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Gender Differences in Health Service Utilization among Iraq and Afghanistan Veterans with Posttraumatic Stress Disorder

Citation:

Maguen, Shira, Beth Cohen, Greg Cohen, Erin Madden, Daniel Bertenthal, and Karen Seal. 2012. "Gender Differences in Health Service Utilization among Iraq and Afghanistan Veterans with Posttraumatic Stress Disorder." Journal of Women's Health 21(6): 666-673.

Authors: Shira Maguen, Beth Cohen, Greg Cohen, Erin Madden, Daniel Bertenthal, Karen Seal

Abstract:

Background: Little is known about gender differences in healthcare use among newly returning veterans with posttraumatic stress disorder (PTSD). We investigated gender differences in Veterans Affairs (VA) medical center health service use among Iraq and Afghanistan veterans with PTSD with and without comorbid depression and alcohol use disorders (AUD).

Methods: Using VA administrative data, bivariate and multivariate statistics were used to examine gender differences in health service use among 159,705 Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) veterans with PTSD seeking VA healthcare from October 7, 2001, to December 31, 2010.

Results: Female veterans with PTSD were more likely to be black and single and to have higher mental health, primary care, and emergency care use compared to men with PTSD. Men were more likely to have higher mental health inpatient use compared to women. Women and men with comorbid PTSD and depression or comorbid PTSD and AUD were more likely to have higher use in all domains compared to their counterparts with PTSD without these comorbid disorders. Women with comorbid PTSD and depression were 12.5 times more likely to have a mental health inpatient hospitalization compared to their female counterparts without depression and twice as likely to have a mental health hospitalization compared to men with comorbid PTSD and depression.

Conclusions: Women with PTSD had higher use than men in almost all areas, as did all veterans with comorbid PTSD and depression and comorbid PTSD and AUD, regardless of gender. Better understanding these health service use differences will allow for targeted evaluation and integrated treatment interventions in veterans with PTSD.

Keywords: female veterans, male veterans, posttraumatic stress disorder, mental health

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

Year: 2012

The Impact of Sexual Harassment on Military Personnel: Is it the Same for Men and Women?

Citation:

Magley, Vicki J., Craig R. Waldo, Fritz Drasgow, and Louise F. Fitzgerald. 1999. "The Impact of Sexual Harassment on Military Personnel: Is it the Same for Men and Women?" Military Psychology 11 (3): 283-302.

Authors: Vicki J. Magley, Craig R. Waldo, Fritz Drasgow, Louise F. Fitzgerald

Abstract:

Research in the civilian workplace has documented the serious psychological, health-related, and job-related outcomes of sexual harassment of women by men. The question of whether men experience sexual harassment similarly has more recently been proposed (Berdahl, Magley, & Waldo, 1996; Popovich, Campbell, Everton, Mangan, & Godinho, 1994; Vaux, 1993; Waldo, Berdahl, & Fitzgerald, 1998; Waldo & Magley, 1996), resulting in considerable debate regarding not only the extent of the outcomes of such experiences but also the sex of the offender. This study directly compared outcomes of sexual harassment for men and women utilizing data from the U.S. Department of Defense's (1995) recent gender issues survey. The results of both linear and quadratic regression analyses indicate that within the range of similar experiences, sexual harassment exerts a negative effect on male and female personnel in similar ways on 3 sets of outcomes: psychological, health, and job-related. Three differences emerged, however, suggesting differential experiences of sexual harassment for men and women. First, women were more likely to have been sexually harassed than were men. Second, women experienced sexual harassment at higher frequencies than did men; the negative impact on women, both individually and as a group, is thus considerably more pronounced. Finally, women almost always experienced sexual harassment from men; men were somewhat more likely to experience such behaviors from men than from women.

