Highlights on Post-Deployment Health Research among Women

1
Highlights on Post-Deployment Health Research
among Women

• Elizabeth M. Yano, PhD, MSPH
• VA Greater Los Angeles HSRD Center of Excellence
• UCLA School of Public Health

2
Women in the Military

• Women now represent
• 15 active duty
• 20 new recruits
• 17 reserve/National Guard
• Equalization of hardships/risks
• 71 w/1 combat exposure
• Fastest growing segment of new VA users
• Currently 5-7 of VA users, but gt40 OEF/OIF
  market penetration
• Different sociodemographics
• gt60 under age 45, ? minorities

Source Murdoch, et al., Women and war What
physicians need to know. JGIM, 21S5-10, 2006.
3
Purpose of Talk

• To review highlights from current post-deployment
  health research among women veterans
• Both post-deployment health and women veterans
  research are top priorities in VA
• Need to inform development and design of programs
  that improve entry into and delivery of
  appropriate services

4
Health Safety of Women in the Reserves,
National Guard Active Duty Military

• Goal ? Study antecedent risks of sexual violence
  and consequent health outcomes in deployed
  Reserve/National Guard Active Duty women
• VA HSRD and DoD funded companion studies
• Comparison groups are women
• Not deployed
• Deployed to combat regions once
• Deployed to combat regions more than once
• Deployed elsewhere other than combat regions

Anne Sadler, PhD, RN (PI), BM Booth, BL Cook, MA
Mengeling, JC Toner Iowa City VA.
5
Health Safety of Women in the Reserves,
National Guard Active Duty MilitaryPreliminary
Results

• Lack of knowledge about mental health symptoms
• Barriers to reporting post-deployment problems
• Barriers to care
• Unmet or delayed mental health care
• Cross-leveling stressors (deployed with other
  than home unit)
• Couple and parenting readjustment issues
• Social isolation
• Concern about other soldiers readjustment
  problems

Anne Sadler, PhD, RN (PI), BM Booth, BL Cook, MA
Mengeling, JC Toner Iowa City VA.
6
Stigma, Gender and Other Barriers to Care for
OEF/OIF Veterans

• Goal ? Explore the unique contribution of
  stigma-related factors to VA health care seeking
• National sample of female and male OEF/OIF
  veterans
• Phase 1 (focus groups) completed
• Six focus groups with male and female OEF/OIF
  veterans (including VA users and non-users)
• Phase 2 (survey) ongoing
• Mail survey to a stratified national sample of
  1,538 OEF/OIF veterans

Dawne Vogt, PhD, Principal Investigator National
Center for PTSD (Boston VA Healthcare System)
7
Stigma, Gender and Other Barriers to Care
Preliminary Phase 1 Findings

• Reluctance to acknowledge mental health problems
  due to perceived stigma
• Tendency to want to tough it out with respect
  to mental health problems
• Concerns about impact of using VA on career and
  confidentiality of records
• General sense VA is for veterans who are older
  and men with severe mental health problems or
  physical disabilities
• Women veterans
• feel need to suck it up to prove worth as
  service members
• feeling out of place in VA, that their service is
  less respected because of assumption that they do
  not experience direct combat

Dawne Vogt, PhD, Principal Investigator National
Center for PTSD (Boston VA Healthcare System)
8
Further Development of the Deployment Risk
Resilience Inventory (DRRI)

• DRRI is a suite of scales used to assess pre-,
  during and post-deployment factors for
  stress-related illnesses
• Primarily intended for research but clinical
  applications possible
• Goal ? Revise DRRI to make it broadly applicable
  to different veteran subgroups (e.g., OEF/OIF
  veterans, female veterans)
• Phase 1 (focus groups) completed
• Six focus groups with diverse population of male
  and female OEF/OIF veterans
• Phase 2 (survey) proposal under review
• Mail survey to stratified random sample of 1000
  OEF/OIF veterans to validate DRRI-2 scales and
  develop short forms

Dawne Vogt, PhD, Principal Investigator National
Center for PTSD (Boston VA Healthcare System)
9
Reintegration and Service Needs of Women Veteran
Mothers

