Spotlight on Research into Women Veterans' Health
Women are entering the military in record numbers. They currently comprise 20% of new recruits, and it's estimated that by 2018, 10% of the Veteran population 1 will consist of women Veterans. In the recent conflicts in Iraq and Afghanistan, that number is proportionally higher, with women Veterans comprising nearly 12 percent of Veterans, more than half of whom have received VA healthcare.2
The VA healthcare system has responded to this changing demographic via a number of initiatives designed to improve the access to, and quality of care for women Veterans. In particular, research into women Veterans' health has accelerated considerably: more research on the health of women Veterans was published between 2004 and 2008 than in the previous 25 years combined. Much of this growth can be attributed to VA's Office of Research and Development (ORD) having put forward a comprehensive research agenda on women's health in 2004.
VA's Health Services Research & Development Service (HSR&D) provides significant support for that agenda—from individual research studies to the funding of the VA Women's Health Research Network (WHRN). A recent initiative, the WHRN, was created to support and enhance health services research studies focused on women Veterans by building capacity, meeting field-based technical needs, and reducing barriers associated with conducting multi-site studies. The WHRN is composed of two partner entities—the Women's Health Research Consortium (WHRC) and the Women's Health Practice Based Research Network (PBRN).
The following describe a few of the recent contributions HSR&D investigators have made toward VA research on women Veterans' health issues.
- Women's Health Issues: Focus on Women Veterans This special supplement to the journal Women's Health Issues includes 18 original peer-reviewed articles summarizing health services research findings about women Veterans and women in the military. Topics include: tailoring primary care to women Veterans; offering mental healthcare services specifically for women Veterans; military sexual trauma and patient perceptions of VA healthcare; gender differences in smoking cessation; and homelessness among women Veterans.
Informing the Status of Women Veterans' Access to Care and Healthcare Needs [i]
The National Survey of Women Veterans, a major study fielded in 2008-09, collected information about demographics, healthcare needs, barriers, and delivery preferences in a nationally representative sample of 3,611 women Veterans who served in the regular armed forces, as well as women in the National Guard, or reservists who served a tour of duty. Participants included both VA users and VA nonusers. Findings include the following: Women Veterans have high rates of cardiovascular and other chronic disease risk factors. VA cares for a women Veteran population with a higher burden of physical and mental illness compared to healthcare settings outside of VA. Ratings of satisfaction with care and quality of care are similar for women Veterans using VA and non-VA systems of care. A substantial portion of women Veterans are not well-informed about VA eligibility and services. Almost one in five women Veterans delayed healthcare or went without needed care in the prior 12 months. The most commonly cited barriers to VA healthcare use were: Many women do not think they are eligible for VA services; many women are not familiar with how to apply for health care benefits; and the nearest VA location is too far from their residence. VA users and non-users differed in VA quality perceptions, with VA non-users having poorer assessments of VA quality.
Women as Resilient to Combat-Related Stress as Men Following Return from Deployment 3
As a consequence of women's changing role in the war zone, as well as the evolving nature of modern warfare, female service members have experienced unprecedented levels of combat exposure in Afghanistan and Iraq. While women are still barred from direct ground combat positions, they serve in a variety of positions that put them at risk for combat exposure. This study examined gender differences in various dimensions of combat-related stress and associated consequences for post-deployment mental health in a nationally representative sample of male and female OEF/OIF Veterans (340 women and 252 men), who had returned from deployment between October 2007 and July 2008. Study results suggest that women OEF/OIF service members may be as resilient to combat-related stress as men in the first year following deployment. There were no significant interactions between combat-related stressors and gender in the prediction of post-traumatic stress disorder (PTSD) symptoms, mental health functioning, or depression.
Gender Differences among Veterans with PTSD
Gender differences in healthcare use among newly returning Veterans with PTSD are still not well understood.4 This study examined gender differences in rates of VA healthcare use among 159,705 OEF/OIF Veterans with PTSD, with and without comorbid depression and alcohol use disorders who sought VA healthcare from October 2001 through December 2010. Findings show that, overall, female OEF/OIF Veterans with PTSD were more likely to have slightly higher mental health, primary care, and emergency care utilization compared to male Veterans with PTSD. Women Veterans with both PTSD and depression were 12.5 times more likely to have a mental health inpatient hospitalization compared to their female counterparts without depression, and they were twice as likely to have a mental health hospitalization compared to male Veterans with both PTSD and depression. Diagnoses of comorbid PTSD and depression were present in 72% of women and 57% of men.
In another study of military sexual trauma (MST) and mental health disorders in Veterans who had PTSD, 5 researchers found a greater than four-fold increase in PTSD in women Veterans when they had experienced MST, and a nearly-three-fold increase in men. Additionally, researchers found that three-quarters of women Veterans with PTSD and MST had depression; more than one one-third had another anxiety disorder; and 4% were diagnosed with an eating disorder.
Women Veterans and Homelessness
According to a VA study of nearly 200 women in Los Angeles,6 unemployment, disability, and unmarried status are among the strongest predictors of homelessness for women Veterans. Homeless women Veterans also were more than four times as likely to have experienced military sexual trauma, and five times as likely to screen positive for PTSD. Notably, the homeless women Veterans in the study were just as likely as housed women to have a regular healthcare provider, and were twice as likely to have used any VA healthcare in the past year. Researchers suggest findings illustrate the impact of VA's homeless outreach—and represent an opportunity for further interventions to help this population.
In another study, investigators sought to examine whether gender played a role in accessing a VHA homeless program. 7 Overall, researchers found no substantial difference in gender-specific risk of using a VHA homeless program; in other words, women Veterans were just as likely as males to use a homeless program.
Women's Research Media Roundtable
On March 27, 2012, VA's Office of Research & Development (ORD) held a virtual media roundtable addressing women Veterans health research. The roundtable, which was designed to coincide with the conclusion of Women's History Month,featured three leading VA HSR&D investigators. Susan Frayne, M.D., M.P.H., part of HSR&D's Center for Health Care Evaluation ( CHCE) and Associate Director at the Women's Health Center of Excellence at the VA Palo Alto Healthcare System, and Elizabeth Yano, Ph.D., M.S.P.H., Director of HSR&D's Center for the Study of Healthcare Provider Behavior in Sepulveda, CA, discussed the VA Women's Health Practice-Based Research Network (PBRN), which supports clinical research that tests women's health-related interventions and studies requiring the recruitment of women Veterans at multiple sites. Rachel Kimerling, Ph.D., also part of CHCE and VA's National Center for PTSD, talked about military sexual trauma (MST) and women Veterans. All Veterans who screen positive for MST are eligible to receive free VA healthcare services for both mental and physical conditions related to their MST.