Veteran s access to Mental Health Services based on Gender

Does Gender Affect the Utilization of Mental Health Care Services among Veterans?
The decision one makes when choosing a career poses a lifelong effect on his own life as well as of his family members. The deployment decision of a career that the person has to face sometimes harms his mental health and family both (Brooks & Chopik, 2020). For example, if the person belongs to the army, he might be deployed in a war zone, which later would have disastrous impacts on his mental health in the form of stress, depression, and excessive use of alcohol, etc. The intensity of trauma might increase if the diagnosis is not done on time and may lead to family problems like divorce, social dysfunction, substance abuse, difficulties in future employment, legal complications, and, most of all, physical health troubles.
Recently, women's inclusion in almost all areas of life has been largely increased, and the same stands true for the army. Generally, it is observed that women need special care for small illnesses and therefore require outpatient health care services more frequently as compared to men; the same stands true for reproductive and depression care as well. So, per person, the medical costs of women are higher than men in general.
If women are deployed in conflict areas of war while being in the army, the medical costs might be higher (high outpatient and pharmacy costs) due to resulting mental health problems despite lower overall costs incurred by women in comparison to army men. It is important to understand that V.A. (Veteran Affairs) mental health costs based on gender differ among veterans of the army. The thesis statement of the following literature review highlights that there is a gender difference in the utilization of health care services among veterans, specifically military women. Although women's presence is large, since they are either young or belong to minorities, but the benefits they get against men are unfair. In further sections, a literature review is presented to provide sufficient background on the selected topic.
Literature Review
A Definite Need for Mental Health Care for Military Veterans
Various studies have now emerged which prove that military veterans who have served in conflict seas like Iraq and Afghanistan need special mental health care. The reason for this being that they suffer from severe mental impacts of the war circumstances during their service years in the deployment field. It has been proved from these researches that there has been a constant growth in the number of veterans seeking mental health care.
Therefore, the costs incurred on the visits per veterans for receiving mental care have also risen (Harpaz-Rotem & Rosenheck, 2011). This includes new veterans as well since it is imperative to retain them so that their services could be used for future years of their deployment. This study holds significance with relevance to the selected topic here as it shows that military veterans need special V.A. mental health care, and there is no left ambiguity in this regard.
It is accurate to assert that the negative impacts of the warzone are observed equally on V.A. military men and women who either have or not have received mental health care. Depression is a part of their personality when they return and therefore need special attention. Rates of PTSD were detected to be three times greater in military veterans who have received mental health care as compared to those who have not (Vaughan et al., 2014).
A key reason for such failure can be because the V.A. mental health care service was not meeting the veterans' treatment requirement. This difference can be eliminated by providing high-quality mental health care so that enrollment in V.A. mental care could be increased in the future, as still, a large population of veterans exists, who are not receiving this facility as yet. This research is similar to the selected topic here since it suggests the effects of V.A. mental health care on those who are receiving it and on those who are not, regardless of gender.
Signs when Medical Intervention for V.A. Health Care is Needed
Post-deployment health care includes numerous factors that provide the basis for veteran mental health care intervention. In a current research study, it had been established that mainly military men, who were older and belonged to the White community, were in war zone deployments (Adams et al., 2019).
The visible signs of mental health disorders included suicidal thoughts, depression, post-traumatic stress disorder (PTSD), and over usage of alcohol. The prominent factor of this research was the veteran identity and the number of years he had served in the military. Moreover, it was noted that older veterans had less income but were more likely to use alcohol and qualified strongly for V.A. services. This study is similar to the selected topic here since it provides the factors which are paid attention to for studying the need for V.A. services for veterans.
More Military Inclusion of Women and More Service Utilization
Veterans in any field serve several years in that specific career and expect returns after they are deployed. It should not be limited to those only who serve in the military but also applies to various other veterans who are in other careers. Recently, there has been a growing number of women seeking V.A. medical health care concerning chronic cancer pain. A study directed that there was a gender difference in the prescription of younger veterans as compared to the older ones (Weimer et al., 2013). Women observed higher visits, but the prevalence of pain was higher in females as compared to males. The difference was observed on the basis that women used more V.A. health care services in comparison with men. The data would have varied if the women using health care services were outside V.A. service, but this may provide a substantial basis for our research here. This study is similar to the selected topic since it provides grounds for gender difference with relevance to V.A. mental health care for military men and women.
In a similar study where men and women receiving V.A. medical health care for chronic pain showed that women use higher rates of outpatient services with chronic pain in terms of V.A. utilization (Kaur et al., 2007). Several research studies have demonstrated that women are less tolerant of the pain stimuli and exhibit high levels of distress when in pain, be it tissue injury.
