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：中年妇女面临着与更年期相关的日益增加的健康风险，这是一个生理、 荷尔蒙和社会变化通常以破坏性更年期症状为特征。 与退伍军人健康的相关性和重要性 几乎一半的退伍军人退伍军人事务部女性用户正处于中年， 未解决的更年期症状的常见危险因素是造成沉重的更年期症状的原因。 造成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 1：描述中年女性退伍军人的更年期症状经历，以及 更年期症状负担与心理健康之间的关联 H1a。 (HT) 的使用以及更年期症状的患病率和负担将被观察 H1b。 症状将比 VA 临床记录分类所建议的更为普遍。 诊断和症状将与更普遍和更严重的更年期症状相关，并且 H1d. HT 使用更普遍 目标 2：检查患者和提供者的偏好、经验和当前情况。 在 VA 中寻求和接受与更年期相关的护理 通过患者收集的信息。 提供者访谈将告知目标 3、优点提交以及未来的干预工作，重点是 改善更年期相关护理 目标 3：开发用户可用的工具以增加获得性别相关服务的机会。 在退伍军人事务部机构中提供敏感的更年期相关护理，并激活更年期症状的自我管理。 专为更年期量身定制的专注于更年期心理教育和症状跟踪的移动应用程序 对退伍军人人口进行规划，提供循证、低资源密集型、高收益的干预措施。 目标 1：我将使用国家队列研究（PI：Seal）的分析数据集来检查心理。 全国 45-64 岁女性退伍军人退伍军人使用者样本中的健康和更年期相关诊断 （当前 n=151,546）旧金山 VA 医疗保健系统 (SFVAHCS) 参与者的样本（目标 n=200）。 将招募全国队列来完成结构化调查，以彻底评估更年期 状态、更年期症状以及当前的抑郁、焦虑和创伤后应激障碍 (PTSD) 症状，并简要评估与更年期相关的护理实践，我将把调查数据与医疗记录数据联系起来， 并使用回归模型来检查自我报告和诊断的更年期之间的关联 目标 1 中的症状、心理健康问题、医疗合并症和 HT 使用情况将为目标 2 提供信息。 面试和目标 3、优点和未来的项目：我将使用 VA 的半结构化电话面试。 初级保健提供者和中年妇女 从特定性别和一般初级保健中招募的退伍军人 全国各地妇女健康实践研究网络 (WH-PBRN) 站点的设置 检查与更年期相关的护理的偏好、经验和当前做法。 目标 1 调查结果的背景，并告知目标 3、优点和未来的项目：我将使用目标 1 和 2 的调查结果。 以及参与性研究过程，为更年期重点心理教育的发展提供信息 专为更年期退伍军人量身定制的症状跟踪工具，将在提交的优点中进一步评估。 这些项目将作为更年期相关的新颖评估。 这些项目也将增加 VA 环境中的症状、合并症、实践和需求。 关于更年期抑郁症的文献，解决了与焦虑和创伤后应激障碍相关的知识差距。 开发专注于更年期的工具将为促进协作自我治疗提供创新模式 管理并增加获得性别敏感、以患者为中心的护理的机会。 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保健提供信息。 相关技术研究，增加了研究老龄化人口的使用和需求的有限文献。