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

背景资料。中年女性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征通常是破坏性的更年期症状。 对退伍军人健康的相关性和意义。几乎一半的退伍军人管理局女性用户都是中年， 负担沉重的更年期症状的普遍危险因素。未解决的更年期症状促成了 严重的卫生保健负担，影响健康危险行为、慢性健康状况和精神健康。 明确的目标。目标1：描述中年女性退伍军人的更年期症状经历，以及 更年期症状负担与心理健康的关系。H1a。激素治疗率高 (HT)的使用和更年期症状的发生率和负担将被观察。H1B。自我报告的更年期 症状将比退伍军人管理局临床记录分类所建议的更为普遍。H1c.心理健康 诊断和症状将与更普遍和负担更重的更年期症状相关，以及 H1d。更普遍地使用羟色胺。目标2：检查患者和提供者的偏好、体验和当前 退伍军人管理局寻求和接受与更年期相关的护理的做法。通过患者收集的信息 与供应商的面谈将为AIM 3、功绩提交和未来的干预工作提供信息，重点是 改善更年期相关护理。目标3：开发一个方便用户的工具，以增加对性别问题的了解-- 在退伍军人事务部的环境中提供与更年期相关的敏感护理，并激活对更年期症状的自我管理。 一款针对更年期患者的心理教育和症状跟踪移动应用程序 规划了退伍军人人口，提供了基于证据、低资源密集型、高收益的干预措施。 方法：研究方法。目标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 全国45岁退伍军人健康和更年期相关诊断-- (当前n=151,546)。旧金山退伍军人医疗保健系统(SFVAHCS)参与者样本(目标n=200) 将从国家队列中招募人员完成结构化调查，以彻底评估更年期 状态、更年期症状、当前抑郁、焦虑和创伤后应激障碍(PTSD) 症状，并简要评估与更年期相关的护理做法。我会把调查数据和病历数据联系起来， 并使用回归模型来检验自我报告和诊断为更年期之间的关系 症状、心理健康问题、医学合并症和羟色胺的使用。来自目标1的见解将为目标2提供信息 面试和目标3、功绩和未来项目。目标2：我将使用与退伍军人管理局的半结构化电话面试 初级保健提供者和从特定性别和一般初级保健招募的中年女性退伍军人 全国妇女健康实践研究网络(WH-PBRN)网站的设置 检查更年期相关护理的偏好、经验和当前做法。采访将提供 为目标1的发现提供背景，并为目标3、优点和未来项目提供信息。目标3：我将使用目标1和2的调查结果 以及参与性研究过程，以促进以更年期为重点的心理教育和 为更年期退伍军人量身定做的症状跟踪工具，将在优点提交中进一步评估。 独具特色，勇于创新。这些项目将作为对与更年期相关的新的评估 退伍军人病区的症状、合并症、实践和需求。这些项目还将增加 有关更年期抑郁症的文献，解决与焦虑和创伤后应激障碍相关的知识空白。最后， 开发以更年期为重点的工具将提供一种创新的模式，促进协作性自我 管理和增加对性别问题有敏感认识、以病人为中心的护理。 对其他领域的影响。这项研究将增加与退伍军人管理局相关的生殖心理健康研究 和社区环境，并可广泛地为综合妇女保健提供信息。它还将通知卫生部门- 相关技术研究，增加了研究老龄化人口使用和需求的有限文献。

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.