Graduation Year

2016

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Nursing

Major Professor

Susan McMillan, Ph.D., ARNP

Committee Member

Allyson Duffy, Ph.D., RN

Committee Member

Kevin Kip, Ph.D.

Committee Member

Gail Powell-Cope, Ph.D., ARNP

Keywords

Women Veterans, Female Veterans, Women’s Health, Veterans, VA, Quality of Life, Depression, Disparities, Underrepresented, Education, Gender Gap, and Women’s Health Center

Abstract

Currently, between 21.9 and 23 million veterans have served in the United States armed forces. Of those, 2 million are women, and of those, only 6.5% use the Veterans Health Administration system. These females often suffer from physical and mental health disorders, and overall impaired quality of life (QOL), rendering their healthcare needs complex. Seeking, and providing care in this specialty area may become overwhelming not only for the women seeking the care, but also for healthcare systems that are unfamiliar with the specific needs of this population.

A retrospective medical records review was completed of 51 female veterans between the ages of 40 and 60 years, and who attended a women’s health specialty clinic in a women’s health center in the VA healthcare system. This center provides comprehensive women’s health services to female veterans. By attending this center, female veterans are having most if not all of their healthcare needs met in one location. Some of the services provided at the center include: primary care; gynecology; other gender specific health care needs; mental health care; and social assistance among other issues that may be associated with the overall QOL and depression.

Despite this study having a small sample size (n = 51), the participants were ethnically diverse: White (52.9%); African American (29.4%); Hispanic/Latino (15.7%); and Asian/Pacific Islander (2%). The overall results of this study reveal that female veterans who attend this clinic, have significantly lower baseline scores for QOL when compared to a North American population reference value. Means and standard deviation for total Menopause Rating Scale (MRS) score were; (n = 51, M = 21.2, SD = 9.2) compared to the North American women population reference values (n = 1,376, M = 9.1, SD = 7.6), z = 9.41, p < .0001, cohens d = 1.31. These results were significantly lower for all MRS subsets. The higher the means and standard deviation, the lower the QOL. A paired sample t-test indicated significant improvement in QOL after treatment in QOL (t = 7.80, p < .0001), and depression levels (t = 3.74, p < .0001) among female veterans attending the women’s health specialty clinic. Forward stepwise multiple linear regression models were fit to explore the association between the following variables and the outcomes of QOL and depression levels: low socioeconomic status (SES); number of deliveries; years of service; and military sexual trauma (MST). The only predictor that appeared to be significantly associated with higher MRS scores at baseline was a history of MST (β = .363; t = 2.44; p = 0.02). Higher MRS scores can be interpreted as lower QOL among female veterans.

Despite the complexities and unique needs of female veterans, the findings of this study suggest that timely, comprehensive and gender specific healthcare can significantly improve overall QOL and depression levels. In addition, further studies are need to assess what other variables may have a direct association with QOL, depression levels, and overall health of female veterans.

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