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1.  Patient-Centered Mental Health Care for Female Veterans 
Objective
Mental health services for women vary widely across the Veterans Health Administration (VHA) system, without consensus on the need for, or organization of, specialized services for women. Understanding women’s needs and priorities is essential to guide the implementation of patient-centered behavioral health services.
Methods
In a cross-sectional, multisite survey of female veterans using primary care, potential stakeholders were identified for VHA mental health services by assessing perceived or observed need for mental health services. These stakeholders (N=484) ranked priorities for mental health care among a wide range of possible services. The investigators then quantified the importance of having designated women’s mental health services for each of the mental health services that emerged as key priorities.
Results
Treatment for depression, pain management, coping with chronic general medical conditions, sleep problems, weight management, and posttraumatic stress disorder (PTSD) emerged as women’s key priorities. Having mental health services specialized for women was rated as extremely important to substantial proportions of women for each of the six prioritized services. Preference for primary care colocation was strongly associated with higher importance ratings for designated women’s mental health services. For specific types of services, race, ethnicity, sexual orientation, PTSD symptoms, and psychiatric comorbidity were also associated with higher importance ratings for designated women’s services.
Conclusions
Female veterans are a diverse population whose needs and preferences for mental health services vary along demographic and clinical factors. These stakeholder perspectives can help prioritize structural and clinical aspects of designated women’s mental health care in the VHA.
doi:10.1176/appi.ps.201300551
PMCID: PMC4776740  PMID: 25642611
2.  High-Risk Behavior and Sexually Transmitted Infections Among U.S. Active Duty Servicewomen and Veterans 
Journal of Women's Health  2012;21(11):1155-1169.
Abstract
The number of women who are active duty service members or veterans of the U.S. military is increasing. Studies among young, unmarried, active duty servicewomen who are sexually active indicate a high prevalence of risky sexual behaviors, including inconsistent condom use, multiple sexual partners, and binge drinking, that lead to unintended and unsafe sex. These high-risk sexual practices likely contribute to chlamydia infection rates that are higher than the rates in the U.S. general population. Human papillomavirus (HPV) infection and cervical dysplasia may also be higher among young, active duty servicewomen. Little is known about the sexual practices and rates of sexually transmitted infections among older servicewomen and women veterans; however, women veterans with a history of sexual assault may be at high risk for HPV infection and cervical dysplasia. To address the reproductive health needs of military women, investigations into the prevalence of unsafe sexual behaviors and consequent infection among older servicewomen and women veterans are needed. Direct comparison of military and civilian women is needed to determine if servicewomen are a truly high-risk group. Additionally, subgroups of military women at greatest risk for these adverse reproductive health outcomes need to be identified.
doi:10.1089/jwh.2012.3605
PMCID: PMC3491632  PMID: 22994983
3.  Sexual Victimization, Health Status, and VA Healthcare Utilization Among Lesbian and Bisexual OEF/OIF Veterans 
Journal of General Internal Medicine  2013;28(Suppl 2):604-608.
ABSTRACT
Background
Many lesbian and bisexual (LB) women veterans may have been targets of victimization in the military based on their gender and presumed sexual orientation, and yet little is known regarding the health or mental health of LB veterans, nor the degree to which they feel comfortable receiving care in the VA.
Objective
The purpose of this study was to examine the prevalence of mental health and gender-specific conditions, VA healthcare satisfaction and trauma exposure among LB veterans receiving VA care compared with heterosexually-identified women veterans receiving.
Design
Prospective cohort study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) women veterans at two large VA facilities.
Participants
Three hundred and sixty five women veterans that completed a baseline survey. Thirty-five veterans (9.6 %) identified as gay or lesbian (4.7 %), or bisexual (4.9 %).
Main Measures
Measures included sexual orientation, military sexual trauma, mental and gender-specific health diagnoses, and VA healthcare utilization and satisfaction.
Key Results
LB OEF/OIF veterans were significantly more likely to have experienced both military and childhood sexual trauma than heterosexual women (MST: 31 % vs. 13 %, p < .001; childhood sexual trauma: 60 % vs. 36 %, p = .01), to be hazardous drinkers (32 % vs. 16 %, p = .03) and rate their current mental health as worse than before deployment (35 % vs. 16 %, p < .001).
Conclusions
Many LB veterans have experienced sexual victimization, both within the military and as children, and struggle with substance abuse and poor mental health. Health care providers working with female Veterans should be aware of high rates of military sexual trauma and childhood abuse and refer women to appropriate VA treatment and support groups for sequelae of these experiences. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country.
doi:10.1007/s11606-013-2357-9
PMCID: PMC3695265  PMID: 23807072
lesbian; health services research; Veterans; women
4.  The VA Women’s Health Practice-Based Research Network: Amplifying Women Veterans’ Voices in VA Research 
Journal of General Internal Medicine  2013;28(Suppl 2):504-509.
doi:10.1007/s11606-013-2476-3
PMCID: PMC3695282  PMID: 23807057
women’s health; veterans; implementation research; quality improvement
5.  Urinary Incontinence, Depression and Post-traumatic Stress Disorder in Women Veterans 
Objective
To study associations between urinary incontinence (UI) symptoms, depression and post-traumatic stress disorder (PTSD) in women veterans.
Study Design
This cross-sectional study enrolled women 20 to 52 years of age registered at two Midwestern U.S. Veterans Affairs Medical Centers or outlying clinics within five years preceding study interview. Participants completed a computer-assisted telephone interview assessing urogynecologic, medical and mental health. Multivariable analyses studied independent associations between stress and urgency UI and depression and PTSD.
Results
968 women mean age 38.7 ± 8.7 years were included. 191 (19.7%) reported urgency/mixed UI and 183 (18.9%) stress UI. PTSD (OR [95%CI] = 1.8 [1.0, 3.1]) but not depression (OR [95%CI] = 1.2 [0.73, 2.0]) was associated with urgency/mixed UI. Stress UI was not associated with PTSD or depression.
Conclusion
In women veterans, urgency/mixed UI was associated with PTSD but not depression.
doi:10.1016/j.ajog.2012.04.016
PMCID: PMC3381607  PMID: 22631867
Depression; Post-traumatic Stress Disorder; Urinary incontinence, Stress; Urinary incontinence, Urgency; Veterans, Women

Results 1-5 (5)