Mental Health

Citation:

Schaal, Susanne, Roland Weierstall, Jean-Pierre Dusingizemungu, and Thomas Elbert. 2012. “Mental Health 15 Years after the Killings in Rwanda: Imprisoned Perpetrators of the Genocide against the Tutsi versus a Community Sample of Survivors.” Journal of Traumatic Stress 25 (4): 446–53. doi:10.1002/jts.21728.

Authors: Susanne Schaal, Roland Weierstall, Jean-Pierre Dusingizemungu, Thomas Elbert

Abstract:

Objectives of this study were to compare rates of mental health disorders in Rwandan genocide perpetrators with those of genocide survivors and to investigate potential predictors of symptoms of posttraumatic stress disorder (PTSD) and depression for both groups. We expected high rates of mental disorders in both study groups and hypothesized that symptom severity would be predicted by female gender, older age, lower level of education, higher level of trauma exposure, lower level of agreement to reconciliation, and the participation in killing. Structured clinical interviews were carried out with 269 imprisoned perpetrators (66% men) and 114 survivors (64% women). Significantly more survivors than perpetrators met symptom criteria for PTSD (46% vs. 14%) and suffered from anxiety symptoms (59% vs. 36%). A substantial proportion of both groups suffered from clinically significant depression (46% vs. 41%). PTSD severity in perpetrators was associated with trauma exposure, high levels of agreement to reconciliation, and no participation in killing; the severity of depression was associated with trauma exposure and no participation in killing. In the survivor sample, the severity of PTSD and depression were both correlated with female gender, trauma exposure, and low levels of agreement to reconciliation. Results suggest that both groups exhibit considerable psychiatric morbidity.

Topics: Armed Conflict, Civil Wars, Gender, Women, Genocide, Health, Mental Health, PTSD, Trauma, Military Forces & Armed Groups, Violence Regions: Africa, Central Africa, East Africa Countries: Rwanda

Year: 2012

Citation:

Hassija, Christina M., Matthew Jakupcak, Shira Maguen, and Jillian C. Shipherd. 2012. “The Influence of Combat and Interpersonal Trauma on PTSD, Depression, and Alcohol Misuse in U.S. Gulf War and OEF/OIF Women Veterans.” Journal of Traumatic Stress 25 (2): 216–19. doi:10.1002/jts.21686.

Authors: Christina M. Hassija, Matthew Jakupcak, Shira Maguen, Jillian C. Shipherd

Abstract:

The present study evaluated the impact of combat and interpersonal trauma exposure in a sample of 115 U.S. women veterans from Gulf War I and the Iraq and Afghanistan wars on 3 postdeployment trauma-related mental health outcomes: posttraumatic stress disorder symptoms (PSS), depressive symptom severity (DSS), and alcohol misuse. Patients presenting for healthcare services at a Veterans Affairs postdeployment health specialty clinic completed screening questionnaires that assessed combat exposure, lifetime interpersonal trauma history of childhood neglect, physical, or sexual abuse, and adult sexual and physical assault. In a regression model, combat exposure was the only significant independent variable associated with PSS, DSS, and alcohol misuse (β = .42, .27 and B = 1.58, respectively) even after adding lifetime interpersonal assault exposure to the model. Results highlight the negative effects of combat exposure on treatment-seeking women veterans' postdeployment mental health. Incorporating combat exposure into routine screening procedures for Gulf War and Iraq and Afghanistan war women veterans can aid in mental health treatment planning.

Topics: Armed Conflict, Combatants, Female Combatants, Gender, Women, Health, Mental Health, PTSD, Military Forces & Armed Groups Regions: MENA, Americas, North America, Asia, Middle East, South Asia Countries: Afghanistan, Iraq, United States of America

Year: 2012

Citation:

Falb, Kathryn L., Marie C. McCormick, David Hemenway, Katherine Anfinson, and Jay G. Silverman. 2013. “Suicide Ideation and Victimization Among Refugee Women Along the Thai–Burma Border.” Journal of Traumatic Stress 26 (5): 631–35. doi:10.1002/jts.21846.

