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RRP 09-115 – HSR&D Study

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RRP 09-115
Online Interventions for Female OEF/OIF Reserve/National Guard war Vets
Anne G. Sadler PhD RN
Iowa City VA Health Care System, Iowa City, IA
Iowa City, IA
Funding Period: November 2009 - October 2010

BACKGROUND/RATIONALE:
VHA is challenged with meeting the needs of dramatically changing service populations. Women and OEF/OIF Reserve/National Guard (R/NG) war Veterans are among the fastest growing groups of new VA users. The effects of military experiences, including combat, post-deployment readjustment, and sexual victimization are particularly poorly characterized in R/NG servicewomen. For a variety of reasons (e.g., stigma, military sexual trauma, VHA care perceptions, established pre- deployment health care) facilitating access to mental health services for OEF/OIF R/NG female Veterans is challenging and will require new approaches.

OBJECTIVE(S):
1)To determine the feasibility of online mental health screening using a tailored questionnaire assessing post-deployment mental health disorders; and 2)to determine user perceptions about the online tailored instrument, and access to and acceptability of available VA mental health treatments among participants who screen positive for mental health conditions.

METHODS:
Defense Manpower Data Center identified a Mid-Western sample of R/NG servicewomen returning from deployment to Iraq and Afghanistan in the 24 months preceding study participation. Phase 1 of this study included development and implementation of a web-based survey of post-deployment mental health and readjustment disorders with educational information tailored to each participant's responses (n=131). Phase 2 involved a follow-up telephone interview (n=37) with women screening positive for any mental health concern to determine their perceptions of 1) using the internet for mental health information, 2) the survey and tailored information, and 3) VA mental health care.

FINDINGS/RESULTS:
Post-deployment mental health problems were common, including: combat trauma (95%), prescription drug abuse (54%),military sexual trauma (50%), PTSD (41%),depression (37%), family adjustment issues (30%), substance abuse (13%), domestic violence (11%),traumatic brain injury (10%). Most (48%) participants had 3-4 positive screens, while 29% had 1-2 positive screens and 22% had more than 4 positive screens. Almost a third (32%) reported that the information they received reduced their discomfort with seeking care and 38% indicated that they would subsequently seek assessment from a VA provider and 26% would from a non-VA provider. The majority of participants (74%) indicated they preferred to receive VA information through e-mail. Almost half (48%) indicated this web-based intervention provided them with information that they might not have received otherwise. Most (74%) participants would recommend this survey to other military women. Key reasons reported for why women don't use VA mental health care included stigma and lack of knowledge about VA women's health services.

IMPACT:
Given the well recognized stigma of seeking mental health services, dual health care use and reluctance to use VA care acknowledged in R/NG populations, the DVA must move beyond traditional avenues for engaging this population and providing needed mental health services. A successful online intervention tailored to individuals' needs for specific services may represent an effective and relatively low cost care approach. This study demonstrated that web-based mental health interventions are possible to implement and are considered desirable by high risk R/NG service women post-deployment.

PUBLICATIONS:

Journal Articles

  1. Sadler AG, Mengeling MA, Torner JC, Smith JL, Franciscus CL, Erschens HJ, Booth BM. Feasibility and desirability of web-based mental health screening and individualized education for female OEF/OIF reserve and national guard war veterans. Journal of traumatic stress. 2013 Jun 1; 26(3):401-4.
Conference Presentations

  1. Cucciare MA, Sadler A, Mengeling M, Torner J, Han X, Ray JM, Booth BM. Associations Between Deployment-Related Experiences and Binge Drinking Among US Servicewomen Deployed to Iraq and Afghanistan. Poster session presented at: AcademyHealth Annual Research Meeting; 2016 Jun 27; Boston, MA.
  2. Mengeling M, Booth B, Torner J, Sadler AG. OEF/OIF Reserve and National Guard Women Veteran Barriers to Mental Healthcare: Deployment & Provider Effects. Paper presented at: VA HSR&D National Meeting; 2011 Feb 18; National Harbor, MD.
  3. Sadler AG, Mengeling M, Booth B, Torner J. Interpersonal Violence and OEF/OIF Reserve and National Guard Service Women. Paper presented at: VA HSR&D National Meeting; 2011 Feb 18; National Harbor, MD.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Observational, Prevention
Keywords: Operation Enduring Freedom, Operation Iraqi Freedom, QUERI Implementation, Women's health
MeSH Terms: none

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