PTSD

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

Impact of Combat and Sexual Harassment on the Severity of Posttraumatic Stress Disorder among Men and Women Peacekeepers in Somalia

Citation:

Fontana, Alan, Brett Litz, and Robert Rosenheck. 2000. "Impact of Combat and Sexual Harassment on the Severity of Posttraumatic Stress Disorder among Men and Women Peacekeepers in Somalia." Journal of Nervous and Mental Disease 188 (3): 163-169.

Authors: Alan Fontana, Brett Litz, Robert Rosenheck

Abstract:

The impact of combat and sexual harassment on the severity of posttraumatic stress disorder (PTSD) is compared for 1307 men and 197 women peacekeepers who served in the same military units. A theoretical model was proposed to express the nature of the impact. Structural equation modeling was used to evaluate the model separately for men and women. Good-fitting, parsimonious models were developed that showed substantial similarity for men and women. For men, severity of PTSD symptoms was impacted by exposure to combat directly and indirectly through fear and sexual harassment. For women, severity of PTSD symptoms was impacted by combat indirectly through the same two influences, although the mechanisms involving fear and sexual harassment were somewhat different. For both genders, moreover, PTSD severity was impacted directly by exposure to the dying of the Somali people. These similarities suggest that in modern stressful overseas military missions, both genders may be susceptible to the same types of risk for the development of PTSD. The incidence and impact of sexual harassment is particularly noteworthy in the case of men and calls for more detailed investigation in future studies.

Keywords: sexual assault, posttraumatic stress disorder, peacekeepers

Topics: Armed Conflict, Combatants, Gender, Women, Men, Health, Mental Health, PTSD, Trauma, Humanitarian Assistance, Peacekeeping, Peace Processes, Sexual Violence, Sexual Exploitation and Abuse Regions: Africa, East Africa Countries: Somalia

Year: 2000

Cognitive-Behavioral Therapy Versus Other PTSD Psychotherapies as Treatment for Women Victims of War-Related Violence: A Systematic Review

Citation:

Dossa, N. Ines., and Marie Hatem. 2012. "Cognitive-Behavioral Therapy Versus Other PTSD Psychotherapies as Treatment for Women Victims of War-Related Violence: A Systematic Review." The Scientific World Journal 2012:  1-19.

Authors: N. Ines Dossa, Marie Hatem

Abstract:

Although war-trauma victims are at a higher risk of developing PTSD, there is no consensus on the effective treatments for this condition among civilians who experienced war/conflict-related trauma. This paper assessed the effectiveness of the various forms of cognitive-behavioral therapy (CBT) at lowering PTSD and depression severity. All published and unpublished randomized controlled trials studying the effectiveness of CBT at reducing PTSD and/or depression severity in the population of interest were searched. Out of 738 trials identified, 33 analysed a form of CBTs effectiveness, and ten were included in the paper. The subgroup analysis shows that cognitive processing therapy (CPT), culturally adapted CPT, and narrative exposure therapy (NET) contribute to the reduction of PTSD and depression severity in the population of interest. The effect size was also significant at a level of 0.01 with the exception of the effect of NET on depression score. The test of subgroup differences was also significant, suggesting CPT is more effective than NET in our population of interest. CPT as well as its culturally adapted form and NET seem effective in helping war/conflict traumatised civilians cope with their PTSD symptoms. However, more studies are required if one wishes to recommend one of these therapies above the other.

Keywords: mental health, counseling, therapy, posttraumatic stress disorder

Topics: Armed Conflict, Gender, Women, Health, Mental Health, PTSD, Trauma, Violence

Year: 2012

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

Screening for Post-Traumatic Stress Disorder in Female Veteran’s Affairs Patients: Validation of the PTSD Checklist

Citation:

Dobie, Dorcas J., Daniel R. Kivlahan, Charles Maynard, Kristen R. Bush, Miles McFall, Amee J. Epler, and Katharine A. Bradley. 2002. "Screening for Post-Traumatic Stress Disorder in Female Veteran’s Affairs Patients: Validation of the PTSD Checklist." General Hospital Psychiatry 24 (6): 367-74.

