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Kroll-Desrosiers A, Wallace KF, Higgins DM, Martino S, Mattocks KM. Musculoskeletal Pain During Pregnancy Among Veterans: Associations With Health and Health Care Utilization. Womens Health Issues 2024; 34:90-97. [PMID: 37580185 DOI: 10.1016/j.whi.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 07/03/2023] [Accepted: 07/07/2023] [Indexed: 08/16/2023]
Abstract
INTRODUCTION Musculoskeletal (MSK) pain is more likely to be diagnosed in veterans compared with the general population; however, MSK pain during pregnancy has not been studied in veterans. This study examined health and health care use differences between pregnant veterans with and without MSK pain (MSK-). METHODS Veterans who delivered a newborn before June 1, 2021, were identified from an existing cohort (n = 1,181). Survey and Veterans Health Administration (VA) electronic health record data were obtained on participants. Veterans meeting inclusion criteria were identified as those with MSK pain (MSK+) and were compared with MSK- participants. We examined differences between primary outcomes of VA health care engagement (including mental health diagnoses, health care visits, receipt of prescription opioids, and complementary and integrative health use) and secondary outcomes (including postpartum variables) between MSK pain groups. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were calculated. RESULTS There were 172 veterans (14.6%) who met MSK pain eligibility criteria. In adjusted models, MSK+ veterans were more likely to be diagnosed with major depressive disorder (aOR, 1.76; 95% CI, 1.22-2.53) and post-traumatic stress disorder (aOR, 1.79; 95% CI, 1.21-2.64) during pregnancy compared with MSK- veterans. The use of VA mental health care (aOR, 1.52; 95% CI, 1.09-2.12) and the odds of receiving an opioid prescription during pregnancy (aOR, 2.76; 95% CI, 1.53-5.00) was higher in MSK+ veterans compared with MSK- veterans. Only a small proportion (3.6%) of our entire cohort used complementary and integrative health approaches during pregnancy. MSK+ veterans were more likely to deliver by cesarean section compared with MSK- veterans (36% vs. 26%). CONCLUSIONS MSK+ veterans were more likely to be diagnosed with mental health conditions and to use VA mental health care during pregnancy compared with MSK- veterans. Because veterans receive their obstetrical care in the community, understanding the unique needs of pregnant MSK+ veterans in comparison with MSK- veterans is important to provide comprehensive care during the perinatal period.
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Affiliation(s)
- Aimee Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts.
| | - Kate F Wallace
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts
| | - Diana M Higgins
- VA Durham Healthcare System, Durham, North Carolina; Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Steve Martino
- VA Connecticut Healthcare System, West Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
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2
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Nechuta S, Mukhopadhyay S, Golladay M, Rainey J, Krishnaswami S. Trends, patterns, and maternal characteristics of opioid prescribing during pregnancy in a large population-based cohort study. Drug Alcohol Depend 2022; 233:109331. [PMID: 35149439 PMCID: PMC10838571 DOI: 10.1016/j.drugalcdep.2022.109331] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND Opioid use during pregnancy has been associated with adverse maternal and infant health outcomes. Prescription drug monitoring programs (PDMP) provide a population-based source of prescription data. We linked statewide PDMP and birth certificate data in Tennessee (TN) to determine patterns of prescription opioid and benzodiazepine use during pregnancy. METHODS We constructed a cohort of 311,217 live singleton births from 2013 to 2016 with prescription history from 90 days before pregnancy to birth. Descriptive statistics were used to describe opioid prescription patterns during pregnancy overall, by maternal characteristics and by year. Multivariable logistic regression models estimated adjusted odds ratios and 95% confidence intervals for factors associated with prescription use. RESULTS The prevalence of prescription use during pregnancy was 14.1% for opioid analgesics, 1.6% buprenorphine for medication-assisted treatment, and 2.6% for benzodiazepines. The prevalence of opioid analgesic use decreased from 16.6% (2013) to 11.8% (2016) (ptrend< 0.001). About 25% used for > 7 and 9.7% for > 30 days' supply. The most common types were hydrocodone (9.3%), codeine (3.4%), and oxycodone (2.9%). In adjusted models, lower education, lower income, pre-pregnancy obesity and smoking during pregnancy were associated with increased odds of any opioid and opioid analgesic use. CONCLUSION(S) Despite the encouraging trend of decreasing use of prescription opioid analgesics, the overall prevalence remained close to 12% with many women using for long durations. Use was associated with lower socioeconomic status, obesity, and prenatal smoking. Findings highlight the need for maternal education and resources, and provider support for implementation of evidence-based care.
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Affiliation(s)
- Sarah Nechuta
- Grand Valley State University, Department of Public Health, College of Health Professions, Grand Rapids, MI 49503, USA; Tennessee Department of Health, Office of Informatics and Analytics, Nashville, TN 37243, USA.
| | - Sutapa Mukhopadhyay
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, TN 37243, USA
| | - Molly Golladay
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, TN 37243, USA; Tennessee Department of Health, Office of the State Chief Medical Examiner, Nashville, TN 37243, USA
| | - Jacob Rainey
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, TN 37243, USA; Johns Hopkins University, Department of Mental Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Shanthi Krishnaswami
- Tennessee Department of Health, Office of Informatics and Analytics, Nashville, TN 37243, USA
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3
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A way forward in the maternal mortality crisis: addressing maternal health disparities and mental health. Arch Womens Ment Health 2021; 24:823-830. [PMID: 34427773 DOI: 10.1007/s00737-021-01161-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022]
Abstract
Our objective was to review the role of maternal health disparities and mental health in the maternal mortality crisis in the USA, and discuss how perinatal care quality improvement in these areas is a critical lever for reducing maternal death. This paper summarizes content from a plenary talk delivered at the 2020 Biennial Meeting of the International Marcé Society for Perinatal Mental Health, in commemoration of the Society's 40th anniversary. The talk synthesized literature on two characteristics of the maternal mortality crisis in the US: (1) wide racial and ethnic disparities in maternal mortality and severe morbidity and (2) the impact of mental health and substance use disorders on maternal death, and introduced a framework for how health care quality gaps contribute to both of these issues. The US remains an outlier among similar nations in its alarmingly high rates of maternal mortality. Achieving significant progress on this measure will require confronting longstanding racial and ethnic disparities that exist throughout the pregnancy-postpartum continuum, as well as addressing the under-reported issue of maternal self-harm. Suicide and overdose are leading but under-recognized causes of death among pregnant and postpartum women in some states. Health care delivery failures, including inadequate risk assessment, care coordination, and communication, are identified in the literature on drivers of maternal health disparities and self-harm. Many of the same steps to improve quality of perinatal care can help to reduce health disparities and address the essential role of mental health in maternal well-being.
