Predictors of Veterans Affairs Health Service Utilization by Women Veterans during Pregnancy

  • Rebecca Grekin
    Correspondence
    Correspondence to: Rebecca Grekin, PhD, Ann Arbor VA Healthcare System, 2215 Fuller Road, Ann Arbor, MI 48105. Phone: 734-222-7455; fax: 734-845-3233.
    Affiliations
    Ann Arbor VA Healthcare System, Ann Arbor, Michigan

    Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan
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  • Kara Zivin
    Affiliations
    Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan

    Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan
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  • Stephanie V. Hall
    Affiliations
    Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan

    Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan

    Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
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  • Tony Van
    Affiliations
    Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan
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  • Kristin M. Mattocks
    Affiliations
    VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts

    Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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      Abstract

      Background

      Researchers have examined predictors of Veterans Affairs (VA) service use by women veterans in general, but less is known about predictors of VA service use by pregnant veterans. This study examined characteristics associated with planned and actual VA service use by pregnant veterans.

      Methods

      This study includes data from 510 pregnant veterans enrolled in the Center for Maternal and Infant Outcomes Research in Translation Study. Women veterans completed phone interviews during their first trimester and at 3 months postpartum. The Center for Maternal and Infant Outcomes Research in Translation surveys assessed medical and mental health conditions, VA health care use, trauma history, and pregnancy complications. We conducted bivariate and multivariable logistic regression models assessing planned and actual use of VA services during pregnancy.

      Results

      Lifetime post-traumatic stress disorder (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.11–2.69) and history of military sexual trauma (OR, 1.85; 95% CI, 1.19–2.87) were significantly associated with planned VA service use in multivariable models. Lifetime diagnoses of anxiety (OR, 1.78; C.I., 1.15–2.75) were associated with an increased likelihood of actual VA use during pregnancy, whereas Hispanic ethnicity (OR, 0.59; 95% CI, 0.36–0.96), younger age (OR, 0.95; 95% CI, 0.91–0.99), and access to private health insurance (OR, 0.55; 95% CI, 0.37–0.84) were associated with a decreased likelihood of actual VA service use during pregnancy.

      Conclusions

      Results emphasize the association between high-risk mental health characteristics and specific demographic characteristics with VA service use among pregnant veterans. Study findings highlight a continued need for women's health care at the VA, as well as the availability of VA providers knowledgeable about perinatal health issues, and informed community providers regarding women veterans' health.
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      Biography

      Rebecca Grekin, PhD, is a staff psychologist at the Ann Arbor VA Healthcare System.

      Biography

      Kara Zivin, PhD, is a Research Scientist at the Center for Clinical Management Research, VA Ann Arbor Healthcare System and Professor of Psychiatry and Obstetrics and Gynecology at the University of Michigan Medical School.

      Biography

      Stephanie V. Hall, MPH, is a doctoral student in the Department of Learning Health Sciences at the University of Michigan Medical School.

      Biography

      Tony Van, MA, is a data analyst at the VA Center for Clinical Management Research, VA Ann Arbor Healthcare System.

      Biography

      Kristin M. Mattocks, PhD, MPH, is Associate Chief of Staff for Research and Education at VA Central Western Massachusetts Healthcare System and Associate Professor of Quantitative Health Sciences and Psychiatry at the University of Massachusetts Medical School.