title: Posttraumatic Stress Disorder Symptom Severity and Socioeconomic Factors Associated with Veterans Health Administration Use among Women Veterans.
abstract: BACKGROUND
  The Veterans Health Administration (VA) has historically focused on treating men. Although women veterans' VA use is increasing, they remain more likely than male veterans to receive their care in non-VA settings. To date, there is limited research on factors associated with VA use among women. We examined the relationship between demographic, civilian, military, and health-related variables with past-year VA use among women veterans.
  
  
  METHODS
  Women veterans were recruited over the internet to participate in an anonymous national survey (n = 617) in 2013. An empirically derived decision tree was computed using signal detection software for iterative receiver operator characteristics (ROC) to identify variables with the best sensitivity/specificity balance associated with past-year VA use.
  
  
  RESULTS
  ROC analysis indicated that 85% of participants with high posttraumatic stress disorder (PTSD) and depressive symptoms and who were younger than 54 years of age used VA in the past year. Of those who were 54 years of age or older and had very high PTSD symptoms, 94% used the VA in the last year. By contrast, only 40% of participants with relatively lower PTSD symptoms had VA past-year use, although among these individuals, VA past-year use increased to 65% for those with a relatively lower income.
  
  
  CONCLUSIONS
  Findings suggest that greater PTSD symptoms, depressive symptoms, and low income correlate with VA use, with very high PTSD symptoms in older groups, high PTSD symptoms coupled with high depressive symptoms in younger groups, and low income in those with lower PTSD symptoms each associated with greater past-year VA use. Ensuring PTSD assessment and treatment, and addressing socioeconomic factors, may be key strategies for health care delivered directly or through contract with VA facilities.
authors.affiliation: Health Services Research & Development (HSR&D) Center of Innovation (COIN), VA Puget Sound Health Care System, Seattle, Washington; Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington. Electronic address: klehavot@uw.edu.
authors.forename: Keren
authors.initials: K
authors.lastname: Lehavot
authors.affiliation: Sierra Pacific Mental Illness Research, Education, and Clinical Center (MIRECC), Palo Alto VA Health Care System, Palo Alto, California; Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California.
authors.forename: Ruth
authors.initials: R
authors.lastname: O'Hara
authors.affiliation: VA Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda and Los Angeles, California; Department of Medicine, University of California Los Angeles (UCLA) David Geffen School of Medicine, Los Angeles, California.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Washington
authors.affiliation: VA Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda and Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California.
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
authors.affiliation: Mental Illness Research, Education, and Clinical Center (MIRECC), VA Puget Sound Health Care System, Seattle, Washington; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington; Center of Excellence in Substance Abuse Treatment and Education (CESATE), VA Puget Sound Health Care System, Seattle, Washington.
authors.forename: Tracy L
authors.initials: TL
authors.lastname: Simpson
mesh_terms: D000328:Adult; D000368:Aged; D003863:Depression / Q000191:economics / Q000628:therapy*; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000191:economics / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008605:Mental Health Services / Q000191:economics / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000191:economics / Q000628:therapy*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*; D058014:Veterans Health; D014930:Women / Q000523:psychology; D016387:Women's Health; D055815:Young Adult