Top

Journal of General Internal Medicine

Published in:

01-07-2013 | Original Research

PTSD Risk and Mental Health Care Engagement in a Multi-War Era Community Sample of Women Veterans

Authors: Donna L. Washington, MD, MPH, Teri D. Davis, PhD, Claudia Der-Martirosian, PhD, Elizabeth M. Yano, PhD, MSPH

Published in: Journal of General Internal Medicine | Issue 7/2013

ABSTRACT

BACKGROUND

Post-traumatic stress disorder (PTSD) is common in women veterans (WVs), and associated with significant co-morbidity. Effective treatment is available; however, PTSD is often unrecognized.

OBJECTIVES

Identify PTSD prevalence and mental healthcare (MHC) use in a representative national WV sample.

DESIGN AND PARTICIPANTS

Cross-sectional, population-based 2008–2009 national survey of 3,611 WVs, weighted to the population.

MAIN MEASURES

We screened for PTSD using a validated instrument, and also assessed demographic characteristics, health characteristics, and MHC use in the prior 12 months. Among those screening positive, we conducted multivariate logistic regression to identify independent predictors of MHC use.

KEY RESULTS

Overall, 13.0 % (95 % confidence interval [CI] 9.8–16.2) of WVs screened PTSD-positive. Veterans Health Administration (VA) healthcare was used by 31.1 % of PTSD-positives and 11.4 % of PTSD-negatives (p < 0.001). Among those screening positive, 48.7 % (95 % CI 35.9–61.6) used MHC services (66.3 % of VA-users, 40.8 % of VA-nonusers; p < 0.001). Having a diagnosis of depression (OR = 8.6; 95 % CI 1.5–48.9) and VA healthcare use (OR = 2.7; 95 % CI 1.1–7.0) predicted MHC use, whereas lacking a regular provider for health care (OR = 0.2; 95 % CI 0.1–0.4) and household income below the federal poverty level (OR = 0.2; 95 % CI 0.1–0.5) predicted nonuse.

CONCLUSIONS

More than one in eight WVs screened positive for PTSD. Though a majority of VA-users received MHC, low income predicted nonuse. Only a minority of VA-nonusers received MHC. The majority of WVs use non-VA healthcare providers, who may be unaware of their veteran status and PTSD risk. VA outreach to educate VA-nonusers and their healthcare providers about WVs’ PTSD risk and available evidence-based VA treatment options is one approach to extend the reach of VA MHC. Research to characterize barriers to VA MHC use for VA-nonusers and low income VA-users is warranted to better understand low service utilization, and to inform program development to engage more WVs in needed MHC.

National Center for Veterans Analysis and Statistics. VetPop2007 National Tables, table 5 L. Available at: http://www.va.gov/VETDATA/Demographics/Demographics.asp. Accessed June 20, 2012.

Washington DL, Yano EM, Simon B, Sun S. To use or not to use—what influences why women veterans choose VA healthcare? J Gen Intern Med. 2006;21(Suppl 3):S11–S18.PubMedCrossRef

U.S. Department of Commerce. Profiles of General Demographic Characteristics, 2000 Census of Population and Housing. Available at: http://www.census.gov/prod/cen2000/dp1/2kh00.pdf. Accessed June 20, 2012.

Bean-Mayberry B, Yano EM, Washington DL, et al. Systematic review of women veterans health: update on successes and gaps. Womens Health Issues. 2011;21(4 Suppl):S84–S97.

Kessler RC, Berglund P, Delmer O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602.PubMedCrossRef

Murdoch M, Hodges J, Cowper D, Sayer N. Med Care. 2005;43(2):112–121.PubMedCrossRef

Middleton K, Craig CD. A systematic literature review of PTSD among female veterans from 1990 to 2010. Soc Work Ment Heal. 2012;10(3):233–252.CrossRef

Frayne SM, Seaver MR, Loveland S, Christiansen CL, Spiro A, Parker VA, Skinner KM. Burden of mental illness in women with depression and posttraumatic stress disorder. Arch Intern Med. 2004;164:1306–1312.PubMedCrossRef

Schnurr PP, Lunney CA. Exploration of gender differences in how quality of life relates to posttraumatic stress disorder in male and female veterans. J Rehabil Res Dev. 2008;45(3):383–394.PubMedCrossRef

10.

Schnurr PP, Friedman MJ, Engel CC, et al. Cognitive behavioral therapy for posttraumatic stress disorder in women: a randomized controlled trial. JAMA. 2007;297(8):820–830.PubMedCrossRef

11.

Liebschutz J, Saitz R, Brower V, et al. PTSD in urban primary care: high prevalence and low physician recognition. J Gen Intern Med. 2007;22(6):719–726.PubMedCrossRef

12.

Seal KH, Maguen S, Cohen B, et al. VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses. J Trauma Stress. 2010;23(1):5–16.PubMed

13.

Washington DL, Sun S, Canning M. Creating a sampling frame for population-based veteran research: coverage and overlap of VA and non-VA databases. J Rehabil Res Dev. 2010;47(8):763–771.PubMedCrossRef

14.

Washington DL, Bean-Mayberry B, Riopelle D, Yano EM. Access to care for women veterans: delayed healthcare and unmet need. J Gen Intern Med. 2011;26(Suppl 2):655–661.PubMedCrossRef

15.

Breslau N, Peterson EL, Kessler RC, Schultz LR. Short screening scale for DSM-IV Posttraumatic Stress Disorder. Am J Psychiatry. 1999;156:908–911.PubMed

16.