Keywords: military sexual assault, female soldiers, male soldiers, mental health

Topics: Combatants, Female Combatants, Male Combatants, Gender, Women, Men, Health, Mental Health, Sexual Violence, SV against men, SV against women Regions: Americas, North America Countries: United States of America

Year: 1999

Group Counseling with Traumatized East African Refugee Women in the United States

Citation:

Loewy, Michael I., DiAnna T. Williams, and Aster Keleta. 2002. "Group Counseling with Traumatized East African Refugee Women in the United States." The Journal for Specialists in Group Work 27 (2): 173-191.

Authors: Michael I. Loewy, DiAnna T. Williams, Aster Keleta

Abstract:

The Kaffa ceremony is a unique, culturally appropriate, group counseling intervention for female East African refugees. A counseling group is described in which the Kaffa ceremony was instrumental in helping to bridge the gap between Western counseling and East African culture, providing a context for the group members to resolve long-held trauma. Stages of group process and therapeutic factors are identified and ethical concerns are addressed. Recommendations for incorporating the Kaffa Intervention into professional practice with this population, as well as relevant information about the cultures, are provided.

Keywords: mental health, female refugees, trauma, counseling

Topics: Displacement & Migration, Refugees, Gender, Women, Health, Mental Health, Trauma, Humanitarian Assistance, Context-Appropriate Response to Trauma Regions: Africa, East Africa, Americas, North America Countries: United States of America

Year: 2002

Alternative Representations of War Zone Stressors: Relationships to Posttraumatic Stress Disorder in Male and Female Vietnam Veterans

Citation:

King, Daniel W., Lynda A. King, David M. Gudanowski, and Dawn L. Vreven. 1995. "Alternative Representations of War Zone Stressors: Relationships to Posttraumatic Stress Disorder in Male and Female Vietnam Veterans." Journal of Abnormal Psychology 104 (1): 184-96.

Authors: Daniel W. King, Lynda A. King, David M. Gudanowski, Dawn L. Vreven

Abstract:

Four conceptualizations of war zone stressor experiences were defined: traditional combat, atrocities-abusive violence, perceived threat, and malevolent environment. Items from the National Vietnam Veterans Readjustment Study (NVVRS) were reviewed for content, and stressor indexes were created. Using retrospective self-report data from the NVVRS, intercorrelations among stressor scores and between these scores and measures of posttraumatic stress disorder (PTSD) were computed for all veterans and for men and women separately. Structural equation modeling procedures followed. Results indicated that the four stressor indexes were internally consistent, reasonably distinct from one another, and influenced PTSD differentially. Men scored significantly higher than women on all 4 indexes. Whereas the pattern of relationships among the variables was comparable across genders, there was evidence that one path coefficient in the model differed for men and women.

Keywords: fe

Topics: Gender, Health, Mental Health, PTSD, Trauma, Military Forces & Armed Groups Regions: Americas, North America Countries: United States of America

Year: 1995

Fathers, Sons, and Vietnam: Masculinity and Betrayal in the Life Narratives of Vietnam Veterans with Post Traumatic Stress Disorder

Citation:

Karner, Tracy. 1996. "Fathers, Sons, and Vietnam: Masculinity and Betrayal in the Life Narratives of Vietnam Veterans with Post Traumatic Stress Disorder." American Studies 37 (1): 63-94.

Author: Tracy Karner

Keywords: masculinity, posttraumatic stress disorder, mental health

Topics: Armed Conflict, Gender, Masculinity/ies, Health, Mental Health, PTSD, Trauma, Military Forces & Armed Groups Regions: Americas, North America Countries: United States of America

Year: 1996

The Role of Sexual Assault on the Risk of PTSD among Gulf War Veterans

Citation:

Kang, Han, Nancy Dalager, Clare Mahan, and Erick Ishii. 2005. "The Role of Sexual Assault on the Risk of PTSD among Gulf War Veterans." Annals of Epidemiology 15 (3): 191-95.

Authors: Han Kang, Nancy Dalager, Clare Mahan, Erick Ishii

Abstract:

Purpose: The 1991 Gulf War was the first major military deployment where female troops were integrated into almost every military unit, except for combat ground units. We evaluated the impact of reported sexual trauma during this deployment on the risk of post-traumatic stress disorder (PTSD) after the war.

