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PTSD risk and mental health care engagement in a multi-war era community sample of women veterans.

Washington DL, Davis TD, Der-Martirosian C, Yano EM. PTSD risk and mental health care engagement in a multi-war era community sample of women veterans. Journal of general internal medicine. 2013 Jul 1; 28(7):894-900.

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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.

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