兰德-Behavioral-Health-and-Service-Use-Among-Civilian-Wives-of-Service-Members-and-Veterans_-Evidence-from-the-National-Survey-of-Drug-Use-and-Health_12页_254kb

Summary of Behavioral Health and Service Use Among Civilian Wives of Service Members and Veterans

Core Content

This study examines behavioral health service use among military wives (women married to current or former service members or veterans who are covered by TRICARE or CHAMP-VA) compared to a comparison group of non-military-insured women who were also married. The research uses data from the National Survey of Drug Use and Health (NSDUH) collected from 2008 to 2011, pooling four years of data to ensure a sufficient sample size for meaningful analysis.

Main Findings

• Behavioral Health Status:
  Military wives and the comparison group are generally similar in their past-year behavioral health status. However, military wives are more likely to have experienced lifetime major depression (OR = 1.3; 95% CI = 1.1–1.6), even after adjusting for demographic and health-related factors.

• Service Use:

  • Military wives are more likely to use any behavioral health service in the past year (19.5% vs. 15.1%), but this difference is not consistent across service types.
  • The increased service use is primarily due to higher prescription medication use (OR = 1.61; 95% CI = 1.23–2.09).
  • There is no significant difference in use of specialty behavioral health treatment (OR = 1.15; 95% CI = 0.81–1.62) or substance use disorder treatment (OR = 0.45; 95% CI = 0.20–1.01).

• Geographic Influence:

  • Rural areas are associated with lower use of behavioral health services for both groups.
  • For substance use disorder treatment, the disparity is particularly strong, with those in rural or small town areas significantly less likely to receive treatment compared to urban residents (OR = 0.6).
  • Proximity to MTFs has an unexpected effect:
    • Military wives living closer to an MTF are less likely to use prescription medications than those living farther away.
    • In contrast, the comparison group is more likely to use services when living near an MTF.
    • The relationship between MTF proximity and service use differs significantly between the two groups, indicating that the source of health coverage influences care patterns.

Key Information

• Sample Characteristics:
  Military wives differ from the comparison group in several ways, including:

  • Higher likelihood of being younger or older.
  • More likely to be retired or not in the labor market.
  • More likely to live in the South and near MTFs.
  • Less likely to be non-U.S. born.

• Geographic Categorization:

  • The study uses RUCA codes to classify areas as:
    • Core area of a large metropolitan area.
    • Noncore area of a large metropolitan area.
    • Micropolitan area.
    • Small town/rural area.
  • Proximity to MTFs is defined as within or outside a 30-minute driving radius.

• Methodology:

  • The study uses logistic regression models to adjust for demographic and behavioral health factors.
  • It compares service use across:
    • Specialty behavioral health treatment.
    • Prescription psychiatric medications.
    • Substance use disorder treatment.
    • Any behavioral health service.

• Limitations and Implications:

  • The study relies on indirect identification of military wives, which may affect accuracy.
  • The unexpected finding that military wives living farther from MTFs are more likely to use prescription medications raises questions about the quality of care they receive.
  • The study does not find evidence of disparities in behavioral health care between military wives and the general population, suggesting equal access.

Conclusion

This is the first study to examine behavioral health service use in a representative sample of TRICARE- or CHAMP-VA-covered military wives. While there are differences in service use patterns, particularly in prescription medication use, the overall findings suggest that military wives do not experience significant disparities in access to behavioral health care compared to the general population. The geographic and proximity effects highlight the complexity of service access and suggest the need for further research to understand the quality of care for those living farther from MTFs.