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Underdiagnosis of PTSD and Substance Use Disorders in Hospitalized Female Veterans

Citation:

Grossman, Linda S., Janet K. Willer, Jeffrey G. Stovall, Sandra G. McRae, Sarz Maxwell, and Rebecca Nelson. 1997. "Underdiagnosis of PTSD and Substance Use Disorders in Hospitalized Female Veterans." Psychiatric Services 48 (3): 393-95.

Authors: Linda S. Grossman, Janet K. Willer, Jeffrey G. Stovall, Sandra G. McRae, Sarz Maxwell, Rebecca Nelson

Abstract:

Discharge diagnoses of 31 female veterans and 31 male veterans hospitalized at a large urban VA medical center were examined to elucidate possible biases in clinicians' diagnostic practices. Only one woman in the sample was diagnosed as having posttraumatic stress disorder, compared with seven men. All men given this diagnosis were combat veterans. Although about half of each group had a drug-positive urine screen on admission, only 11 women received a diagnosis of a substance use disorder, compared with 24 men. VA clinicians may need further training and experience assessing the presentation of PTSD and substance use disorders in women.

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

Year: 1997

Southeast Asian Refugee Women and Depression: A Nursing Intervention

Citation:

Fox, P.G., J.M. Cowell, A.C. Montgomery, and M.A. Willgerodt. 1998. "Southeast Asian Refugee Women and Depression: A Nursing Intervention." The International Journal of Psychiatric Nursing Research 4 (1): 423-32.

Authors: P.G. Fox, J.M. Cowell, A.C. Montgomery, M.A. Willgerodt

Abstract:

Globally, conflicts continue to result in large numbers of refugees and displaced persons, the majority are women. At present, there is scant literature on the mental health status of refugee women following resettlement in countries that grant asylum. We do know that adaptation following migration is a complex cultural, psychological and social process. Some studies have suggested a high prevalence of depression symptoms related to premigration and post-migration experiences. The purpose of this paper will be to describe the mental health status of Southeast Asian (S.E.A.) refugee women in the United States, before home visit interventions by school nurses and bilingual teachers, and at 10, 20 and 33 weeks following the intervention. A comparison group of S.E.A. refugee women, who did not receive the intervention, were evaluated for mental health status on two occasions ten weeks apart. The identified needs and problems identified by the women, the interventions implemented by the school nurses and the success of the interventions will also be discussed. The underlying problem for the majority of women was poverty and social isolation. The study demonstrates that indeed, refugee women in the U.S., are experiencing needs and problems related to basic survival issues in multiple areas of their lives. The findings suggest that home visit interventions by nurses may be a valuable means of reducing depression in S.E.A. refugee women.

Keywords: female refugees, depression, mental health, counseling

Topics: Displacement & Migration, Refugees, Economies, Poverty, Gender, Women, Health, Mental Health Regions: Americas, North America, Asia, Southeast Asia Countries: United States of America

Year: 1998

Focus on Women: Duty-Related and Sexual Stress in the Etiology of PTSD among Women Veterans Who Seek Treatment

Citation:

Fontana, Alan, and Robert Rosenheck. 1998. "Focus on Women: Duty-Related and Sexual Stress in the Etiology of PTSD among Women Veterans Who Seek Treatment." Psychiatric Services 49 (5): 658-662.

Authors: Alan Fontana, Robert Rosenheck

Abstract:

Objective: The stressful experiences of women serving in the military have been a focus of increasing concern. A model of the impact of stress related to military duty and stress related to sexual abuse and harassment on the development of posttraumatic stress disorder (PTSD) among female veterans was evaluated. 

Methods: Structural equation modeling was applied to data from 327 women treated in a VA clinical program for women with stress disorders. The model was a chronological one and included variables related to the women's premilitary experience, their military service, and their postmilitary experience.

Results: Altogether 48 percent of the sample served overseas, and 12 percent were exposed to enemy fire. A total of 63 percent reported experiences of physical sexual harassment during military service, and 43 percent reported rape or attempted rape. Both duty-related and sexual stress were found to contribute separately and significantly to the development of PTSD. Sexual stress was found to be almost four times as influential in the development of PTSD as duty-related stress. Postmilitary social support played a highly significant mediational role between sexual stress during military service and development of PTSD.

Conclusions: Women's exposure to sexual stress in the military is much more prevalent than previously believed. It is particularly toxic for the development of PTSD. Correct assessment is essential to effective treatment.