• Goal ? Deepen understanding of concerns and
  stressors that accompany reintegration into
  civilian life for OEF/OIF Reserve and Guard women
  veterans who were or were not mothers of
  dependent children at deployment
• Reintegration issues related to family and to
  work
• Barriers to use of current services and how to
  improve these services
• Focus groups and semi-structured interviews of
  previously deployed OEF/OIF women veterans

Gudrun Lange, PhD (PI) Karen Quigley, PhD
(Co-PI) NJ War Related Illness Injury Study
Center (WRIISC)
10
Reintegration and Service Needs of Women Veteran
Mothers Family

• Feelings of isolation and having difficult
  communicating with family and friends
• Not having enough time to readjust
• Family members expectations for them to return
  to their former roles and old selves
• Difficulties bonding with children (differed
  depending on age of child, time/distance away)
• Feeling need to compensate for being away
• Feeling out of sync w/children, partners/family

Gudrun Lange, PhD (PI) Karen Quigley, PhD
(Co-PI) NJ War Related Illness Injury Study
Center (WRIISC)
11
Reintegration and Service Needs of Women Veteran
Mothers Family

• My husband thought I was going to come back and
  straighten it all outhe, you know let them get
  away with a little bit more
• I felt like I had missed out on so muchI just
  felt like so detached from everything and
  everyone. Then as more time went on Im trying
  to play catch up, trying to find out what I
  missed.

Gudrun Lange, PhD (PI) Karen Quigley, PhD
(Co-PI) NJ War Related Illness Injury Study
Center (WRIISC)
12
Reintegration and Service Needs of Women Veteran
Mothers Work

• Employment concerns (with or without children)
• Making more in military than since returning
  home
• Difficulty finding civilian job that pays as well
  as military
• Going back to school as attractive option (GI
  bill)
• Difficulties in money management
• From having basic needs (housing, food, clothing)
  taken care of to learning how to budget/manage
• Made more difficult by lower earning power
• Tensions about (mis)management of while away

Gudrun Lange, PhD (PI) Karen Quigley, PhD
(Co-PI) NJ War Related Illness Injury Study
Center (WRIISC)
13
Reintegration and Service Needs of Women Veteran
Mothers Work

• I was making more money deployed than my
  civilian job. So I ended up having to look for
  another job.
• I came back and needed to look for a new job,
  and I just had to wait. I just didnt feel like
  I couldI wasnt in the mindsetI just couldnt
  get back on my feetuntil I got a couple months,
  and you know I just once I decided in my mind
  that I was ready to go back to work.

Gudrun Lange, PhD (PI) Karen Quigley, PhD
(Co-PI) NJ War Related Illness Injury Study
Center (WRIISC)
14
Reintegration and Service Needs of Women Veteran
Mothers Barriers

• Hard time finding supports upon return home
• Vocal about need for additional support from
  military and VA to help them with reintegration
• VA needs to reach out to them with supports
  within 3-6 months of return home
• Insufficient pre-deployment planning for
  financial matters, custody arrangements for minor
  children
• Family support groups and post-deployment
  briefings of variable quality and helpfulness

Gudrun Lange, PhD (PI) Karen Quigley, PhD
(Co-PI) NJ War Related Illness Injury Study
Center (WRIISC)
15
Reintegration and Service Needs of Women Veteran
Mothers Barriers

• I signed up the VA forms and got hooked up
  because I didnt have any medical insurance and
  needed to follow up with that. As far as mental
  issues, I really didnt have anybody to help me
  out with them, so I thought Id go to the church
  just to talk to someone.
• You get stared at a lot when you come here
  VA.
• I think its very important that they understand
  that women are different from men also. That you
  cant just throw everyone in a group

Gudrun Lange, PhD (PI) Karen Quigley, PhD
(Co-PI) NJ War Related Illness Injury Study
Center (WRIISC)
16
Women at War Survey

• Goals ?
• Identify among men and women deployed to OEF and
  OIF
• Frequency of combat exposure and military sexual
  trauma (MST)
• Post-deployment adjustment post-exposure
• Explore additive effects of both combat and MST
• Examine gender differences in VA health care use
  and satisfaction with VA care

