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

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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.