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2015 HSR&D/QUERI National Conference Abstract

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1153 — Perceived and Objective Mental Health Complexity among Women in VA Primary Care, Alison Hamilton

Hamilton AB, VA Greater Los Angeles COIN; Maisel N, VA Palo Alto COIN; Oishi S, VA Greater Los Angeles COIN; Yano EM, VA Greater Los Angeles COIN; Klap R, VA Greater Los Angeles COIN; Balasubramanian V, VA Palo Alto COIN; Saechao F, VA Palo Alto COIN; Frayne SM, VA Palo Alto COIN;

Objectives:
Mounting evidence demonstrates that women Veterans (WVs) have a high burden of mental health (MH) conditions. Our original objective was to investigate VHA providers' perceptions of WVs' MH needs. We then assessed the prevalence of MH conditions and MH service utilization among these patients.

Methods:
Semi-structured interviews in 2011 and 2012 with frontline WH primary care (PC) and MH providers and staff (n = 96) from six VA healthcare systems. Analysis of VHA administrative data to ascertain the frequency of co-occurring MH diagnoses by mapping ICD-9 diagnosis codes to 16 MH conditions, and examining past-year MH utilization patterns by count of MH conditions.

Results:
Respondents pervasively observed that women's MH needs were predominant and typically "complex." Complexity included MH conditions, trauma histories, and issues such as pain, eating and sleep disorders, family and relationship difficulties, unemployment, and housing instability. Providers were especially challenged by women's inconsistent use of health care (often due to their life stressors), which made it difficult to maintain comprehensive, integrated care and innovative programming. Among 313,029 fiscal year 2012 WV VHA PC patients, 48% had at least one MH condition; 27% had ? two conditions. The top three conditions were Depression (34%), Anxiety Disorder (17%), and PTSD (16%). The most common MH co-occurrences were PTSD/Depression (11%) and Anxiety Disorder/Depression (11%). Among those with ? two conditions, 82% had Depression; 51%, PTSD. Among those with one MH condition, 47% had no MH encounters, 38% had ? two encounters; among those with ? two MH conditions, 9% had no MH encounters and 82% had ? two encounters.

Implications:
More than one-quarter of WV VHA primary care patients had two or more MH conditions, corroborating providers' perceptions that many of their patients are "complex" in their MH needs. Women with multiple MH conditions typically utilized MH services, but almost half of women with one MH condition did not. WH providers may be challenged with prioritizing and coordinating the diverse services needed to address women's often complex needs.

Impacts:
With the population of WV VHA users increasing, the system will need to generate innovative ways to address their MH and psychosocial needs and varying degrees of engagement in care.