(PS10-61) Mental and Physical Health Co-morbidities and Health Service Use Among Women Veterans with History of Intimate Partner Violence

Background:  Intimate partner violence (IPV) is prevalent among women Veterans, with recent lifetime estimates as high as 38%. Known IPV risk factors include age under 30, history of military sexual trauma (MST), and identifying as LGBTQ+. Among Veterans, rates of PTSD, mood and anxiety disorders, insomnia, substance use, eating disorders, suicidal ideation and suicide behaviors have been found to be nearly twice as high in women who have experienced IPV compared to those who have not. Given the high prevalence of IPV among women Veterans and its association with deleterious outcomes, IPV screening and intervention has become a national priority within the Veterans Health Administration (VHA). While the resources to address IPV within VHA have grown, more work is needed to characterize the clinical needs of women who have experienced IPV and to understand their engagement with health care. A better understanding of these clinical dimensions will better prepare the healthcare system to provide comprehensive care. This study aimed to (1) assess MH and physical health co-morbidities and (2) describe care utilization in a national sample of women Veterans with IPV history.

Method: Multi-year retrospective review of VHA medical record data of 57,410 women Veterans with chart indicators of IPV. Measures included pain and body mass index (BMI) vital signs, standard IPV and MH screen results (e.g., unhealthy alcohol use, depression, PTSD, MST, traumatic brain injury), International Classification of Diseases-9 or 10 mental health diagnostic codes and counts of medical and MH service use. Descriptive statistics summarized participant characteristics, health service category totals, and estimated bivariate associations among variables. Negative binomial regressions modelled observed service utilization over five years.

Results: A total of 14,592 records evidenced complete observations on the variables of interest (age M = 36.9 ± 9.9 years; 59.1% White, 32.2% Black, 8.7% Other; 14.2% Hispanic). Low to moderate pain (pain numeric rating scale M = 2.9 ± 2.0) and overweight and obesity (BMI M = 29.0 ± 5.8, Mdn = 28.4) were common across the sample. Nearly all (98.2%) evidenced at least one positive MH screen: 55.6% PTSD; 50.3% depression; 41.0% unhealthy alcohol use. The majority (70.7%) screened positive for MST history. Nearly one in five (18.1%) evidenced at least one chart indicator of a possible traumatic brain injury: 10.8% positive deployment-related traumatic brain injury screen; 10.6% recorded diagnosis in medical record. Nearly all (94.4%) evidenced at least one MH contact during the observation (number of MH appointments M = 43.8 ± 70.5, Mdn = 23.0). Pain (ρ = .23) and BMI (ρ = .07) were positively correlated with overall medical visits (p < .001); pain was also positively correlated with MH visits (ρ = .26, p < .001). Positive MST, traumatic brain injury, and alcohol screens were associated with increased health care utilization in multiple domains.

Conclusions: IPV is associated with high MH comorbidity and in turn, increased service utilization in multiple clinical domains. Providers should consider comorbidity in the context of comprehensive assessment and treatment planning.