Methods: A nested case–control analysis was conducted using the data collected in a population-based health survey of 30,000 Gulf War era veterans. A total of 1381 Gulf War veterans with current PTSD were compared with 10,060 Gulf veteran controls without PTSD for self-reported in-theater experiences of sexual harassment/assault and combat exposure.

Results: The adjusted odds ratio (aOR) for PTSD associated with a report of sexual assault was 5.41 (95% confidence interval [CI], 3.19–9.17) in female veterans and 6.21 (95% CI, 2.26–17.04) in male veterans. The aOR for PTSD associated with “high” combat exposure was also statistically significant (aOR, 4.03 [95% CI, 1.97–8.23] for females; aOR, 4.45 [95% CI, 3.54–5.60] for males).

Conclusion: Notwithstanding a possibility of recall bias of combat and sexual trauma, for both men and women, sexual trauma as well as combat exposure appear to be strong risk factors for PTSD.

Keywords: military sexual assault, posttraumatic stress disorder, male veterans, female veterans, mental health

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

Year: 2005

The Mental Health Status of Women in the Navy and Marine Corps: Preliminary Findings from the Perceptions of Wellness and Readiness Assessment

Citation:

Hourani, Laurel L., and Huixing Yuan. 1999. "The Mental Health Status of Women in the Navy and Marine Corps: Preliminary Findings from the Perceptions of Wellness and Readiness Assessment." Military Medicine 164 (3): 174- 81.

Authors: Laurel L. Hourani, Huixing Yuan

Abstract:

Examined the most common adult psychiatric disorders of Navy and Marine Corps personnel and compared their military subpopulations. A population-based, multi-stage, cluster sample of 782 active duty Navy and Marine Corps females and males (aged 18–64 yrs) were administered a structured computerized telephone interview to make Diagnostic and Statistical Manual of Mental Disorders-III-Revised (DSM-III-R) psychiatric diagnoses. Results indicate that females had about 5 times the risk of experiencing posttraumatic stress disorder (PTSD) than males and about twice the risk of a major depressive episode. Of all personnel meeting diagnostic criteria for an active mental disorder, only 19% sought mental health care in the last year. Females generally sought treatment more readily than males. (Abstract from PsycINFO)

Keywords: mental health, female soldiers, posttraumatic stress disorder, depression

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

Year: 1999

The Use of VA and Non-VA Mental Health Services by Female Veterans

Citation:

Hoff, Rani A., and Robert A. Rosenheck. 1998. "The Use of VA and Non-VA Mental Health Services by Female Veterans." Medical Care 36 (11): 1524-33.

Authors: Rani A. Hoff, Robert A. Rosenheck

Abstract:

Objectives. This study compared Department of Veterans Affairs (VA) and non-VA mental health service use among male and female veterans. Because female veterans are a distinct minority in VA, it was hypothesized that they would be less likely to use VA mental health care than would male veterans.

Methods. Using data from a national sample of Vietnam and Vietnam-era male (n = 1,612) and female (n = 736) veterans, the following were examined: (1) gender differences in use of VA mental health services, (2) gender differences in use of non-VA mental health services, and (3) differences in utilization of mental health services across subgroups defined by psychiatric diagnosis, adjusting for sociodemographic and need variables.

Results. Female veterans were equally likely to use VA mental health services as male veterans, but were substantially more likely to use non-VA mental health services. This suggests that the demand for mental health services overall is substantially greater among female veterans than among male veterans and, by implication, that the equal levels of observed VA service use actually represent underutilization of VA services on the part of female veterans. Logistic regression models showed that these utilization patterns were consistent across diagnostic subgroups.

Conclusions. Special efforts, such as the development of women's specialty mental health clinics, may be needed to enhance the acceptability of VA mental health services to female veterans. This study also highlights the importance of considering overall demand for services in addition to more objective diagnostic data in evaluating the adequacy of service delivery and its accessibility.

