Reproductive Life Planning for Women Veterans with Mental Illness

项目背景：许多女退伍军人处于生育年龄，其中相当一部分 体验心理健康方面的担忧。患有精神疾病的女性退伍军人有更大的意外风险 因精神疾病和心理健康的独特因素造成的妊娠和不良妊娠结局 治疗。此外，心理健康和与怀孕有关的心理健康问题(例如 怀孕对心理健康的影响、怀孕期间使用精神科药物)常常影响生殖 生活决定和健康结果。出于这些原因，生殖生活规划(RLP)，设置个人 关于生殖意向的目标和计划，其中包括考虑因素和解决关切问题 具体到精神健康状况对患有精神疾病的妇女来说尤为重要。尽管有这种需要， 患有精神疾病的女性退伍军人很少接受RLP，目前的工具没有充分考虑或 解决患有精神疾病的妇女经常经历的独特的生殖健康问题。 解决了差距：关于RLP在改善生殖结果和为其量身定做方面的有效性的研究 患有精神疾病的女性是有限的。RLP在常规护理和RLP干预中的使用 满足女性精神疾病退伍军人的独特需求更是匮乏。两者都代表着 严重的差距阻碍了VHA为妇女提供高质量的全面卫生保健的能力 退伍军人--将生殖心理健康确定为退伍军人管理局的优先目标所凸显的差距 加强生殖健康服务提供和妇女健康研究的战略计划 议程。目前的研究试图通过检查可行性、可接受性和 心理健康信息促进的RLP/RLP目标设定干预的潜在效果 为患有精神疾病的女性退伍军人设计的(心理健康生殖生活计划；RLP-MH)。 创新性：我们调整了现有的RLP材料，以创建以客户为中心的交互式RLP 专门为解决可能影响RLP决策的心理健康因素而设计的干预措施 以及患有精神疾病的女性退伍军人的结局。女退伍军人与促进者一起探索 怀孕意向和RLP目标；考虑影响这些目标的重要因素(例如，医学、精神 健康或心理社会关切)；并确定解决其区域合作伙伴关系目标的步骤。因此，RLP-MH 干预可能使患有精神疾病的女性退伍军人在生育过程中发挥积极作用 健康，并从事可能改善生殖结果的行为。因此，这个项目具有潜力 为意外怀孕高危人群提供重要服务并改善生育结果 以及糟糕的生殖结果。 具体目标：本研究的具体目标是检查：1)可行性，2)可接受性，3) 与提供有关RLP的书面材料相比，RLP-MH干预的潜在效果。 项目方法：这项研究是对40名被诊断为精神疾病的女性退伍军人进行的先导性随机试验。 疾病，育龄(18-40岁)，在退伍军人马里兰州健康中心接受门诊精神卫生服务 护理系统。参与者将被随机分配接受以下任一项：1)促进RLP-MH干预 或2)收到RLP书面信息/材料。所有参与者将完成一个基线和一个2个月的 后续评估。RLP-MH条件下的参与者还将在以下位置完成简短评估 干预后立即采取行动。可行性和可接受性将通过招聘、留住、 参与者报告了可接受性。将探索的潜在结果包括：退伍军人的自我效能 对RLP/RLP目标、RLP行为意图以及参与旨在 解决RLP目标。下一步将包括使用该试验的结果来为设计更大的 RLP-MH干预的量表随机对照试验。

Project Background: Many women Veterans are of reproductive age and, of those, a substantial number experience mental health concerns. Women Veterans with mental illness are at greater risk for unplanned pregnancy and adverse pregnancy outcomes due to factors unique to mental illness and mental health treatment. In addition, mental health and mental health-related concerns associated with pregnancy (e.g. impact of pregnancy on mental health, psychiatric medication use during pregnancy) often affect reproductive life decisions and health outcomes. For these reasons, reproductive life planning (RLP), setting personal goals and plans regarding reproductive intentions, that incorporates considerations and addresses concerns specific to mental health conditions is particularly important for women with mental illness. Despite this need, women Veterans with mental illness rarely receive RLP, and current tools do not adequately consider or address the unique reproductive health considerations women with mental illness often experience. Gaps Addressed: Research on the efficacy of RLP in improving reproductive outcomes in and tailoring for women with mental illness is limited. Use of RLP in routine care and RLP interventions that specifically address the unique needs of women Veterans with mental illness are even more lacking. Both represents significant gaps that hamper the VHA’s ability to provide quality comprehensive health care for women Veterans—gaps highlighted by the identification of reproductive mental health as a priority goal in the VHA’s Strategic Plan for Enhancing Delivery of Reproductive Health Services and in the Women’s Health Research Agenda. The current study attempts to address these gaps by examining the feasibility, acceptability, and potential efficacy of a mental health-informed facilitated RLP/RLP goal setting intervention specifically designed for women Veterans with mental illness (Reproductive Life Plan for Mental Health; RLP-MH). Innovativeness: We adapted existing RLP materials to create an interactive, client-centered RLP intervention specifically designed to address mental health considerations that can influence RLP decisions and outcomes in women Veterans with mental illness. Women Veterans work with a facilitator to explore pregnancy intentions and RLP goals; consider important factors that impact those goals (e.g. medical, mental health or psychosocial concerns); and identify steps to address their RLP goals. As such, the RLP-MH intervention may empower women Veterans with mental illness to take an active role in their reproductive health and engage in behaviors that may improve reproductive outcomes. Thus, this project has the potential to provide important services and improve reproductive outcomes for a group at risk for unplanned pregnancy and poor reproductive outcomes. Specific Aims: The specific aims of this study are to examine the: 1) feasibility, 2) acceptability, and 3) the potential efficacy of the RLP-MH intervention when compared to the provision of written materials on RLP. Project Methods: This study is a pilot randomized trial of 40 women Veterans with a diagnosis of mental illness, of reproductive age (18-40), and receiving outpatient mental health services at the VA Maryland Health Care System. Participants will be randomly assigned to receive either: 1) the facilitated RLP-MH intervention or 2) receipt of written RLP information/materials. All participants will complete a baseline and a 2-month follow-up assessment. Participants in the RLP-MH condition will also complete a brief assessment at immediate post-intervention. Feasibility and acceptability will be assessed via rates of recruitment, retention, and participant reported acceptability. Potential outcomes that will be explored include: Veterans’ self-efficacy for and attitudes towards RLP/RLP goals, RLP behavioral intentions, and engagement in behaviors aimed at addressing RLP goals. Next steps will include using the results of this pilot to inform the design of a larger scale randomized controlled trial of the RLP-MH intervention.