title: Sex differences in mental health and substance use disorders and treatment entry among justice-involved Veterans in the Veterans Health Administration.
abstract: BACKGROUND
  Over half of veterans in the criminal justice system have mental health or substance use disorders. However, there is a critical lack of information about female veterans in the criminal justice system and how diagnosis prevalence and treatment entry differ by sex.
  
  
  OBJECTIVE
  To document prevalence of mental health and substance use disorder diagnoses and treatment entry rates among female veterans compared with male veterans in the justice system.
  
  
  METHODS
  Retrospective cohort study using national Veterans Health Administration clinical/administrative data from veterans seen by Veterans Justice Outreach Specialists in fiscal years 2010-2012.
  
  
  METHODS
  A total of 1535 females and 30,478 male veterans were included.
  
  
  METHODS
  Demographic characteristics (eg, sex, age, residence, homeless status), mental health disorders (eg, depression, post-traumatic stress disorder), substance use disorders (eg, alcohol and opioid use disorders), and treatment entry (eg, outpatient, residential, pharmacotherapy).
  
  
  RESULTS
  Among female veterans, prevalence of mental health and substance use disorders was 88% and 58%, respectively, compared with 76% and 72% among male veterans. Women had higher odds of being diagnosed with a mental health disorder [adjusted odds ratio (AOR)=1.98; 95% confidence interval (CI), 1.68-2.34] and lower odds of being diagnosed with a substance use disorder (AOR=0.50; 95% CI, 0.45-0.56) compared with men. Women had lower odds of entering mental health residential treatment (AOR=0.69; 95% CI, 0.57-0.83).
  
  
  CONCLUSIONS
  Female veterans involved in the justice system have a high burden of mental health disorders (88%) and more than half have substance use disorders (58%). Entry to mental health residential treatment for women is an important quality improvement target.
authors.affiliation: *Center for Innovation to Implementation (Ci2i), Substance Use Disorder Quality Research Enhancement Initiative, VA Palo Alto Health Care System, Menlo Park, CA †Division of General Internal Medicine University of Colorado School of Medicine, Community Health Services, Denver Health Medical Center, Denver, CO ‡National Center on Homelessness Among Veterans, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA §Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA ∥School of Criminology and Justice Studies, University of Massachusetts, Lowell, Bedford, MA ¶Department of Veterans Affairs, Veterans Justice Programs #Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, Menlo Park, CA **Department of Psychiatry and Behavioral Sciences ††Division of General Medical Disciplines, Stanford University School of Medicine, Menlo Park, CA.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Finlay
authors.forename: Ingrid A
authors.initials: IA
authors.lastname: Binswanger
authors.forename: David
authors.initials: D
authors.lastname: Smelson
authors.forename: Leon
authors.initials: L
authors.lastname: Sawh
authors.forename: Jim
authors.initials: J
authors.lastname: McGuire
authors.forename: Joel
authors.initials: J
authors.lastname: Rosenthal
authors.forename: Jessica
authors.initials: J
authors.lastname: Blue-Howells
authors.forename: Christine
authors.initials: C
authors.lastname: Timko
authors.forename: Janet C
authors.initials: JC
authors.lastname: Blodgett
authors.forename: Alex H S
authors.initials: AH
authors.lastname: Harris
authors.forename: Steven M
authors.initials: SM
authors.lastname: Asch
authors.forename: Susan
authors.initials: S
authors.lastname: Frayne
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008875:Middle Aged; D015995:Prevalence; D011329:Prisoners; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans; D016387:Women's Health