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Nicosia FM, Gibson CJ, Purcell N, Zamora K, Tighe J, Seal KH. Women Veterans' Experiences with Integrated, Biopsychosocial Pain Care: A Qualitative Study. PAIN MEDICINE 2021; 22:1954-1961. [PMID: 33547797 DOI: 10.1093/pm/pnaa481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Biopsychosocial, integrated pain care models are increasingly implemented in the Veterans Health Administration to improve chronic pain care and reduce opioid-related risks, but little is known about how well these models address women veterans' needs. DESIGN Qualitative, interview-based study. SETTING San Francisco VA Health Care System Integrated Pain Team (IPT), an interdisciplinary team that provides short-term, personalized chronic pain care emphasizing functional goals and active self-management. SUBJECTS Women with chronic pain who completed ≥3 IPT sessions. METHODS Semistructured phone interviews focused on overall experience with IPT, perceived effectiveness of IPT care, pain care preferences, and suggested changes for improving gender-sensitive pain care. We used a rapid approach to qualitative thematic analysis to analyze interviews. RESULTS Fourteen women veterans (mean age 51 years; range 33-67 years) completed interviews. Interviews revealed several factors impacting women veterans' experiences: 1) an overall preference for receiving both primary and IPT care in gender-specific settings, 2) varying levels of confidence that IPT could adequately address gender-specific pain issues, 3) barriers to participating in pain groups, and 4) barriers to IPT self-management recommendations due to caregiving responsibilities. CONCLUSIONS Women veterans reported varied experiences with IPT. Recommendations to improve gender-sensitive pain care include increased provider training; increased knowledge of and sensitivity to women's health concerns; and improved accommodations for prior trauma, family and work obligations, and geographic barriers. To better meet the needs of women veterans with chronic pain, integrated pain care models must be informed by an understanding of gender-specific needs, challenges, and preferences.
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Affiliation(s)
- Francesca M Nicosia
- San Francisco VA Health Care System, San Francisco, California.,Institute for Health and Aging, University of California San Francisco, San Francisco, California
| | - Carolyn J Gibson
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California San Francisco, San Francisco, California
| | - Natalie Purcell
- San Francisco VA Health Care System, San Francisco, California.,Institute for Health and Aging, University of California San Francisco, San Francisco, California.,Department of Social and Behavioral Sciences, University of California San Francisco, San Francisco, California
| | - Kara Zamora
- San Francisco VA Health Care System, San Francisco, California.,Department of Anthropology, History, and Social Medicine, University of California San Francisco, San Francisco, California
| | - Jennifer Tighe
- San Francisco VA Health Care System, San Francisco, California
| | - Karen H Seal
- San Francisco VA Health Care System, San Francisco, California.,Department of Psychiatry, University of California San Francisco, San Francisco, California.,Department of Anthropology, History, and Social Medicine, University of California San Francisco, San Francisco, California.,Department of Medicine, University of California San Francisco, San Francisco, California, USA
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5
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A Clinical Trial of a Program for Pain Management and Opioid Reduction During Pregnancy. Reprod Sci 2021; 29:606-613. [PMID: 34403125 DOI: 10.1007/s43032-021-00701-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 07/16/2021] [Indexed: 12/25/2022]
Abstract
A substantial proportion of pregnant women use prescription opioids. However, the lack of efficacy of chronic prescription opioid use for pain, combined with an increased risk of these medications in general and during pregnancy, suggests that the risks of these medications may outweigh the benefits of continued use. Though research has not evaluated non-pharmacological approaches to treat chronic pain during pregnancy, research conducted with the general population outside of pregnancy suggests that cognitive behavioral therapy (CBT) is an effective, non-pharmacological treatment. Therefore, the purpose of this study was to evaluate the effectiveness of CBT for chronic pain paired with shared decision-making for prescription opioid dose reduction among pregnant women with prescription opioid misuse. The study was an open-label, 8-week clinical trial of CBT for chronic pain and shared decision-making for prescription opioid dose reduction. Participants included a clinical sample of 20 pregnant women between the ages of 18 and 45 years who were misusing opioids but did not meet DSM-IV criteria for an opioid use disorder or other substance use disorder. Compared to baseline, at 8 weeks, participants had significant reductions in average prescription opioid morphine equivalent dose, prescription opioid misuse, worst pain ratings, and pain interference in general activity and at work. They did not report improvement in other pain ratings or areas of functioning. This study provides valuable information regarding the preliminary efficacy of CBT for chronic pain paired with shared decision-making among pregnant women misusing prescription opioids. ClinicalTrials.gov: NCT02804152.
