Approximately 2.2 million female Veterans currently comprise about 10% of the U.S. Veteran population. As female Veterans are the fastest growing population served by VA, those numbers are expected to double in the next 10 years.1 With more women serving in combat facing positions during OIF/OEF/OND than previous operations, both incidence and prevalence rates of female Veterans with combat-related health problems such as PTSD and physical trauma have increased.2 Additionally, those and other factors, including military sexual trauma (MST) and comorbid mental health issues can affect reproductive and gynecological health.3 In many instances women Veterans delay or avoid seeking care at higher rates than male Veterans4 or struggle with psychosocial barriers not applicable to Veteran men.5 To address the healthcare needs associated with both current and future women Veterans, VA's Health Services Research & Development Service (HSR&D) supports VA’s comprehensive women's health research agenda.6
In honor of Women’s History Month,7 the following featured HSR&D studies address health issues specific to women Veterans.
Unintended pregnancy is prevalent in the U.S. population and is associated with significant adverse health and social consequences. Contraceptive counseling, a highly effective way to prevent unintended pregnancy, is an integral component of primary care for women of reproductive age. The number of female Veterans of reproductive age is rapidly increasing, yet little is known about contraceptive care or outcomes among the growing population of women Veterans who receive health care within the VA Healthcare System. This study sought to determine rates of contraceptive use, unmet need for prescription contraception, and unintended pregnancy in a national sample of female Veterans of reproductive age who use VA for primary care.
Approximately 2,300 VA-using women aged 18-44 completed telephone surveys regarding contraceptive use, pregnancy history, and experiences with VA reproductive healthcare. Researchers also conducted qualitative interviews with a subgroup of 195 participants.
Implications: As the first published data on rates of contraceptive use, unmet contraceptive need, and unintended pregnancy among women VA users, this study provides a comprehensive picture of the current state of contraceptive care in VA and has yielded a rich dataset that can be further used to answer research questions about women Veterans' reproductive healthcare experiences and outcomes within VA. Findings suggest that additional efforts are needed to help women Veterans reduce their risk of unintended pregnancy.
Antipsychotic and mood stabilizer medications for serious mental illnesses (SMI) such as schizophrenia and bipolar disorder are widely prescribed in VA. Weight gain and other metabolic effects of these medications have been implicated in the high rates of obesity and cardiovascular disease among people living with SMI. Women are more susceptible to weight gain from these medications and report more distress than men. Since weight gain is linked to medication nonadherence, women may experience disproportionate adverse effects yet little research has addressed these complex inter-relationships. This study sought to understand the perspective of female Veterans with SMI and VA mental health prescribers on how knowledge, attitudes, and experiences regarding weight gain influence medication selection, adherence, and female patients’ physical and mental health.
Qualitative interviews were conducted with 30 female Veterans with SMI and 18 mental health prescribers.
Implications: Understanding how certain side effects of antipsychotic and mood stabilizer medications that are of particular concern to women (e.g., weight gain) influence prescribing choices and outcomes of treatment will facilitate more informed shared decision-making by women Veterans and VA clinicians regarding the risks and benefits of these treatments. Ultimately, this will enable VA to better address the unique physical and mental health treatment needs of female Veterans with SMI.
Women Reserve and National Guard (RNG) OEF/OIF/OND war Veterans are a fast growing group of new VA users. Although PTSD is highly prevalent in this group of Veterans, most do not seek care. This gap between need for VA PTSD care and pursuit thereof indicates persistent barriers to Veteran engagement in mental health (MH). This study sought to identify and alleviate these barriers and support post-deployment adjustment to mediate the severity of additional MH conditions associated with PTSD.
The study consisted of four phases: 1) Recently returned OEF/OIF/OND RNG female Veterans who screened positive for PTSD (PTSD+) were interviewed to evaluate their preferences, barriers, and facilitators to pursuing VA MH services and evidence-based psychotherapy (EBP) for PTSD; 2) With this information, investigators refined the WEB-ED, a web-based interface that screens for post-deployment readjustment and MH concerns; 3) The revised interface was used to assess Veteran satisfaction with it, and to identify and recruit participants to be randomly assigned to either the standard of care outreach or a nurse care manager (NCM); 4) Follow-up assessments at 6 and 12 months compared the efficacy of the two approaches in promoting initiation of VA MH services.
Implications: This study provides valuable insights into barriers and facilitators regarding female RNG Veterans who may delay or not access MH and PTSD treatment. PTSD+ Veterans with low patient-activation scores require additional support for engaging in needed MH care that this study’s methods addressed. Focusing on these high-risk populations and providing Veteran-centered approaches, this study demonstrated the efficacy of relatively inexpensive interventions that can be implemented within existing models of care and indicated clear implications for expansion to other Veteran populations. Participants reported high satisfaction with WEB-ED, SDM, and EBP. Next steps include engaging providers with PTSD decision aid/SDM use and refining interventions to further focus on the Veteran-provider partnership.
VA has implemented a universal military sexual trauma (MST) screening program and extensive treatment resources targeting MST-related health conditions. Existing research has evaluated VHA's MST Screening Program from an organizational perspective, but there have been few efforts to understand patients’ perspectives on this process. This study sought to ascertain Veterans' attitudes, preferences, and satisfaction regarding MST screening conversations, and to understand associations between MST screening satisfaction, willingness to disclose an MST history, and health outcomes.
The study team conducted semi-structured qualitative interviews with 55 Veterans whose medical records indicated a recent conversation with a VA healthcare provider about MST. Participants included Veterans who had experienced MST and those who had not.
Implications: Despite provider concerns that Veterans may feel uncomfortable discussing MST, most Veterans were comfortable with their screening experiences. These findings may help providers feel more comfortable raising this important but sensitive topic. Provider trainings specific to MST screening should focus on strategies that are consistent with Veteran preference and with best practices for screening for histories of interpersonal violence.