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SDR 12-196 – HSR&D Study

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SDR 12-196
The VA Women's Overall Mental Health Assessment of Needs (WOMAN)
Rachel Kimerling PhD BA
VA Palo Alto Health Care System, Palo Alto, CA
Palo Alto, CA
Funding Period: April 2012 - September 2014

BACKGROUND/RATIONALE:
Women are among the fastest growing population subgroups of VA health care users, but are still an under-represented minority within the health care system. Most research on women Veterans' mental health to date has focused specifically on PTSD and military sexual trauma (MST), and little is known about the prevalence and impact of other symptoms and conditions that may exist among women Veterans and be appropriate targets for gender-specific intervention. Some data suggest that women Veterans' concerns about comfort in the VA environment and the quality of care limit health care utilization, but little is known about how such concerns may specifically impact access to mental health care nor what strategies for intervention might promote better treatment engagement among these women. Gender-specific data are essential to inform the current efforts to expand mental health resources for women Veterans and assure their access to and engagement with these services.

OBJECTIVE(S):
The goal of this project was to build on the WOMAN study by adding an emphasis on gender-sensitive access to mental health care and explore the role of patient activation and engagement in women Veterans' access to mental health care. Specifically, the objectives of this project are to:

a) Assess potential gender-sensitive dimensions of access to mental health services
b) Validate indicators of gender-sensitive access by examining the associations of the access dimensions to utilization and quality.
c) Examine the associations of patient activation with mental health care utilization, quality, and gender-sensitive access

METHODS:
The WOMAN study was a nationwide telephone survey of a nationally representative sample of 6,287 women Veteran VA primary care users designed to determine the prevalence of a wide range of mental health symptoms and conditions among women in VA, and to assess mental health care needs, utilization, and mental health care experiences. Survey responses were matched to VA administrative data to obtain diagnoses and utilization. Objective access was defined as utilization of mental health care conditional on perceived need; perceived access was defined using women's subjective ratings of the extent to which mental health care met her needs. Mental health experiences included ratings of overall quality and ease of getting needed care, and gender-related experiences included access to female providers, women-only treatment settings, and women women-only treatment groups as often as preferred, as well as gender-related comfort in mental health treatment settings.

FINDINGS/RESULTS:
Objective access to mental health was high. Nearly all women who used mental health services in the past year used VA care for at least some of their mental health care. Half of all women reported perceived need; 84.3% of those women used mental health services in the past year. Nearly all mental health users (90.9%) used VA services. Only about half of these women (48.8%) indicated that their mental health care met their needs completely or very well, suggesting gaps in perceived access. Gender-related care experiences were each associated with two-fold increased odds of perceived access, and associations remained after adjusting for logistical barriers to care.

Higher levels of patient activation were associated with better ratings for all mental health care experiences, including gender-related care experiences. Associations remained significant after adjusting for patient characteristics, disability, and dual use.

IMPACT:
The WOMAN study was the first population-based study of the mental health and mental health care needs of women Veteran users of VA health care. This study identified gender-sensitive dimensions of access to mental health services. Patient activation is a potential point of intervention to improve perceived access to care and could help women receive care concordant with gender-related preferences.

PUBLICATIONS:

Journal Articles

  1. Kimerling R, Iverson KM, Dichter ME, Rodriguez AL, Wong A, Pavao J. Prevalence of Intimate Partner Violence among Women Veterans who Utilize Veterans Health Administration Primary Care. Journal of general internal medicine. 2016 Aug 1; 31(8):888-94.
  2. Brignone E, Gundlapalli AV, Blais RK, Carter ME, Suo Y, Samore MH, Kimerling R, Fargo JD. Differential Risk for Homelessness Among US Male and Female Veterans With a Positive Screen for Military Sexual Trauma. JAMA psychiatry (Chicago, Ill.). 2016 Jun 1; 73(6):582-9.
  3. Barth SK, Kimerling RE, Pavao J, McCutcheon SJ, Batten SV, Dursa E, Peterson MR, Schneiderman AI. Military Sexual Trauma Among Recent Veterans: Correlates of Sexual Assault and Sexual Harassment. American journal of preventive medicine. 2016 Jan 1; 50(1):77-86.
  4. Iverson KM, Vogt D, Dichter ME, Carpenter SL, Kimerling R, Street AE, Gerber MR. Intimate Partner Violence and Current Mental Health Needs Among Female Veterans. Journal of the American Board of Family Medicine : JABFM. 2015 Nov 1; 28(6):772-6.
Book Chapters

  1. Kimerling R, Haskell S, Maguen S, Mattocks K, Garrett-Ray S, Veet L, McCutcheon S. VA Health Care in Response to a New Generation of Female Veterans. In: Amara J, Hendricks AM, editors. Military medical care: From predeployment to post-separation (Cass Military Studies). Abington, United Kingdom: Routledge; 2013. 249-265 p.
Conference Presentations

  1. Karpenko JA, Greene L, Pavao JR, Rodriguez A, Turchik JA, Makin-Byrd K, Kimerling R. Lesbian and Bisexual Women Veterans in VA: Mental Health Status and VA Mental Health Care Utilization. Presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Aug 1; Arlington, VA.
  2. Makin-Byrd K, Greene L, Rodriguez A, Cloitre M, Pavao JR, Kimerling R. Serving Veterans who are mothers: Differences in mental health needs, utilization of services, and perceptions of care between parents and non-parents. Presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA.
  3. Pavao JR, Makin-Byrd K, Turchik JA, Karpenko JA, Greene L, Saweikis M, Rodriguez A, Kimerling R. Prevalence of Intimate Partner Violence and Association with Mental Health Symptoms and Life Stressors among Women Veterans. Presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA.
  4. Washington DL, Kimerling R, Yano EM. Sexual Assault of Women in the U.S. Military – Population-based Prevalence and Health Consequences from the National Survey of Women Veterans. Paper presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA.
  5. Pomernacki A, Carney D, Kimerling R, Bastian L, Bean-Mayberry B, Blakeney J, Erschens H, Goldstein K, Martin B, Sadler A, Yano EM, Yosef J, Frayne SM. Launching the First VA Women’s Health Practice-Based Research Network Study: Lessons from the Field. Poster session presented at: Agency for Healthcare Research and Quality Practice-Based Research Network Annual Meeting; 2014 Jun 30; Bethesda, MD.
  6. Kimerling R. Intimate partner violence and military sexual trauma: Access and Quality of mental health care among women in VHA. Presented at: AcademyHealth Annual Research Meeting; 2014 Jun 9; San Diego, CA.
  7. Kimerling R, Gierisch JM, Dichter M, Iverson K, Sadler A. Patient-Centered Care for Interpersonal Violence: Screening, Counseling, and Engagement with Care. Paper presented at: AcademyHealth Annual Research Meeting; 2014 Jun 3; San Diego, CA.
  8. Karpenko JA, Greene L, Pavao JR, Rodriguez A, Turchik JA, Makin-Byrd K, Kimerling R. Lesbian and Bisexual Women Veterans in VA: Mental Health Status and VA Mental Health Care Utilization. Presented at: VA Ci2i / NCPTSD / HERC Annual Research Assistant Conference; 2014 May 21; Menlo Park, CA.


DRA: Military and Environmental Exposures, Mental, Cognitive and Behavioral Disorders, Health Systems
DRE: Diagnosis
Keywords: Anxiety Disorders, Attitudes/Beliefs, Clinical Diagnosis and Screening, Depression, Family, Patient Preferences, PTSD, Quality of Care, Sexual Trauma/Assault, Social Support
MeSH Terms: none