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Publication Briefs

Significant Disparities among Women Veterans with and without Mental Illness in Delaying or Going without Medical Care

While individuals with mental health conditions compared to those without mental health conditions may find barriers to healthcare to be more challenging to overcome, this has not been explored in women Veterans. This study examined associations of PTSD and depressive symptoms with unmet medical needs and barriers to care among women Veterans. Using data from the National Survey of Women Veterans (collected in 2008-2009), investigators identified 3,593 women Veterans with complete information on both the PTSD and depression items, and then compared women with PTSD symptoms only (9%), depressive symptoms only (4%), comorbid symptoms (4%), and neither (83%). All participants were asked if they delayed or went without medical care they thought was needed in the past 12 months – and about barriers to care if unmet need was present. Perceived barriers to VA care also were assessed among Veterans who had formerly used VA healthcare (defined as more than 12 months since last use), and who had never used VA care (n=1,677), regardless of the presence of unmet need. Other measures included demographics, healthcare use, combat exposure, and sexual assault during military service.


  • There was a significant degree of disparities reported by women Veterans with and without mental health symptoms in delaying or going without needed medical care. The majority of those who screened positive for both PTSD and depressive symptoms had unmet medical care needs in the prior 12 months (59%) – compared to 30% of women with PTSD symptoms only, 18% of those with depressive symptoms only, and 16% of women with neither set of symptoms. This pattern remained the same after adjustment (e.g., for demographics, insurance, combat exposure).
  • Overall, among women Veterans in this study who reported unmet medical needs (19% of the women surveyed; n=840), those with both PTSD and depressive symptoms were more likely than women in the other groups to identify affordability as a reason for going without or delaying care (69%). Being unable to take time off work (31%) was the second most common reason reported among this group.
  • Among women Veterans not using VA healthcare, those with both PTSD symptoms and depressive symptoms, and PTSD symptoms only were more likely than those with depressive symptoms only to report not knowing if they were eligible for VA benefits. Women with PTSD symptoms (w/ or w/o depression) were less likely than all other groups to have health insurance to cover non-VA care.


  • The survey used in this study did not assess the seriousness of the condition for which healthcare was delayed or not obtained, or the resulting health consequences.
  • The survey asked about PTSD symptoms over the Veteran's lifetime rather than about current symptoms.

This study was partly funded by HSR&D (SDR 08-270). Drs. Lehavot and Simpson are part of the VA Puget Sound Health Care System, Seattle, WA. Drs. Der-Martirosian and Washington are part of HSR&D's Center for the Study of Health Care Provider Behavior, Sepulveda, CA. Dr. Sadler is part of HSR&D's Center for Comprehensive Access and Delivery Research and Evaluation, Iowa City, IA.

PubMed Logo Lehavot K, Der-Martirosian C, Simpson TL, Sadler AG, and Washington DL. Barriers to Care for Women Veterans with Post-Traumatic Stress Disorder and Depressive Symptoms. Psychological Services May 2013;10(2):203-212.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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