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Shivakumar G, Kroll-Desrosiers AR, Copeland L, Anderson EH, Maydon A, Mattocks K. Patterns of Treatment Utilization Across the Perinatal Period in the Center for Maternal and Infant Outcomes and Research in Translation (COMFORT) Veterans Study. J Womens Health (Larchmt) 2021; 30:882-890. [DOI: 10.1089/jwh.2020.8435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Geetha Shivakumar
- Mental Health, VA North Texas Health Care System, Dallas, Texas, USA
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Aimee R. Kroll-Desrosiers
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Laurel Copeland
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
- Department of Psychiatry, UT Health Science Center, San Antonio, Texas, USA
| | | | - Amaris Maydon
- Mental Health, VA North Texas Health Care System, Dallas, Texas, USA
| | - Kristin Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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7
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Mattocks KM, Kroll-Desrosiers A, Kinney R, Bastian LA, Bean-Mayberry B, Goldstein KM, Shivakumar G, Copeland L. Racial Differences in the Cesarean Section Rates Among Women Veterans Using Department of Veterans Affairs Community Care. Med Care 2021; 59:131-138. [PMID: 33201084 DOI: 10.1097/mlr.0000000000001461] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Racial disparities in maternal morbidity and mortality remain a pressing public health problem. Variations in cesarean section (C-section) rates among racial and ethnic groups have been well documented, though reasons for these variations remain unknown. In the Department of Veterans Affairs (VA), nearly half of all women Veterans are of reproductive age and >40% of these women are racial and ethnic minorities. Because the VA does not provide obstetrical services, all obstetrical care is provided by community obstetrical providers under the auspices of the VA Community Care Network. However, little is known regarding the rates and correlates of C-sections among women Veterans receiving community obstetrical care. OBJECTIVE To examine predictors of C-section deliveries among a cohort of racially diverse pregnant Veterans enrolled in VA care at 15 VA medical facilities nationwide. RESEARCH DESIGN Cross-sectional analysis of a longitudinal, prospective, multisite, observational cohort study of pregnant, and postpartum Veterans receiving community-based obstetrical care. RESULTS Overall, 659 Veterans delivered babies during the study period, and 35% of the deliveries were C-sections. Predictors of C-section receipt included being a woman of color [adjusted odds ratio (AOR), 1.76; 95% confidence interval (CI), 1.19-2.60], having an Edinburgh Postnatal Depression Scale score ≥10 (AOR, 1.71; 95% CI, 1.11-2.65), having a higher body mass indexes (AOR, 1.07; 95% CI, 1.04-1.11), and women who were older (AOR, 1.08; 95% CI, 1.03-1.13). There was a substantial racial variation in C-section rates across our 15 study sites, with C-section rates meeting or exceeding 50% for WOC in 8 study sites. CONCLUSIONS There is substantial racial and geographic variation in C-section rates among pregnant Veterans receiving obstetrical care through VA community care providers. Future research should carefully examine variations in C-sections by the hospital, and which providers and hospitals are included in VA contracts. There should also be an increased focus on the types of providers women Veterans have access to for obstetrical care paid for by the VA and the quality of care delivered by those providers.
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Affiliation(s)
- Kristin M Mattocks
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
- VA Central Western Massachusetts Healthcare System, Leeds, MA
| | - Aimee Kroll-Desrosiers
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
- VA Central Western Massachusetts Healthcare System, Leeds, MA
| | - Rebecca Kinney
- VA Central Western Massachusetts Healthcare System, Leeds, MA
| | - Lori A Bastian
- Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System, West Haven
- Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Bevanne Bean-Mayberry
- VA Greater Los Angeles Healthcare System, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP)
- Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, CA
| | - Karen M Goldstein
- Durham VA Health Care System-Center for Health Services Research in Primary Care
- Division of General Internal Medicine, Duke University School of Medicine, Durham, NC
| | - Geetha Shivakumar
- Mental Health, VA North Texas Health Care System
- Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX
| | - Laurel Copeland
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester
- VA Central Western Massachusetts Healthcare System, Leeds, MA
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8
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Chen G, Delcher C, Xiao H, Roussos-Ross D, Huo J, Chen X. Factors associated with opioid prescriptions among women proximal to pregnancy in the United States. Res Social Adm Pharm 2020; 17:1483-1488. [PMID: 33234451 DOI: 10.1016/j.sapharm.2020.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 09/08/2020] [Accepted: 11/11/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pregnant women are a vulnerable population exposed to opioids in the United States. OBJECTIVE To examine trends and factors associated with opioid prescribing to women proximal to pregnancy. METHODS The 2011 to 2015 Medical Expenditure Panel Survey (MEPS) was used to identify participants (n = 3020) with self-reported pregnancy or pregnancy-relevant events aged between 18 and 44 years old. To investigate factors associated with opioid prescriptions, we categorized participants into two subgroups: having one or more opioid prescription or having none during the observational period. We used survey multivariable logistic regression to identify factors associated with opioid prescribing accounting for the complex survey design in MEPS. RESULTS From 2011 to 2015, the prevalence of opioid prescribing among study participants was 31%. Opioids were more likely to be prescribed to women who had psychiatric conditions (odds ratio, 1,76, 95%CI: 1.27-2.44, p < 0.001). Other significant factors included being non-Hispanic white or black, living in the South, active tobacco users, and those with lower Physical Component Summary Scores. CONCLUSION Receipt of an opioid prescription in the perinatal period is associated with maternal psychiatric disorders in the United States. Study findings add new data to the literature on opioid use among pregnant women and provide evidence for healthcare providers and policy makers to tailor treatment and educational programs to avoid opioid overuse among pregnant women.
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Affiliation(s)
- Guanming Chen
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Chris Delcher
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Kentucky, Lexington, KY, USA
| | - Hong Xiao
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, New Jersey, USA
| | - Dikea Roussos-Ross
- Department of Obstetrics & Gynecology and Psychiatry, University of Florida College of Medicine, Gainesville, FL, USA
| | - Jinhai Huo
- Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb, New Jersey, USA
| | - Xinguang Chen
- Department of Epidemiology, College of Public Health, University of Florida, Gainesville, FL, USA.
