title: PTSD risk and mental health care engagement in a multi-war era community sample of women veterans.
abstract: BACKGROUND
  Post-traumatic stress disorder (PTSD) is common in women veterans (WVs), and associated with significant co-morbidity. Effective treatment is available; however, PTSD is often unrecognized.
  
  
  OBJECTIVE
  Identify PTSD prevalence and mental healthcare (MHC) use in a representative national WV sample.
  
  
  METHODS
  Cross-sectional, population-based 2008-2009 national survey of 3,611 WVs, weighted to the population.
  
  
  METHODS
  We screened for PTSD using a validated instrument, and also assessed demographic characteristics, health characteristics, and MHC use in the prior 12 months. Among those screening positive, we conducted multivariate logistic regression to identify independent predictors of MHC use.
  
  
  RESULTS
  Overall, 13.0 % (95 % confidence interval [CI] 9.8-16.2) of WVs screened PTSD-positive. Veterans Health Administration (VA) healthcare was used by 31.1 % of PTSD-positives and 11.4 % of PTSD-negatives (p<0.001). Among those screening positive, 48.7 % (95 % CI 35.9-61.6) used MHC services (66.3 % of VA-users, 40.8 % of VA-nonusers; p<0.001). Having a diagnosis of depression (OR=8.6; 95 % CI 1.5-48.9) and VA healthcare use (OR=2.7; 95 % CI 1.1-7.0) predicted MHC use, whereas lacking a regular provider for health care (OR=0.2; 95 % CI 0.1-0.4) and household income below the federal poverty level (OR=0.2; 95 % CI 0.1-0.5) predicted nonuse.
  
  
  CONCLUSIONS
  More than one in eight WVs screened positive for PTSD. Though a majority of VA-users received MHC, low income predicted nonuse. Only a minority of VA-nonusers received MHC. The majority of WVs use non-VA healthcare providers, who may be unaware of their veteran status and PTSD risk. VA outreach to educate VA-nonusers and their healthcare providers about WVs' PTSD risk and available evidence-based VA treatment options is one approach to extend the reach of VA MHC. Research to characterize barriers to VA MHC use for VA-nonusers and low income VA-users is warranted to better understand low service utilization, and to inform program development to engage more WVs in needed MHC.
authors: VA Greater Los Angeles Health Services Research and Development (HSR&D) Center of Excellence for the Study of Healthcare Provider Behavior, Sepulveda, Sepulveda, CA, USA. Donna.washington@va.gov
authors: Donna L
authors: DL
authors: Washington
authors: Teri D
authors: TD
authors: Davis
authors: Claudia
authors: C
authors: Der-Martirosian
authors: Elizabeth M
authors: EM
authors: Yano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011159:Population Surveillance / Q000379:methods; D012111:Residence Characteristics; D012307:Risk Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000523:psychology* / Q000628:therapy; D014481:United States; D014728:Veterans / Q000523:psychology*; D058014:Veterans Health; D014857:Warfare; D055815:Young Adult