Gender differences in health service utilization among Iraq and Afghanistan veterans with posttraumatic stress disorder.
BACKGROUND
Little is known about gender differences in healthcare use among newly returning veterans with posttraumatic stress disorder (PTSD). We investigated gender differences in Veterans Affairs (VA) medical center health service use among Iraq and Afghanistan veterans with PTSD with and without comorbid depression and alcohol use disorders (AUD).


METHODS
Using VA administrative data, bivariate and multivariate statistics were used to examine gender differences in health service use among 159,705 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with PTSD seeking VA healthcare from October 7, 2001, to December 31, 2010.


RESULTS
Female veterans with PTSD were more likely to be black and single and to have higher mental health, primary care, and emergency care use compared to men with PTSD. Men were more likely to have higher mental health inpatient use compared to women. Women and men with comorbid PTSD and depression or comorbid PTSD and AUD were more likely to have higher use in all domains compared to their counterparts with PTSD without these comorbid disorders. Women with comorbid PTSD and depression were 12.5 times more likely to have a mental health inpatient hospitalization compared to their female counterparts without depression and twice as likely to have a mental health hospitalization compared to men with comorbid PTSD and depression.


CONCLUSIONS
Women with PTSD had higher use than men in almost all areas, as did all veterans with comorbid PTSD and depression and comorbid PTSD and AUD, regardless of gender. Better understanding these health service use differences will allow for targeted evaluation and integrated treatment interventions in veterans with PTSD.
San Francisco VA Medical Center, San Francisco, CA 94121, USA. shira.maguen@va.gov
Shira
S
Maguen
Beth
B
Cohen
Greg
G
Cohen
Erin
E
Madden
Daniel
D
Bertenthal
Karen
K
Seal
D000293:Adolescent; D000328:Adult; D055826:Afghan Campaign 2001-; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D017533:Marital Status; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D017678:Sex Distribution; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*