Authors: Dorcas J. Dobie, Daniel R. Kivlahan, Charles Maynard, Kristen R. Bush, Miles McFall, Amee J. Epler, Katharine A. Bradley

Abstract:

We evaluated the screening validity of a self-report measure for post traumatic stress disorder (PTSD), the PTSD Checklist (PCL), in female Veterans Affairs (VA) patients. All women seen for care at the VA Puget Sound Health Care system from October 1996–January 1999 (n=2,545) were invited to participate in a research interview. Participants (n=282) completed the 17-item PCL, followed by a gold standard diagnostic interview for PTSD, the Clinician Administered PTSD Scale (CAPS). Thirty-six percent of the participants (n=100) met CAPS diagnostic criteria for current PTSD. Receiver Operating Characteristic (ROC) analysis was used to evaluate the screening performance of the PCL. The area under the ROC curve was 0.86 (95% CI 0.82–0.90). A PCL score of 38 optimized the performance of the PCL as a screening test (sensitivity 0.79, specificity 0.79). The PCL performed well as a screening measure for the detection of PTSD in female VA patients.

Keywords: female veterans, posttraumatic stress disorder, mental health

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

Year: 2002

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

Refugee Experiences and Southeast Asian Women's Mental Health

Citation:

Davis, Ruth E., Michael G. Kennedy, and Wendy Austin. 2000. "Refugee Experiences and Southeast Asian Women’s Mental Health." Western Journal of Nursing Research 22 (2): 144-68.

Authors: Ruth E. Davis, Michael G. Kennedy, Wendy Austin

Abstract:

The wars in Southeast Asia displaced thousands of families from Cambodia, Laos, and Vietnam. The upheavals led to a number of waves of immigration to the United States. Current research supports hypotheses of post-traumatic stress disorder diagnoses in refugees from the wars in Vietnam but omits pertinent cultural factors. This phenomenological study of 19 women from Southeast Asia examines the meanings of their refugee experiences. Open-ended interviews with these women reveal themes of survival, despair, and isolation. Health care providers may notice cultural bereavement as opposed to post-traumatic stress disorder, reflecting a psychological resilience not extensively explored previously. Developing empathetic interactions and including important ethnic identity factors in caring for refugee women appear essential in providing appropriate health care.

Keywords: female refugees, mental health, posttraumatic stress disorder

Topics: Displacement & Migration, Refugees, Ethnicity, Gender, Women, Health, Mental Health, PTSD, Trauma Regions: Asia, Southeast Asia Countries: Cambodia, Laos, Vietnam

Year: 2000

Improvement in Post-Traumatic Stress Disorder in Post-Conflict Rwandan Women

Citation:

Cohen, Mardge H., Qiuhu Shi, Mary Fabri, Henriette Mukanyonga, Xiaoto Cai, Donald R. Hoover, and Kathryn Anastos. 2011. "Improvement in Post-Traumatic Stress Disorder in Post-Conflict Rwandan Women." Journal of Women's Health 20 (9): 1325-1332.

Authors: Mardge H. Cohen, Qiuhu Shi, Mary Fabri, Henriette Mukanyonga, Xiaoto Cai, Donald R. Hoover, Kathryn Anastos

Abstract:

BACKGROUND: Depression and posttraumatic stress disorder (PTSD) are common in developing and postconflict countries. The purpose of this study is to examine longitudinal changes in PTSD in HIV-infected and uninfected Rwandan women who experienced the 1994 genocide.

METHODS: Five hundred thirty-five HIV-positive and 163 HIV-negative Rwandan women in an observational cohort study were followed for 18 months. Data on PTSD symptoms were collected longitudinally by the Harvard Trauma Questionnaire (HTQ) and analyzed in relationship to demographics, HIV status, antiretroviral treatment (ART), and depression. PTSD was defined as a score on the HTQ of >/=2.

RESULTS: There was a continuing reduction in HTQ scores at each follow-up visit. The prevalence of PTSD symptoms changed significantly, with 61% of the cohort having PTSD at baseline vs. 24% after 18 months. Women with higher HTQ score were most likely to have improvement in PTSD symptoms (p<0.0001). Higher rate of baseline depressive symptoms (p<0.0001) was associated with less improvement in PTSD symptoms. HIV infection and ART were not found to be consistently related to PTSD improvement.

CONCLUSIONS: HIV care settings can become an important venue for the identification and treatment of psychiatric problems affecting women with HIV in postconflict and developing countries. Providing opportunities for women with PTSD symptoms to share their history of trauma to trained counselors and addressing depression, poverty, and ongoing violence may contribute to reducing symptoms.

Keywords: posttraumatic stress disorder, mental health, HIV/AIDS, genocide, war rape

Topics: Armed Conflict, Gender, Women, Genocide, Health, HIV/AIDS, Mental Health, PTSD, Trauma, Post-Conflict, Sexual Violence, Rape Regions: Africa, Central Africa, East Africa Countries: Rwanda

Year: 2011

Prevalence and Predictors of Posttraumatic Stress Disorder and Depression in HIV-Infected and At-Risk Rwandan Women

Citation:

Cohen, Mardge H., Mary Fabri, Xiaotao Cai, Qiuhu Shi, Donald R. Hoover, Agnes  Binagwaho, Melissa A. Culhane, Henriette Mukanyonga, Davis K. Karegeya, and Kathryn Anastos. 2009. "Prevalence and Predictors of Posttraumatic Stress Disorder and Depression in HIV-Infected and At-Risk Rwandan Women." Journal of Women's Health 18 (11): 1783-1791.

