VA Adapts to Changing Demographics: Improving Healthcare for Women Veterans
Women are entering the military at record numbers. Women make up 20% of new recruits, and it is estimated that women Veterans will comprise 10% of the Veteran population by 2018. Moreover, studies suggest that Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) Veterans are among the fastest growing segments of new VA healthcare users, with as many as 44% electing to use VA healthcare.1 However, gender-specific care (e.g., reproductive health services) and care for conditions of higher prevalence among women (e.g., osteoporosis), or with different clinical presentations (e.g., heart attacks) impose challenges for VA providers with limited exposure to female patients. Key priorities for women Veterans' care include improving:
- Access to VA care,
- Culture of care surrounding women Veterans,
- Women Veteran-centered care, and
- Coordination of care across providers (e.g., primary and specialty care).
In response to the changing demographic in the Veteran population and the specialized healthcare needs of women, VA established women's health as a research priority in the early 1990s. For example, in 1993 VA established a new division within the National Center for Post-Traumatic Stress Disorder devoted to studying the impact of military trauma on women Veterans. Additionally, the Center for Women Veterans was established in 1994 to ensure that women Veterans have access to VA benefits and services, and that VA healthcare and benefits programs are responsive to the gender-specific needs of women. Specific goals of the center include promoting research activities on women Veterans' issues and fostering communication between all elements of VA to assure that this group's needs are incorporated into overall strategic planning.
Expanding the Scope of Research for Women Veterans
VA's Office of Research and Development (ORD) tasked a VA Women's Health Research Planning Group that worked to develop a comprehensive research agenda for women Veterans - and to position VA as a national leader in women's health research. The Planning Group, which includes several HSR&D investigators, worked to critically appraise the VA research portfolio, identify strategic priorities for the women's health research agenda, and foster the conduct of research on women's health. The Planning Group held a Women's Health Research agenda setting conference in November 2004, and identified key research priorities. In parallel to this conference, a special supplement on VA research on women's health was published in the Journal of General Internal Medicine, with several contributions from HSR&D investigators.2 Also, partly as a result of this work, in April 2005 a special solicitation was issued for research that assessed the needs of women Veterans with chronic illness. This encompassed physical and mental health conditions and their combined impact on women Veterans, as well as their use of the VA healthcare services.
Continuing to work toward enhanced research on women Veterans, HSR&D and the Women Veterans Health Strategic Healthcare Group co-sponsored a conference in 2010 titled "Using Research to Build the Evidence Base for Improving the Quality of Care for Women Veterans: VA Women's Health Services Research Conference." This conference brought together investigators interested in pursuing research on women Veterans, and women serving in our military, with leaders in women's healthcare delivery and policy within and outside the VA (e.g., DoD, NIH, IOM), who collaborated to advance the state and potential impact of VA women's health research. As a result, HSR&D is generating an updated VA women's health research agenda. In addition, 16 peer-reviewed articles summarizing VA and military health services research results will appear in the journal Women's Health Issues in the Spring of 2011.
Research at Work
HSR&D continues to contribute to the growing body of research being conducted to improve the health and healthcare of women Veterans.
- An HSR&D-funded study of nearly 200 women Veterans in Los Angeles showed that unemployment, disability, and unmarried status are among the strongest predictors of homelessness for women Veterans.3
- A study, partly funded by HSR&D, found that combat exposure is not associated with a higher risk of mental health problems for women compared with men. Women are more likely than men, however, to develop PTSD following a range of traumatic experiences.4
- An HSR&D study showed that minor depression is highly prevalent among women Veterans with complex chronic illness such as diabetes, heart disease, or hypertension.5
- An HSR&D study showed that although a relatively small proportion of OEF/OIF Veterans received VA healthcare related to pregnancy (7%), a substantial proportion of these women (32%) received one or more mental health diagnoses compared with 21% of women without a pregnancy related condition.1
- A study, partly funded by HSR&D, found that compared to women without a history of military sexual assault, women veterans with histories of military sexual assault reported more use of VA healthcare services.6
HSR&D also commissioned a systematic literature review to synthesize research knowledge about women Veterans' health issues. The results of that project are now online in the form of a searchable database that was designed to serve as a resource for the VA women's health community, which includes clinicians, managers, policymakers, researchers, and Veterans. This database updates an original systematic review conducted in 2004 and now includes literature citations on women Veterans' health and healthcare published through 2008. An update to the database that covers articles published from 2008 through 2010 will be added soon, and periodic updates will continue to keep the database current.
New Initiatives in Women's Health Research
In addition to ongoing research in women's health and healthcare, HSR&D is funding a women Veterans' Practice-Based Research Network (PBRN). Building this infrastructure will enable and promote more women Veterans' participation in research, and support multi-site interventional research, thus resulting in an expansion of research initiatives with the potential to transform VA care. The PBRN will provide a laboratory for examining new treatments, quality performance and quality improvements, models of care (e.g., integrated mental health and primary care), and provider education and training innovations. For more information, contact Susan Frayne, M.D. at Susan.Frayne@va.gov or Elizabeth Yano, Ph.D. at Elizabeth.Yano@va.gov , co-lead for the first women Veterans' PBRN.
- Mattocks K, Skanderson M, Goulet J, et al. Pregnancy and mental health among women Veterans returning from Iraq and Afghanistan. Journal of Women's Health December 2010;19(12):2159-2166.
- Journal of General Internal Medicine Special Supplement, March 2006;21(3).
- Washington D, Yano E, McGuire J, et al. Risk factors for homelessness among women Veterans. Brief Communication. Journal of Health Care for the Poor and Underserved February 2010;21(1):81-91.
- Street A, Vogt D, and Dutra L. A new generation of women Veterans: Stressors faced by women deployed to Iraq and Afghanistan. Clinical Psychology Review December 2009;29(8):685-694.
- Shen C, Findley P, Banerjea R, Sambamoorthi U. Depressive disorders among cohorts of women Veterans with diabetes, heart disease, and hypertension. Journal of Women's Health August 2010;19(8):1475-1486.
- Kelly M, Vogt D, Scheiderer E, et al. Effects of military trauma exposure on women Veterans' use and perceptions of Veterans Health Administration care. Journal of General Internal Medicine June 2008;23(6):741-7.