Improving Health Care for Women Veterans: Addressing Menopause and Mental Health

改善女性退伍军人的医疗保健：解决更年期和心理健康问题

• 批准号: 10186536
• 负责人: Carolyn Gibson
• 金额: --
• 依托单位: VETERANS AFFAIRS MED CTR SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-06-01 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10186536
• 关键词: Address; Affect; Aging; Anxiety; Area; Awareness; Biological; Caring; Chronic; Clinical; Cohort Studies; Communities; Complex; Comprehensive Health Care; Country; Data; Data Collection; Data Set; Development; Diagnosis; Evaluation; Exhibits; Face; Future; Gender; Genitourinary system; Geographic Locations; Goals; Health; Health Services Research; Healthcare; Healthcare Systems; Hormonal Change; Hot flushes; Improve Access; Intervention; Interview; Knowledge; Lead; Link; Literature; Medical; Medical Records; Menopausal Status; Menopausal Symptom; Menopause; Mental Depression; Mental Health; Methods; Modeling; Network-based; Night Sweating; Patient Self-Report; Patient-Centered Care; Patients; Personal Satisfaction; Population; Positioning Attribute; Post-Traumatic Stress Disorders; Prevalence; Process; Provider; Qualitative Evaluations; Quality of life; Records; Reproductive Health; Research; Research Personnel; Research Training; Resources; Risk; Risk Behaviors; Risk Factors; Sampling; San Francisco; Scientific Advances and Accomplishments; Self Management; Site; Social Change; Structure; Surveys; Symptoms; Technology; Telephone; Veterans; Vulnerable Populations; Woman; Women' s Health; Work; aged; aging population; associated symptom; base; care burden; care providers; career; cohort; common symptom; community setting; comorbidity; cost; daily functioning; evidence base; experience; health care service utilization; health practice; healthy aging; hormone therapy; hybrid type 1 trial; improved; innovation; insight; middle age; military veteran; mobile application; novel; peer; population health; practice-based research network; preference; primary care setting; psychoeducation; recruit; reproductive; seal; skills; sleep difficulty; tool

Background. Women in midlife face increasing health risks related to menopause, a period of biological, hormonal, and social change characterized by often disruptive menopausal symptoms. Relevance and significance to Veterans’ Health. Almost half of women Veteran VA users are in midlife, with prevalent risk factors for burdensome menopausal symptoms. Unaddressed menopausal symptoms contribute to significant health care burden, impacting health risk behaviors, chronic health conditions, and mental health. Specific Aims. Aim 1: To describe midlife women Veterans’ experience of menopausal symptoms, and associations between menopausal symptom burden and mental health. H1a. High rates of hormone therapy (HT) use and menopausal symptom prevalence and burden will be observed. H1b. Self-reported menopausal symptoms will be more prevalent than suggested by VA clinical record categorization. H1c. Mental health diagnoses and symptoms will be associated with more prevalent and burdensome menopausal symptoms, and H1d. more prevalent HT use. Aim 2: To examine patient and provider preferences, experiences, and current practices seeking and receiving care related to menopause in the VA. Information gathered through patient and provider interviews will inform Aim 3, a Merit submission, and future intervention efforts focused on improving menopause-related care. Aim 3: To develop a user-ready tool to increase access to gender- sensitive menopause-related care in VA settings, and to activate self-management of menopausal symptoms. A menopause-focused psychoeducation and symptom tracking mobile application tailored to the menopausal Veteran population is planned, providing an evidence-based, low-resource intensive, high-yield intervention. Methods. Aim 1: I will use an analytic dataset from the National Cohort Study (PI: Seal) to examine mental health and menopause-related diagnoses in a national sample of women Veteran VA users aged 45-64 (current n=151,546). A sample (target n=200) of San Francisco VA Health Care System (SFVAHCS) enrollees from the national cohort will be recruited to complete structured surveys to thoroughly assess menopause status, menopausal symptoms, and current depression, anxiety, and posttraumatic stress disorder (PTSD) symptoms, and briefly assess menopause-related care practices. I will link survey data to medical record data, and use regression models to examine associations between self-reported and diagnosed menopausal symptoms, mental health concerns, medical comorbidities, and HT use. Insights from Aim 1 will inform Aim 2 interviews and Aim 3, Merit, and future projects. Aim 2: I will use semi-structured phone interviews with VA primary care providers and midlife women Veterans recruited from gender-specific and general primary care settings in Women’s Health Practice-Based Research Network (WH-PBRN) sites across the country to examine preferences, experiences, and current practices in menopause-related care. Interviews will provide context to Aim 1 findings, and inform Aim 3, Merit, and future projects. Aim 3: I will use Aims 1 and 2 findings and a participatory research process to inform the development of a menopause-focused psychoeducation and symptom tracking tool tailored to menopausal Veterans, to be further evaluated in a Merit submission. Unique features and innovation. These projects will serve as a novel evaluation of menopause-related symptoms, comorbidities, practices, and needs in the VA setting. These projects will also add to a body of literature on menopausal depression, addressing gaps in knowledge related to anxiety and PTSD. Finally, the development of a menopause-focused tool will provide an innovative model for promoting collaborative self- management and increasing access to gender-sensitive, patient-centered care. Implications for other areas. This research will add to reproductive mental health research relevant to VA and community settings, and may broadly inform integrated women’s health care. It will also inform health- related technology research, adding to the limited literature examining use and needs in aging populations.

