VA Women’s Mental Health Services Research

1. VA Women’s Mental Health Services Research Paula P. Schnurr, Ph.D VA National Center for PTSD Dartmouth Medical School

2. HSR&D Support for Women’s 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 Women’s Health Research Consortium/Practice-Based Research Network

3. Areas of HSR&D 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

4. VA is A Natural Translational Research Environment

5. 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

6. HSR&D Women’s Health Research Projects FY 2006-2009 $10.9 million 34 projects • 26 mental health • 5 organization & quality of care • 3 other

7. Why Focus on Mental Health in Women Veterans? VA Health Services Research has Answers

8. 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 21:S40 (2006)

9. 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 Women’s 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. 9

10. 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

11. 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

12. Military Sexual Trauma is Prevalent in Women Veterans – Kimerling et al., 2007 & in press

13. Military Sexual Trauma Increases Risk of Comorbid Problems Odds Ratio for MST vs. no MST All AORs significant at p < .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

14. And Where are We Headed?

15. Mental HealthAreas of HSR&D∧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

16. CSP #579: Long Term Health Outcomes of Women’s 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

17. Women Veterans Cohort Study – C. Brandt, PI

18. Online Interventions for Female OEF/OIF Reserve/National Guard War Vets – A. Sadler, PI

19. 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

20. Other Examples of Current HSR&D Projects on Women’s 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

21. Implications of Women’s 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