This clearly shows a difference in the utilization of V.A. services among women, and this was also because patients linked with higher rates of depression received more outpatient care services. The study is similar to the currently chosen topic of research since it indicates that patients' psychological stage of mind determines his or her level of V.A. health care reception. The difference, however, comes with the gender when coping with pain.
Women and men are different from each other, physically and mentally. They both would suffer pain in different extents. Here, gender plays an important part since it would be interesting to see which gender is more persistent in receiving and bearing with pain. A study conducted by Haskell et al. (2009) showed that there was a gender difference in the prevalence of overall pain. The levels of pain varied from slight to moderate pain among participants from V.A. outpatient clinic visits.
The results showed that during the first year of deployment, women were less prevalent to have moderate to severe pain despite women being slightly more likely to have moderate to severe pain. This shows that women might not be directly deployed to the war zone, but they were taking part in equal assisting roles in the same area and were exposed to the same circumstances in comparison to men. However, the rate of persistent pain was lesser in women than in men. This study is similar to the currently chosen topic here since it matches the differentiation in gender regarding the prevalence of pain, which would be interesting to notice when both men and women receive V.A. medical health care.
Factors that play a part in the Utilization of V.A. Mental Health Care along with Gender
i. Hierarchy
Another study signified that hierarchy played a significant part in the receiving of healthcare services among women who were enrolled in V.A. healthcare a year post-discharge. Allore et al. (2013) discussed that hierarchical characteristics like branch and rank played an important role in making women eligible for V.A. healthcare based on their demographic factors like marital status, age or race, etc.
However, the variation in hierarchy produces different results on certain levels, which should be determined by further deeper research. The utilization of hierarchical structure would be important in determining whether men and women differ in receiving V.A. health care services at each level. Certain clusters and limitations were found in this research, which might produce biased results in current research here. This study is similar to the selected topic here since it enlists prominent factors for receiving of V.A. health care services such as hierarchy and demographics.
ii. Demographics
Demographics play an important part with gender for receiving V.A. mental health care, and this is validated with another study that verified this deduction. When race and ethnicity are studied alongside demographics, the females were observed to use more outpatient services, especially those who were in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) V.A. returns (Koo, Madden & Maguen, 2015).
To highlight more in this respect and verifying that women use more outpatient mental health care services as compared to men, a study indicated that it was evident. Still, in higher age groups, the difference might be subtle. The visits to psychiatric doctors were more overt among women, which was 4.6 percent in comparison to men, which was 3.3 percent (Hansen & Hoye, 2015). The mental health care, specifically when it was related to outpatient services, was typically used more by women. Anxiety and depression were reportedly seen more among females, but when the ages grew higher, that is more than 50 years, the trend was the opposite. Among women, it was also noticeable that a higher number of visits were associated with higher education, lower age, and low income leading to depression.
Mental health care services may be provided both inpatient and outpatient; however, since the outpatient services do not require the patient to stay within the facility, it is more often used by them. The patient satisfaction in outpatient mental health care services depends on several factors; one of them is critical, which is the patient's level of education (Desta, Berhe & Hintsa, 2018). If the patient's education level is high, he would be more aware of the mental services provided at the outpatient centers. He would be more critical of their treatment, leading to a lower satisfaction level.
These findings lead to another interesting fact that women veterans are both satisfied and unsatisfied with the outpatient medical health care services. A study depicted female veterans were less satisfied with the location of the care but greatly satisfied with the prescription services (Wright et al., 2006). On the contrary, it was also observed in another study that women felt more satisfied in clinics specifically designed for this gender rather than outpatient clinics serving both genders.
Women using more outpatient services also suggest the fact that they are more depressed, and they are more emotionally affected by the negative circumstances they were facing around themselves. For example, if a female military veteran would have experienced the same war events that are faced by men but get back home with disturbed mental states, they would not be in the apt shape of mind to deal with their kids or take care of other household chores. Therefore, they are noted to be using more outpatient services so that they could recover soon and get back normally to their home, kids, and professional responsibilities.
