Seeking Behavioral Health Care: Perspectives of Women Veterans in VA and Non-VA Settings

A study published in The Journal of Behavioral Health Services & Research explores current perspectives of women veterans on seeking behavioral health care, highlighting barriers and facilitators within Department of Veterans Affairs (VA) and non-VA settings, as well as the impact of telehealth implementation and the COVID-19 pandemic on their treatment experiences and satisfaction.

US veterans, especially women, face significant behavioral health challenges, such as depression, anxiety, post-traumatic stress disorder (PTSD), and substance use disorders. Many do not seek treatment due to various barriers, including stigma, negative beliefs about care, and a military culture of self-reliance that discourages seeking help. Despite efforts by the VA to improve women-focused behavioral health care, utilization remains low, with only 22% of women veterans using VA services at the time of the study. The COVID-19 pandemic has worsened existing behavioral health symptoms among veterans, highlighting the importance of understanding and addressing barriers to care for women veterans.

The University of Southern California Institutional Review Board approved all study procedures for recruiting participants from general and veteran-targeted social media websites in February 2020. US veterans from the Navy, Air Force, Marine Corps, and Army between the ages of 18 and 40 were eligible, with a final sample size of 1230 participants. Efforts were made to minimize fraudulent participation, resulting in a final sample size of 965 participants, including cisgender women and men. Follow-up surveys were sent at 6-, 9-, 12-, and 18-month post-baseline, with participants receiving gift cards for survey completion. 

A subset of participants completed qualitative interviews to discuss coping with COVID-19; 18 women veterans completed these interviews. Participants were compensated for interviews and follow-up surveys, with findings focusing on unique experiences related to behavioral health care. This study reports methods and findings from questions unique to the 18-month follow-up interview.

Participants' mental health and substance use concerns, such as depression, PTSD, anxiety, and alcohol use disorder (AUD), were assessed through standardized measures and self-reported data on treatment utilization, satisfaction, perceived barriers, and facilitators.

Results are presented with quantitative survey findings followed by qualitative narrative accounts, providing a detailed understanding of behavioral health treatment-seeking among post-9/11 women veterans and areas for improvement. High rates of probable depression, PTSD, and anxiety were observed among women veterans, with significant differences compared to men. Women utilized behavioral health care services more than men, both within VA and non-VA settings, with varying perceptions of care quality between in-person and telehealth services. Barriers to treatment-seeking were reported less frequently by women compared to men; however, women faced unique challenges, including experiences of military sexual trauma (MST) and feeling judged by health care providers and other veterans. Facilitators to care-seeking included positive experiences with VA health care services and enhancements in women's health care services.

Interviews revealed barriers and facilitators for women that were not captured by existing measures, with themes emphasizing the influence of masculinity in the military culture. The study highlighted the need for questionnaires that more accurately capture women's experiences seeking behavioral health care. Women in the sample also did not endorse key facilitators to receiving care as frequently as men, indicating a need for future work to consider items that better capture women's experiences. 
Actions that could be taken by VA providers to enhance reach include promoting women's behavioral health services more widely and continued training on women-centered care. The study also found that treatment outside VA settings was common among women, suggesting a need to explore additional avenues to enhance access to care for women veterans. Future research should focus on examining health care access disparities for other demographic subgroups, such as racial/ethnic minority veterans, and consider the unique challenges faced by women veterans with probable AUD.

“The recency of this study’s data allows for assessment recent changes in VA behavioral healthcare—importantly, where many participants were perhaps first introduced to telehealth—and could thus offer perspectives on treatment modality preferences,” researchers said. “As the population of women veterans grows, the current study can inform VA efforts to improve care for this historically underserved group.” 

Reference
Fitzke RE, Bouskill KE, Sedano A, et al. Barriers and facilitators to behavioral healthcare for women veterans: a mixed-methods analysis of the current landscape. J Behav Health Serv Res. 2024;51(2):164-184. doi:10.1007/s11414-023-09862-3