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2008 HSR&D National Meeting Abstract

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National Meeting 2008

1004 — VA and Community Mental Healthcare Use by Women Veterans Who Screen Positive for Post-traumatic Stress Disorder

Washington DL (VA Greater Los Angeles HSR&D Center of Excellence), Yano EM (VA Greater Los Angeles HSR&D Center of Excellence)

Objectives:
Post-traumatic stress disorder (PTSD) is common in women veterans, and associated with significant co-morbidity. Effective treatment is available. However, PTSD is often unrecognized. PTSD prevalence and mental healthcare use in the general women veteran population is unknown.

Methods:
We conducted a population-based telephone survey of a stratified random sample of 2,174 women veterans residing in southern California and southern Nevada (VISN22). Stratification was by current VA use and age group, with similar numbers of VA users and nonusers, and age groups enrolled. We screened for PTSD using a validated 7-item instrument, and also assessed demographic characteristics, co-morbidity, and use of mental healthcare in the prior 12 months. Among those screening positive, we conducted multivariate logistic regression to identify independent predictors of mental healthcare use. All analyses applied weights to account for disproportional allocation of the population by strata so that resulting estimates are representative of the VISN22 women veteran population.

Results:
Overall, 10.9% of respondents screened positive for PTSD (26.0% of VA-users, 9.7% of VA-nonusers; p < 0.0001). Among those screening positive, 27.3% used mental healthcare services in the prior 12 months (63.7% of VA-users, 19.9% of VA-nonusers; p < 0.0001), and 16.7% used VA healthcare. PTSD-positive African-American (odds ratio [O.R.]=0.1; 95% confidence interval [C.I.] 0.01-0.5) and Hispanic (O.R.=0.1; 95% C.I. 0.03-0.6) veterans were less likely than Whites to receive mental healthcare. Screening positive for an anxiety disorder (O.R.=14.2; 95% C.I. 3.2-62.7), being low income (O.R.=7.6; 95% C.I. 1.9-30.3), using VA healthcare (O.R.=4.4; 95% C.I. 1.3-14.7), and having a service-connected disability (O.R.=3.9; 95% C.I. 1.4-11.1) all predicted mental healthcare use.

Implications:
One in nine women veterans screened positive for PTSD. Though a majority of VA-users received mental healthcare, this was not uniform across racial-ethnic groups. Only a minority of VA-nonusers received mental healthcare.

Impacts:
The majority of women veterans use non-VA healthcare providers who may be unaware of their veteran status and PTSD risk. Education of non-VA providers about women veterans’ PTSD risk may be warranted. Barriers to VA mental healthcare use for VA-nonusers and ethnic-minority VA-users should be explored. Though VA-wide PTSD screening and mental healthcare are available, these services only reach a fraction of affected veterans.


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