Davis Teri D, Campbell Duncan G, Bonner Laura M, Bolkan Cory R, Lanto Andrew, Chaney Edmund F, Waltz Thomas, Zivin Kara, Yano Elizabeth M, Rubenstein Lisa V
VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; University of California, Los Angeles School of Medicine, Division of Psychiatry and Behavioral Sciences-Semel Institute, Los Angeles, California.
University of Montana, Department of Psychology, Missoula, Montana.
Womens Health Issues. 2016 Nov-Dec;26(6):656-666. doi: 10.1016/j.whi.2016.08.001. Epub 2016 Sep 30.
Depression is the most prevalent mental health condition in primary care (PC). Yet as the Veterans Health Administration increases resources for PC/mental health integration, including integrated care for women, there is little detailed information about depression care needs, preferences, comorbidity, and access patterns among women veterans with depression followed in PC.
We sampled patients regularly engaged with Veterans Health Administration PC. We screened 10,929 (10,580 men, 349 women) with the two-item Patient Health Questionnaire. Of the 2,186 patients who screened positive (2,092 men, 94 women), 2,017 men and 93 women completed the full Patient Health Questionnaire-9 depression screening tool. Ultimately, 46 women and 715 men with probable major depression were enrolled and completed a baseline telephone survey. We conducted descriptive statistics to provide information about the depression care experiences of women veterans and to examine potential gender differences at baseline and at seven month follow-up across study variables.
Among those patients who agreed to screening, 20% of women (70 of 348) had probable major depression, versus only 12% of men (1,243 of 10,505). Of the women, 48% had concurrent probable posttraumatic stress disorder and 65% reported general anxiety. Women were more likely to receive adequate depression care than men (57% vs. 39%, respectively; p < .05); 46% of women and 39% of men reported depression symptom improvement at the 7-month follow-up. Women veterans were less likely than men to prefer care from a PC physician (p < .01) at baseline and were more likely than men to report mental health specialist care (p < .01) in the 6 months before baseline.
PC/mental health integration planners should consider methods for accommodating women veterans unique care needs and preferences for mental health care delivered by health care professionals other than physicians.
抑郁症是初级保健（PC）中最常见的心理健康状况。然而，随着退伍军人健康管理局增加用于PC/心理健康整合的资源，包括为女性提供综合护理，对于在PC中接受治疗的患有抑郁症的女性退伍军人的抑郁症护理需求、偏好、合并症和就医模式，几乎没有详细信息。
我们对定期参与退伍军人健康管理局PC服务的患者进行了抽样。我们使用两项患者健康问卷对10929名患者（10580名男性，349名女性）进行了筛查。在2186名筛查呈阳性的患者（2092名男性，94名女性）中，2017名男性和93名女性完成了完整的患者健康问卷-9抑郁症筛查工具。最终，46名女性和715名男性被纳入研究并完成了基线电话调查。我们进行了描述性统计，以提供有关女性退伍军人抑郁症护理经历的信息，并在基线和七个月随访时检查研究变量之间潜在的性别差异。
在同意接受筛查的患者中，20%的女性（348名中的70名）可能患有重度抑郁症，而男性中只有12%（10505名中的1243名）。在这些女性中，48%同时可能患有创伤后应激障碍，65%报告有广泛性焦虑。女性比男性更有可能接受充分的抑郁症护理（分别为57%和39%；p <.05）；46%的女性和39%的男性在7个月随访时报告抑郁症症状有所改善。女性退伍军人在基线时比男性更不愿意接受初级保健医生的护理（p <.01），并且在基线前6个月比男性更有可能报告接受心理健康专家的护理（p <.01）。
PC/心理健康整合规划者应考虑采取方法，以满足女性退伍军人独特的护理需求以及她们对由非医生的医疗保健专业人员提供心理健康护理的偏好。