Amy Street, PhD, Principal Investigator Womens
Health Sciences Division
17
Women at War Survey

• Funded by National Center for PTSD
• Mail survey of 2000 female and 2000 male OEF-OIF
  veterans
• Measures
• Deployment stressors, traumatic brain injury,
  mental and physical health symptoms, readjustment
  issues, relationship and family functioning,
  suicidal behavior

Amy Street, PhD, Principal Investigator Womens
Health Sciences Division
18
Women Veterans Cohort Study

• Goal ? To evaluate use, costs and outcomes among
  female and male OEF/OIF veterans after separation
  from service
• 2-years post-discharge, 2-years after coverage
  ends
• Compare diagnosis/treatment of stress-related
  conditions
• Assess trajectories in use, cost, outcomes by
  gender over time
• OEF/OIF roster from Defense Manpower Data Center
  who have enrolled in VA or used VA care
• Multi-site prospective cohort study

Cynthia Brandt, MD, MPH (PI) Sally Haskell, MD
(Co-PI) VA Connecticut Healthcare System
19
Women Veterans Cohort Study

• 12 of VA-enrolled OEF/OIF vets are women
• OEF/OIF women veterans (vs. men) are
• Younger (average 2 years)
• More likely to be racial-ethnic minorities
• Less likely to be married
• More likely to be educated beyond high school
• More likely to be active duty (vs. NG/R)
• More likely to be Air Force, less to be Marines
• More likely to be officers

Cynthia Brandt, MD, MPH (PI) Sally Haskell, MD
(Co-PI) VA Connecticut Healthcare System
20
Women Veterans Cohort Study

• Most prevalent conditions among women
• Back problems, joint problems, PTSD, depression
• Many gender differences, women have
• More depression, less PTSD
• More connective tissue and skin disorders
• Less hypertension, hyperlipidemia, diabetes or
  coronary artery disease
• Less alcohol or drug abuse

Cynthia Brandt, MD, MPH (PI) Sally Haskell, MD
(Co-PI) VA Connecticut Healthcare System
21
Women Veterans Cohort Study

• Enrollment for prospective cohort in two sites
  underway
• Assessing demographics, deployment info, combat
  exposure, traumatic life events, depression,
  quality of life, social support, stress, sexual
  behavior, eating behavior, PTSD, alcohol use,
  smoking, substance abuse, military sexual trauma,
  pain, satisfaction, utilization, medication,
  comorbidities, reproductive health history

Cynthia Brandt, MD, MPH (PI) Sally Haskell, MD
(Co-PI) VA Connecticut Healthcare System
22
National Survey of Women Veterans

• Goal ? Assess health care needs, VA experiences,
  knowledge/awareness of VA eligibility and
  services, preferences for care
• Funded by VA Office of Public Health
  Environmental Hazards (Women Veterans Health
  Strategic Health Care Group)
• Last such national survey conducted in 1985
• Over 3,500 telephone interviews completed
• VA users non-users OEF/OIF oversampled

Donna L. Washington, MD, MPH (Principal
Investigator VA Greater Los Angeles Healthcare
System
23
Post-Deployment Health Research among Women
Veterans Next Steps

• Translate qualitative research findings into
  improved programs and delivery models
• Important to synthesize findings across research
  studies (validation, adaptation)
• Relatively small size requires special attention
  to their inclusion in VA research
• Observational studies, clinical trials, etc.
• WV practice-based research network (PBRN)

Source Yano EM, Hayes P, Wright S, et al.
Importance of inclusion of women veterans in VA
quality improvement research. J Gen Intern Med.
2009in press.
24
VA Health Services Research PrioritiesPost-Deplo
yment Health

• Outreach, coordination of care, recognition of
  unique injuries and problems, including chronic
  care needs of this new generation of veterans
• Improve transitions between acute care,
  outpatient care and community needs evaluate
  caregiver needs
• Chronic pain, PTSD, neurological disorders, TBI,
  rehab (vision, hearing, mobility, neurological
  losses), military sexual trauma
• Treatment effectiveness/quality at veteran and
  system levels, emotional and cognitive recovery,
  community reintegration, overall quality of life

25
(No Transcript)