title: Gender Differences in Service Utilization among OEF/OIF Veterans with Posttraumatic Stress Disorder after a Brief Cognitive-Behavioral Intervention to Increase Treatment Engagement: A Mixed Methods Study.
abstract: OBJECTIVE
  Women veterans who served in Iraq and Afghanistan (Operation Enduring Freedom and Operation Iraqi Freedom [OEF/OIF]) have a moderately higher risk of developing posttraumatic stress disorder (PTSD) than male veterans. However, gender disparities in treatment engagement may prevent women veterans from initiating the care they need. Understanding gender differences in predictors of and barriers to treatment is essential to improving engagement and mental health outcomes. The purpose of this study was to examine gender differences in treatment utilization after a brief, cognitive-behavioral therapy (CBT) intervention among male and female OEF/OIF veterans.
  
  
  METHODS
  Participants were assigned randomly to either the intervention or control conditions. Intervention participants received the telephone-based CBT intervention. Participants were 35 female and 238 male OEF/OIF veterans who screened positive for PTSD and had never initiated PTSD treatment. Participants were asked about treatment utilization, beliefs about PTSD treatment, and symptoms at months 1, 3, and 6 months subsequent to the baseline telephone assessment. The PTSD Checklist-Military Version was used to assess PTSD and the Patient's Health Questionnaire was used to assess symptoms of depression.
  
  
  RESULTS
  Female veterans who received an intervention were significantly more likely to have attended treatment over the 6-month follow-up period than male veterans who received an intervention (χ(2) = 7.91; df = 3; odds ratio, 3.93; p = .04).
  
  
  CONCLUSIONS
  The CBT intervention may be a critical mechanism to engage female veterans in treatment. Further research is needed to understand how to engage male veterans with PTSD in treatment.
authors.affiliation: Department of Psychiatry, University of Rochester Medical Center, Rochester, New York. Electronic address: autumn_gallegos@urmc.rochester.edu.
authors.forename: Autumn M
authors.initials: AM
authors.lastname: Gallegos
authors.affiliation: Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Kristina B
authors.initials: KB
authors.lastname: Wolff
authors.affiliation: Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Streltzov
authors.affiliation: Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Leslie B
authors.initials: LB
authors.lastname: Adams
authors.affiliation: Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Carpenter-Song
authors.affiliation: Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Joanne
authors.initials: J
authors.lastname: Nicholson
authors.affiliation: Dartmouth Psychiatric Research Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; White River Junction VA Medical Center, White River Junction, Vermont.
authors.forename: Tracy
authors.initials: T
authors.lastname: Stecker
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000346:Afghanistan; D015928:Cognitive Behavioral Therapy; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007493:Iraq; D054542:Iraq War, 2003-2011; D016015:Logistic Models; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012727:Sex Characteristics; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011795:Surveys and Questionnaires; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D055815:Young Adult