Authors: Katherine Anfinson, Kathryn L. Falb, David Hemenway, Marie C. McCormick, Jay G. Silverman

Abstract:

Refugee women may experience multiple forms of victimization. The hypotheses underlying the present analyses were that experiences of victimization during conflict and intimate partner violence (IPV) would be associated with heightened odds of suicide ideation among refugee women living in 3 camps along the Thai–Burma border. Descriptive statistics were generated to describe the prevalence of conflict victimization, past-year IPV victimization, past-month suicide ideation, and covariates among partnered women with complete data (N = 848) from a cross-sectional survey conducted in early 2008. Logistic generalized estimating equations were used to assess the crude and adjusted relationships between variables. The mean age of women was 32.12 years, 91.0% were married, and 78.8% were of Karen ethnicity. Overall, 7.4% of women reported past-month suicide ideation. Of those women who did not experience any victimization or conflict victimization only, 5.1% and 5.2% reported suicide ideation, respectively. By contrast 26.7% of women who experienced only IPV victimization reported suicide ideation, and 50.0% of women who experienced both forms of victimization reported suicide ideation. Understanding each form of violence victimization and their relationships to suicide ideation may be important for targeting psychosocial services and violence prevention programs within protracted refugee settings.

Topics: Armed Conflict, Displacement & Migration, Refugees, Gender, Women, Gender Analysis, Health, Mental Health, Trauma, Households Regions: Asia, Southeast Asia Countries: Myanmar, Thailand

Year: 2013

Citation:

King, Matthew W., Amy E. Street, Jaimie L. Gradus, Dawne S. Vogt, and Patricia A. Resick. 2013. “Gender Differences in Posttraumatic Stress Symptoms Among OEF/OIF Veterans: An Item Response Theory Analysis.” Journal of Traumatic Stress 26 (2): 175–83. doi:10.1002/jts.21802.

Authors: Jaimie L. Gradus, Matthew W. King, Patricia A. Resick, Amy E. Street, Dawne S. Vogt

Abstract:

Establishing whether men and women tend to express different symptoms of posttraumatic stress in reaction to trauma is important for both etiological research and the design of assessment instruments. Use of item response theory (IRT) can reveal how symptom reporting varies by gender and help determine if estimates of symptom severity for men and women are equally reliable. We analyzed responses to the PTSD Checklist (PCL) from 2,341 U.S. military veterans (51% female) who completed deployments in support of operations in Afghanistan and Iraq (Operation Enduring Freedom/Operation Iraqi Freedom [OEF/OIF]), and tested for differential item functioning by gender with an IRT-based approach. Among men and women with the same overall posttraumatic stress severity, women tended to report more frequent concentration difficulties and distress from reminders whereas men tended to report more frequent nightmares, emotional numbing, and hypervigilance. These item-level gender differences were small (on average d = 0.05), however, and had little impact on PCL measurement precision or expected total scores. For practical purposes, men's and women's severity estimates had similar reliability. This provides evidence that men and women veterans demonstrate largely similar profiles of posttraumatic stress symptoms following exposure to military-related stressors, and some theoretical perspectives suggest this may hold in other traumatized populations.

Topics: Combatants, Female Combatants, Male Combatants, Women, Men, Gender Analysis, Mental Health, PTSD, Military Forces & Armed Groups Regions: Africa, MENA, Americas, North America, Asia, Middle East, South Asia Countries: Afghanistan, Iraq, United States of America

Year: 2013

Citation:

Kimbrel, Nathan A., Margaret E. Johnson, Carolina Clancy, Michael Hertzberg, Claire Collie, Elizabeth E. Van Voorhees, Michelle F. Dennis, Patrick S. Calhoun, and Jean C. Beckham. 2014. “Deliberate Self-Harm and Suicidal Ideation Among Male Iraq/Afghanistan-Era Veterans Seeking Treatment for PTSD.” Journal of Traumatic Stress 27 (4): 474–77. doi:10.1002/jts.21932.

Authors: Patrick S. Calhoun, Carolina Clancy, Claire Collie, Michelle F. Dennis, Michael Hertzberg, Margaret E. Johnson, Nathan A. Kimbrel, Elizabeth E. Van Voorhees, Jean C. Beckham

Abstract:

The objectives of the present research were to examine the prevalence of deliberate self-harm (DSH) among 214 U.S. male Iraq/Afghanistan-era veterans seeking treatment for posttraumatic stress disorder (PTSD) and to evaluate the relationship between DSH and suicidal ideation within this population. Approximately 56.5% (n = 121) reported engaging in DSH during their lifetime; 45.3% (n = 97) reported engaging in DSH during the previous 2 weeks. As hypothesized, DSH was a significant correlate of suicidal ideation among male Iraq/Afghanistan-era veterans, OR = 3.88, p < .001, along with PTSD symptom severity, OR = 1.03, p < .001, and combat exposure, OR = 0.96, p = .040. A follow-up analysis identified burning oneself, OR = 17.14, p = .017, and hitting oneself, OR = 7.93, p < .001, as the specific DSH behaviors most strongly associated with suicidal ideation. Taken together, these findings suggest that DSH is quite prevalent among male Iraq/Afghanistan-era veterans seeking treatment for PTSD and is associated with increased risk for suicidal ideation within this population. Routine assessment of DSH is recommended when working with male Iraq/Afghanistan veterans seeking treatment for PTSD.

