Gender & Access to VA Mental Health Care: The Example of Military Sexual Trauma

描述(由申请人提供)： 背景/理由：每年约有20%的女性退伍军人和1%的男性退伍军人报告过军人性创伤(MST)，这是退伍军人管理局定义的术语，指的是在服兵役期间发生的不受欢迎和具有威胁性的性骚扰或性侵。2011财政年度，整个退伍军人管理局大约有65,000名女性和53,000名男性退伍军人。与没有经历过MST的退伍军人相比，报告MST的退伍军人患上广泛的心理健康诊断的风险要大得多。虽然退伍军人管理局被授权每年监测MST的筛查和治疗，但目前还没有可用的数据来说明获得MST相关的精神卫生保健(MST MH护理)是否足够。研究表明，退伍军人可能没有充分利用MST MH护理，尤其是男性退伍军人。最近对MST筛查阳性的OEF/OIF退伍军人进行的一项研究发现，在筛查后的一年里，男性使用MST MH护理的可能性明显低于女性，男性使用的服务明显少于女性。需要进一步的研究来检验退伍军人是否有足够的机会获得MST MH护理，因为还没有研究检查退伍军人对这些服务的知识、感知的需求或障碍。目标：拟议的CDA-2项目的研究目标是量化获得MST护理的性别差距，检查与获得MST MH护理相关的因素，并试行旨在减少性别差距和促进获得护理的干预措施。这些目标将分三个阶段实现。在第一阶段，我们将量化使用和获取方面的性别差异，并通过精神健康诊断检查性别差异。在第二阶段，将审查一些因素(耻辱、知识)，这些因素是否与获得MST护理有关，然后这些重要因素是否解释了获得MST MH护理方面的性别差异。最后，在第三阶段，来自第二阶段的重要可获得因素将用于调整旨在促进获得护理的现有干预措施。拟议的CDA-2的培训目标包括：1)关键医疗服务研究领域的正式和非正式培训：获取和健康差距；2)大型医疗保健管理数据库的使用和分析；3)调查研究方法；4)干预措施的设计、评估和实施；5)专业发展技能，如赠款和与退伍军人管理局政策和业务办公室的合作。方法：研究目标将通过三个主要途径实现：1)分析退伍军人管理局的国家行政数据(阶段1和2)；2)将退伍军人管理局的数据与全国邮件调查联系起来，在MST筛查阳性的具有代表性的退伍军人中解决MST MH护理的感知需求和潜在障碍(第2阶段)；以及3)调整、实施和评估促进获得MST MH护理的干预措施(阶段3)。这项干预将在当地退伍军人事务部与MST支持团队合作进行，并将用于为更广泛的干预努力提供可行性数据。潜在影响：通过实现拟议奖励的研究目标，这项研究将提供关于退伍军人获得MST MH护理的有价值的信息，并将被用于为促进获得护理的干预措施提供信息，并消除这一弱势群体中的性别差异。目前的工作符合HSR&D的当前优先事项和退伍军人事务部妇女健康研究议程确定的研究优先事项，重点是促进弱势人群获得护理的机会和减少健康差距。这项研究将导致提交IIR以及其他后续干预和实施工作，重点是增加获得精神卫生保健的机会。

DESCRIPTION (provided by applicant): Background/Rationale: Each year, approximately 20% of female and 1% of male Veterans seen in VHA care have reported military sexual trauma (MST), a VA-defined term that refers to unwanted and threatening sexual harassment or sexual assault that occurred during military service. In fiscal year 2011, this translated into approximately 65,000 female and 53,000 male Veterans across VHA. Veterans who report MST are at significantly greater risk for a wide range of mental health diagnoses as compared to Veterans who have not experienced MST. While VA is mandated to annually monitor screening and treatment for MST, there is no currently available data that can address whether access to MST-related mental health care (MST MH care) is sufficient. Research suggests that Veterans may be underutilizing MST MH care, and that this may be particularly so for male Veterans. A recent study of OEF/OIF Veterans with a positive MST screen found that men were significantly less likely to utilize MST MH care than female Veterans in the year following screening, and that men utilized significantly fewer services than women. Further research is needed to examine whether Veterans have adequate access to MST MH care as no studies have examined Veterans' knowledge of, perceived need for, or barriers to these services. Objectives: The research objectives of the proposed CDA-2 project are to quantify the gender disparity in access to MST care, examine factors related to access to MST MH care, and pilot an intervention designed to reduce the gender disparity and promote access to care. These goals will be accomplished in three subsequent phases. In Phase 1, we will quantify the gender disparity in utilization and access, and examine the gender disparity by mental health diagnosis. In Phase 2, a number of factors (stigma, knowledge) will be examined in relation to whether they are related to access to MST care and then whether these significant factors account for the gender disparity in access to MST MH care. Finally, in Phase 3, the significant access factors from Phase 2 will be used to adapt an existing intervention designed to promote access to care. The training objectives of the proposed CDA-2 include formal and informal training in 1) key health services research areas: access and health disparities; 2) the use of and analysis of large healthcare administrative databases; 3) survey research methodology; 4) the design, evaluation, and implementation of interventions, and 5) professional development skills, such as grantsmanship and working in partnership with VA policy and operations offices. Methods: Research objectives will be achieved through 3 major avenues: 1) analysis of VA national administrative data (Phases 1 and 2), 2) linking VA administrative data to a nationwide mail survey that addresses perceived need and potential barriers to MST MH care among a representative sample of Veterans with positive MST screens (Phase 2); and 3) adapting, conducting, and evaluating an intervention to promote access to MST MH care (Phase 3). This intervention will be conducted at the local VA site in partnership with the MST Support Team, and will be used to provide feasibility data for wider intervention efforts. Potential Impact: By achieving the research aims of the proposed award, this research will provide valuable information about Veterans' access to MST MH care and will be used to used to inform an intervention to promote access to care and eliminate gender disparities among this vulnerable population. The current work is consistent with current priorities of HSR&D and the research priorities set by the VA Women's Health Research Agenda focusing on promoting access to care among vulnerable populations and reducing health disparities. This research will lead to the submission of an IIR, as well as other subsequent intervention and implementation work focused on increasing access to mental health care.