The ethnic and racial categories of military women who were war zone returns were utilizing these services lesser as compared to the regular U.S. ones. The study suggested that this category should be studied more closely concerning their ethnic group so that medical care could be served equally to all sects. This study is similar to the chosen topic here since it provides a strong basis for studying gender differences based on ethnic group structures for the utilization of V.A. mental health care services.
iii. Reluctance
A different interesting factor found in previous research was that women themselves felt reluctant to receive mental health care. Women have been included on a very small scale in previous studies that were based on gender regarding prevalence rates of mental disorders. The demographic factors that were highlighted in these studies were mainly either young age or belonging to an ethnic group. These demographic factors have implications on their V.A. mental health services as young women had to fulfill their responsibilities of looking after their kids and families, further employment, and school (Maguen et al., 2010). These stood as barriers to their receiving of mental health care treatment. This study is similar to the currently chosen topic here as the gender disparity majorly depends on the women's own reluctance to receive it.
Various previous studies point out the reasons for not seeking mental health care treatment. The low rates of veterans seeking mental health care are due to the reasons like societal shame, the impression of being weak, fear that people might deem them less suitable for military inclusion or leadership, negative impacts on friends and future employment, self-disgrace and functional barriers including distance from the clinic and time restrictions (True, Rigg & Butler, 2015). Building upon this work, it was further found that displeasure with specific treatment procedures and lack of willingness also deterred them from seeking treatment.
When talking about women, particularly, a study predominantly included White female respondents in reporting their response regarding civilian and veteran perceptions of stigma about PTSD (Roscoe & Anderson, 2019). Most of the labels selected by the participants were "crazy, weird, unfit to raise kids, unreliable," etc. This means that women thought they had a responsibility towards their home and kids, and that would be on risk if they are stigmatized as depressed veterans; thus, they were reluctant to receive mental health care. Moreover, they thought their friends and families would humiliate them, which can also lead to divorce and further depression.
In the above discussion, it was mentioned that women are using more outpatient mental health care services as compared to men so that they could get back to their normal lives with a clear state of mind. This observation sets in contrast with what is said here; the source of conflict being the females themselves. Most of them who have sought medical help are found to be showing positive results, but they're still is a majority that does not believe in getting medical help. The greatest deterrent for such behaviors is a social stigma in their professions, in families, and the perception that their children would have if they come to know about their mental state. This needs further research and needs to be revised so that this inconsistency could be studied deeper to understand the women's psyche and how these hindrances could be eliminated.
While this inconsistency remains, a study was conducted in which female military veterans from Iraq and Afghanistan recommended strategies for boosting their mental health care (Koblinsky, Scroeder & Leslie, 2016). This is a powerful leap towards mending their mental health since it includes their thoughts and proposals in this specified area. The researchers of this study were well aware that many women were reluctant to receive mental health care. For that, these females suggested that military culture should be studied thoroughly for understanding best practices for women and then devising treatments for them. The focus group responses of these women pointed out three aspects: enhancement of therapeutic relationship, clinical settlements, and overall system of health care itself. The interpersonal relations between the female patients and the psychiatric doctor were critical since the females needed to be listened too; they needed to share their devastating experiences in the warzone and wanted to take out all of their grief, anger, and depression. For this purpose, active listening and empathetic treatments are the core requirement. They required respect and care, which formed the basis of their mental health treatment. The gender-sensitive care was imperative since clinicians should have military, cultural expertise, which would be greatly helpful in welcoming unwilling females of the military setting. This is an advancement in the study of women's reluctance to receive mental health care since this study provided some groundwork mentioning women's thoughts in this area.
The difference in Costs when Military Men and Women used V.A. Mental Health Care
As the increase in women inclusion is seen in the army, especially those who are female veterans linked to OEF and OIF, the V.A. services are used by them more frequently. It was observed in research conducted among male and female veterans who used one-year V.A. health care to deduce costs between male and female veterans (Leslie et al., 2011).
The gender difference of this study showed that, in actuality, there was not much difference in the total incurred by both the genders regarding the utilization of V.A. healthcare service. It might be as in earlier studies. It was noted that women in the army were included lesser in numbers as compared to these days; hence, the women population is as greater in number as men these days. This study is similar to the currently selected topic here since the gender composition of the serving population in the military and those using the V.A. health care system would be vital in current research here for closer study of gender differentiation.
Identical research conducted in the year 2010 also specified that there was no significant difference in the utilization of health care services based on gender. Even when socio-demographic and military variables were adjusted for the study, no considerable difference was noted (Duggal et al., 2010).
This was due to the reason that the military veterans who returned from war zones like Afghanistan and Iraq were under trauma equally and needed identical mental health care. It could be deducted that mental care is crucial for both genders fairly and should not be neglected on the base of gender. This research is similar to the chosen topic here since it points out the importance of gender, along with the unbiased need for mental health care among veterans.