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Grekin R, Zivin K, Hall SV, Van T, Mattocks KM. Predictors of Veterans Affairs Health Service Utilization by Women Veterans during Pregnancy. Womens Health Issues 2020; 30:292-298. [PMID: 32417074 DOI: 10.1016/j.whi.2020.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 03/26/2020] [Accepted: 04/03/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Researchers have examined predictors of Veterans Affairs (VA) service use by women veterans in general, but less is known about predictors of VA service use by pregnant veterans. This study examined characteristics associated with planned and actual VA service use by pregnant veterans. METHODS This study includes data from 510 pregnant veterans enrolled in the Center for Maternal and Infant Outcomes Research in Translation Study. Women veterans completed phone interviews during their first trimester and at 3 months postpartum. The Center for Maternal and Infant Outcomes Research in Translation surveys assessed medical and mental health conditions, VA health care use, trauma history, and pregnancy complications. We conducted bivariate and multivariable logistic regression models assessing planned and actual use of VA services during pregnancy. RESULTS Lifetime post-traumatic stress disorder (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.11-2.69) and history of military sexual trauma (OR, 1.85; 95% CI, 1.19-2.87) were significantly associated with planned VA service use in multivariable models. Lifetime diagnoses of anxiety (OR, 1.78; C.I., 1.15-2.75) were associated with an increased likelihood of actual VA use during pregnancy, whereas Hispanic ethnicity (OR, 0.59; 95% CI, 0.36-0.96), younger age (OR, 0.95; 95% CI, 0.91-0.99), and access to private health insurance (OR, 0.55; 95% CI, 0.37-0.84) were associated with a decreased likelihood of actual VA service use during pregnancy. CONCLUSIONS Results emphasize the association between high-risk mental health characteristics and specific demographic characteristics with VA service use among pregnant veterans. Study findings highlight a continued need for women's health care at the VA, as well as the availability of VA providers knowledgeable about perinatal health issues, and informed community providers regarding women veterans' health.
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Affiliation(s)
- Rebecca Grekin
- Ann Arbor VA Healthcare System, Ann Arbor, Michigan; Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Kara Zivin
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan
| | - Stephanie V Hall
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan; Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Tony Van
- Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan
| | - Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts; Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
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10
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Kroll-Desrosiers AR, Crawford SL, Moore Simas TA, Clark MA, Mattocks KM. Treatment and Management of Depression Symptoms in Pregnant Veterans: Varying Experiences of Mental Health Care in the Prenatal Period. Psychiatr Q 2020; 91:475-493. [PMID: 32008211 DOI: 10.1007/s11126-019-09676-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Depression screening is recommended for all pregnant veterans; however, little is known on how often symptomatic women receive care, how depression treatment presents in practice, and whether women veterans are utilizing treatment during the appreciable perinatal period. Our sample included 142 pregnant veterans from 15 Veterans Health Administration (VA) medical facilities with Edinburgh Postnatal Depression Scale (EPDS) scores ≥10. Sociodemographic characteristics, military service, health utilization, and pregnancy related factors were collected as part of a telephone survey. A majority of our sample (70%) had 1 or more mental health visits or antidepressant prescriptions during pregnancy. Women with a history of depression had more mental health visits and a higher percentage of antidepressant use before and during pregnancy than women without a history of depression. Pregnant women veterans without a history of depression may be less likely to receive care for depression during pregnancy. However, the majority of our veterans showing depression symptoms prenatally had at least one mental health visit or an antidepressant medication fill during their pregnancy window, suggesting that mental health care is readily available for women veterans.
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Affiliation(s)
- Aimee R Kroll-Desrosiers
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA.
- Research and Development, VA Central Western Massachusetts, Leeds, MA, USA.
| | - Sybil L Crawford
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA
| | - Tiffany A Moore Simas
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
- Department of Obstetrics & Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, MA, USA
- Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, USA
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Melissa A Clark
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
| | - Kristin M Mattocks
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Worcester, MA, 01605, USA
- Research and Development, VA Central Western Massachusetts, Leeds, MA, USA
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11
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Coleman JN, DeRycke EC, Bastian LA, Calhoun PS, Beckham JC, Kroll-Desrosiers AR, Haskell SG, Mattocks K, Brandt CA, Wilson SM. Predictors of prenatal smoking among US women veterans. J Health Psychol 2020; 26:2648-2655. [PMID: 32255376 DOI: 10.1177/1359105320913100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated prevalence and factors associated with prenatal smoking among US women veterans using cross-sectional data from a cohort study of veterans from recent wars utilizing Veterans Health Administration primary care (N = 6190). Among the participants, 747 (12.0%) were current smokers and 1039 (16.8%) were former smokers. Multivariable logistic regression indicated that White race, substance use disorder, and posttraumatic stress disorder were associated with increased likelihood of smoking during pregnancy. Conversely, being married and officer rank were associated with decreased likelihood of prenatal smoking. Findings suggest a need for empirical testing of interventions to address perinatal smoking, substance use, and mental health.
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Affiliation(s)
| | | | - Lori A Bastian
- VA Connecticut Healthcare System, USA.,Yale University School of Medicine, USA
| | - Patrick S Calhoun
- Duke University School of Medicine, USA.,Durham VA Health Care System, USA.,VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, USA
| | - Jean C Beckham
- Duke University School of Medicine, USA.,VA Mid-Atlantic Region Mental Illness Research, Education and Clinical Center, USA
| | | | | | - Kristin Mattocks
- University of Massachusetts Medical School, USA.,VA Central Western Massachusetts Healthcare System, USA
| | - Cynthia A Brandt
- VA Connecticut Healthcare System, USA.,Yale University School of Medicine, USA
| | - Sarah M Wilson
- Duke University School of Medicine, USA.,Durham VA Health Care System, USA
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12
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Sujan AC, Quinn PD, Rickert ME, Wiggs KK, Lichtenstein P, Larsson H, Almqvist C, Öberg AS, D’Onofrio BM. Maternal prescribed opioid analgesic use during pregnancy and associations with adverse birth outcomes: A population-based study. PLoS Med 2019; 16:e1002980. [PMID: 31790390 PMCID: PMC6886755 DOI: 10.1371/journal.pmed.1002980] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/04/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Published research on prescribed opioid analgesic (POA) use during pregnancy and birth outcomes is limited in scope and has not adequately adjusted for potential confounding factors. To help address these gaps, we estimated associations between maternal POAs during pregnancy and two adverse birth outcomes using a large population-based dataset, multiple definitions of POA exposure, and several methods to evaluate the influence of both measured and unmeasured confounding factors. METHODS AND FINDINGS We obtained data by linking information from several Swedish registers and conducted a retrospective cohort study on a population-based sample of 620,458 Swedish births occurring between 2007 and 2013 (48.6% female; 44.4% firstborn). We evaluated associations between prenatal POA exposure and risk for preterm birth (PTB; <37 gestational weeks) and small for gestational age (SGA; birth weight 2 standard deviations below the expected weight for gestational age or lower). We evaluated the influence of confounding by adjusting for a wide range of measured covariates while comparing exposed and unexposed infants. Additionally, we adjusted for unmeasured confounding factors by using several advanced epidemiological designs. Infants exposed to POAs anytime during pregnancy were at increased risk for PTB compared with unexposed infants (6.4% exposed versus 4.4% unexposed; adjusted odds ratio [OR] = 1.38, 95% confidence interval [CI] 1.31-1.45, p < 0.001). This association was attenuated when we compared POA-exposed infants with acetaminophen-exposed infants (OR = 1.18, 95% CI 1.07-1.30, p < 0.001), infants born to women who used POAs before pregnancy only (OR = 1.05, 95% CI 0.96-1.14, p = 0.27), and unexposed siblings (OR = 0.99, 95% CI 0.85-1.14, p = 0.92). We also evaluated associations with short-term versus persistent POA use during pregnancy and observed a similar pattern of results, although the magnitudes of associations with persistent exposure were larger than associations with any use or short-term use. Although short-term use was not associated with SGA (adjusted ORsingle-trimester = 0.95, 95% CI 0.87-1.04, p = 0.29), persistent use was associated with increased risk for SGA (adjusted ORmultiple-trimester = 1.40, 95% CI 1.17-1.67, p < 0.001) compared with unexposed infants. The association with persistent exposure was attenuated when we used alternative comparison groups (e.g., sibling comparison OR = 1.22, 95% CI 0.60-2.48, p = 0.58). Of note, our study had limitations, including potential bias from exposure misclassification, an inability to adjust for all sources of confounding, and uncertainty regarding generalizability to countries outside of Sweden. CONCLUSIONS Our results suggested that observed associations between POA use during pregnancy and risk of PTB and SGA were largely due to unmeasured confounding factors, although we could not rule out small independent associations, particularly for persistent POA use during pregnancy.
