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.
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Biography
Beth E. Cohen, MD, MAS, is an Assistant Professor of Medicine at the University of California, San Francisco/San Francisco Veterans Affairs Medical Center. Her research areas include the effects of PTSD on physical health and the biological, behavioral and psychosocial mechanisms connecting PTSD to chronic illness.
Biography
Shira Maguen, PhD, is an Assistant Professor of Psychiatry at the University of California, San Francisco/San Francisco Veterans Affairs Medical Center. Dr. Maguen's areas of research include gender differences in mental health outcomes in veterans and the mental health effects of killing.
Biography
Daniel Bertenthal, MPH, is an analyst with the San Francisco Veterans Affairs Medical Center. He has an expertise in health services research and use of national VA administrative data.
Biography
Ying Shi, PhD, is an analyst with the San Francisco Veterans Affairs Medical Center. Dr. Shi's expertise is in health services research and use of national VA administrative data.
Biography
Vanessa Jacoby, MD, MAS, is an Assistant Professor of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco. Her research areas of interest include long-term health outcomes after hysterectomy and randomized, controlled trials of gynecologic surgical techniques.
Biography
Karen H. Seal, MD, MPH, is an Associate Professor of Medicine and Psychiatry at the University of California, San Francisco/San Francisco VA Medical Center. Dr. Seal's research areas are mental health outcomes among Iraq and Afghanistan Veterans and the development and evaluation of integrated mental health and primary care models.
Article info
Publication history
Accepted:
June 30,
2012
Received in revised form:
June 29,
2012
Received:
August 16,
2011
Identification
Copyright
Published by Elsevier Inc.
