The use of VA and non-VA mental health services by female veterans.
OBJECTIVE
This study compared Department of Veterans Affairs (VA) and non-VA mental health service use among male and female veterans. Because female veterans are a distinct minority in VA, it was hypothesized that they would be less likely to use VA mental health care than would male veterans.


METHODS
Using data from a national sample of Vietnam and Vietnam-era male (n = 1,612) and female (n = 736) veterans, the following were examined: (1) gender differences in use of VA mental health services, (2) gender differences in use of non-VA mental health services, and (3) differences in utilization of mental health services across subgroups defined by psychiatric diagnosis, adjusting for sociodemographic and need variables.


RESULTS
Female veterans were equally likely to use VA mental health services as male veterans, but were substantially more likely to use non-VA mental health services. This suggests that the demand for mental health services overall is substantially greater among female veterans than among male veterans and, by implication, that the equal levels of observed VA service use actually represent underutilization of VA services on the part of female veterans. Logistic regression models showed that these utilization patterns were consistent across diagnostic subgroups.


CONCLUSIONS
Special efforts, such as the development of women's specialty mental health clinics, may be needed to enhance the acceptability of VA mental health services to female veterans. This study also highlights the importance of considering overall demand for services in addition to more objective diagnostic data in evaluating the adequacy of service delivery and its accessibility.
Hoff
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Practice Pattern Research Unit, Northeast Program Evaluation Center, West Haven VAMC, CT 06516, USA.
Rosenheck
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D000328:Adult; D000368:Aged; D003130:Combat Disorders / Q000453:epidemiology* / Q000523:psychology / Q000534:rehabilitation; D015897:Comorbidity; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D012737:Sex Factors; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*; D014744:Vietnam