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Affiliation(s)
- Ayesha C. Sujan
- Department of Psychological & Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, United States of America
- * E-mail:
| | - Patrick D. Quinn
- Department of Applied Health Science, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, United States of America
| | - Martin E. Rickert
- Department of Psychological & Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, United States of America
| | - Kelsey K. Wiggs
- Department of Psychological & Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, United States of America
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Catarina Almqvist
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - A. Sara Öberg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Epidemiology, T.H. Chan School of Public Health, Harvard, Boston, United States of America
| | - Brian M. D’Onofrio
- Department of Psychological & Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, United States of America
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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13
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Gibson CJ, Li Y, Huang AJ, Rife T, Seal KH. Menopausal Symptoms and Higher Risk Opioid Prescribing in a National Sample of Women Veterans with Chronic Pain. J Gen Intern Med 2019; 34:2159-2166. [PMID: 31414358 PMCID: PMC6816610 DOI: 10.1007/s11606-019-05242-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 05/15/2019] [Accepted: 07/09/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The greatest increases in long-term opioid use and opioid-related overdose mortality in recent years have been among women in midlife. Common menopausal symptoms broadly affect health and health care utilization in midlife, but their contribution to chronic pain management during this period is unknown. OBJECTIVE To examine relationships between menopausal symptoms and long-term opioid prescription patterns among midlife women with chronic pain. DESIGN Cross-sectional analysis of national Veterans Health Administration medical and pharmacy records (2014-2015). PARTICIPANTS Women Veterans aged 45-64 with ≥ 1 outpatient visit and chronic pain diagnoses spanning ≥ 90 days. MAIN MEASURES Long-term opioids (prescribed oral opioids for ≥ 90 days), high-dose long-term opioids (> 50 mg average morphine equivalent daily dose), and long-term opioids co-prescribed with central nervous system depressants (benzodiazepine and non-benzodiazepine sedative-hypnotics, gabapentin/pregabalin, muscle relaxants). Multivariable logistic regression models were used to examine associations between outcomes and menopausal symptoms (menopausal symptom-related diagnoses (i.e., "symptomatic menopausal states") on ≥ 2 encounters and/or menopausal hormone therapy, adjusting for race, age, body mass index, and mental health and substance use disorder diagnoses. KEY RESULTS In this national sample of 104,984 midlife women Veterans with chronic pain (mean age 54.5, SD 5.4 years), 17% had evidence of menopausal symptoms, 51% were prescribed long-term opioids, 13% were prescribed high-dose long-term opioids, and 35% were co-prescribed long-term opioids and central nervous system depressants. In multivariable analyses, women with menopausal symptoms had increased odds of long-term opioids (OR 1.21, 95% CI 1.18-1.26), high-dose long-term opioids (OR 1.08, 95% CI 1.02-1.13), and long-term opioids co-prescribed with central nervous system depressants (sedative-hypnotics OR 1.25, 95% CI 1.22-1.30; gabapentin/pregabalin OR 1.23, 95% CI 1.20-1.27; muscle relaxants OR 1.24, 95% CI 1.20-1.28). CONCLUSIONS Among midlife women Veterans with chronic pain, evidence of menopausal symptoms was associated with potentially risky long-term opioid prescription patterns, independent of known risk factors.
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Affiliation(s)
- Carolyn J Gibson
- San Francisco VA Health Care System, San Francisco, USA.
- University of California, San Francisco, San Francisco, USA.
| | - Yongmei Li
- San Francisco VA Health Care System, San Francisco, USA
| | - Alison J Huang
- University of California, San Francisco, San Francisco, USA
| | - Tessa Rife
- San Francisco VA Health Care System, San Francisco, USA
- University of California, San Francisco, San Francisco, USA
| | - Karen H Seal
- San Francisco VA Health Care System, San Francisco, USA
- University of California, San Francisco, San Francisco, USA
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14
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Mangla K, Hoffman MC, Trumpff C, O'Grady S, Monk C. Maternal self-harm deaths: an unrecognized and preventable outcome. Am J Obstet Gynecol 2019; 221:295-303. [PMID: 30849358 DOI: 10.1016/j.ajog.2019.02.056] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 02/19/2019] [Accepted: 02/27/2019] [Indexed: 12/14/2022]
Abstract
Maternal mortality continues to be a public health priority in national and international communities. Maternal death rates secondary to medical illnesses such as cardiovascular disease, preeclampsia, and postpartum hemorrhage are well documented. The rates of maternal death secondary to self-harm, including suicide and overdose, have been omitted from published rates of maternal mortality, despite growing attention to the prevalence of perinatal mood disorders, estimated at up to 15% of pregnant and postpartum women in the United States. Underlying psychiatric disorder, including depression, is consistently identified as a risk factor in substance abuse and suicide. The rate of opioid-associated morbidity and mortality has recently been deemed a national crisis. Pregnancy does not protect against these risks, and the postpartum period has been identified as a particularly vulnerable time. The lack of consistent and inclusive data on self-harm deaths in the pregnancy-postpartum period is alarming. This review will identify barriers to reporting and ascertainment of maternal suicide and overdose deaths, summarize geographic-specific data available, address potential social and psychological biases that have led to neglect of the topic of maternal self-harm deaths, and suggest recommendations that incorporate the whole woman in prenatal care and thus prevention of this devastating outcome.