Keywords: female veterans, mental health

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

Year: 1998

Gender Differences in Rates of Depression, PTSD, Pain, Obesity, and Military Sexual Trauma among Connecticut War Veterans of Iraq and Afghanistan

Citation:

Haskell, Sally G., Kirsha S. Gordon, Dristen Mattocks, Mona Duggal, Joseph Erdos, Amy Justice, and Cynthia A. Brandt. 2010. "Gender Differences in Rates of Depression, PTSD, Pain, Obesity, and Military Sexual Trauma among Connecticut War Veterans of Iraq and Afghanistan." Journal of Women's Health 19 (2): 267-271.

Authors: Sally G. Haskell, Kirsha S. Gordon, Dristen Mattocks, Mona Duggal, Joseph Erdos, Amy Justice, Cynthia A. Brandt

Abstract:

Purpose: The current wars in Iraq and Afghanistan have led to an increasing number of female veterans seeking medical and mental healthcare in the Department of Veterans Affairs (VA) healthcare system. To better understand gender differences in healthcare needs among recently returned veterans, we examined the prevalence of positive screenings for depression, posttraumatic stress disorder (PTSD), military sexual trauma ( MST), obesity, and chronic pain among female and male veterans of Operation Enduring Freedom=Operation Iraqi Freedom (OEF=OIF) receiving care at the VA Connecticut Healthcare System.

Methods: We performed a retrospective, cross-sectional data analysis of OEF=OIF veterans at VA Connecticut who received services in either Primary Care or the Women’s Health Clinic between 2001 and 2006. 

Results: In this study, 1129 electronic medical records (1032 men, 197 women) were examined. Female veterans were more likely to screen positive for MST (14% vs. 1%, p < 0.001) and depression (48% vs. 39%, p ¼ 0.01) and less likely to screen positive for PTSD (21% vs. 33%, p ¼ 0.002). There was no significant gender difference in clinically significant pain scores. Men were more likely than women to have body mass index (BMI) >30 kg=m2 (21% vs. 13%, p ¼ 0.008).

Conclusions: These results suggest that important gender differences exist in the prevalence of positive screenings for MST, depression, obesity, and PTSD. As the VA continues to review and improve its services for women veterans, clinicians, researchers, and senior leaders should consider innovative ways to ensure that female veterans receive the health services they need within the VA system.

Keywords: depression, posttraumatic stress disorder, obesity, military sexual assault, female veterans, male veterans

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

Year: 2010

Prevalence of Depressive and Alcohol Abuse Symptoms among Women VA Outpatients Who Report Experiencing Sexual Assault While in the Military

Citation:

Hankin, Cheryl S., Katherine Skinner, Lisa M. Sullivan, Donald R. Miller, Susan Frayne, and Tara J. Tripp. 1999. "Prevalence of Depressive and Alcohol Abuse Symptoms among Women VA Outpatients Who Report Experiencing Sexual Assault While in the Military." Journal of Traumatic Stress 12 (4): 601-612.

Authors: Cheryl S. Hankin, Katherine Skinner, Lisa M. Sullivan, Donald R. Miller, Susan Frayne, Tara J. Tripp

Abstract:

Among a national sample of 3,632 women VA outpatients, we determined self-reported prevalence of sexual assault experienced during military service and compared screening prevalence for current symptoms of depression and alcohol abuse between those who did and did not report this history. Data were obtained by mailed questionnaire. Military-related sexual assault was reported by 23%. Screening prevalence for symptoms of current depression was 3 times higher and for current alcohol abuse was 2 times higher among those who reported experiencing military-related sexual assault. Recent mental health treatment was reported by 50% of those who reported experiencing sexual assault during military service and screened positive for symptoms of depression, and by 40% of those who screened positive for symptoms of alcohol abuse.

Keywords: depression, substance abuse, female veterans, military sexual assault

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

Year: 1999

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