Evans Elizabeth A, Glover Dawn L, Washington Donna L, Hamilton Alison B
a Department of Health Promotion and Policy , School of Public Health and Health Sciences, University of Massachusetts , Amherst , Massachusetts , USA.
b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.
Subst Use Misuse. 2018 Sep 19;53(11):1878-1892. doi: 10.1080/10826084.2018.1441309. Epub 2018 Feb 27.
Women Veterans who use the Veterans Health Administration (VA) have high rates of substance abuse and poorer health than non-Veteran women. Less is known about the psychosocial needs of women Veterans who seek care in non-VA settings.
We provide a grounded description of factors that impact substance abuse, mental health, and related quality of life of women Veterans who use non-VA community-based health and social services.
Utilizing a mixed methods design, we conducted semi-structured in-person interviews with 22 women Veterans in Los Angeles in 2013-2015.
The current health of these women Veterans was shaped by substance abuse and several other factors, including: histories of trauma (in childhood, during military service) and discrimination, and associated mental health conditions; post-military socio-economic stressors; shifting social roles and adverse social support; and lost personal identity after military service. Psychosocial factors collectively underscore areas in which delivery of health and social services to women Veterans being treated in non-VA settings could be improved: (1) diffuse, implement, and sustain evidence-based gender-sensitive substance abuse treatment; (2) address traumas contributing to poor health; (3) recognize stress proliferation processes erode women's capacity to access healthcare or cope with stressors in healthy ways; (4) champion women Veterans who embody resilience and thereby can help others to form empowered personal identities of health and wellness.
Findings can inform interventions and services that ameliorate vulnerability to substance abuse and other health risks among women Veterans.
使用退伍军人健康管理局（VA）服务的退伍女兵药物滥用率较高，且健康状况比非退伍女兵更差。对于在非VA机构寻求治疗的退伍女兵的心理社会需求，人们了解较少。
我们对影响使用非VA社区健康和社会服务的退伍女兵药物滥用、心理健康及相关生活质量的因素进行了基于实证的描述。
采用混合方法设计，2013年至2015年期间，我们对洛杉矶的22名退伍女兵进行了半结构化的面对面访谈。
这些退伍女兵当前的健康状况受到药物滥用和其他几个因素的影响，包括：创伤史（童年时期、服役期间）和歧视，以及相关的心理健康状况；退伍后的社会经济压力源；不断变化的社会角色和不良的社会支持；以及服役后个人身份的丧失。心理社会因素共同凸显了在非VA机构接受治疗的退伍女兵健康和社会服务提供方面可以改进的领域：（1）传播、实施并维持基于证据的对性别敏感的药物滥用治疗；（2）解决导致健康状况不佳的创伤问题；（3）认识到压力扩散过程削弱了女性以健康方式获得医疗保健或应对压力源的能力；（4）支持那些展现出复原力的退伍女兵，她们从而能够帮助他人形成有力量的健康和幸福的个人身份认同。
研究结果可为改善退伍女兵药物滥用及其他健康风险易感性的干预措施和服务提供参考。
