title: Reproductive and other health outcomes in Iraq and Afghanistan women veterans using VA health care: association with mental health diagnoses.
abstract: BACKGROUND
  An increasing number of women serve in the military and are exposed to trauma during service that can lead to mental health problems. Understanding how these mental health problems affect reproductive and physical health outcomes will inform interventions to improve care for women veterans.
  
  
  METHODS
  We analyzed national Department of Veterans Affairs (VA) data from women Iraq and Afghanistan veterans who were new users of VA healthcare from October 7, 2001, through December 31, 2010 (n = 71,504). We used ICD-9 codes to categorize veterans into five groups by mental health diagnoses (MH Dx): Those with no MH Dx, posttraumatic stress disorder (PTSD), depression, comorbid PTSD and depression, and a MH Dx other than PTSD and depression. We determined the association between mental health category and reproductive and other physical health outcomes defined by ICD-9 codes. Categories included sexually transmitted infections, other infections (e.g., urinary tract infections), pain-related conditions (e.g., dysmenorrhea and dsypareunia), and other conditions (e.g., polycystic ovarian syndrome, infertility, sexual dysfunction). Models were adjusted for sociodemographic and military service factors.
  
  
  RESULTS
  There were 31,481 patients (44%) who received at least one mental health diagnosis. Women veterans with any mental health diagnosis had significantly higher prevalences of nearly all categories of reproductive and physical disease diagnoses (p < .0001 for adjusted prevalences). There was a trend of increasing prevalence of disease outcomes in women with PTSD, depression, and comorbid PTSD and depression (p for trend <.0001 for all outcomes).
  
  
  CONCLUSIONS
  Iraq and Afghanistan women veterans with mental health diagnoses had significantly greater prevalences of several important reproductive and physical health diagnoses. These results provide support for VA initiatives to address mental and physical health concerns and improve comprehensive care for women veterans.
authors.affiliation: San Francisco VA Medical Center, University of California-San Francisco, CA 94121, USA. beth.cohen@va.gov
authors.forename: Beth E
authors.initials: BE
authors.lastname: Cohen
authors.forename: Shira
authors.initials: S
authors.lastname: Maguen
authors.forename: Daniel
authors.initials: D
authors.lastname: Bertenthal
authors.forename: Ying
authors.initials: Y
authors.lastname: Shi
authors.forename: Vanessa
authors.initials: V
authors.lastname: Jacoby
authors.forename: Karen H
authors.initials: KH
authors.lastname: Seal
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D015897:Comorbidity; D005260:Female; D006801:Humans; D038801:International Classification of Diseases; D054542:Iraq War, 2003-2011; D008603:Mental Health; D008875:Middle Aged; D015995:Prevalence; D060728:Reproductive Health; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D058014:Veterans Health; D014932:Women's Health Services / Q000706:statistics & numerical data; D055815:Young Adult