In order for the VA to meet the needs of combat-exposed women, more information is needed about the clinical characteristics of this population, their specific service needs and barriers they encounter in seeking VA care.
Study questions included: 1. Are there gender-based differences in the clinical presentation of PTSD, including the presence of co-morbid mental and physical health conditions? 2. Is the VA adequately identifying and addressing co-morbid conditions among veterans with PTSD? 3. What personal and system barriers and facilitators affect treatment utilization and are these gender-specific?
We conducted telephone interviews and medical records reviews on 100 VA New Jersey patients (50 men and 50 women) randomly selected from a DSS list of patients who screened positive for PTSD in the last 3 years. The questionnaire consisted of mixed and open-ended response items exploring mental and physical health and VA treatment experiences. We used ATLAS-ti software to analyze the qualitative data and SPSS Vs. 16 for the quantitative analyses.
Equal proportions of men and women screened positive for PTSD on the PCL-17 during the research interview (78% for both). However, women were somewhat less likely than men to receive a diagnosis of PTSD in their medical charts (66% vs.76%) and were more likely to be diagnosed with adjustment disorder (30% vs. 14%, p<=0.05) and anxiety disorder (32% vs. 14%, p<=0.05). Among veterans diagnosed with PTSD, women were somewhat more likely than men to have co-occurring mental health conditions.
Among veterans with a PTSD medical diagnosis, women were less likely than men to be service-connected for PTSD (36.4% vs. 71.1%; p<=.01). Somewhat fewer women than men sought service connection (54.5% vs. 71.1%) and, of those who did, only 56.5% of women vs. 86.2% of men were approved (p<=.05). The difference in approval rates was accounted for by lower combat exposure among women.
Overall, there were no gender-based differences in service utilization, which was low for both men and women. Although 78% screened positive for current PTSD, only 40% of women and 50% of men were currently in treatment. Women completed a median of 9 outpatient mental health visits and men, 8. Treatment drop-out rates were high for men (63%) and women (60%). Women were somewhat more likely than men to have sought care from non-VA providers (45% vs. 34%) and to plan to seek outside care in the future (25% vs. 20%).
Barriers to Care:
Women were more likely than men to cite work and other outside responsibilities as barriers to care (74.3% vs. 52.4%, p<=0.05) and to express concerns relating to mental health stigma, including embarrassment at seeking treatment (62.9% vs. 41.5%, p<=.10) and fear that treatment-seeking would harm their careers (57.1% vs. 27.0%, p<=0.05). Women also expressed discomfort at the male-oriented service environment, preferring a separate physical space in which to receive services, more women therapists and women-only groups.
This study provides important information regarding ways in which the VA can enhance mental health services to improve treatment engagement for women veterans.
- Smelson D, Kalman D, Losonczy MF, Kline A, Sambamoorthi U, Hill LS, Castles-Fonseca K, Ziedonis D. A brief treatment engagement intervention for individuals with co-occurring mental illness and substance use disorders: results of a randomized clinical trial. Community mental health journal. 2012 Apr 1; 48(2):127-32.