Study Suggests Gender Differences in Healthcare Utilization among Veterans with PTSD
BACKGROUND:
Published literature suggests an under-utilization of mental health services and an increase in medical health services in both military personnel and Veterans with PTSD, but little is known about gender differences in healthcare use among newly returning Veterans with PTSD. This cross-sectional, retrospective study examined gender differences in rates of VA healthcare use among OEF/OIF Veterans with PTSD, with and without comorbid depression and alcohol use disorders. Using VA data, investigators identified 159,705 OEF/OIF Veterans with PTSD who sought VA healthcare from 10/01 through 12/10. VA clinic codes were used to assess VA healthcare services, including mental health outpatient, mental health inpatient, primary care, and emergency services. The type and rate of use of VA healthcare services was compared by gender between Veterans with PTSD with/without a depression diagnosis, and with/without an alcohol use disorder diagnosis.
FINDINGS:
- Overall, female OEF/OIF Veterans with PTSD were more likely to have slightly higher mental health, primary care, and emergency care utilization compared to male Veterans with PTSD.
- Women Veterans with comorbid PTSD and depression were 12.5 times more likely to have a mental health inpatient hospitalization compared to their female counterparts without depression, and they were twice as likely to have a mental health hospitalization compared to male Veterans with comorbid PTSD and depression. Diagnoses of comorbid PTSD and depression were present in 72% of women and 57% of men.
- Both men and women with PTSD and alcohol use disorders had more than double the mean number of mental health outpatient visits compared to their counterparts with PTSD but without alcohol use disorders. Comorbid PTSD and alcohol use disorders diagnoses were present in 8% of women and 29% of men.
- Regardless of gender, Veterans with comorbid PTSD and depression or comorbid PTSD and alcohol use disorders had higher healthcare utilization in all areas, as compared to their counterparts with PTSD but without these comorbid disorders.
- Authors note that women and men with PTSD had a median of about three mental health outpatient visits per year, which is lower than expected given that nine or more visits are recommended for evidence-based PTSD treatment.
LIMITATIONS:
- This study was limited to treatment-seeking OEF/OIF Veterans.
- Diagnoses were based on administrative data and were not verified with standardized diagnostic measures.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D (RCD 06-042). Dr. Maguen was supported by an HSR&D Career Development Award and is part of HSR&D's Program to Improve Care for Veterans with Complex Comorbid Conditions, San Francisco, CA.
Maguen S, Cohen B, Cohen G, et al. Gender Differences in Health Service Utilization among Iraq and Afghanistan Veterans with Post-Traumatic Stress Disorder. Journal of Women’s Health February 7, 2012;e-pub ahead of print.
