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PTSD

Experiences of Trauma, Discrimination, Microaggressions, and Minority Stress among Trauma-Exposed LGBT Veterans: Unexpected Findings and Unresolved Service Gaps

Citation:

Livingston, Nicholas A., Danielle S. Berke, Mollie A. Ruben, Alexis R. Matza, and Jillian C. Shipherd. 2019. "Experiences of Trauma, Discrimination, Microaggressions, and Minority Stress among Trauma-Exposed LGBT Veterans: Unexpected Findings and Unresolved Service Gaps." Psychological Trauma: Theory, Research, Practice, and Policy 11 (7): 695-703.

Authors: Nicholas A. Livingston, Danielle S. Berke, Mollie A. Ruben, Alexis R. Matza, Jillian C. Shipherd

Abstract:

Objective: LGBT veterans experience high rates of trauma, discrimination, and minority stress. However, guidelines for case conceptualization and treatment remain limited. The aim of the current study was to examine the experiences of trauma and other high impact experiences among LGBT veterans to inform case conceptualization and treatment.
 
Method: We recruited 47 LGBT veterans with a history of exposure to LGBT-related Criterion A trauma and performed semistructured interviews about their experiences in trauma treatment, barriers to engagement, and treatment needs and preferences. We used thematic analysis of qualitative codes guided by inductive and deductive approaches to characterize the variety of trauma and high impact experiences reported.
 
Results: LGBT veterans disclosed a range of clinically relevant stressors, including Criterion A traumatic events, minority stress, and microaggression experiences, including interpersonal and institutional discrimination perpetrated by fellow service members/veterans, citizens, therapy group members, and health care providers.
 
Conclusion: These data provide a unique account of LGBT veteran's identity-related trauma and concomitant interpersonal and institutional discrimination, microaggression experiences, minority stress, and traumatic stress symptoms. Findings highlight existing service gaps regarding evidence-based treatments for the sequalae of trauma, discrimination, microaggressions, and minority stress. In addition, we noted past and present issues in military and health care settings that may lead to or exacerbate trauma-related distress and discourage treatment seeking among LGBT veterans. We provide suggestions for clinical work with LGBT veterans and encourage ongoing research and development to eliminate remaining service gaps. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

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

Year: 2019

The Contribution of Mental Health and Gender Attitudes to Intimate Partner Violence in the Context of War and Displacement: Evidence from a Multi-Informant Couple Survey in Iraq

Citation:

Goessmann, Katharina, Hawkar Ibrahim, Laura Bebra Saupe, Azad Ali Ismail, and Frank Neuner. 2019. "The Contribution of Mental Health and Gender Attitudes to Intimate Partner Violence in the Context of War and Displacement: Evidence from a Multi-Informant Couple Survey in Iraq." Social Science & Medicine 237.

Authors: Katharina Goessmann, Hawkar Ibrahim, Laura Bebra Saupe, Azad Ali Ismail, Frank Neuner

Abstract:

Rationale: Intimate partner violence is a prevalent issue in refugee and internally displaced populations in postwar and migration settings including camps in the Middle East. In this context, partner violence has been associated with war-related trauma, camp factors, individual characteristics, and gender attitudes. 
 
Objective: With a dual-informant survey among a sample of Iraqi couples residing in a camp for displaced people in the Kurdistan Region of Iraq (N = 92) this study investigated the relationship between war-related psychopathology, attitudes towards women, and male-perpetrated partner violence. 
 
Method: Moderated regression analysis was applied using information from both partners to predict partner violence reported by wives. 
 
Results: Over 58% of the women in this sample reported past-year exposure to partner violence. Further analyses revealed significant main effects of men's self-reported psychopathology (posttraumatic stress disorder and depression) and their own gender attitudes on partner violence. In a multivariate regression, moderating effects were found, as higher psychopathology levels and inequitable gender attitudes in men interacted in the prediction of male-perpetrated partner violence. 
 
Conclusions: This study highlights the high prevalence of partner violence among Iraqi displaced women. In addition, the results show an interplay of several violence-impelling factors in war-affected men. This emphasizes the importance of addressing both mental health issues and gender attitudes in the efforts to reduce or end violence against women in post-war settings.

Keywords: Iraq, Intimate partner violence, forced displacement, traumatic, experiences, mental health, gender attitudes, moderated regression analysis

Topics: Displacement & Migration, IDPs, Refugees, Refugee/IDP Camps, Domestic Violence, Gender, Health, Mental Health, PTSD, Trauma, Post-Conflict Regions: MENA, Asia, Middle East Countries: Iraq

Year: 2019

Gender Differences in Children Mental Health Disorders after Earthquakes in Iran: A Systematic Review

Citation:

Seddighi, Hamed, and Ibrahim Salmani. 2019. "Gender Differences in Children Mental Health Disorders after Earthquakes in Iran: A Systematic Review." Journal of Community Health Research 8 (1): 54-64.

