Study Finds Higher Rates of Reproductive and Physical Health Problems in OEF/OIF Women Veterans with Mental Illness
BACKGROUND:
Women represent the fastest growing population of new military recruits — and a rapidly increasing portion of patients who use the VA healthcare system. Most prior research on the association of mental and physical health problems in women Veterans has focused on the effects of PTSD, but recent findings suggest that depression is also important to consider. This study examined the associations of PTSD, depression, comorbid PTSD and depression, and other mental disorders with a broad range of reproductive and physical health outcomes. Using VA data, investigators identified 71,504 OEF/OIF women Veterans who were new users of VA healthcare from 10/7/01 through 12/31/10. Variables that were measured included: demographics, military rank, service branch, number of deployments, as well as distance to and type of the nearest VAMC. ICD-9 codes associated with VA outpatient or inpatient visits during the study period were used to place Veterans into one of five groups: 1) no mental health diagnoses (n=40,347), 2) PTSD but no depression (n=4,279), 3) depression but no PTSD (n=9,756), 4) both depression and PTSD (n=11,024), and 5) other types of mental health diagnoses (n=6,098). Overall, 44% of the women Veterans in this study received at least one mental health diagnosis.
FINDINGS:
- OEF/OIF women Veterans with any mental health diagnoses had significantly higher prevalence of nearly all categories of reproductive and physical disease diagnoses compared to women Veterans without mental health diagnoses. Women with mental health diagnoses had approximately two to four times the odds of receiving diagnoses of sexually transmitted infections, cervical dysplasia, dysmenorrhea, and gynecologic pain syndromes, as well as other reproductive and gynecologic health conditions, with prevalence being highest in women with comorbid PTSD and depression.
- The most striking difference was in sexual dysfunction (a relatively rare outcome), in which women Veterans diagnosed with mental health disorders had 6 to 10 times the odds of receiving this diagnosis than women without mental disorders.
- Findings were similar after adjusting for demographics, military service characteristics, and distance to/type of nearest VAMC. The magnitude of the associations of mental and physical health diagnoses were reduced after adjusting for primary care utilization, but most remained significant.
LIMITATIONS:
- This study relied on administrative data; therefore, the mental and physical health conditions examined could have been misclassified.
- Investigators did not have information on traumatic event history and did not examine military sexual trauma screening results.
AUTHOR/FUNDING INFORMATION:
This study was partly funded by HSR&D, and Dr. Maguen was supported by an HSR&D Career Development Award. Drs. Maguen and Seal are part of HSR&D's Program to Improve Care for Veterans with Complex Comorbid Conditions, San Francisco, CA.
Cohen B, Maguen S, Bertenthal D, Shi Y, Jacoby V, and Seal K. Reproductive and Other Health Outcomes in Iraq and Afghanistan Women Veterans Using VA Health Care: Association with Mental Health Diagnoses. Women’s Health Issues September 2012;22(5):e461-71.
