Chatterjee Sharmila, Rath Maria E, Spiro Avron, Eisen Susan, Sloan Kevin L, Rosen Amy K
Center for Health Quality, Outcomes and Economic Research (CHQOER), Bedford VAMC (152), Bedford, Massachusetts 01730, USA.
Womens Health Issues. 2009 May-Jun;19(3):176-84. doi: 10.1016/j.whi.2009.03.002.
The objective of this study was to compare gender differences in mental health disease burden and outpatient mental health utilization among veterans utilizing Veterans Health Administration (VHA) mental health services in fiscal year 1999 (FY99), after the first Gulf War and significant restructuring of VHA services.
We used logistic regression to examine the relationships among gender, age, diagnostic groups, and utilization of mental health and specialty mental health services in a national sample of veterans. The sample included 782,789 veterans with at least 1 outpatient visit in the VHA in FY99 associated with a mental health or substance abuse (SA) diagnosis. Subgroup analyses were performed for 4 diagnostic categories: 1) posttraumatic stress disorder (PTSD), 2) SA disorders, 3) bipolar and psychotic disorders, and 4) mood and anxiety disorders.
Younger women veterans (<35 years old) were significantly less likely and older women (> or =35) more likely to use any mental health services in comparison with their male counterparts. Similar findings were observed for younger women diagnosed with SA or mood and anxiety disorders, but not among veterans with PTSD or bipolar and psychotic disorders, among whom no there were no gender or age differences. In the case of specialized services for SA or PTSD, women younger than 55 with SA or PTSD were significantly less likely to use services than men.
Women veterans underutilized specialty mental health services in relation to men but receipt of mental health care overall in FY99 varied by age and diagnosis. Examining gender differences alone, without taking other factors into account, may not provide an adequate picture of women veterans' current mental health service needs.
本研究的目的是比较在1999财年（FY99）使用退伍军人健康管理局（VHA）心理健康服务的退伍军人中，心理健康疾病负担和门诊心理健康服务利用情况的性别差异。这一时期是在第一次海湾战争之后，VHA服务进行了重大重组。
我们使用逻辑回归来研究性别、年龄、诊断组以及心理健康和专科心理健康服务利用情况之间的关系，研究对象为全国范围内的退伍军人样本。该样本包括782,789名在FY99期间至少有1次与心理健康或药物滥用（SA）诊断相关的VHA门诊就诊的退伍军人。对4个诊断类别进行了亚组分析：1）创伤后应激障碍（PTSD），2）SA障碍，3）双相情感障碍和精神障碍，4）情绪和焦虑障碍。
与男性退伍军人相比，年轻女性退伍军人（<35岁）使用任何心理健康服务的可能性显著较低，而老年女性（≥35岁）使用的可能性较高。在被诊断患有SA或情绪和焦虑障碍的年轻女性中也观察到了类似的结果，但在患有PTSD或双相情感障碍和精神障碍的退伍军人中没有观察到这种情况，在这些人群中没有性别或年龄差异。在SA或PTSD的专科服务方面，年龄小于55岁且患有SA或PTSD的女性使用服务的可能性显著低于男性。
与男性相比，女性退伍军人对专科心理健康服务的利用不足，但在FY99期间，总体心理健康护理的接受情况因年龄和诊断而异。仅考察性别差异而不考虑其他因素，可能无法充分了解女性退伍军人当前的心理健康服务需求。