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

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

Year: 1998

Posttraumatic Stress Disorder Screening Status is Associated with Increased VA Medical and Surgical Utilization in Women

Citation:

Dobie, Dorcas J., Charles Maynard, Daniel R. Kivlahan, Kay M. Johnson, Tracy Simpson, Andrew C. David, and Katharine Bradley. 2006. "Posttraumatic Stress Disorder Screening Status is Associated with Increased VA Medical and Surgical Utilization in Women." Journal of General Internal Medicine 21 (S3): S58-S64.

Authors: Dorcas J. Dobie, Charles Maynard, Daniel R. Kivlahan, Kay M. Johnson, Tracy Simpson, Andrew C. David, Katharine Bradley

Abstract:

BACKGROUND: Women with posttraumatic stress disorder (PTSD) report poor health, but associations with health care utilization are understudied.

OBJECTIVE: To determine associations between medical/surgical utilization and PTSD in female Veterans Affairs (VA) patients.

DESIGN: Prospective comparison of utilization rates between women screening positive or negative for PTSD on a mailed survey.

SUBJECTS: Women receiving care at an urban VA medical center between October 1996 and January 2000.

MEASUREMENTS: Survey responses, including a validated screen for PTSD (PCL-C), and VA utilization data through September 2002.

RESULTS: Two thousand five hundred and seventy-eight (2,578) women (78% of those eligible) completed the PCL-C; 858 (33%) of them screened positive for PTSD (PTSD+). In unadjusted models, PTSD+ women had higher rates of medical/surgical hospitalizations and surgical inpatient procedures. Among women ages 35 to 49, mean days hospitalized/100 patients/year was 43.4 (95% CI 26 to 61) for PTSD+ women versus 17.0 (16 to 18) for PTSD negative (PTSD?) women. More PTSD+ women underwent surgical procedures (P<.001). Mean annual outpatient visits were significantly higher among PTSD+ women, including: emergency department (ED) (1.1 [1.0 to 1.2] vs 0.6 [0.5 to 0.6]), primary care (3.2 [3.0 to 3.4] vs 2.2 [2.1 to 2.3]), medical/surgical subspecialists (2.1 [1.9 to 2.3] vs 1.5 [1.4 to 1.6]), ancillary services (4.1 [3.7 to 4.5] vs 2.4 [2.2 to 2.6]), and diagnostic tests (5.6 [5.1 to 6.1] vs 3.7 [3.4 to 4.0]). In multivariate models adjusted for demographics, smoking, service access, and medical comorbidities, PTSD+ women had greater likelihood of medical/surgical hospitalization (OR=1.37 [1.04 to 1.79]) and of being among the top quartile of patients for visits to the ED, primary care, ancillary services, and diagnostic testing.

CONCLUSIONS: Female veterans who screen PTSD+ receive more VA medical/surgical services. Appropriateness of that care deserves further study.

Keywords: female veterans, mental health, posttraumatic stress disorder

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

Year: 2006

Post-Traumatic Stress Disorder in Female Veterans: Association with Self-Reported Health Problems and Functional Impairment

Citation:

Dobie, Dorcas J., Daniel R. Kivlahan, Charles Maynard, Kristen R. Bush, Tania M. Davis and Katharine A. Bradley. 2004. "Post-Traumatic Stress Disorder in Female Veterans: Association with Self-Reported Health Problems and Functional Impairment." Archives of Internal Medicine 164 (4): 394-400.

Authors: Dorcas J. Dobie, Daniel R. Kivlahan, Charles Maynard, Kristen R. Bush, Tania M. Davis, Katharine A. Bradley

Abstract:

Background: The purpose of this report is to identify self-reported health problems and functional impairment associated with screening positive for posttraumatic stress disorder (PTSD) in women seen for care at a Department of Veterans Affairs (VA) medical center.

Methods: A survey was mailed to all women (N = 1935) who received care at the VA Puget Sound Health Care System between October 1996 and January 1998. The survey inquired about health history and habits. It included the PTSD Checklist–Civilian Version (PCL-C) and validated screening measures for other psychiatric disorders. The veteran's version of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36-V) was included to assess health-related quality of life.

