outcomes of Women’s Service During the Vietnam War Understand impact of wartime deployment on physical and mental health 40 years after the Vietnam War 10,000+ women Vietnam era Veterans – K. Magruder, A. Kilbourne, & Kang, co-Chairs

Women Veterans Cohort Study – C. Brandt, PI

Online Interventions for Female OEF/OIF Reserve/National Guard War Vets – A. Sadler, PI

Caring for Women Veterans Study Evaluate a 30-minute multi-media program for enhancing VA staff sensitivity to and knowledge about women Veterans and their needs Extension of this project will be conducted through new PBRN – D. Vogt, PI

Other Examples of Current HSR&D Projects on Women’s Mental Health Bradley Urogenital Symptoms, Depression and PTSD in OEF/OIF Women Veterans Gerlock Relationship and PTSD Study: Detection of Intimate Partner Violence Kline Gender Differences in Mental Health Treatment Needs and Service Use Lange Pilot Study of Re-Integration and Service Needs for Women Veteran Mothers ShipherdMST Effect on PTSD and Health Behavior: A Longitudinal Study of Marines Vogt Stigma, Gender and Other Barriers to VHA Use for OIF/OEF Veterans

Implications of Women’s Mental Health Services Research Prominence of mental health reflects need as well as cross-cutting effects of mental health on physical health and health behaviorsProminence of mental health reflects need as well as cross-cutting effects of mental health on physical health and health behaviors Women Veterans are womenWomen Veterans are women –Generalizability to civilian women Women Veterans are VeteransWomen Veterans are Veterans –Generalizability to male veterans too