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Affiliation(s)
- Kimberly Mangla
- Department of Psychiatry, Columbia University Medical Center, New York, NY.
| | - M Camille Hoffman
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine/Denver Health and Hospital Authority, Denver, Colorado
| | - Caroline Trumpff
- Division of Behavioral Medicine, Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Sinclaire O'Grady
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; Division of Behavioral Medicine, Department of Psychiatry, Columbia University Medical Center, New York, NY
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY; Division of Behavioral Medicine, Department of Psychiatry, Columbia University Medical Center, New York, NY; Department of Obstetrics and Gynecology, University of Colorado School of Medicine/Denver Health and Hospital Authority, Denver, Colorado; New York State Psychiatric Institute, New York, NY
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15
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Kroll-Desrosiers AR, Crawford SL, Moore Simas TA, Clark MA, Bastian LA, Mattocks KM. Rates and Correlates of Depression Symptoms in a Sample of Pregnant Veterans Receiving Veterans Health Administration Care. Womens Health Issues 2019; 29:333-340. [PMID: 31105035 DOI: 10.1016/j.whi.2019.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 04/11/2019] [Accepted: 04/12/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Depression is the most commonly diagnosed medical condition among women veterans ages 18 to 44; however, depression symptoms occurring during pregnancy have not been well-studied in this population. METHODS Pregnant veterans were recruited from 15 Veterans Health Administration sites across the United States; our sample included 501 participants. Sociodemographic characteristics, military service, health status, and pregnancy related factors, as well as the Edinburgh Postnatal Depression Scale (EPDS), were collected as part of a telephone survey. Additional data were obtained from electronic health record data. We used multivariable logistic regression models to examine factors associated with an EPDS score suggestive of clinically significant depressive symptoms (≥10). FINDINGS Prenatal EPDS scores of 10 or greater were calculated for 28% of our sample. Our final model indicated that factors associated with decreased odds of an EPDS score of 10 or greater included spousal or partner support during pregnancy (adjusted odds ratio [aOR], 0.35; 95% confidence interval [CI], 0.16-0.77) and employment (aOR, 0.40; 95% CI, 0.24-0.67). A past diagnosis of anxiety (aOR, 2.54; 95% CI, 1.43-4.50), past antidepressant use (aOR, 3.27; 95% CI, 1.71-6.24), and active duty service (aOR, 1.91; 95% CI, 1.08-3.37) were associated with increased odds of having an EPDS score of 10 or greater. CONCLUSIONS This is the first quantitative estimate of depression symptoms in pregnant veterans across multiple Veterans Affairs facilities. The prevalence of depression symptomology was greater than the high end of prevalence estimates in the general pregnant population. Given that the risk of depression increases during the postpartum period, women who can be identified with depressive symptomatology during pregnancy can be offered critical resources and support before giving birth.
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Affiliation(s)
- Aimee R Kroll-Desrosiers
- Department of Population and Quantitative Sciences, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Sybil L Crawford
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Tiffany A Moore Simas
- Department of Population and Quantitative Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Obstetrics & Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, Massachusetts; Department of Pediatrics, University of Massachusetts Medical School, Worcester, Massachusetts; Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Melissa A Clark
- Department of Population and Quantitative Sciences, University of Massachusetts Medical School, Worcester, Massachusetts
| | - Lori A Bastian
- Division of General Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; Pain Research, Informatics, Multimorbidities, and Education Center, VA Connecticut Healthcare System, West Haven, Connecticut
| | - Kristin M Mattocks
- Department of Population and Quantitative Sciences, University of Massachusetts Medical School, Worcester, Massachusetts; Research and Development, VA Central Western Massachusetts, Leeds, Massachusetts
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16
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Mattocks KM, Kroll-Desrosiers A, Kinney R, Singer S. Understanding Maternity Care Coordination for Women Veterans Using an Integrated Care Model Approach. J Gen Intern Med 2019; 34:50-57. [PMID: 31098973 PMCID: PMC6542965 DOI: 10.1007/s11606-019-04974-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND An increasing number of women veterans are using VA maternity benefits for their pregnancies. However, because the VA does not offer obstetrical care, women must seek maternity care from non-VA providers. The growing number of women using non-VA care has increased the importance of understanding how this care is integrated with ongoing VA medical and mental health services and how perceptions of care integration impact healthcare utilization. Therefore, we sought to understand these relationships among a sample of postpartum veterans utilizing VA maternity benefits. METHODS We fielded a modified version of the Patient Perceptions of Integrated Care survey among a sample of postpartum veterans who had utilized VA maternity benefits for their pregnancies (n = 276). We assessed relationships between perceptions of six domains of patient-reported integrated care, indicating how well-integrated patients perceived the care received from VA and non-VA clinicians, and utilization of mental healthcare following pregnancy. RESULTS Domain scores were highest for items focused on VA care, including test result communication and VA provider's knowledge of patient's medical conditions. Scores were lower for obstetrician's knowledge of patient's medical history. Women with depressive symptom scores indicative of depression rated test result communication as highly integrated, while women who received mental healthcare following pregnancy had low integrated care ratings for the Support for Medication and Home Health Management domain, indicating a lack of support for mental health conditions following pregnancy. DISCUSSION Among a group of postpartum veterans, poor ratings of integrated care across some domains were associated with higher rates of mental healthcare use following pregnancy. Further assessment of integrated care by patients may assist VA providers and policymakers in developing systems to ensure integrated care for veterans who receive care outside the VA.