背景。中年的妇女面临着与更年期有关的健康风险，这是一个生物学时期， 荷尔蒙和社会变革的特征是经常破坏性的更年期符号。 与退伍军人健康的相关性和意义。几乎一半的女性VA使用者处于中年生活， 燃烧更年期症状的普遍危险因素。未解决的绝经症状贡献 承担重大的医疗保健负担，影响健康风险行为，慢性健康状况和心理健康。 具体目标。目的1：描述中年妇女退伍军人对更年期症状的经历，以及 更年期症状伯恩与心理健康之间的关联。 H1a。高训练疗法率高 （HT）将观察到使用和更年期的症状患病率和灼伤。 H1b。自我报告的更年期 症状将比VA临床记录类别所建议的更为普遍。 H1C。心理健康 诊断和符号将与更普遍和更易碎的更年期符号有关，并且 H1D。更普遍的HT使用。目标2：检查患者和提供者的偏好，经验和当前 在弗吉尼亚州寻求和接受与更年期有关的实践。通过病人收集的信息 提供者的访谈将为AIM 3提供信息3，优点提交以及未来的干预工作。 改善与更年期有关的护理。目标3：开发一个可以用户就绪的工具来增加对性别的访问 在VA环境中与敏感的更年期相关的护理，并激活更年期症状的自我管理。 以更年期为中心的心理教育和症状跟踪移动应用程序适用于绝经 计划对退伍军人人口进行计划，提供基于证据的低资源密集，高收益干预措施。 方法。目的1：我将使用来自国家队列研究（PI：SEAS）的分析数据集检查心理 在全国性的VA妇女VA使用者样本中，健康与更年期相关的诊断年龄45-64岁 （当前n = 151,546）。旧金山弗吉尼亚州卫生保健系统（SFVAHCS）的样本（目标n = 200） 从国家队列中将招募到完全结构化的调查，以彻底评估更年期 状态，绝经症状以及当前的抑郁症，动画和创伤后应激障碍（PTSD） 症状，并简要评估与更年期相关的护理实践。我将链接调查数据与病历数据， 并使用回归模型检查自我报告和诊断的绝经之间的关联 症状，心理健康问题，医学合并症和HT使用。 AIM 1的见解将为AIM 2提供信息2 访谈和目标3，优点和未来项目。 AIM 2：我将使用VA的半结构化电话采访 从性别特定和一般初级保健招募的初级保健提供者和中年女性退伍军人 全国各地的妇女健康研究网络（WH-PBRN）站点的设置 检查与更年期有关的护理中的偏好，经验和当前实践。面试将提供 AIM 1调查结果的上下文，并告知AIM 3，功绩和未来项目。目标3：我将使用目标1和2的发现 以及参与研究过程，以告知开发以更年期为中心的心理教育和 症状跟踪工具是针对绝经退伍军人量身定制的，将在优点提交中进一步评估。 独特的功能和创新。这些项目将作为对更年期有关的新评估 VA环境中的症状，合并症，实践和需求。这些项目还将增加 关于更年期抑郁症的文献，解决了与焦虑和PTSD有关的知识差距。最后， 以更年期为中心的工具的开发将提供一个创新的模型，以促进协作自我 管理和增加获得性别敏感的，以患者为中心的护理。 对其他领域的影响。这项研究将增加与VA相关的生殖心理健康研究 和社区环境，并可能广泛地为综合妇女的医疗保健提供信息。它也将为卫生提供通知 - 相关的技术研究，增加了有限的文献研究，从而研究了人口老龄化的使用和需求。