4113 — Gender differences in comorbidities and service utilization of Veterans in VHA care with serious mental illness

Lead/Presenter: Nichole Goodsmith,  COIN - Los Angeles
All Authors: Goodsmith N (VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy; VA Desert Pacific MIRECC; VA Greater Los Angeles; UCLA), Merrill SL (Serious Mental Illness Treatment Resource and Evaluation Center, VA Office of Mental Health and Suicide Prevention); Cordasco KM (VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy; VA Greater Los Angeles Healthcare System; Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles); Austin KL (Serious Mental Illness Treatment Resource and Evaluation Center, VA Office of Mental Health and Suicide Prevention); Kawentel LM (VA QUERI Center for Evaluation and Implementation Resources, VA Ann Arbor Healthcare System); Jackson NJ (VA Greater Los Angeles Healthcare System; University of California, Los Angeles); Hamilton AB (VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy; VA Greater Los Angeles Healthcare System; University of California, Los Angeles); Bowersox NW (Serious Mental Illness Treatment Resource and Evaluation Center, VA Office of Mental Health and Suicide Prevention; University of Michigan, Ann Arbor)

Objectives:
Studies have demonstrated gender differences in demographics and service utilization for Veterans Health Administration (VHA) users, suggesting potential value of providing gender-tailored health care. Veterans with serious mental illness (SMI) are a unique and high-need population, but little is known about differences in potential care needs between men and women in this population. To explore this area, this study compared, by gender, the characteristics and service utilization of Veterans with SMI using VHA health care.

Methods:
Data from VHA Corporate Data Warehouse (CDW) was used to identify all Veterans who received at least one SMI diagnosis (schizophrenia-spectrum, bipolar, or other psychotic disorder) and attended at least two VHA encounters during fiscal year (FY) 2019. CDW data was used to create measures reflecting Veteran demographics, mental health comorbidities, and utilization of VHA outpatient, emergency room, and inpatient services during FY2019. Potential gender differences in these characteristics were assessed with Student’s t-tests and Pearson’s chi-square tests. Relative probabilities (RP) were calculated to reflect the magnitude of differences between groups. This study focused on statistically significant findings that also met an absolute relative probability threshold of > = 0.2.

Results:
Women comprised 15.9% of the study sample (N = 225,650). Women with SMI (N = 35,826), compared to men with SMI (N = 189,824), were more likely to screen positive for military sexual trauma (MST; women: 45.5%, men: 5.7%, RP 8.00) and receive a PTSD diagnosis (women: 47.3%, men: 32.6%, RP 1.45). Men were more likely to receive a substance use disorder diagnosis (women: 24.8%, men: 35.4%, RP 0.70). There were not substantial differences between men and women in major depressive disorder prevalence (women: 34.6%, men: 29.2%, RP 1.19) and utilization of outpatient mental health group services (women: 19.5%, men: 17.2%, RP 1.14), individual mental health care (women: 92.4%, men: 89.0%, RP 1.04), and primary care (women: 91.0%, men: 89.0%, RP 1.02). Substantial gender differences were not found in VHA emergency room utilization for medical (women: 34.5%, men: 34.0%; RP 1.02) and psychiatric concerns (women: 9.1%, men: 10.7%, RP 0.85), although women were significantly less likely to utilize VHA inpatient medical services (women: 8.5%, men: 12.7%, RP 0.67) or VHA inpatient psychiatric services (women: 9.6%, men: 12.0%, RP 0.80). All reported results are significant at the p < .001 level.

Implications:
In this sample of Veterans with SMI, women were significantly less likely than men to be hospitalized for medical or psychiatric care, and had similar use of outpatient and emergency services. Prevalence of MST was notably higher than in the general Veteran population.

Impacts:
These results suggest gender differences in utilization of inpatient psychiatric and medical services for Veterans with SMI. Further studies are necessary to understand whether these differences are due to differential need, access, acceptability, or other factors—information which may inform gender-tailoring of VHA services to improve uptake by women Veterans with SMI. The high prevalence of MST highlights the imperative to ensure that VHA SMI care is tailored to the needs of Veterans with sexual trauma.