Results: Of the 1259 eligible women who completed the survey, 266 women (21%) screened positive for current PTSD (PCL-C score ≥ 50). In age-adjusted bivariate analyses, women who screened positive for PTSD reported more psychiatric problems, substance abuse, and lifetime exposure to domestic violence. They were significantly more likely to endorse physical health problems including obesity, smoking, irritable bowel syndrome, fibromyalgia, chronic pelvic pain, polycystic ovary disease, asthma, cervical cancer, and stroke. In fully adjusted multivariate models, a PCL-C score of 50 or greater was independently associated with scoring in the lowest quartile on SF-36-V subscales and composite scales.

Conclusions: Symptoms of PTSD are common in women treated at VA facilities. In addition, PTSD is associated with self-reported mental and physical health problems and poor health-related quality of life in these patients. These findings have implications for the design of VA primary care services for the growing population of female veterans.

Keywords: female veterans, mental health, posttraumatic stress disorder

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

Year: 2004

Depression and Anxiety among Cambodian Refugee Women in France and the United States

Citation:

D'Avanzo, Carolyn E., and Sasha A. Barab. 1998. Depression and Anxiety among Cambodian Refugee Women in France and the United States. Issues in Mental Health Nursing 19 (6): 541-556.

Authors: Carolyn E. D'Avanzo, Sasha A. Barab

Abstract:

This study reports on Cambodian refugee data related to signs symptomatic of depression and anxiety, the tendency to worry or ruminate over past events (a culture-bound syndrome called ''Khoucherang''), and differences that might be influenced by social system and cultural practice. A sample consisting of 155 women of Cambodian national origin were interviewed in their homes in the USA and France. Answers to the research questions were collected by a focused interview to elicit demographic information, and the Hopkins Symptom Checklist (HSCL) in the Cambodian language to elicit depression and anxiety scores. Women residing in France (87%) were significantly more likely to show signs symptomatic of depression than women residing in the USA (65%). Women in the study reported about three times as much depression as the average American woman. Large numbers of women residing in both countries were symptomatic of anxiety (82% on average). Both groups experienced extreme symptoms of the culture-bound syndrome, “Khoucherang,” and appeared to be strongly influenced by the different social systems of the two countries.

Keywords: depression, anxiety, mental health, female refugees

Topics: Displacement & Migration, Refugees, Gender, Women, Health, Mental Health Regions: Americas, North America, Asia, Southeast Asia, Europe Countries: Cambodia, France, United States of America

Year: 1998

Women's Physical and Mental Health Sequellae of Wartime Service

Citation:

Bond, E. F. 2004. "Women's Physical and Mental Health Sequellae of Wartime Service." The Nursing Clinics of North America 39 (1): 53-68.

Author: E.F. Bond

Abstract:

War exposes soldiers to many risks; it is one of the most stressful known experiences. Increasing attention is being focused on the impact of war-related experiences on the health of the soldier. There is mounting evidence that men and women differ with respect to their health responses to stress exposure and other health challenges. However, most of our understanding of the effects of war on the subsequent health of the soldier is based on studies primarily or exclusively of men. Women have served as soldiers or support personnel in all US wars. In this article, health consequences of that service are explored. The purpose of this article is to (1) summarize evidence relating to war service and its impact on women's physical and mental health and (2) provide guidance for nurses caring for female soldiers and veterans. The information is based on a review of published and archived literature and on the observations of the author, who served as an army nurse at the 24th Evacuation Hospital, Long Binh, Vietnam, during 1 year (1970 to 1971) of the Vietnam War.

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

Year: 2004

Impact of Deployment Length and Experience on the Well-Being of Male and Female Soldiers

Citation:

Adler, Amy B., Ann H. Huffman, Paul D. Bliese, and Carl A. Castro. 2005. "The Impact of Deployment Length and Experience on the Well-Being of Male and Female Soldiers." Journal of Occupational Health Psychology 10 (2): 121-137.

Authors: Amy B. Adler, Ann H. Huffman, Paul D. Bliese, Carl A. Castro

Abstract:

This study examined the effects of stressor duration (deployment length) and stressor novelty (no prior deployment experience) on the psychological health of male and female military personnel returning from a peacekeeping deployment. The sample consisted of men (n = 2,114) and women (n= 1,225) surveyed for symptoms of depression and posttraumatic stress. The results confirmed the hypotheses. Longer deployments and 1st-time deployments were associated with an increase in distress scores. However, the relationship between deployment length and increased distress was found only for male soldiers. The findings demonstrate the importance of considering the impact of exposure to long-term occupational stressors and confirm, in part, previous research that has demonstrated a different stress response pattern for men and women.

