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2023 HSR&D/QUERI National Conference Abstract

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4142 — Gender and Racial Differences in Psychiatric Diagnoses and Psychotherapy Use among Veterans with Military Sexual Trauma

Lead/Presenter: Derrecka Boykin,  COIN - Houston
All Authors: Boykin DM (Houston COIN), Amspoker A (Houston COIN) Meers J (Houston COIN) Bryan J (Houston COIN) Hamer J (Houston COIN) Walder A (Houston COIN) Lindsay J (Houston COIN) Hundt N (Houston COIN)

This study examined differences in psychiatric diagnoses and psychotherapy use among veterans with military sexual trauma (MST) by gender and race/ethnicity.

A retrospective cohort study of 318,956 veterans with MST in fiscal year 2018 extracted from Veterans Health Administration patient data. Logistic regression analyses examined the main and interaction effects of gender (male and female) and race/ethnicity (across six categories) on psychiatric diagnoses and psychotherapy use controlling for age. Race/ethnicity categories were White, Black, Hispanic, American Indian/Alaska Native, Asian, and Native Hawaiian/Pacific Islander. Psychiatric diagnoses included posttraumatic stress disorder (PTSD), anxiety, depression, and substance use disorders. Psychotherapy use was examined by type (individual, group) and clinic setting (integrated primary care-mental health, general mental health, PTSD clinical team).

Men veterans with MST from each racial/ethnic group were less likely to be diagnosed with depression (adjusted odds ratios [AORs] = 0.77-0.88) but twice as likely to be diagnosed with substance use disorders (AORs = 1.94-2.99) compared to women from each racial/ethnic group. Gender differences in psychotherapy use only emerged among non-Hispanic, Hispanic, and Black veterans such that men were less likely to receive individual psychotherapy in general mental health clinics compared to women (AORs = 0.78, 0.86, and 0.87, respectively). Black men were also more likely to use group psychotherapy (AOR = 1.17) and less likely to use individual psychotherapy in PTSD clinics (AOR = 0.90) compared to black women. Results on psychotherapy use were unchanged after controlling for age and history of a psychiatric diagnosis.

Consistent with other studies, mental health and treatment disparities were observed among men veterans with MST. In this study, differences were most apparent for Black men veterans.

Research on health equity and disparities among veterans with MST remains limited. To the authors’ knowledge, this is the first study to explore gender and racial/ethnic differences in psychiatric diagnoses and psychotherapy use among MST survivors. Study findings demonstrate that attending to the specific needs of male survivors continues to be an important target for MST-related equity work. Further investigation into gender differences across different racial/ethnic groups are warranted to fully understand their health equity challenges, especially among Black men.