Elsevier

Women's Health Issues

Volume 25, Issue 5, September–October 2015, Pages 542-547
Women's Health Issues

Original article
Gender Differences in Service Utilization among OEF/OIF Veterans with Posttraumatic Stress Disorder after a Brief Cognitive–Behavioral Intervention to Increase Treatment Engagement: A Mixed Methods Study

https://doi.org/10.1016/j.whi.2015.04.008Get rights and content

Abstract

Purpose

Women veterans who served in Iraq and Afghanistan (Operation Enduring Freedom and Operation Iraqi Freedom [OEF/OIF]) have a moderately higher risk of developing posttraumatic stress disorder (PTSD) than male veterans. However, gender disparities in treatment engagement may prevent women veterans from initiating the care they need. Understanding gender differences in predictors of and barriers to treatment is essential to improving engagement and mental health outcomes. The purpose of this study was to examine gender differences in treatment utilization after a brief, cognitive–behavioral therapy (CBT) intervention among male and female OEF/OIF veterans.

Methods

Participants were assigned randomly to either the intervention or control conditions. Intervention participants received the telephone-based CBT intervention. Participants were 35 female and 238 male OEF/OIF veterans who screened positive for PTSD and had never initiated PTSD treatment. Participants were asked about treatment utilization, beliefs about PTSD treatment, and symptoms at months 1, 3, and 6 months subsequent to the baseline telephone assessment. The PTSD Checklist—Military Version was used to assess PTSD and the Patient's Health Questionnaire was used to assess symptoms of depression.

Findings

Female veterans who received an intervention were significantly more likely to have attended treatment over the 6-month follow-up period than male veterans who received an intervention (χ2 = 7.91; df = 3; odds ratio, 3.93; p = .04).

Conclusions

The CBT intervention may be a critical mechanism to engage female veterans in treatment. Further research is needed to understand how to engage male veterans with PTSD in treatment.

Section snippets

Participants

To be eligible for this trial, participants had to have served in the wars in Iraq and/or Afghanistan, specifically OEF/OIF, and thus could be active or separated; screen positive for PTSD; and have never initiated any treatment for PTSD. The research team visited local armories to recruit participants. Advertisements to social media websites like Craigslist and Facebook were also used to recruit participants. Initial screenings for PTSD were conducted with the Mini-International

Results

Characteristics of study participants are presented in Table 1. A total of 35 female veterans were randomized to the intervention (n = 21) or control (n = 14) conditions and 238 male veterans were randomized to the intervention (n = 102) and control (n = 136) conditions. This sample size is a proportionate representation of the strata of female veterans compared with male veterans. Female participants reported significantly higher symptoms of depression at baseline than male participants. PTSD

Discussion

This is the first study to examine gender differences in treatment utilization after a brief CBT intervention among OEF/OIF veterans. Our findings supported the hypothesis that female veterans would be more likely to seek treatment than male veterans. Women who had the intervention session were four times as likely to seek treatment over the course of the study as men who had an intervention session. There were no differences in the number of sessions participants received. Women, particularly

Autumn M. Gallegos, PhD, is a Senior Instructor and clinical psychologist in the Department of Psychiatry at the University of Rochester Medical Center. Her research explores complementary approaches to the treatment of PTSD among women exposed to interpersonal violence.

References (18)

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    With the exception of education and psychotherapeutic services, none of the socio-demographic factors examined were associated with participation in either neuropsychological assessments or psychotherapeutic services. Previous research with OEF/OIF/OND Veterans showed higher attendance of PTSD treatment among female Veterans (Gallegos et al., 2015) and slightly greater utilization of outpatient mental health services among minority groups when compared to white Veterans (Koo et al., 2015). However, as those studies focused on Veterans with a primary mental health disorder, the lack of gender and other socio-demographic differences in utilization rates may represent different attitudes or approaches to psychological services if there is a primary medical condition, albeit one associated with a high prevalence of depression and anxiety.

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Autumn M. Gallegos, PhD, is a Senior Instructor and clinical psychologist in the Department of Psychiatry at the University of Rochester Medical Center. Her research explores complementary approaches to the treatment of PTSD among women exposed to interpersonal violence.

Kristina B. Wolff, PhD, MPH, MPA, is an Associated Health Post-Doctoral Fellow in the VA Advanced Fellowship Program in Patient Safety and Gender Research Institute at Dartmouth (GRID). Her research interests include systematic inequality, military sexual trauma, and veterans' issues.

Nicholas A. Streltzov, BA, is a research assistant at the Dartmouth Psychiatric Research Center. He works on a study aiming to reduce barriers to treatment among war veterans at risk of suicide.

Leslie B. Adams, MPH, is with the Dartmouth Psychiatric Research Center. Her research is focused on mental healthcare seeking disparities among African Americans. She examines preferred coping strategies and treatment modalities, as well as gendered paradigms of healthcare utilization.

Elizabeth Carpenter-Song, PhD, is Assistant Professor of Psychiatry at the Geisel School of Medicine at Dartmouth. As a medical anthropologist, she applies qualitative and ethnographic methods to understanding lived experiences of individuals with mental illnesses in order to improve services.

Joanne Nicholson, PhD, is Professor of Psychiatry at the Dartmouth Psychiatric Research Center. Her work focuses on families living with mental health conditions and parents with PTSD, depression and anxiety. She employs mixed methods to explore the impact of interventions.

Tracy Stecker, PhD, is Assistant Professor at the Dartmouth Psychiatric Research Center at Dartmouth College and a Health Science Specialist at the White River Junction VA. Her primary research interest is help-seeking behavior.

This research was funded by grant R01 MH086939 from the National Institute of Mental Health. The writing of this manuscript was funded in part by the VISN 2 Center of Excellence for Suicide Prevention in Canandaigua, New York. The authors' views or opinions do not necessarily represent those of the Department of Veterans Affairs or the United States Government.

The authors declare no conflict of interest.

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