title: Gender differences in veterans health administration mental health service use: effects of age and psychiatric diagnosis.
abstract: OBJECTIVE
  The objective of this study was to compare gender differences in mental health disease burden and outpatient mental health utilization among veterans utilizing Veterans Health Administration (VHA) mental health services in fiscal year 1999 (FY99), after the first Gulf War and significant restructuring of VHA services.
  
  
  METHODS
  We used logistic regression to examine the relationships among gender, age, diagnostic groups, and utilization of mental health and specialty mental health services in a national sample of veterans. The sample included 782,789 veterans with at least 1 outpatient visit in the VHA in FY99 associated with a mental health or substance abuse (SA) diagnosis. Subgroup analyses were performed for 4 diagnostic categories: 1) posttraumatic stress disorder (PTSD), 2) SA disorders, 3) bipolar and psychotic disorders, and 4) mood and anxiety disorders.
  
  
  RESULTS
  Younger women veterans (<35 years old) were significantly less likely and older women (> or =35) more likely to use any mental health services in comparison with their male counterparts. Similar findings were observed for younger women diagnosed with SA or mood and anxiety disorders, but not among veterans with PTSD or bipolar and psychotic disorders, among whom no there were no gender or age differences. In the case of specialized services for SA or PTSD, women younger than 55 with SA or PTSD were significantly less likely to use services than men.
  
  
  CONCLUSIONS
  Women veterans underutilized specialty mental health services in relation to men but receipt of mental health care overall in FY99 varied by age and diagnosis. Examining gender differences alone, without taking other factors into account, may not provide an adequate picture of women veterans' current mental health service needs.
authors.affiliation: Center for Health Quality, Outcomes and Economic Research (CHQOER), Bedford VAMC (152), Bedford, Massachusetts 01730, USA. sharmcha@bu.edu
authors.forename: Sharmila
authors.initials: S
authors.lastname: Chatterjee
authors.forename: Maria E
authors.initials: ME
authors.lastname: Rath
authors.forename: Avron
authors.initials: A
authors.lastname: Spiro
authors.forename: Susan
authors.initials: S
authors.lastname: Eisen
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Sloan
authors.forename: Amy K
authors.initials: AK
authors.lastname: Rosen
mesh_terms: D000328:Adult; D000367:Age Factors; D001007:Anxiety / Q000628:therapy; D001714:Bipolar Disorder / Q000628:therapy; D005260:Female; D047830:Gulf War; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders; D008605:Mental Health Services / Q000706:statistics & numerical data*; D019964:Mood Disorders / Q000628:therapy; D012737:Sex Factors; D013313:Stress Disorders, Post-Traumatic / Q000628:therapy; D019966:Substance-Related Disorders / Q000628:therapy; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000523:psychology*