Authors: Hamed Seddighi, Ibrahim Salmani

Abstract:

Introduction: Earthquake occurs in the world every year and Iran is one of the most earthquake-prone countries in the world with the ranking of 15 between 120 countries. Children are the most vulnerable group in disasters and they have a number of negative symptoms after a disaster. 
 
Methods: This study used the systematic review method and followed systematic review principles. Mental health, earthquake, psychosocial, PTSD, post-traumatic stress disorder, and stress were the keywords used to search in the Iranian scientific information database (SID), Noor Specialized Magazines (Noormags) and Google Scholar. The language of the search was Farsi and just Farsi articles were included in the review. 
 
Results: The result were presented in five sections (Psychosocial interventions, Signs of disorder, Gender, Age, Geographical area). It showed psychosocial interventions of those studied in reviewed papers were effective and there were gender differences in children mental health disorders after earthquakes in Iran. In addition, PTSD group, girls reported all the symptoms of PTSD more than the boys except anger symptoms, but the prevalence of PTSD symptoms in males was higher than in girls. 
 
Conclusion: Iranian studies just focused on male and female gender and found that disorders are higher in girls of different ages in childhood. In the age group of 13 to 18 years, the frequency of each disorder was less than that of the seven to twelve-year old group.

Keywords: children, mental health, earthquake, natural disaster, PTSD, gender

Topics: Age, Youth, Environment, Environmental Disasters, Gender, Health, Mental Health, PTSD Regions: MENA, Asia, Middle East Countries: Iran

Year: 2019

Traumatic Stress Among Sexual and Gender Minority Refugees from the Middle East, North African, and Asia who Fled to the European Union

Citation:

Alessi, Edward J., Sarilee Kahn, Leah Woolner, and Rebecca Van Der Horn. 2018. "Traumatic Stress Among Sexual and Gender Minority Refugees From the Middle East, North Africa, and Asia Who Fled to the European Union." Journal of Traumatic Stress 31 (6): 805-15.

Authors: Edward J. Alessi, Sarilee Kahn, Leah Woolner, Rebecca Van Der Horn

Abstract:

In 2015, more than 600,000 individuals from Syria, Iraq, and Afghanistan fled to Europe in search of protection. Among the most understudied of this population are individuals who identify as lesbian, gay, bisexual, transgender, and queer (LGBTQ). These individuals have not only fled war but also violence due to their sexual and/or gender identities. At the same time, LGBTQ individuals from other parts of the Middle East, Central and South Asia, and North Africa have also fled to Europe to escape persecution. The purpose of this multimethod study was to understand how traumatic stress shaped the experiences of 38 LGBTQ individuals who fled to Austria (n = 19) and the Netherlands (n = 19) from these regions. We assessed participants for posttraumatic stress disorder (PTSD) and conducted qualitative interviews to understand their migration experiences. Of the 37 participants assessed for PTSD, 33 (89.2%) reported that their most distressing event occurred prior to migration. For the 24 (64.9%) participants who met criteria for a provisional diagnosis of PTSD, 15 reported that the precipitating event was related to their sexual and/or gender identities and 9 reported that it was related to another type of event (e.g., war). Grounded theory was used to analyze qualitative data. Themes demonstrated that participants encountered targeted violence and abuse throughout migration and upon their arrival in Austria and the Netherlands. Findings indicate that LGBTQ refugees may be vulnerable to ongoing trauma from other refugees and immigration officials. Recommendations for protecting and supporting LGBTQ refugees during humanitarian emergencies are provided.

 

Topics: Armed Conflict, Displacement & Migration, Refugees, Gender, Health, PTSD, Trauma, Humanitarian Assistance, Sexuality, Violence Regions: Africa, MENA, North Africa, Asia, Central Asia, Middle East, South Asia, Europe, Western Europe Countries: Afghanistan, Austria, Iraq, Netherlands, Syria

Year: 2018

Impacts of Violent Rapes among Women in Eastern Democratic Republic of Congo

Citation:

Mirindi, Benoit Munganga. 2018. "Impacts of Violent Rapes among Women in Eastern Democratic Republic of Congo." PhD diss., Walden University.

