Abstract
BackgroundWomen comprise a growing proportion of Veterans seeking care at Veterans Affairs (VA) healthcare facilities. VA initiatives have accelerated changes in services for female Veterans, yet the corresponding literature has not been systematically reviewed since 2008. In 2015, VA Women’s Health Services and the VA Women’s Health Research Network requested an updated literature review to facilitate policy and research planning.MethodsThe Minneapolis VA Evidence-based Synthesis Program performed a systematic search of research related to female Veterans’ health published from 2008 through 2015. We extracted study characteristics including healthcare topic, design, sample size and proportion female, research setting, and funding source. We created an evidence map by organizing and presenting results within and across healthcare topics, and describing patterns, strengths, and gaps.ResultsWe identified 2276 abstracts and assessed each for relevance. We excluded 1092 abstracts and reviewed 1184 full-text articles; 750 were excluded. Of 440 included articles, 208 (47%) were related to mental health, particularly post-traumatic stress disorder (71 articles), military sexual trauma (37 articles), and substance abuse (20 articles). The number of articles addressing VA priority topic areas increased over time, including reproductive health, healthcare organization and delivery, access and utilization, and post-deployment health. Three or fewer articles addressed each of the common chronic diseases: diabetes, hypertension, depression, or anxiety. Nearly 400 articles (90%) used an observational design. Eight articles (2%) described randomized trials.ConclusionsOur evidence map summarizes patterns, progress, and growth in the female Veterans’ health and healthcare literature. Observational studies in mental health make up the majority of research. A focus on primary care delivery over clinical topics in primary care and a lack of sex-specific results for studies that include men and women have contributed to research gaps in addressing common chronic diseases. Interventional research using randomized trials is needed.
Highlights
Despite serving in or alongside the US military since the Revolutionary War, women have experienced unequal access to Veterans Affairs (VA) benefits, and few women used the VA healthcare system prior to the early 1980s.1 In the subsequent 30 years, clinical, research, and policy initiatives have sought to improve the quality and accessibility of evidence-based healthcare for female Veterans.2 Today, women are the fastestgrowing population of US Veterans receiving VA healthcare.3When the literature related to female Veterans’ health and healthcare was last reviewed in 2008,4–6 the authors encountered a rapidly emerging field of research
Mental health articles were dominated by conditions often associated with military service, primarily post-traumatic stress disorder (PTSD) (71/208, 34%), military sexual trauma (MST) (37/208, 18%), and substance abuse (20/208, 10%)
Twelve articles presented the primary findings (4 studies) or secondary analyses (8 studies) of randomized trials related to PTSD, MST, or multiple mental health diagnoses
Summary
When the literature related to female Veterans’ health and healthcare was last reviewed in 2008,4–6 the authors encountered a rapidly emerging field of research. They described growth in research related to access, utilization, and organizational quality, but identified gaps in research related to chronic physical and mental health conditions, complex combinations of disease, pregnancy and aging, traumatic brain injury, comanaged mental and physical preventive care, and postdeployment transitional health. A focus on primary care delivery over clinical topics in primary care and a lack of sex-specific results for studies that include men and women have contributed to research gaps in addressing common chronic diseases.
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