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RRP 09-152 – HSR&D Study

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RRP 09-152
Gender Differences in Mental Health Treatment Needs and Service Use
Anna Kline PhD
East Orange Campus of the VA New Jersey Health Care System, East Orange, NJ
East Orange, NJ
Funding Period: October 2009 - May 2011

BACKGROUND/RATIONALE:
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.

OBJECTIVE(S):
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?

METHODS:
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.

FINDINGS/RESULTS:
Diagnoses:

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.

Service Connection:

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.

Service Utilization:

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.

IMPACT:
This study provides important information regarding ways in which the VA can enhance mental health services to improve treatment engagement for women veterans.

PUBLICATIONS:

Journal Articles

  1. 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.


DRA: Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Observational, Treatment - Comparative Effectiveness
Keywords: PTSD, QUERI Implementation, Women - or gender differences
MeSH Terms: none

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