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Affiliation(s)
- Kristin M Mattocks
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA.
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Aimee Kroll-Desrosiers
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Rebecca Kinney
- VA Central Western Massachusetts Healthcare System, Leeds, MA, USA
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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17
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Katon JG, Zephyrin L, Meoli A, Hulugalle A, Bosch J, Callegari L, Galvan IV, Gray KE, Haeger KO, Hoffmire C, Levis S, Ma EW, Mccabe JE, Nillni YI, Pineles SL, Reddy SM, Savitz DA, Shaw JG, Patton EW. Reproductive Health of Women Veterans: A Systematic Review of the Literature from 2008 to 2017. Semin Reprod Med 2019; 36:315-322. [PMID: 31003246 DOI: 10.1055/s-0039-1678750] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The literature on the reproductive health and healthcare of women Veterans has increased dramatically, though there are important gaps. This article aims to synthesize recent literature on reproductive health and healthcare of women Veterans. We updated a literature search to identify manuscripts published between 2008 and July 1, 2017. We excluded studies that were not original research, only included active-duty women, or had few women Veterans in their sample. Manuscripts were reviewed using a standardized abstraction form. We identified 52 manuscripts. Nearly half (48%) of the new manuscripts addressed contraception and preconception care (n = 15) or pregnancy (n = 10). The pregnancy and family planning literature showed that (1) contraceptive use and unintended pregnancy among women Veterans using VA healthcare is similar to that of the general population; (2) demand for VA maternity care is increasing; and (3) women Veterans using VA maternity care are a high-risk population for adverse pregnancy outcomes. A recurrent finding across topics was that history of lifetime sexual assault and mental health conditions were highly prevalent among women Veterans and associated with a wide variety of adverse reproductive health outcomes across the life course. The literature on women Veterans' reproductive health is rapidly expanding, but remains largely observational. Knowledge gaps persist in the areas of sexually transmitted infections, infertility, and menopause.
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Affiliation(s)
- Jodie G Katon
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Laurie Zephyrin
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia.,Department of Obstetrics and Gynecology, VA Harbor Medical Center, New York City, New York.,Department of Obstetrics and Gynecology, New York School of Medicine, New York, NY
| | - Anne Meoli
- VHA, SimLEARN National Simulation Center, Orlando, Florida
| | - Avanthi Hulugalle
- New York University College of Global Public Health, New York City, New York
| | - Jeane Bosch
- VA San Diego Healthcare System, San Diego, California
| | - Lisa Callegari
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Obstetrics and Gynecology, University of Washington School of Medicine, Seattle, Washington
| | - Ileana V Galvan
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia
| | - Kristen E Gray
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington.,Department of Health Services, University of Washington School of Public Health, Seattle, Washington
| | - Kristin O Haeger
- VA Office of Patient Care Services, Women's Health Services, Washington, District of Columbia
| | - Claire Hoffmire
- Rocky Mountain MIRECC for Suicide Prevention, VA Eastern Colorado Health Care System, Denver, Colorado.,Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado
| | - Silvina Levis
- Geriatric Research, Education and Clinical Center, Miami Veterans Affairs Medical Center, Miami, Florida
| | - Erica W Ma
- US Department of Veterans Affairs (VA) Puget Sound Health Care System, Health Services Research and Development (HSR&D) Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, Washington
| | | | - Yael I Nillni
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Suzanne L Pineles
- National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts.,Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
| | - Shivani M Reddy
- VA Boston Healthcare System, Boston, Massachusetts.,Center for Advanced Methods Development, RTI International, Waltham, Massachusetts
| | - David A Savitz
- Department of Epidemiology, Brown University, Providence, Rhode Island
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, California.,Center for Innovation to Implementation, VA Palo Alto Healthcare System, Palo Alto, California
| | - Elizabeth W Patton
- Division of Gynecology, Department of Surgery, VA Boston Healthcare System, Boston, Massachusetts.,Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, Massachusetts
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18
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Factors Impacting Perceived Access to Early Prenatal Care among Pregnant Veterans Enrolled in the Department of Veterans Affairs. Womens Health Issues 2019; 29:56-63. [DOI: 10.1016/j.whi.2018.10.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 09/25/2018] [Accepted: 10/04/2018] [Indexed: 11/18/2022]
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19
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Evans EA, Glover DL, Washington DL, Hamilton AB. Psychosocial Factors that Shape Substance Abuse and Related Mental Health of Women Military Veterans who Use Community-Based Services. Subst Use Misuse 2018; 53:1878-1892. [PMID: 29485302 DOI: 10.1080/10826084.2018.1441309] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND Women Veterans who use the Veterans Health Administration (VA) have high rates of substance abuse and poorer health than non-Veteran women. Less is known about the psychosocial needs of women Veterans who seek care in non-VA settings. OBJECTIVES We provide a grounded description of factors that impact substance abuse, mental health, and related quality of life of women Veterans who use non-VA community-based health and social services. METHODS Utilizing a mixed methods design, we conducted semi-structured in-person interviews with 22 women Veterans in Los Angeles in 2013-2015. RESULTS The current health of these women Veterans was shaped by substance abuse and several other factors, including: histories of trauma (in childhood, during military service) and discrimination, and associated mental health conditions; post-military socio-economic stressors; shifting social roles and adverse social support; and lost personal identity after military service. Psychosocial factors collectively underscore areas in which delivery of health and social services to women Veterans being treated in non-VA settings could be improved: (1) diffuse, implement, and sustain evidence-based gender-sensitive substance abuse treatment; (2) address traumas contributing to poor health; (3) recognize stress proliferation processes erode women's capacity to access healthcare or cope with stressors in healthy ways; (4) champion women Veterans who embody resilience and thereby can help others to form empowered personal identities of health and wellness. CONCLUSION Findings can inform interventions and services that ameliorate vulnerability to substance abuse and other health risks among women Veterans.
