Original article| Volume 22, ISSUE 5, e461-e471, September 2012

Reproductive and Other Health Outcomes in Iraq and Afghanistan Women Veterans Using VA Health Care: Association with Mental Health Diagnoses



      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.


      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.


      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).


      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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      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.


      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.


      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.


      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.


      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.


      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.