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PTSD

Sexual Victimization, Health Status, and VA Healthcare Utilization Among Lesbian and Bisexual OEF/OIF Veterans

Citation:

Mattocks, Kristin M., Anne Sadler, Elizabeth M. Yano, Erin E. Krebs, Laurie Zephyrin, Cynthia Brandt, Rachel Kimerling, Theo Sandfort, Melissa E. Dichter, Jeffrey J. Weiss, Jeroan Allison, and Sally Haskell. 2013. “Sexual Victimization, Health Status, and VA Healthcare Utilization Among Lesbian and Bisexual OEF/OIF Veterans.” Journal of General Internal Medicine 28 (S2): S604–8. 

Authors: Kristin M. Mattocks, Anne Sadler, Elizabeth M. Yano, Erin E. Krebs, Laurie Zephyrin, Cynthia Brandt, Rachel Kimerling, Theo Sandfort, Melissa E. Dichter, Jeffrey J. Weiss, Jeroan Allison, Sally Haskell

Abstract:

BACKGROUND: Many lesbian and bisexual (LB) women veterans may have been targets of victimization in the military based on their gender and presumed sexual orientation, and yet little is known regarding the health or mental health of LB veterans, nor the degree to which they feel comfortable receiving care in the VA. 
 
OBJECTIVE: The purpose of this study was to examine the prevalence of mental health and gender-specific conditions, VA healthcare satisfaction and trauma exposure among LB veterans receiving VA care compared with heterosexually-identified women veterans receiving. 
 
DESIGN: Prospective cohort study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) women veterans at two large VA facilities. 
 
PARTICIPANTS: Three hundred and sixty five women veterans that completed a baseline survey. Thirty-five veterans (9.6 %) identified as gay or lesbian (4.7 %), or bisexual (4.9 %). 
 
MAIN MEASURES: Measures included sexual orientation, military sexual trauma, mental and gender-specific health diagnoses, and VA healthcare utilization and satisfaction. 
 
KEY RESULTS: LB OEF/OIF veterans were significantly more likely to have experienced both military and childhood sexual trauma than heterosexual women (MST: 31 % vs. 13 %, p<.001; childhood sexual trauma: 60 % vs. 36 %, p=.01), to be hazardous drinkers (32 % vs. 16 %, p=.03) and rate their current mental health as worse than before deployment (35 % vs. 16 %, p<.001). 
 
CONCLUSIONS: Many LB veterans have experienced sexual victimization, both within the military and as children, and struggle with substance abuse and poor mental health. Health care providers working with female Veterans should be aware of high rates of military sexual trauma and childhood abuse and refer women to appropriate VA treatment and support groups for sequelae of these experiences. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country. (C) Society of General Internal Medicine 2013

Keywords: lesbian, health services research, veterans, women

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

Year: 2013

Palestinian Women’s Voices Challenging Human Rights Activism

Citation:

Shalhoub-Kevorkian, Nadera, and Sana Khsheiboun. 2009. “Palestinian Women’s Voices Challenging Human Rights Activism.” Women’s Studies International Forum 32 (5): 354–62. doi:10.1016/j.wsif.2009.07.012.

Authors: Nadera Shalhoub-Kevorkian, Sana Khsheiboun

Abstract:

A recent study in the Occupied Territories has shown that the most vulnerable groups of society (women, children, and the elderly) are psychologically influenced by the attacks on Palestinian home and land. Psychological and sociological research in Gaza has shown that women suffer the most from psychosomatic problems, while the children and the elderly are subject to depression, severe trauma, and post-traumatic stress disorder. Women's testimonies in the region have demonstrated their capacity to protect themselves, their work, and even their studies despite the dangers involved. These appear to heighten women's defensive mechanisms for facing continuously aggressive acts and practices. Women's stories about homelessness and loss are mainly constructed through their own understanding that the attack on the Palestinian home is part of a larger trend of dominating military forces against the Palestinian ‘Other’. Women have maintained that the destruction of their homes hindered their own progress especially in the domain of protecting family unity, and they have concluded that it is precisely the goal of such policies to destabilize society in this manner. This article uses case studies and interviews with Palestinian women to support a socio-political analysis of this particular situation in the Occupied Territories.