Author: Benoit Munganga Mirindi

Abstract:

For the last 22 years, systematic rapes and punitive violence against women in the Democratic Republic of Congo (DRC) were utilized as weapons of war and a control strategy. This quantitative study built upon the ecological model of impact of sexual assault on women’s mental health to investigate the relationship between the health impacts and chronic pain and depression among women survivors of sexual rape in eastern DRC. The sample included 156 female rape survivors, between 18–80 years old, and raped between 2010 and 2014 while residing in the conflict area. The research questions focused on the association between fistulas, other sexual rape-related injuries, post-traumatic stress disorder (PTSD), feelings of worthlessness, social rejection, support from family/friends, and chronic pain and depression among women victims of sexual rape in eastern DRC. Results from multinomial logistic regression and ordinal regression tests showed strong links between independent and dependent variables: Fistula was strongly linked with chronic illness over 6 months (p = 0.003), and with upset all the time (p = 0.033); PTSD was associated with chronic illness due to violent rapes ( p = 0.004) and sadness (p = 0.000); feelings of worthlessness was related to prolonged illness over 6 months (p = 0.024) and feeling blue (p = 0.006); social rejection was linked to avoidance (p = 0.003); and support from family/friends was associated with prolonged illness over 6 months (p = 0.025) and lack of excitement (p = 0.011). The results of this study could assist health care providers in formulating response strategies for identifying public health priorities in conflict area, addressing health needs, and defining approaches for reducing war-related sexual violence, chronic pain, and depression among rape survivors.

Topics: Armed Conflict, Conflict, Gender, Women, Health, Mental Health, PTSD, Sexual Violence, Rape, SV against Women, Violence Regions: Africa, Central Africa Countries: Democratic Republic of the Congo

Year: 2018

Visual Responses: Women’s Experience of Sexual Violence as Represented in Israeli Holocaust-Related Cinema

Citation:

Meiri, Sandra. 2015. “Visual Responses: Women’s Experience of Sexual Violence as Represented in Israeli Holocaust-Related Cinema.” European Journal of Women’s Studies 22 (4): 443-456.  

Author: Sandra Meiri

Abstract:

This article explores the function of Israeli narrative films’ persistent, albeit marginal, portrayal of women as victims of sexual violence during the Holocaust. While the marginalization of such characters may be attributed to the difficulty of representing sexually-related trauma/post-trauma, their portrayal attests both to the ubiquity of sexually-related crimes in the Holocaust and to its aftermath: namely, the persistence of women’s trauma. The first of the two waves of ‘retro films’ examined here evinces the importance of the visual, cinematic representation of women’s trauma. Its main function is to legitimize its disclosure through cinematic aesthetic/artistic mediation, for sexual violence was a crime committed against helpless victims. The second wave includes films made from the point of view of ‘the second generation’, and explores the topic further by dealing with the transmission of post-traumatic symptoms of women’s trauma to the second generation.

Keywords: cinematic visualization, insanity, sexualized violence, the second generation, transmission of women's trauma, unfit motherhood

Topics: Gender, Women, Gendered Discourses, Gender-Based Violence, Genocide, Health, Mental Health, PTSD, Trauma, Sexual Violence, SV against Women Regions: MENA, Asia, Middle East, Europe Countries: Israel

Year: 2015

Coming out in camouflage: A Queer Theory Perspective on the Strength, Resilience, and Resistance of Lesbian, Gay, Bisexual, and Transgender Service Members and Veterans

Citation:

Ramirez, M. Heliana, and Paul R. Sterzing. 2017. “Coming out in Camouflage: A Queer Theory Perspective on the Strength, Resilience, and Resistance of Lesbian, Gay, Bisexual, and Transgender Service Members and Veterans.” Journal of Gay & Lesbian Social Services 29 (1): 68–86. 

Authors: M. Heliana Ramirez, Paul R. Sterzing

Abstract:

Lesbian, gay, bisexual, and transgender (LGBT) service members have made profound contributions to the U. S. military despite serving under anti-LGBT military policies. Little is known about their everyday acts of strength and resistance, which is vital information for developing strengths-based services. This article utilizes a queer theory framework to (a) discuss LGBT military contributions and anti-LGBT military policies, (b) explore three LGBT-specific military minority stressors, and (c) identify four strategies of strength and resistance used to manage an antiLGBT military environment. Clinical suggestions are proposed for integrating military and LGBT identities and designing interventions that blend military and LGBT cultures.

Keywords: LGBT, military, veteran, strengths-based, resilience, queer theory

Topics: Combatants, Gender, Health, HIV/AIDS, Mental Health, PTSD, Trauma, LGBTQ, Military Forces & Armed Groups, Militaries, Sexual Violence, Rape Regions: Americas, North America Countries: United States of America

Year: 2017

Mental Health of Transgender Veterans of the Iraq and Afghanistan Conflicts Who Experienced Military Sexual Trauma: MST and Mental Health of Transgender Veterans

Citation:

Lindsay, Jan A., Colt Keo-Meier, Sonora Hudson, Annette Walder, Lindsey A. Martin, and Michael R. Kauth. 2016. “Mental Health of Transgender Veterans of the Iraq and Afghanistan Conflicts Who Experienced Military Sexual Trauma: MST and Mental Health of Transgender Veterans.” Journal of Traumatic Stress 29 (6): 563–67.

