Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4013 — Women Veterans Enrolling in Women-Only versus Mixed-Gender Pain Treatment Groups Demonstrate Greater Psychological Distress and Attrition from Treatment

Lead/Presenter: Jennifer DelVentura
All Authors: DelVentura JL (Atlanta VA Health Care System) Miceli A (Emory University)

Objectives:
Research suggests that women veterans report higher rates of pain and psychological complaints (e.g., PTSD, depression) compared with men veterans and non-veteran women. However, they underutilize VA care compared with men, due in part to perceived lack of women-specific services/providers and barriers to accessing care. Services for women have expanded through the VA in recent decades to help meet these needs. Within the Empower Veterans Program (EVP), an interdisciplinary pain treatment program in the Atlanta VA Health Care System, a women's group option is offered. The present study examined differences in women electing women-only (WO) versus traditional mixed-gender (MG; predominantly male) groups on pain and psychological variables at enrollment, as well as impact of different group formats on attrition.

Methods:
Methods: Veterans enrolling in EVP attend 10 weekly 3-hour sessions 1 hour of group therapy, psychoeducation, and physical therapy groups for self-management of pain. WO and MG groups were compared on week 1 pre-assessment scores on: pain intensity (Numerical Rating Scale; NRS), pain interference (Multidimensional Pain Inventory-Interference; MPI), depression (PHQ-9), pain-related worries (Pain Catastrophizing Scale; PCS), and quality of life (WHOQOL-BREF). Attrition rates between groups were compared.

Results:
Results indicate that women in WO groups had significantly higher (ps < .05) baseline scores on the PHQ-9 (mean difference = 3.15), PCS (mean difference = 6.85), and lower scores on the WHOQOL-psychological scale (mean difference = 1.83) compared with those enrolling in MG groups. No differences were observed in other quality of life scales, pain severity, or perceived pain interference at pre-assessment (ps > .05). Data also suggests that WO groups demonstrate significantly higher attrition compared with MG groups (58% vs. 34%, p < .05).

Implications:
Compared with MG groups, WO groups reported greater psychological distress (depression, pain-related worry, lower psychological well-being) at enrollment and were less likely to complete the program thereby limiting potential benefit of services. Thus, while offering women-specific services is an important step, it may not be sufficient in ensuring access and full benefit of care. More targeted support for veterans electing these services may be warranted and plans for quality improvement modifications are discussed.

Impacts:
This work enhances understanding of disparities in access to care for women veterans seeking women-specific services.