Conclusion of Literature Review with an Assessment of the Problem at Hand
The above literature review gives a clear picture that military men and women need uniform medical intervention since being in the army means they both have to face tough circumstances alike. In recent years, army women have been included in larger numbers, although they might not be deployed directly to the war field they work in the same area in assisting roles and are close to the conflict area.
The negative impacts on their mental health are quite noticeable and are important to be dealt with as soon as possible, as women have to return to their homes and children and need to be clear-headed for that purpose. If they come back with depression and suicidal thoughts in later stages, it would be hard for them in further employments and handle their daily home chores. Giving time to their children would be equally tough.
The key findings of the literature review include an undeniable need for mental health care for V.A. military men and women. Various signs exist that indicate when medical healthcare is required, such as post-traumatic stress disorder (PTSD), depression, suicidal thought, and overconsumption of alcohol. Moreover, there is increased usage of outpatient services by women due to the increased admittance of women in the army lately. Also, factors that play a vital role in receiving of V.A. mental health care along with gender include hierarchy, demographics, and the reluctance of women themselves, and minor or no major difference in costs incurred on the health care services on both genders.
The current status of the problem being researched is that military men and women do have mental health problems. Still, it is the critical role of the government and the psychologists who should look into this matter with more concern. The quality of services delivered is not up to the mark, and the women have to suffer since they are the homemakers after they are retired. They would have to stay home with their children, and if the after-effects of their deployment are lifelong, then their families would have to suffer. Thus, it is highly essential to give V.A. military women excellent mental health care to function exceptionally both at duty and at home.
References
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Allore, H.G., Ning, Y., Brandt, C.A., & Goulet, J.L. (2013). Accounting for the hierarchical structure in veterans' health administration data: Differences in healthcare utilization between men and women veterans. International Journal of Statistics in Medical Research, 2(2), 94-103. DOI: 10.6000/1929-6029.2013.02.02.03
Brooks, C. & Chopik, W. (2010, June 17). Research finds deployment affects mental health of veterans differently. Michigan State University. https://msutoday.msu.edu/news/2020/research-finds-deployment-affects-mental-health-of-veterans-differently/
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Koo, K.H., Madden, E. & Maguen, S. (2015). Race, ethnicity, and gender differences in V.A. health care service utilization among U.S. veterans of recent conflicts. Psychiatric Services, 66(5), 507-513. https://doi.org/10.1176/appi.ps.201300498
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Appendix
To become an effective scholarly writer, I realized that I need to make more use of active voice instead of passive. I should be more vigilant in my sentence structure since I learned that there could be many ways of putting words in interesting forms. If the writing style is descriptive or informative, then it is necessary to mention the details of the facts. Just as in the case of writing a literature review, I had to mention what various authors of the scholarly articles have found and had to link it with my topic of the paper. Hence, the writing style here was descriptive. However, in other scholarly writings, I have to keep in mind that sentence structure could be changed to make it more engaging.
While writing this paper, I also noticed that the writing should not be repetitive. There always have to be new words or synonyms that could be used as a replacement to avoid replication. For example, when I wrote about a scholarly article, "the findings showed," I used certain other words like depicted, verified, portrayed, represented, or described, etc. in place of "showed" so that repetition should not be there. More use of synonyms is the best way to avoid monotony in the research paper and make it more interesting for the reader. This further helps the writer to escape blandness in his writing.
In addition to that, becoming an effective scholarly writer requires being concise. The information resented in this paper was carefully chosen and had to be linked with the topic so that the literature review did not look out of line. The extracted information from the previous researches was summarized with great scrutiny so that it should not look extra detailed, and the reader should not feel bored. It means that there should be knowledge within the text, but it should be properly phrased and succinct. The overall expression should be strong, and it should not give the impression that it was written just for the sake of using fancy words.
My area of strength for further growth is my research skill. I can search on the internet for hours to acquire the precise information I need. I took a lot of time for careful selection of scholarly articles that should match my topic and also should reflect the thoughts of previous intellectuals on the topic. I also kept in mind that the reader should only know about the central topic, and for that, I should not sway away from the main idea. I knew my reader and presented the right information for that purpose. This strength would help me in future research paper writing as it would help me in gaining the confidence of my reader by citing the right evidence and in a logical way.
I felt that the area where I need more development is the organization and progression of ideas throughout the paper. I experienced that I had collected a lot of information on the first day, but it became difficult for me to put it in a systematized manner. It took me several hours to think what heading of the literature review should be first, why it needs to be on the top, why is it important, and why the others are secondary important, the transition of ideas from heading to heading and finally linking the main idea to the topic of research. Although I had tried my best to give structured sub-headings within the literature review so that all the factors of the topic appear clear and connected, it required a lot of time.
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