Improving Health Care for Women Veterans: Addressing Menopause and Mental Health

背景中年妇女面临着越来越多的与更年期有关的健康风险， 荷尔蒙和社会变化的特点往往是破坏性的更年期症状。 对退伍军人健康的重要性和意义。几乎一半的女性退伍军人退伍军人管理局用户处于中年， 负担性更年期症状的普遍危险因素。未解决的更年期症状有助于 严重的医疗保健负担，影响健康风险行为，慢性健康状况和心理健康。 具体目标。目的1：描述中年妇女退伍军人的更年期症状的经验， 绝经期症状负担与心理健康之间的关系。H1a。激素治疗率高 (HT)将观察使用情况和绝经期症状的患病率和负担。H1b。自报绝经 症状将比VA临床记录分类所建议的更普遍。H1c。心理健康 诊断和症状将与更普遍和负担的更年期症状相关， H1d。更普遍的HT使用。目标2：检查患者和提供者的偏好、经验和当前 在退伍军人事务部寻求和接受与更年期有关的护理的做法。通过患者收集的信息 和提供商访谈将告知Aim 3、Merit提交以及未来的干预工作重点 改善更年期相关护理。目标3：开发一个用户可使用的工具，以增加获得性别平等信息的机会， 敏感的更年期相关护理在VA设置，并激活更年期症状的自我管理。 针对更年期的心理教育和症状跟踪移动的应用程序 退伍军人群体是有计划的，提供了一个循证的，低资源密集型，高收益的干预措施。 方法.目的1：我将使用来自国家队列研究（PI：Seal）的分析数据集来检查心理健康状况。 全国45-64岁退伍军人退伍军人使用者健康和更年期相关诊断 （目前人数为151 546人）。旧金山弗朗西斯科卫生保健系统（SFVAHCS）入组者样本（目标n=200） 将从全国队列中招募100名妇女完成结构化调查，以彻底评估更年期 状态、更年期症状和当前抑郁、焦虑和创伤后应激障碍（PTSD） 症状，并简要评估更年期相关的护理实践。我会把调查数据和医疗记录数据联系起来 并使用回归模型来检查自我报告和诊断的绝经期之间的关联， 症状、心理健康问题、医学合并症和HT使用。目标1的见解将为目标2提供信息 面试和目标3，优点，和未来的项目。目标2：我将与VA进行半结构化电话访谈 初级保健提供者和中年妇女退伍军人从特定性别和一般初级保健招募 在全国各地的妇女健康实践为基础的研究网络（WH-PBRN）网站的设置， 检查更年期相关护理的偏好、经验和当前实践。面试将提供 目标1调查结果的背景，并告知目标3，优点和未来的项目。目标3：我将使用目标1和2的发现 和参与性研究过程，为制定以更年期为重点的心理教育提供信息， 为绝经期退伍军人量身定制的症状跟踪工具，将在Merit提交资料中进一步评价。 独特的功能和创新。这些项目将作为一种新的评估更年期相关的 VA环境中的症状、合并症、实践和需求。这些项目还将增加一个机构， 绝经期抑郁症的文献，解决与焦虑和创伤后应激障碍有关的知识差距。最后 开发一个以更年期为重点的工具将提供一个创新的模式，以促进合作的自我， 管理和增加获得对性别问题有敏感认识的、以病人为中心的护理的机会。 对其他领域的影响。这项研究将增加与VA相关的生殖心理健康研究 在社区和社区环境中，可以广泛地为综合妇女保健提供信息。它还将告知健康- 相关的技术研究，增加了有限的文献审查使用和老龄化人口的需求。

Background. Women in midlife face increasing health risks related to menopause, a period of biological, hormonal, and social change characterized by often disruptive menopausal symptoms. Relevance and significance to Veterans’ Health. Almost half of women Veteran VA users are in midlife, with prevalent risk factors for burdensome menopausal symptoms. Unaddressed menopausal symptoms contribute to significant health care burden, impacting health risk behaviors, chronic health conditions, and mental health. Specific Aims. Aim 1: To describe midlife women Veterans’ experience of menopausal symptoms, and associations between menopausal symptom burden and mental health. H1a. High rates of hormone therapy (HT) use and menopausal symptom prevalence and burden will be observed. H1b. Self-reported menopausal symptoms will be more prevalent than suggested by VA clinical record categorization. H1c. Mental health diagnoses and symptoms will be associated with more prevalent and burdensome menopausal symptoms, and H1d. more prevalent HT use. Aim 2: To examine patient and provider preferences, experiences, and current practices seeking and receiving care related to menopause in the VA. Information gathered through patient and provider interviews will inform Aim 3, a Merit submission, and future intervention efforts focused on improving menopause-related care. Aim 3: To develop a user-ready tool to increase access to gender- sensitive menopause-related care in VA settings, and to activate self-management of menopausal symptoms. A menopause-focused psychoeducation and symptom tracking mobile application tailored to the menopausal Veteran population is planned, providing an evidence-based, low-resource intensive, high-yield intervention. Methods. Aim 1: I will use an analytic dataset from the National Cohort Study (PI: Seal) to examine mental health and menopause-related diagnoses in a national sample of women Veteran VA users aged 45-64 (current n=151,546). A sample (target n=200) of San Francisco VA Health Care System (SFVAHCS) enrollees from the national cohort will be recruited to complete structured surveys to thoroughly assess menopause status, menopausal symptoms, and current depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms, and briefly assess menopause-related care practices. I will link survey data to medical record data, and use regression models to examine associations between self-reported and diagnosed menopausal symptoms, mental health concerns, medical comorbidities, and HT use. Insights from Aim 1 will inform Aim 2 interviews and Aim 3, Merit, and future projects. Aim 2: I will use semi-structured phone interviews with VA primary care providers and midlife women Veterans recruited from gender-specific and general primary care settings in Women’s Health Practice-Based Research Network (WH-PBRN) sites across the country to examine preferences, experiences, and current practices in menopause-related care. Interviews will provide context to Aim 1 findings, and inform Aim 3, Merit, and future projects. Aim 3: I will use Aims 1 and 2 findings and a participatory research process to inform the development of a menopause-focused psychoeducation and symptom tracking tool tailored to menopausal Veterans, to be further evaluated in a Merit submission. Unique features and innovation. These projects will serve as a novel evaluation of menopause-related symptoms, comorbidities, practices, and needs in the VA setting. These projects will also add to a body of literature on menopausal depression, addressing gaps in knowledge related to anxiety and PTSD. Finally, the development of a menopause-focused tool will provide an innovative model for promoting collaborative self- management and increasing access to gender-sensitive, patient-centered care. Implications for other areas. This research will add to reproductive mental health research relevant to VA and community settings, and may broadly inform integrated women’s health care. It will also inform health- related technology research, adding to the limited literature examining use and needs in aging populations.