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Post-deployment readjustment stressors and mental health service utilization among OEF/OIF women Veterans
Davis TD, Der-Martirosian C, Hamilton A, Yano EM, Washington DL. Post-deployment readjustment stressors and mental health service utilization among OEF/OIF women Veterans. Poster session presented at: VA HSR&D Enhancing Partnerships for Research and Care of Women Veterans Conference; 2014 Jul 31; Arlington, VA.
Post-deployment stressors, including lack of social support and employment and relationship instability, have been identified among Operations Enduring and Iraqi Freedom (OEF/OIF) Veteran samples, especially those needing mental health (MH) care. However, the current knowledge about post-deployment stressors includes little work on women, although some exist, and also limited to those not engaged in MH care. Our objective was to assess the association between post-deployment stressors and MH service utilization in a population-based sample of OEF/OIF women Veterans (WVs).
Data are from 1,029 OEF/OIF WV participants in the National Survey of Women Veterans, a 2008-09 telephone survey of a nationally-representative, stratified random WV sample. Measures assessed included sociodemographic, military, and MH characteristics; post-deployment stressors; social support; and MH utilization in the prior 12 months. We conducted logistic regression to assess post-deployment stressors of MH service users and non-users, adjusting for age, combat exposure, PTSD screening result, and VA/non-VA use.
Overall, 70% of OEF/OIF WVs were under age 45, 41% were racial/ethnic minorities, 58% married, 39% college graduates, 67% employed, and 23% with household income < 200% of the federal poverty level. Nearly 25% screened positive for PTSD. Sixty-five percent reported post-deployment employment instability (job change or unemployment) and 19% reported post-deployment relationship instability (including separation or divorce). Twenty-two percent used MH services in the prior 12 months. In adjusted analysis, MH users were more likely to have post-deployment relationship instability than non-users (27% vs. 15%; p < 0.001). MH users and non-users did not differ in employment instability (p = 0.79). MH users were more likely to endorse that non-Veterans did not understand their military experiences (p = 0.01), but did not differ from non-users in their ability to maintain the social support of their military friends (p = 0.23).
Post-deployment employment instability was widespread among OEF/OIF WVs. Relationship instability occurred in a sizable minority, and, along with some aspects of social support, was associated with MH service utilization.
VA clinicians serving OEF/OIF WVs should screen for employment and relationship stressors in this population. Health care systems should assure that both MH services as well as social services are in-place to address the post-deployment stressors of OEF/OIF WVs.