Topics: Combatants, Male Combatants, Gender, Men, Health, Mental Health, Trauma Regions: Africa, MENA, Americas, North America, Asia, Middle East, South Asia Countries: Afghanistan, Iraq, United States of America

Year: 2014

Citation:

Renshaw, Keith D., Sarah B. Campbell, Laura Meis, and Christopher Erbes. 2014. “Gender Differences in the Associations of PTSD Symptom Clusters With Relationship Distress in U.S. Vietnam Veterans and Their Partners.” Journal of Traumatic Stress 27 (3): 283–90. doi:10.1002/jts.21916.

Authors: Sarah B. Campbell, Christopher Erbes, Laura Meis, Keith D. Renshaw

Abstract:

Research has consistently linked symptoms of posttraumatic stress disorder (PTSD) with relationship distress in combat veterans and their partners. Studies of specific clusters of PTSD symptoms indicate that symptoms of emotional numbing/withdrawal (now referred to as negative alterations in cognition and mood) are more strongly linked with relationship distress than other symptom clusters. These findings, however, are based predominantly on samples of male veterans. Given the increasing numbers of female veterans, research on potential gender differences in these associations is needed. The present study examined gender differences in the multivariate associations of PTSD symptom clusters with relationship distress in 465 opposite-sex couples (375 with male veterans and 90 with female veterans) from the National Vietnam Veterans Readjustment Study. Comparisons of nested path models revealed that emotional numbing/withdrawal symptoms were associated with relationship distress in both types of couples. The strength of this association, however, was stronger for female veterans (b = .46) and female partners (b = .28), compared to male veterans (b = .38) and male partners (b = .26). Results suggest that couples-based interventions (e.g., psychoeducation regarding emotional numbing symptoms as part of PTSD) are particularly important for both female partners of male veterans and female veterans themselves.

Topics: Female Combatants, Male Combatants, Women, Men, Gender Analysis, Mental Health, PTSD, Military Forces & Armed Groups Regions: Americas, North America Countries: United States of America

Year: 2014

Citation:

Worthen, Miranda, Sujit D. Rathod, Gregory Cohen, Laura Sampson, Robert Ursano, Robert Gifford, Carol Fullerton, Sandro Galea, and Jennifer Ahern. 2015. “Anger and Posttraumatic Stress Disorder Symptom Severity in a Trauma-Exposed Military Population: Differences by Trauma Context and Gender.” Journal of Traumatic Stress 28 (6): 539–46. doi:10.1002/jts.22050.

Authors: Jennifer Ahern, Gregory Cohen, Carol Fullerton, Sandro Galea, Robert Gifford, Sujit D. Rathod, Laura Sampson, Robert Ursano, Miranda Worthen

Annotation:

Studies have found a stronger association between anger and posttraumatic stress disorder (PTSD) severity in military populations than in nonmilitary populations. Two hypotheses have been proposed to explain this difference: Military populations are more prone to anger than nonmilitary populations, and traumas experienced on deployment create more anger than nondeployment traumas. To examine these hypotheses, we evaluated the association between anger and PTSD severity among never-deployed military service members with nondeployment traumas (n = 226) and deployed service members with deployment traumas (n = 594) using linear regression. We further examined these associations stratified by gender. Bivariate associations between anger and PTSD severity were similar for nondeployment and deployment events; however, gender modified this association. For men, the association for deployment events was stronger than for nondeployment events (β = .18, r = .53 vs. β = .16, r = .37, respectively), whereas the reverse was true for women (deployment: β = .20, r = .42 vs. nondeployment: β = .25, r = .65). Among men, findings supported the hypothesis that deployment traumas produce stronger associations between PTSD and anger and are inconsistent with hypothesized population differences. In women, however, there was not a clear fit with either hypothesis.

Topics: Female Combatants, Male Combatants, Health, Mental Health, Military Forces & Armed Groups

Year: 2015

Citation:

Millegan, Jeffrey, Emma K. Milburn, Cynthia A. LeardMann, Amy E. Street, Diane Williams, Daniel W. Trone, and Nancy F. Crum-Cianflone. 2015. “Recent Sexual Trauma and Adverse Health and Occupational Outcomes Among U.S. Service Women.” Journal of Traumatic Stress 28 (4): 298–306. doi:10.1002/jts.22028.

