Mental health and substance abuse among women veteran clinic users with diabetes

Background: While it is widely known that substance use disorder (SUD) and mental illness (MI) are common conditions among male veteran population, it is not so well known how often these two co-occur in women veterans with a chronic condition like diabetes. The complexity of care increases with the co-occurrence of these multiple conditions and with a high prevalence of serious mental illness among women, it is very likely that their comorbid conditions are higher in the more complex categories of MI/SUD. Objectives: Define the complex categories of chronic illness in women with MI and SUD and determine the predictors of MI/SUD categories. Methods: Cross-sectional analysis of women veterans with diabetes, alive by FY1999, and not enrolled in Medicare HMO (N = 10,315). Chi-square, multinomial logistic regression used to examine association between SUD, MI and covariates. SUD, MI identified using ICD-9-CM codes; diabetes derived from FY1999 Diabetes Epidemiologic Cohort (DEpiC). Results: 42% of women had either MI or SUD or both (alcohol/drug combination or tobacco use); majority of these had a serious mental illness (SMI) (26%). The predictors of MI and SUD varied; African-American women reported lower likelihood of SMI (AOR: 0.69) but higher incidence of alcohol/drug use. Older women (50+ years) reported lower incidence of MI/SUD (AOR: 0.02-0.81).Severely disabled were likely to belong to MI/SUD groups (AOR: 1.59-1.98) (p<.001), Conclusion: Majority of women in SUD groups suffered from MI. High rates of comorbid conditions and severe disabilities in the mentally ill women suggest this population may suffer worse outcomes.