Keywords: male soldiers, female soldiers, mental health, peacekeeping

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

Year: 2005

Military-Related Sexual Trauma among Veterans' Health Administration Patients Returning from Afghanistan and Iraq

Citation:

Kimerling, Rachel, Amy E. Street, Joanne Pavao, Mark W. Smith, Ruth C. Cronkite, Tyson H. Holmes, and Susan M. Frayne. 2010. "Military-Related Sexual Trauma Among Veterans’ Health Administration Patients Returning from Afghanistan and Iraq." American Journal of Public Health 100 (8): 1409-1412.

Authors: Rachel Kimerling, Amy E. Street, Joanne Pavao, Mark W. Smith, Ruth C. Cronkite, Tyson H. Holmes, Susan M. Frayne

Abstract:

We examined military-related sexual trauma among deployed Operation Enduring Freedom and Operation Iraqi Freedom veterans. Of 125729 veterans who received Veterans Health Administration primary care or mental health services, 15.1% of the women and 0.7% of the men reported military sexual trauma when screened. Military sexual trauma was associated with increased odds of a mental disorder diagnosis, including posttraumatic stress disorder, other anxiety disorders, depression, and substance use disorders. Sexual trauma is an important postdeployment mental health issue in this population.
 

Keywords: sexual violence, military, veterans, Operation Enduring Freedom, Operation Iraqi Freedom

Annotation:

Quotes:
 
"For our study, we completed, to our knowledge, the first national, population-based assessment of the mental health profile associated with a history of military sexual trauma among deployed Operation Enduring Freedom and Operation Iraqi Freedom veterans who used Veterans Health Administration services." (1410) 
 
"Women and men who reported a history of military sexual trauma were significantly more likely than those who did not to receive a mental health diagnosis, including  posttraumatic stress disorder (PTSD), other anxiety disorders, depression, and substance use disorders." (1411)
 
"Effect sizes for the relation of military sexual trauma to PTSD were substantially stronger among women compared with men, suggesting that military sexual trauma may be a particularly relevant gender-specific clinical issue in PTSD treatment settings." (1411)
 
"However, survivors of sexual trauma often delay disclosure and treatment of their experiences, and Operation Enduring Freedom and Operation Iraqi Freedom Veterans report stigma associated with help-seeking." (1411)

Topics: Armed Conflict, Combatants, Gender, Women, Men, Health, Mental Health, PTSD, Trauma, Security, Sexual Violence Regions: MENA, Americas, North America, Asia, Middle East, South Asia Countries: Afghanistan, Iraq, United States of America

Year: 2010

Gender Roles and Cultural Continuity in the Asian Indian Immigrant Community in the US

Citation:

Das Dasgupta, Shamita. 1998. "Gender Roles and Cultural Continuity in the Asian Indian Immigrant Community in the US." Sex Roles 38 (11-12): 953-74.

Author: Shamita Das Dasgupta

Abstract:

Ethnic identity is a part of positive self-concept that consciously anchors an individual to a particular ethnic group. Central to this identity is a sense of belonging, as well as a commitment to the group's values, beliefs, behaviors, conventions, and customs. This study focuses on the Asian Indian community in the U.S. to investigate their concerns with the continuity of ethnic identity via maintenance of traditional culture. Intergenerational synchrony in two specific values, attitudes toward women and dating, were examined as indicators of successful transmission of culture and identity. Forty-six educated, middle class Indian immigrant families, the majority of whom were foreign born and Hindus, participated in this study by responding to three questionnaires: Attitude Toward Women Scale, Dating Scale, and IPAT Anxiety Scale. Although the results show a strong similarity between parents and children on target attitudes, distinct intergenerational and gender asymmetries emerged. The conscious attempt to preserve certain critical attitudes, values, and behaviors characteristic of the group was labeled “judicious biculturalism,” an expression of active involvement on the immigrants' part to control the course of their own acculturation. The study has implications for women's status within the Asian Indian community.

Keywords: gender roles, immigration, gender transformation

Topics: Displacement & Migration, Migration, Ethnicity, Gender, Women, Gender Roles, Gendered Power Relations, Households Regions: Americas, North America, Asia, South Asia Countries: India, United States of America

Year: 1998

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