PTSD Risk and Mental Health Care Engagement in a Multi-War Era Community Sample of Women Veterans

Abstract

BACKGROUND: Post-traumatic stress disorder (PTSD) is common in women veterans (WVs), and associated with significant co-morbidity. Effective treatment is available; however, PTSD is often unrecognized. OBJECTIVES: Identify PTSD prevalence and mental healthcare (MHC) use in a representative national WV sample. DESIGN AND PARTICIPANTS: Cross-sectional, population-based 2008-2009 national survey of 3,611 WVs, weighted to the population. MAIN MEASURES: We screened for PTSD using a validated instrument, and also assessed demographic characteristics, health characteristics, and MHC use in the prior 12 months. Among those screening positive, we conducted multivariate logistic regression to identify independent predictors of MHC use. KEY RESULTS: Overall, 13.0 % (95 % confidence interval [CI] 9.8-16.2) of WVs screened PTSD-positive. Veterans Health Administration (VA) healthcare was used by 31.1 % of PTSD-positives and 11.4 % of PTSD-negatives (p<0.001). Among those screening positive, 48.7 % (95 % CI 35.9-61.6) used MHC services (66.3 % of VA-users, 40.8 % of VA-nonusers; p<0.001). Having a diagnosis of depression (OR=8.6; 95 % CI 1.5-48.9) and VA healthcare use (OR=2.7; 95 % CI 1.1-7.0) predicted MHC use, whereas lacking a regular provider for health care (OR=0.2; 95 % CI 0.1-0.4) and household income below the federal poverty level (OR=0.2; 95 % CI 0.1-0.5) predicted nonuse. CONCLUSIONS: More than one in eight WVs screened positive for PTSD. Though a majority of VA-users received MHC, low income predicted nonuse. Only a minority of VA-nonusers received MHC. The majority of WVs use non-VA healthcare providers, who may be unaware of their veteran status and PTSD risk. VA outreach to educate VA-nonusers and their healthcare providers about WVs' PTSD risk and available evidencebased VA treatment options is one approach to extend the reach of VA MHC. Research to characterize barriers to VA MHC use for VA-nonusers and low income VAusers is warranted to better understand low service utilization, and to inform program development to engage more WVs in needed MHC.

PTSD Women Veterans’ Prevalence of PTSD Care

“…1 We agree that a better understanding of posttraumatic stress disorder (PTSD) risks, incidence, and associated physiological changes are important for informing the care of affected individuals. Several recent studies complement those cited by Dr. Lutwak in furthering our understanding of these important issues and their implications for PTSD care.…”

Prenatal Care for Women Veterans Who Use Department of Veterans Affairs Health Care

“…Respondents were asked if they had ever been diagnosed with depression or PTSD. Additionally, respondents completed a two-item screen for current depression symptoms and a screen for current PTSD symptoms (Washington, Davis, Der-Martirosian, & Yano, 2013).…”

Evidence-based Treatments for Military-related Posttraumatic Stress Disorder in a Veterans Affairs Setting

“…Previous research examining PTSD among women Veterans has shown that women tend to report a higher incidence of military sexual trauma (MST) than men and higher symptoms of PTSD. 117 Additional barriers to engagement in treatment are also present for women Veterans and range from low income, a lack of womenspecific care, and the male-oriented nature of care at the VA. [117][118][119][120] For this reason, a women's Veterans program manager is identified and available at all sites who can help women Veterans receive needed service and advocate for the needs of women Veterans. In addition, gender-specific services are available for women Veterans, including Women's Stress Disorder Treatment Teams, specialized inpatient and residential programs for women, cohort treatment or separate wings for women, Women Veterans Comprehensive Health Centers, and Women Veterans Homelessness Programs.…”