Authors: Mardge H. Cohen, Mary Fabri, Xiaotao Cai, Quihu Shi, Donald R. Hoover, Agnes Binagwaho, Melissa A. Culhane, Henriette Mukanyonga, Davis K. Karegeya, Kathryn Anastos

Abstract:

OBJECTIVE: During the 1994 Rwandan genocide, rape was used as a weapon of war to transmit HIV. This study measures trauma experiences of Rwandan women and identifies predictors associated with posttraumatic stress disorder (PTSD) and depressive symptoms.

METHODS: The Rwandan Women's Interassociation Study and Assessment (RWISA) is a prospective observational cohort study designed to assess effectiveness and toxicity of antiretroviral therapy in HIV-infected Rwandan women. In 2005, a Rwandan-adapted Harvard Trauma Questionnaire (HTQ) and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess genocide trauma events and prevalence of PTSD (HTQ mean > 2) and depressive symptoms (CES-D > or = 16) for 850 women (658 HIV-positive and 192 HIV-negative).

RESULTS: PTSD was common in HIV-positive (58%) and HIV-negative women (66%) (p = 0.05). Women with HIV had a higher prevalence of depressive symptoms than HIV-negative women (81% vs. 65%, p < 0.0001). Independent predictors for increased PTSD were experiencing more genocide-related trauma events and having more depressive symptoms. Independent predictors for increased depressive symptoms were making < $18 a month, HIV infection (and, among HIV-positive women, having lower CD4 cell counts), a history of genocidal rape, and having more PTSD symptoms. 

CONCLUSIONS: The prevalence of PTSD and depressive symptoms is high in women in the RWISA cohort. Four of five HIV-infected women had depressive symptoms, with highest rates among women with CD4 cell counts < 200. In addition to treatment with antiretroviral therapy, economic empowerment and identification and treatment of depression and PTSD may reduce morbidity and mortality among women in postconflict countries.

Keywords: mental health, HIV/AIDS, posttraumatic stress disorder, depression, genocide, war rape

Topics: Gender, Women, Genocide, Health, HIV/AIDS, Mental Health, PTSD, Trauma, Post-Conflict, Sexual Violence, Rape, SV against Women Regions: Africa, Central Africa, East Africa Countries: Rwanda

Year: 2009

Report from the CDC: Mental Health of Women in Postwar Afghanistan

Citation:

Cardozo, Barbara L., Oleg O. Bilukha, Carol A. Gotway, Mitchel I. Wolfe, Michael L. Gerber, and Mark Anderson. 2005. "Report from the CDC: Mental Health of Women in Postwar Afghanistan." Journal of Women's Health 14 (4): 285-93.

Authors: Barbara L. Cardozo, Oleg O. Bilukha, Carol A. Gotway, Mitchel I. Wolfe, Michael L. Gerber, Mark Anderson

Abstract:

More than two decades of war and a culture that has denied women freedom of movement, access to healthcare, and education have affected the mental health status of Afghan women more than that of men. In 2002, the Centers for Disease Control and Prevention (CDC) conducted a national population-based mental health survey in Afghanistan. The prevalence of symptoms of depression was 73% (standard error [SE] 8.15) and 59% (SE 5.59), of symptoms of anxiety was 84% (SE 2.98) and 59% (SE 8.65), and of posttraumatic stress disorder (PTSD) was 48% (SE 6.19) and 32% (SE 4.22) for female and male respondents, respectively. Mean scores for social functioning were lower for women (52.00 [SE 2.77]) than for men (66.63 [SE 3.92]). Women had significantly lower mental health status and poorer social functioning than did men. Results of our survey underscore the need for financial donors and healthcare planners to address the current lack of mental healthcare resources, facilities, and trained mental healthcare professionals in Afghanistan and to establish mental health services directed at the specific needs of women. This study highlights the negative impact that war, restrictions in freedoms, and socioeconomic hardship have had on the mental health and social functioning of women in Afghanistan.

Keywords: mental health, depression, posttraumatic stress disorder, anxiety, female refugees

Topics: Gender, Women, Health, Mental Health, PTSD, Post-Conflict Regions: Asia, South Asia Countries: Afghanistan

Year: 2005

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