Gender Differences in Health Care Utilization Among Veterans with Chronic Pain
Abstract: Background: Previous research reports that 48% of veterans regularly experience and express concern over pain. Outpatient service use is higher for veterans with pain than for veterans without pain. Our study objective was to identify differences in outpatient utilization between men and women veterans with chronic pain. Methods: We identified all men and women veterans at the Durham Veterans Affairs Medical Center in fiscal year (FY) 2002 between the ages of 21 and 60 that had two visits for the same pain location at least 6 weeks apart as determined by ICD-9 coding. Men and women were age-matched at a 2:1 ratio. We then compared the number of outpatient visits between genders in FY 2003. Results: We identified 406 female and 812 male veterans. The mean number of clinic visits for women was 25.2 (SD 30.2) and for men 17.6 (SD 24.1). After adjusting for multiple pain sites, psychiatric diagnoses, age, and comorbidities, women veterans had a 27% higher rate of outpatient visits than men (incidence rate ratio [RR] 1.27, 95% confidence [CI] 1.15 to 1.41). Specifically, women had higher rates of visits to primary care (RR 1.36, 95% CI 1.24 to 1.50), physical therapy (RR 1.67, 95% CI 1.20 to 2.33), and other clinics (RR 1.28, 95% CI 1.14 to 1.44), and had a higher rate of visits to address pain (RR 1.15, 95% CI 1.02 to 1.30) than men. Conclusions: This is the first study to examine gender differences in chronic pain and utilization in the veteran population. Women veterans with chronic pain may need more resources to adequately manage chronic pain conditions as well as associated comorbidities and psychiatric disease.
Abstract: The unique demands of military life can adversely impact romantic relationships; however, research has mainly focused on these adverse outcomes at one-time point, overlooking changes over time or potential positive outcomes. Using a subsample of 3,845 male and female military personnel and veterans from a large UK dataset, this study examined positive and negative changes in relationship satisfaction between two-time points (2007–2009; 2014–2016). Most participants reported no change in their relationship satisfaction, suggesting stability − 8% reported a positive change and 10% a negative change. Positive change was associated with being in a long-term relationship, alcohol misuse remission, and persistent alcohol misuse. Negative change was associated with the onset of mental health problems (probable PTSD, CMD, or alcohol misuse) and having children under 18. Some factors, like increasing age, childhood family relationship adversity, and mental health problems, were associated with both positive and negative changes in relationship satisfaction. This study highlights the complexity of factors associated with relationship satisfaction among military personnel and veterans, with some experiencing positive changes, as well as negative changes over time.