Topics: Armed Conflict, Gender, Women, Health, Mental Health, PTSD, Trauma, Rights, Human Rights Regions: MENA, Asia, Middle East Countries: Palestine / Occupied Palestinian Territories

Year: 2009

Stress, Mental Health, and Burnout in National Humanitarian Aid Workers in Gulu, Northern Uganda

Citation:

Ager, Alastair, Eba Pasha, Gary Yu, Thomas Duke, Cynthia Eriksson, and Barbara Lopes Cardozo. 2012. “Stress, Mental Health, and Burnout in National Humanitarian Aid Workers in Gulu, Northern Uganda.” Journal of Traumatic Stress 25 (6): 713–20. doi:10.1002/jts.21764.

Authors: Alastair Ager, Eba Pasha, Gary Yu, Thomas Duke, Cynthia Eriksson, Barbara Lopes Cardozo

Abstract:

This study examined the mental health of national humanitarian aid workers in northern Uganda and contextual and organizational factors predicting well-being. A cross-sectional survey was conducted among 376 national staff working for 21 humanitarian aid agencies. Over 50% of workers experienced 5 or more categories of traumatic events. Although, in the absence of clinical interviews, no clinical diagnoses were able to be confirmed, 68%, 53%, and 26% of respondents reported symptom levels associated with high risk for depression, anxiety disorders, and posttraumatic stress disorder (PTSD), respectively. Between one quarter and one half of respondents reported symptom levels associated with high risk regarding measured dimensions of burnout. Female workers reported significantly more symptoms of anxiety, depression, PTSD, and emotional exhaustion than males. Workers with the United Nations and related agencies reported fewest symptoms. Higher levels of social support, stronger team cohesion, and reduced exposure to chronic stressors were associated with improved mental health. National humanitarian staff members in Gulu have high exposure to chronic and traumatic stress and high risk of a range of poor mental health outcomes. Given that work-related factors appear to influence the relationship between the two strategies are suggested to support the well-being of national staff working in such contexts.

Topics: Gender, Women, Gender Roles, Gender Analysis, Health, Mental Health, PTSD, Trauma, Humanitarian Assistance Regions: Africa, East Africa Countries: Uganda

Year: 2012

Mental Health 15 Years after the Killings in Rwanda: Imprisoned Perpetrators of the Genocide against the Tutsi versus a Community Sample of Survivors

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

The Influence of Combat and Interpersonal Trauma on PTSD, depression, and Alcohol Misuse in U.S. Gulf War and OEF/OIF Women Veterans

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

The Role of Military Social Support in Understanding the Relationship Between PTSD, Physical Health, and Healthcare Utilization in Women Veterans

Citation:

Lehavot, Keren, Claudia Der-Martirosian, Tracy L. Simpson, Jillian C. Shipherd, and Donna L. Washington. 2013. “The Role of Military Social Support in Understanding the Relationship Between PTSD, Physical Health, and Healthcare Utilization in Women Veterans.” Journal of Traumatic Stress 26 (6): 772–75. doi:10.1002/jts.21859.

Authors: Claudia Der-Martirosian, Keren Lehavot, Jillian C. Shipherd, Tracy L. Simpson, Donna L. Washington

Abstract:

Posttraumatic stress disorder (PTSD) is a significant predictor of both poorer physical health and increased health care utilization, whereas adequate social support is associated with better physical health and less health care utilization. However, research has not previously examined the simultaneous effects of PTSD and social support on health and health care utilization. This study examined both the independent and interactive effects of PTSD and a particular type of social support (postactive-duty social support from military friends) on self-reported physical health and number of Veterans Health Administration (VHA) visits in the last year. These relationships were examined in a representative, national sample of 3,524 women veterans who completed telephone interviews as part of the National Survey of Women Veterans in 2008–2009. Regression analyses were conducted using these cross-sectional data to examine main effects of PTSD and military social support on physical health and VHA utilization and their interaction. Screening positive for PTSD was associated with poorer health (B = −3.19, SE = 1.47) and increased VHA utilization (B = 0.98, SE = 0.16), whereas greater military social support was associated with better health (B = 0.97, SE = 0.44) and less frequent VHA utilization (B = −0.15, SE = 0.05). Neither moderation model was significant, such that military social support behaved in a similar way regardless of PTSD status.

