Elsevier

Women's Health Issues

Volume 21, Issue 4, Supplement, July–August 2011, Pages S84-S97
Women's Health Issues

Original article
Systematic Review of Women Veterans’ Health: Update on Successes and Gaps

https://doi.org/10.1016/j.whi.2011.04.022Get rights and content

Abstract

Objective

We assessed the state of women veterans’ health research by conducting a systematic review of scientific literature published from 2004 to 2008, updating a prior review spanning the history of this literature to 2004.

Methods

We identified articles by searching scientific databases and contacting experts. Relevant articles were independently evaluated by two physician reviewers. We categorized 195 articles by study design, funding source, period of military service, research topic, and health condition.

Results

More research was published during this 5-year review (n = 195) than in the 25 years beforehand (n = 182). The 195 studies included five trials, but only one randomized trial, a study that examined treatment outcomes for women with posttraumatic stress disorder (PTSD). The large number of articles focused on Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) soldiers’ health issues (n = 23) reflects the growing participation of women in these conflicts. High rates of positive PTSD symptoms (range, 10%–19%) and other mental health disorders were found among OEF/OIF returning military women. The recent post-deployment literature underscores the need for repeated PTSD/mental health screening in returning veterans, and points to continuity of care needs for psychiatric and gynecological problems which occur in the field. The psychiatric and access/utilization literature confirmed the positive relationship between military sexual trauma and PTSD and the associated negative health effects.

Conclusion

Although most VA women’s health research remains observational, methods are evolving toward an analytical focus. Even though successes are evident in the breadth and depth of publications, remaining gaps in the literature include post-deployment readjustment for veterans/families, and quality-of-care interventions/outcomes for physical and mental conditions.

Section snippets

Background

Women are playing an ever increasing role in the U.S. military, representing about 15% of active military personnel, 17% of reserve and National Guard forces, and 20% of new military recruits (Meehan, 2006). Concurrently, women are one of the fastest growing groups of new users in the Department of Veterans Affairs (VA) Healthcare System, with particularly high rates of utilization among veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). Of the more than 100,000

Search Strategy

We searched MEDLINE/PubMed, PsycINFO, WorldCat, and Web of Science for potentially relevant articles related to women veteran and military health published between January 2004 and September 2008. For each database search, we used the medical subject heading terms women and veterans to search for relevant literature. We supplemented this search by contacting other sources with expertise in women veteran and military health. The Department of Defense Health Affairs Division provided access to

Yield

Our search identified 675 titles of potential relevance. Of these titles, 118 were duplicate references to a study, 151 were rejected as not being relevant to the topic, and 26 could not be retrieved (Figure 1). Of the remaining 380 articles that were evaluated as full-text articles by at least two physician reviewers independently, 154 were rejected because they did not meet our inclusion criteria; 48 did not relate to U.S. veterans or military personnel and 106 failed to meet at least one of

Discussion

The growth in the number of women in the military is reshaping the veteran population, with women constituting one of the fastest growing segments of eligible VA health care users. This trend has been accelerated by the unexpectedly high VA enrollment of women veterans from the recent wars in Iraq and Afghanistan. Concurrently, the VA’s health services research enterprise aligned its funding with high-priority topics such as women veterans’ health and health care. These leadership efforts were

Conclusion

The areas more fully developed in women veterans’ research (access, utilization, and quality of care) will serve as a foundation for future intervention and implementation research in VA. Although the substantial scope of women veterans’ mental health literature is broad, research on better studied conditions needs to be expanded with intervention studies, and quality of care areas will benefit from quality improvement and outcomes research. Future research in each of these areas should explore

Acknowledgments

The authors thank the staff of the VA Greater Los Angeles HSR&D Center of Excellence for their support and participation in abstracting a portion of the articles and coordinating services (Ismelda Canelo, MPA, Ruth Klap, PhD, Britney Chow, MPH, and Jennifer Peralta); in addition to Linda Lipson, MA, Scientific Program Manager, VA HSR&D Service, Washington, DC, and the Women Veterans Health Strategic Health Care Group in the VA Central Office, Washington, DC.

The views expressed in this article

Bevanne Bean-Mayberry, MD, MHS, is an Assistant Professor of Medicine at the VA Greater Los Angeles Healthcare System and UCLA David Geffen School of Medicine. She is a general internist who focuses on gender differences in quality measures and patient satisfaction.

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    Bevanne Bean-Mayberry, MD, MHS, is an Assistant Professor of Medicine at the VA Greater Los Angeles Healthcare System and UCLA David Geffen School of Medicine. She is a general internist who focuses on gender differences in quality measures and patient satisfaction.

    Elizabeth Yano, PhD, MSPH, is Co-Director and a Research Career Scientist at the VA Greater Los Angeles Healthcare System and Adjunct Professor of Health Services at the UCLA School of Public Health. Her work focuses organizational influences on quality.

    Donna L. Washington, MD, MPH, is a Professor of Medicine at the VA Greater Los Angeles Healthcare System and UCLA David Geffen School of Medicine. She is a general internist whose research examines health care access and quality for women and racial/ethnic minorities, with a focus on veterans and VA health care.

    Caroline L. Goldzweig, MD, MSHS, is a Professor of Medicine at the VA Greater Los Angeles Healthcare System and UCLA David Geffen School of Medicine. She is a general internist with expertise in informatics and a special clinical interest in women’s health.

    Fatma Batuman, MD, FACP, is an Assistant Professor of Medicine at the VA Greater Los Angeles Healthcare System and UCLA David Geffen School of Medicine, and Medical Director of Women’s Health Comprehensive Care at VA Greater Los Angeles. She is a general internist with expertise in women’s health care.

    Christine Huang, MD, is an Assistant Professor of Medicine at the VA Greater Los Angeles Healthcare System and UCLA David Geffen School of Medicine. She is a general internist with expertise in women’s health care.

    Isomi Miake-Lye, BA, is a health science specialist at the VA Greater Los Angeles Healthcare System. She provides support for systematic reviews and meta-analysis.

    Paul Shekelle, MD, PhD, is a Professor of Medicine with the VA Greater Los Angeles Healthcare System and UCLA David Geffen School of Medicine. He is a general internist with expertise in systematic reviews and meta-analyses.

    The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

    Dr. Bean-Mayberry was supported by a VA HSR&D Research Career Development Transition Award #02-039. Dr. Yano was supported by a VA Research Career Scientist Award #05-195. Dr. Shekelle is Director of the VA Greater Los Angeles Evidence-based Synthesis Program Center at West Los Angeles VA Medical Center which is supported by the VA Health Services Research & Development Office in Washington, DC for VA-ESP Project #05-226; 2010.

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