Kimerling R, Ouimette P, Prins A, Nisco P, Lawler C, Cronkite R, Moos RH. Brief report: utility of a short screening scale for DSM-IV PTSD in primary care. J Gen Intern Med. 2006;21:65–67.PubMedCrossRef

17.

Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res. 1974;9:208–220.

18.

Andersen R. Revisiting the behavioral model and access to medical care: does it matter? J Health Soc Behav. 1995;36:1–10.PubMedCrossRef

19.

Berwick DM, Murphy JM, Goldman PA, Ware JE Jr, Barsky AJ, Weinstein MC. Performance of a five-item mental health screening test. Med Care. 1991;29:169–176.PubMedCrossRef

20.

Kroenke K, Spitzer RL, Williams JB, Monahan PO, Löwe B. Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007;146(5):317–325.PubMedCrossRef

21.

Bradley KA, Bush KR, Epler AJ, et al. Two brief alcohol-screening tests from the Alcohol Use Disorders Identification Test (AUDIT). Arch Intern Med. 2003;163:821–829.

22.

StataCorp. Stata: Release 12. Statistical Software. College Station, TX: StataCorp LP; 2011.

23.

Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P. Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry. 1998;55:626–632.PubMedCrossRef

24.

Gerrity MS, Corson K, Dobscha SK. Screening for posttraumatic stress disorder in VA primary care patients with depression symptoms. J Gen Intern Med. 2007;22(9):1321–1324.PubMedCrossRef

25.

Women’s Health Services, Office of Patient Care Services, Department of Veterans Affairs. Women’s Health Campaigns. Available at: http://www.womenshealth.va.gov/WOMENSHEALTH/campaigns.asp. Accessed November 14, 2012.

26.

National Center for PTSD, Department of Veterans Affairs. Available at: http://www.ptsd.va.gov/index.asp. Accessed November 14, 2012.

27.

Hoge CW, Auchterlonie JL, Milliken CS. Mental health problems, use of mental health services, and attrition from military service after returning from deployment to Iraq or Afghanistan. JAMA. 2006;295(9):1023–1032.PubMedCrossRef

28.

Hoge CW, Castro CA, Messer SC, McGurk D, Cotting DI, Koffman RL. Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. N Engl J Med. 2004;351(1):13–22.PubMedCrossRef

29.

Khaylis A, Polusny MA, Erbes CR, Gewirtz A, Rath M. Posttraumatic stress, family adjustment, and treatment preferences among National Guard soldiers deployed to OEF/OIF. Mil Med. 2011;176(2):126–131.PubMed

30.

Stecker T, Fortney JC, Hamilton F, Aizen I. An assessment of beliefs about mental health care among veterans who served in Iraq. Psychiatr Serv. 2007;58(10):1358–1361.PubMedCrossRef

31.

Vogt D. Mental health-related beliefs as a barrier to service use for military personnel and veterans: a review. Psychiatr Serv. 2011;62:135–142.PubMedCrossRef

32.

MacGregor C, Hamilton AB, Oishi SM, Yano EM. Description, development, and philosophies of mental health service delivery for female veterans in the VA: a qualitative study. Womens Health Issues. 2011;21(4 Suppl):S138–S144.

33.

Oishi SM, Rose DE, Washington DL, MacGregor C, Bean-Mayberry B, Yano EM. National variations in VA mental health care for women veterans. Wom Health Issues. 2011;21(4 Suppl):S130–S137.CrossRef

34.

Alegria M, Mulvaney-Day N, Woo M, Torres M, Gao S, Oddo V. Correlates of past-year mental health service use among Latinos: results from the National Latino and Asian American Study. Am J Public Health. 2007;97(1):76–83.PubMedCrossRef

35.

Cohen BE, Maguen S, Bertenthal D, Shi Y, Jacoby V, Seal KH. Reproductive and other health outcomes in Iraq and Afghanistan Women Veterans using VA Health Care: association with mental health diagnoses. Womens Health Issues. 2012;22(5):e461–e471.

36.

Nazarian D, Kimerling R, Frayne SM. Posttraumatic stress disorder, substance use disorders, and medical comorbidity among returning U.S. veterans. J Trauma Stress. 2012;25(2):220–225.PubMedCrossRef

Title: PTSD Risk and Mental Health Care Engagement in a Multi-War Era Community Sample of Women Veterans
Authors: Donna L. Washington, MD, MPH
Teri D. Davis, PhD
Claudia Der-Martirosian, PhD
Elizabeth M. Yano, PhD, MSPH
Publication date: 01-07-2013
Publisher: Springer-Verlag
Published in: Journal of General Internal Medicine / Issue 7/2013
Print ISSN: 0884-8734
Electronic ISSN: 1525-1497
DOI: https://doi.org/10.1007/s11606-012-2303-2

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

ABSTRACT

BACKGROUND

OBJECTIVES

DESIGN AND PARTICIPANTS

MAIN MEASURES

KEY RESULTS

CONCLUSIONS

Please log in to get access to this content

Other articles of this Issue 7/2013

Cost Sharing and Decreased Branded Oral Anti-Diabetic Medication Adherence Among Elderly Part D Medicare Beneficiaries

Capsule Commentary on Davydow et al., Depression and Risk of Hospitalizations for Ambulatory Care-Sensitive Conditions in Patients with Diabetes

Direct-To-Consumer Television Advertising Exposure, Diagnosis with High Cholesterol, and Statin Use

Peer Coaching to Improve Diabetes Self-Management: Which Patients Benefit Most?

Healthcare Experiences of Autistic Adults

Appraising the Practice of Etiquette-Based Medicine in the Inpatient Setting

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials