State of VA Women's Mental Health Services Research

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VA Womens Mental Health Services Research
Paula P. Schnurr, Ph.D VA National Center for
PTSD Dartmouth Medical School
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HSRD Support for Womens Health Research

• Special solicitation focused on WHR since 1996
• Aimed at explaining care and utilization by women
  Veterans and improving care
• Includes Career Development Awards, Center of
  Excellence funding, and a new Womens Health
  Research Consortium/Practice-Based Research
  Network

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Areas of HSRD Research on Women Veterans

• Delivery, organization, and systems of care for
  women veterans
• Gender-specific use of VA and non-VA care
• Gender-specific issues related to access and
  barriers to care
• Quality of care
• Continuity, comprehensiveness, outcomes and costs
  of care
• Other factors associated with health care for
  women veterans, their special needs, and
  potential disparities

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VA is A Natural Translational Research Environment
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CSP 494 Cognitive-Behavioral Treatment of PTSD
in Women

• The Science
• 1st clinical trial of PTSD treatment in female
  Veterans and Service Members
• 12 sites 284 women
• Prolonged Exposure (PE) therapy shown to be
  effective (JAMA, 2007)

• The Translation
• National rollout of PE implemented in 2008
• 942 clinicians trained 7/1/10
• Infrastructure created to sustain implementation
• Research to enhance efficiency, outcome, and
  acceptability

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HSRD Womens Health Research Projects FY
2006-2009

• 10.9 million
• 34 projects
• 26 mental health
• 5 organization quality of care
• 3 other

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Why Focus on Mental Health in Women Veterans?

• VA Health Services Research has Answers

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Women Who Use VA have Worse Mental Health
Relative to Women in the General Population
Mental Health Subscales

• Veterans
• General population

Frayne et al., J Gen Intern Med 21S40 (2006)
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Among VA Users, Women are More Likely Than Men to
have Mental Health Problems
31 of women vs. 20 of men have a diagnosed
mental health condition
From Frayne, VA Womens Health Evaluation
Initiative. Percents are based on presence of at
least 2 instances of mental health condition
ICD-9 codes in VA outpatient administrative data
in FY08 includes veteran patients only.
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Mental Health Problems Are Cross-Cutting A
Hidden Variable

• In women Veterans (male Veterans, civilians),
  mental health problems are related to
• More physical health problems and pain
• Greater service utilization
• Lower psychosocial and occupational functioning
• Poor self-care, e.g., smoking
• Reduced quality of life
• Higher likelihood of mental health problems
  More burden

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Even in Veterans with Mental Health Problems, the
Burden is Greater in Women
FY06-07, OEF/OIF Veterans (N 90, 558)
Frayne, Kimerling, under review
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Military Sexual Trauma is Prevalent in Women
Veterans
Kimerling et al., 2007 in press
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Military Sexual Trauma Increases Risk of Comorbid
Problems
Odds Ratio for MST vs. no MST
All AORs significant at p lt .05 adjusted for
age, race, marital status, health insurance,
service connection , prior VHA use, component,
branch, and multiple deployments
Data from 126,729 OEF/OIF Veterans screened for
sexual trauma in VA FYs 2001-2007
Kimerling et al., in press
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And Where are We Headed?
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Mental HealthAreas of HSRD?Research on Women
Veterans

• Delivery, organization, and systems of care for
  women veterans
• Gender-specific use of VA and non-VA care
• Gender-specific issues related to access and
  barriers to care
• Quality of care
• Continuity, comprehensiveness, outcomes and costs
  of care
• Other factors associated with health care for
  women veterans, their special needs, and
  potential disparities

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CSP 579 Long Term Health Outcomes of Womens
Service During the Vietnam War

• Understand impact of wartime deployment on
  physical and mental health 40 years after the
  Vietnam War
• 10,000 women Vietnam era Veterans

K. Magruder, A. Kilbourne, Kang, co-Chairs
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Women Veterans Cohort Study
C. Brandt, PI
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Online Interventions for Female OEF/OIF
Reserve/National Guard War Vets
A. Sadler, PI
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Caring for Women Veterans Study

• Evaluate a 30-minute multi-media program for
  enhancing VA staff sensitivity to and knowledge
  about women Veterans and their needs
• Extension of this project will be conducted
  through new PBRN

D. Vogt, PI
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Other Examples of Current HSRD Projects on
Womens Mental Health

• Bradley Urogenital Symptoms, Depression and PTSD
  in OEF/OIF Women Veterans
• Gerlock Relationship and PTSD Study Detection
  of Intimate Partner Violence
• Kline Gender Differences in Mental Health
  Treatment Needs and Service Use
• Lange Pilot Study of Re-Integration and Service
  Needs for Women Veteran Mothers
• Shipherd MST Effect on PTSD and Health Behavior
  A Longitudinal Study of Marines
• Vogt Stigma, Gender and Other Barriers to VHA
  Use for OIF/OEF Veterans

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Implications of Womens Mental Health Services
Research

• Prominence of mental health reflects need as well
  as cross-cutting effects of mental health on
  physical health and health behaviors
• Women Veterans are women
• Generalizability to civilian women
• Women Veterans are Veterans
• Generalizability to male veterans too