Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1044 — Examining Patterns of Mental Health Utilization Among Pregnant and Postpartum Veterans

Lead/Presenter: Kristin Mattocks, COIN - West Haven
All Authors: Mattocks KM (VA Central Western Massachusetts Healthcare System) Baldor R (VA Central Western Massachusetts Healthcare System) Bastian LA (VA Connecticut Healthcare System)

Objectives:
Increasing numbers of women Veterans are using VA maternity benefits. In the VA, all maternity care is provided by community obstetricians but paid for by VA. The objective of this study is to understand mental health diagnoses and mental health care utilization among pregnant and postpartum women Veterans receiving VA maternity benefits.

Methods:
This multi-site prospective cohort study includes pregnant and postpartum Veterans from 13 VA facilities. At the time of pregnancy diagnosis, women Veterans are invited to participate in the study. During the second trimester of pregnancy, a telephone interview is conducted with Veterans to assess physical and mental health status, history of military sexual trauma, and challenges accessing non-VA obstetrical care. At 12 weeks postpartum, a postpartum interview is conducted to assess selected maternal and child health outcomes, including pregnancy and delivery complications, perinatal depression, and infant health status.

Results:
To date, 280 pregnant Veterans from 13 VAMCs have enrolled in the study and completed the pregnancy interview, and 149 of these women have completed the postpartum interview. The majority of women in the study are white (63%), married (63%), and OEF/OIF/OND Veterans (66%). Thirty-two percent of women Veterans were not able to access prenatal care in a timely manner due to an inability to find a non-VA provider willing to accept VA maternity benefits. Fifty-three percent of pregnant Veterans reported military sexual trauma during their military deployments. At the time of pregnancy diagnosis, 49% of pregnant women had an active diagnosis of depression; while 34% had a diagnosis of PTSD. Forty-nine percent of pregnant women were receiving mental health care at the time of pregnancy diagnosis, and 44% of these women intended to continue to receive mental health care during pregnancy. However, following delivery, only 18% of women reported receiving mental health care from either a VA or community provider. Reasons for not receiving mental health care included lack of knowledge regarding ongoing eligibility for VA mental health care during pregnancy and inability to find a community mental health provider.

Implications:
Pregnant Veterans experience substantial mental health burdens during pregnancy. Despite receipt of mental health care early in their pregnancies, most pregnant Veterans do not continue mental health care throughout their pregnancy and into the postpartum period.

Impacts:
Ensuring that pregnant Veterans continue to receive mental health care throughout the pregnancy and postpartum period is critically important for the health of women and their infants.