Topics: Combatants, Female Combatants, Gender, Women, Health, PTSD, Military Forces & Armed Groups

Year: 2013

Posttraumatic Stress Symptomatology as a Mediator of the Relationship Between Warzone Exposure and Physical Health Symptoms in Men and Women

Citation:

Wachen, Jennifer Schuster, Jillian C. Shipherd, Michael Suvak, Dawne Vogt, Lynda A. King, and Daniel W. King. 2013. “Posttraumatic Stress Symptomatology as a Mediator of the Relationship Between Warzone Exposure and Physical Health Symptoms in Men and Women.” Journal of Traumatic Stress 26 (3): 319–28. doi:10.1002/jts.21818.

Authors: Lynda A. King, Daniel W. King, Jennifer Schuster Wachen, Jillian C. Shipherd, Michael Suvak, Dawne Vogt

Abstract:

The mediating role of posttraumatic stress symptomatology (PSS) on the association between warzone exposure and physical health symptoms in 7 bodily systems (cardiovascular, dermatological, gastrointestinal, genitourinary, musculoskeletal, neurological, and pulmonary) was examined. We also examined if mediation effects varied as a function of sex. A sample of 317 U.S. Gulf war veterans was assessed for warzone exposure, PSS, and physical health symptoms 10 years after deployment. PSS was significantly associated with postdeployment physical health in all symptom categories when accounting for predeployment health (with effect sizes ranging from a 1.27–1.64 increase in the likelihood of postdeployment physical health symptoms with a 1 standard deviation increase in the PSS symptoms). PSS severity mediated the relationship between warzone exposure and postdeployment symptoms in all physical health domains (with percent mediation ranging 44%–75%). A significant Warzone Exposure × PSS interaction emerged for 5 outcomes such that the effect of PSS on physical health was stronger for veterans reporting lower warzone exposure. No significant interactions with sex emerged. These findings suggest the important influence of PSS on physical health symptoms for both men and women.

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

Year: 2013

Religious Coping, Posttraumatic Stress, Psychological Distress, and Posttraumatic Growth Among Female Survivors Four Years After Hurricane Katrina

Citation:

Chan, Christian S., and Jean E. Rhodes. 2013. “Religious Coping, Posttraumatic Stress, Psychological Distress, and Posttraumatic Growth Among Female Survivors Four Years After Hurricane Katrina.” Journal of Traumatic Stress 26 (2): 257–65. doi:10.1002/jts.21801.

Authors: Christian S. Chan, Jean E. Rhodes

Abstract:

Positive and negative religious coping strategies and their relation with posttraumatic stress (PTS), psychological distress, and posttraumatic growth (PTG) were examined in the context of Hurricane Katrina. Positive religious coping was hypothesized to be associated with PTG, whereas negative religious coping was hypothesized to be associated with PTS and psychological distress. Low-income mothers (N = 386, mean age = 25.4 years, SD = 4.43) were surveyed before, and 1 and 4 years after the storm. Results from structural regression modeling indicated that negative religious coping was associated with psychological distress, but not PTS. Positive religious coping was associated with PTG. Further analysis indicated significant indirect effects of pre- and postdisaster religiousness on postdisaster PTG through positive religious coping. Findings underscore the positive and negative effect of religious variables in the context of a natural disaster.