Authors: Jan A. Lindsay, Colt Keo-Meier, Sonora Hudson, Annette Walder, Lindsey A. Martin, Michael R. Kauth

Abstract:

Little is known about military sexual trauma (MST) in transgender veterans. To address this gap, we examined archival data regarding transgender veterans from the Iraq and Afghanistan conflicts. There were 332 transgender veterans treated at the Veterans Health Administration between 2000 and 2013 (78 men, 254 women; mean age 33.86 years), with most being non-Hispanic White. Transgender status and mental health conditions were identified using the International Classification of Diseases, 9th Revision (ICD-9; World Health Organization, 1980) codes and chart review. Men and women were analyzed separately, using contingency tables and χ2 testing for categorical variables and t tests for continuous variables. Likelihood of having a mental health condition and MST were examined using logistic regression. Among the 15% of participants who experienced MST, MST was associated with the likelihood of posttraumatic stress disorder, adjusted OR = 6.09, 95% confidence interval (CI) [1.22, 30.44] and personality disorder, OR = 3.86, 95% CI [1.05, 14.22] for men and with depressive, OR = 3.33, 95% CI [1.12, 9.93], bipolar, OR = 2.87, 95% CI [1.12, 7.44], posttraumatic stress, OR = 2.42, [1.11, 5.24], and personality disorder, OR = 4.61, 95% CI [2.02, 10.52] for women. Implications include that medical forms should include gender identity and biological gender and that MST treatment should be culturally competent.

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

Year: 2016

Lesbian, Gay, Bisexual, and Transgender (LGBT) Service Members: Life After Don’t Ask, Don’t Tell

Citation:

Goldbach, Jeremy T., and Carl Andrew Castro. 2016. “Lesbian, Gay, Bisexual, and Transgender (LGBT) Service Members: Life After Don’t Ask, Don’t Tell.” Current Psychiatry Reports 18 (6): 56.

Authors: Jeremy T. Goldbach, Carl Andrew Castro

Abstract:

Lesbian, gay, and bisexual service members can serve openly in the military with the repeal of the Don’t Ask, Don’t Tell policy. The fate of transgender service members remains uncertain as the policy preventing them from serving in the military remains under review. The health care needs of these populations remain for the most part unknown, with total acceptance and integration in the military yet to be achieved. In this paper, we review the literature on the health care needs of lesbian, gay, bisexual, and transgender (LGBT) service members, relying heavily on what is known about LGBT civilian and veteran populations. Significant research gaps about the health care needs of LGBT service members are identified, along with recommendations for closing those gaps. In addition, recommendations for improving LGBT acceptance and integration within the military are provided.

Keywords: gay, lesbian, Transgender, Bisexual, military, veteran, mental health, Physical health, policy, LGBT acceptance and integration

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

Year: 2016

Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case-Control Study

Citation:

Brown, George R., and Kenneth T. Jones. 2016. “Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case-Control Study.” LGBT Health 3 (2): 122–31. 

Authors: George R. Brown, Kenneth T. Jones

Abstract:

Purpose: There are no large controlled studies of health disparities in transgender (TG) or gender dysphoric patients. The Veterans Health Administration (VHA) is the largest healthcare system in the United States and was an early adopter of electronic health records. We sought to determine whether medical and/or mental health disparities exist in VHA for clinically diagnosed TG veterans compared to matched veterans without a clinical diagnosis consistent with TG status.
 
Methods: Using four ICD-9-CM codes consistent with TG identification, a cohort of 5135 TG veterans treated in VHA between 1996 and 2013 was identified. Veterans without one of these diagnoses were matched 1:3 in a case–control design to determine if medical and/or mental health disparities exist in the TG veteran population.
 
Results: In 2013, the prevalence of TG veterans with a qualifying clinical diagnosis was 58/100,000 patients. Statistically significant disparities were present in the TG cohort for all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. TG Veterans were more likely to have been homeless, to have reported sexual trauma while on active duty, and to have been incarcerated. Significant disparities in the prevalence of medical diagnoses for TG veterans were also detected for 16/17 diagnoses examined, with HIV disease representing the largest disparity between groups.
 
Conclusion: This is the first study to examine a large cohort of clinically diagnosed TG patients for psychiatric and medical health outcome disparities using longitudinal, retrospective medical chart data with a matched control group. TG veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-TG veterans. These findings have significant implications for policy, healthcare screening, and service delivery in VHA and potentially other healthcare systems.

Keywords: disparity, gender dysphoria, military, Transgender, veteran

Topics: Combatants, Health, HIV/AIDS, Mental Health, PTSD, Trauma, LGBTQ, Military Forces & Armed Groups, Militaries Regions: Americas, North America Countries: United States of America

Year: 2016

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