Authors: Nancy F. Crum-Cianflone, Cynthia A. LeardMann, Jeffrey Millegan, Emma K. Milburn, Amy E. Street, Daniel W. Trone, Diane Williams

Abstract:

Sexual trauma is prevalent among military women, but data on potential effects are needed. The association of sexual trauma with health and occupational outcomes was investigated using longitudinal data from the Millennium Cohort Study. Of 13,001 U.S. service women, 1,364 (10.5%) reported recent sexual harassment and 374 (2.9%) recent sexual assault. Women reporting recent sexual harassment or assault were more likely to report poorer mental health: OR = 1.96, 95% CI [1.71, 2.25], and OR = 3.45, 95% CI [2.67, 4.44], respectively. They reported poorer physical health: OR = 1.39, 95% CI [1.20, 1.62], and OR = 1.39, 95% CI [1.04, 1.85], respectively. They reported difficulties in work/activities due to emotional health: OR = 1.80, 95% CI [1.59, 2.04], and OR = 2.70, 95% CI [2.12, 3.44], respectively. They also reported difficulties with physical health: OR = 1.55, 95% CI [1.37, 1.75], and OR = 1.52 95% CI [1.20, 1.91], respectively, after adjustment for demographic, military, health, and prior sexual trauma characteristics. Recent sexual harassment was associated with demotion, OR = 1.47, 95% CI [1.12, 1.93]. Findings demonstrated that sexual trauma represents a potential threat to military operational readiness and draws attention to the importance of prevention strategies and services to reduce the burden of sexual trauma on military victims.

Topics: Combatants, Female Combatants, Health, Mental Health, Military Forces & Armed Groups, Sexual Violence Regions: Americas, North America Countries: United States of America

Year: 2015

Citation:

Stahlman, Shauna, Marjan Javanbakht, Susan Cochran, Alison B. Hamilton, Steven Shoptaw, and Pamina M. Gorbach. 2015. “Mental Health and Substance Use Factors Associated With Unwanted Sexual Contact Among U.S. Active Duty Service Women.” Journal of Traumatic Stress 28 (3): 167–73. doi:10.1002/jts.22009.

Authors: Susan Cochran, Pamina M. Gorbach, Alison B. Hamilton, Marjan Javanbakht, Steven Shoptaw, Shauna Stahlman

Abstract:

Many U.S. military women are exposed to unwanted sexual contact during military service, which can have important implications for mental health. Using data from the 2008 Department of Defense Survey of Health Related Behaviors, we employed multiple logistic regression methods to examine whether unwanted sexual contact was associated with stress, screening positive for mental disorders, or substance use, among active duty service women. The sample included 7,415 female military personnel, of whom 13.4% reported unwanted sexual contact (including any touching of genitals) since entering the military. After adjusting for potentially confounding variables, factors independently associated with unwanted sexual contact included military-related stress (adjusted odds ratio [AOR] = 2.44), family/personal life-related stress (AOR = 1.78), and gender-related stress (AOR = 1.98) in the past 12 months. In addition, screening positive for depression, anxiety, posttraumatic stress disorder, or psychological distress, and suicidal ideation or attempt were associated with unwanted sexual contact (AOR = 1.57–2.11). For drug/alcohol use, only misuse of tranquilizers/muscle relaxers (past 12 months) was associated with report of unwanted sexual contact (AOR = 1.35). Given the prevalence of unwanted sexual contact and corresponding adverse health outcomes in this sample of active duty women, strategies to create military structural/cultural changes and reduce gender-related stress and sexism are needed.

Topics: Armed Conflict, Female Combatants, Gender, Women, Health, Mental Health, Sexual Violence Regions: Americas, North America Countries: United States of America

Year: 2015

Citation:

Porter, Elisabeth. 2015. “Gendered Narratives: Stories and Silences in Transitional Justice.” Human Rights Review 17 (1): 35–50. doi:10.1007/s12142-015-0389-8.

Author: Elisabeth Porter

Abstract:

Stories told about violence, trauma, and loss inform knowledge of post-conflict societies. Stories have a context which is part of the story-teller's life narrative. Reasons for silences are varied. This article affirms the importance of telling and listening to stories and notes the significance of silences within transitional justice's narratives. It does this in three ways. First, it outlines a critical narrative theory of transitional justice which confirms the importance of narrative agency in telling or withholding stories. Relatedly, it affirms the importance of story-telling as a way to explain differentiated gender requirements within transitional justice processes. Second, it examines gendered differences in the ways that women are silenced by shame, choose silence to retain self-respect, use silence as a strategy of survival, or an agential act. Third, it argues that compassionate listening requires gender-sensitive responses that recognize the narrator's sense of self and needs.

Keywords: compassionate listening, gendered narratives, narrative agency, silences, stories in transitional justice

Topics: Gender, Health, Mental Health, Justice, Transitional Justice, Violence

Year: 2015