Topics: Environment, Environmental Disasters, Gender, Women, Gender Analysis, PTSD, Trauma, Religion Regions: Americas, North America Countries: United States of America

Year: 2013

Preliminary Findings of the Relationship of Lower Heart Rate Variability with Military Sexual Trauma and Presumed Posttraumatic Stress Disorder

Citation:

Lee, Elizabeth A. D., Joe K. Bissett, Michael A. Carter, Patricia A. Cowan, Jeffrey M. Pyne, Patricia M. Speck, Sue A. Theus, and Elizabeth A. Tolley. 2013. “Preliminary Findings of the Relationship of Lower Heart Rate Variability with Military Sexual Trauma and Presumed Posttraumatic Stress Disorder.” Journal of Traumatic Stress 26 (2): 249–56. doi:10.1002/jts.21797.

Authors: Joe K. Bissett, Michael A. Carter, Patricia A. Cowan, Elizabeth A. D. Lee, Jeffrey M. Pyne, Patricia M. Speck, Sue A. Theus, Elizabeth A. Tolley

Abstract:

Decreased heart rate variability (HRV) occurs with physical and psychological disorders and is a predictor of cardiac and all-cause mortality. This study was the first of which we are aware to examine and report the relationship between military sexual trauma (MST) and HRV measures. In a historical cohort study of female veterans with (n = 27) and without (n = 99) MST who received Holter and electrocardiogram evaluation at a Veteran Affairs medical center during 2007–2010, we examined the relationship between MST and the standard deviation of all R-R intervals (SDNN) and the square root of the mean of the sum of the squares of differences between adjacent R-R intervals (RMSSD). Female veterans with MST were younger, p = .002, frequently had a probable posttraumatic stress disorder diagnosis, 80% versus 15%, p = < .0001, and had lower SDNN, p = .0001, and RMSSD, p = .001, than those without MST. The SDNN and RMSSD of a 25-year-old female veteran with MST were comparable to that of female veterans aged 69 to 81 years without MST. Further research is needed to evaluate relationships between MST and HRV measures.

Topics: Combatants, Female Combatants, Gender, Women, Gender Analysis, Health, PTSD, Military Forces & Armed Groups, Sexual Violence

Year: 2013

Validation of the Pittsburgh Sleep Quality Index Addendum for Posttraumatic Stress Disorder (PSQI-A) in U.S. Male Military Veterans

Citation:

Insana, Salvatore P., Martica Hall, Daniel J. Buysse, and Anne Germain. 2013. “Validation of the Pittsburgh Sleep Quality Index Addendum for Posttraumatic Stress Disorder (PSQI-A) in U.S. Male Military Veterans.” Journal of Traumatic Stress 26 (2): 192–200. doi:10.1002/jts.21793.

Authors: Daniel J. Buysse, Anne Germain, Martica Hall, Salvatore P. Insana

Abstract:

Sleep disturbances are core symptoms of posttraumatic-stress disorder (PTSD), yet they bear less stigma than other PTSD symptoms. Given the growing number of returning military veterans, brief, valid assessments that identify PTSD in a minimally stigmatizing way may be useful in research and clinical practice. The study purpose was to evaluate the psychometric properties of the Pittsburgh Sleep Quality Index Addendum for PTSD (PSQI-A), and to examine its ability to identify PTSD cases among U.S. male military veterans. Male military veterans (N = 119) completed the PSQI-A, as well as measures of sleep quality, combat exposure, posttraumatic stress, depression, and anxiety. Veterans with PTSD had higher PSQI-A identified disruptive nocturnal behaviors than veterans without PTSD. The PSQI-A had good internal consistency and convergent validity with sleep quality, combat exposure, PTSD symptoms, depression, and anxiety. A cutoff score ≥ 4 provided an area under the curve = .81, with 71% sensitivity, 82% specificity, and 60% positive and 83% negative predictive value for a clinical diagnosis of PTSD; correct classification was 74%. The PSQI-A is a valid measure to possibly detect PTSD among male military veterans. Assessment of disruptive nocturnal behaviors may provide a cost-effective, nonstigmatizing approach to PTSD screening without directly probing for trauma exposure(s).

Topics: Combatants, Male Combatants, Gender, Men, Gender Analysis, Health, PTSD Regions: Americas, North America Countries: United States of America

Year: 2013

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