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Affiliation(s)
- Elizabeth A Evans
- a Department of Health Promotion and Policy , School of Public Health and Health Sciences, University of Massachusetts , Amherst , Massachusetts , USA.,b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Dawn L Glover
- b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA
| | - Donna L Washington
- b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,c Department of Medicine , Geffen School of Medicine, University of California , Los Angeles , California , USA
| | - Alison B Hamilton
- b Department of Veterans Affairs (VA) Health Service Research & Development (HSR&D) Center for the Study of Healthcare Innovation , Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System , Los Angeles , California , USA.,d Department of Psychiatry and Biobehavioral Sciences , David Geffen School of Medicine, University of California , Los Angeles , California , USA
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20
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Shaw JG, Joyce VR, Schmitt SK, Frayne SM, Shaw KA, Danielsen B, Kimerling R, Asch SM, Phibbs CS. Selection of Higher Risk Pregnancies into Veterans Health Administration Programs: Discoveries from Linked Department of Veterans Affairs and California Birth Data. Health Serv Res 2018; 53 Suppl 3:5260-5284. [PMID: 30198185 DOI: 10.1111/1475-6773.13041] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To describe variation in payer and outcomes in Veterans' births. DATA/SETTING Secondary data analyses of deliveries in California, 2000-2012. STUDY DESIGN We performed a retrospective, population-based study of all live births to Veterans (confirmed via U.S. Department of Veterans Affairs (VA) enrollment records), to identify payer and variations in outcomes among: (1) Veterans using VA coverage and (2) Veteran vs. all other births. We calculated odds ratios (aOR) adjusted for age, race, ethnicity, education, and obstetric demographics. METHODS We anonymously linked VA administrative data for all female VA enrollees with California birth records. PRINCIPAL FINDINGS From 2000 to 2012, we identified 17,495 births to Veterans. VA covered 8.6 percent (1,508), Medicaid 17.3 percent, and Private insurance 47.6 percent. Veterans who relied on VA health coverage had more preeclampsia (aOR 1.4, CI 1.0-1.8) and more cesarean births (aOR 1.2, CI 1.0-1.3), and, despite similar prematurity, trended toward more neonatal intensive care (NICU) admissions (aOR 1.2, CI 1.0-1.4) compared to Veterans using other (non-Medicaid) coverage. Overall, Veterans' birth outcomes (all-payer) mirrored California's birth outcomes, with the exception of excess NICU care (aOR 1.15, CI 1.1-1.2). CONCLUSIONS VA covers a higher risk fraction of Veterans' births, justifying maternal care coordination and attention to the maternal-fetal impacts of Veterans' comorbidities.
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Affiliation(s)
- Jonathan G Shaw
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA.,VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.,Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA
| | - Vilija R Joyce
- VA HSR&D Health Economics Resource Center (HERC), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
| | - Susan K Schmitt
- VA HSR&D Health Economics Resource Center (HERC), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.,Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Susan M Frayne
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA.,VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
| | - Kate A Shaw
- Department of Obstetrics & Gynecology, Stanford University School of Medicine, Stanford, CA
| | | | - Rachel Kimerling
- VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.,National Center for Post-traumatic Stress Disorder, US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
| | - Steven M Asch
- Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, Stanford, CA.,VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA
| | - Ciaran S Phibbs
- VA HSR&D Center for Innovation to Implementation (Ci2i), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.,VA HSR&D Health Economics Resource Center (HERC), US Department of Veterans Affairs, VA Palo Alto Health Care System, Palo Alto, CA.,Division of Neonatal and Developmental Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
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21
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Evans EA, Herman PM, Washington DL, Lorenz KA, Yuan A, Upchurch DM, Marshall N, Hamilton AB, Taylor SL. Gender Differences in Use of Complementary and Integrative Health by U.S. Military Veterans with Chronic Musculoskeletal Pain. Womens Health Issues 2018; 28:379-386. [PMID: 30174254 PMCID: PMC6699154 DOI: 10.1016/j.whi.2018.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 07/19/2018] [Accepted: 07/24/2018] [Indexed: 12/16/2022]
Abstract
AIMS The Veterans Health Administration promotes evidence-based complementary and integrative health (CIH) therapies as nonpharmacologic approaches for chronic pain. We aimed to examine CIH use by gender among veterans with chronic musculoskeletal pain, and variations in gender differences by race/ethnicity and age. METHODS We conducted a secondary analysis of electronic health records provided by all women (n = 79,537) and men (n = 389,269) veterans age 18 to 54 years with chronic musculoskeletal pain who received Veterans Health Administration-provided care between 2010 and 2013. Using gender-stratified multivariate binary logistic regression, we examined predictors of CIH use, tested a race/ethnicity-by-age interaction term, and conducted pairwise comparisons of predicted probabilities. RESULTS Among veterans with chronic musculoskeletal pain, more women than men use CIH (36% vs. 26%), with rates ranging from 25% to 42% among women and 15% to 29% among men, depending on race/ethnicity and age. Among women, patients under age 44 who were Hispanic, White, or patients of other race/ethnicities are similarly likely to use CIH; in contrast, Black women, regardless of age, are least likely to use CIH. Among men, White and Black patients, and especially Black men under age 44, are less likely to use CIH than men of Hispanic or other racial/ethnic identities. CONCLUSIONS Women veteran patients with chronic musculoskeletal pain are more likely than men to use CIH therapies, with variations in CIH use rates by race/ethnicity and age. Tailoring CIH therapy engagement efforts to be sensitive to gender, race/ethnicity, and age could reduce differential CIH use and thereby help to diminish existing health disparities among veterans.
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Affiliation(s)
- Elizabeth A Evans
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts.
| | | | - Donna L Washington
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
| | - Karl A Lorenz
- RAND Corporation, Santa Monica, California; Center for Innovation to Implementation (ci2i), VA Palo Alto Health Care System, Palo Alto, California; Stanford School of Medicine, Stanford, California
| | - Anita Yuan
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Dawn M Upchurch
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California
| | - Nell Marshall
- Center for Innovation to Implementation (ci2i), VA Palo Alto Health Care System, Palo Alto, California
| | - Alison B Hamilton
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California
| | - Stephanie L Taylor
- Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
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