Trauma

Gender Differences in Veterans Health Administration Mental Health Service Use: Effects of Age and Psychiatric Diagnosis

Citation:

Chatterjee, Sharmila, Maria E. Rath, Avron Spiro, Susan Eisen, Kevin L. Sloan, and Amy K. Rosen. 2009. “Gender Differences in Veterans Health Administration Mental Health Service Use: Effects of Age and Psychiatric Diagnosis.” Women’s Health Issues 19 (3): 176–84.

Authors: Sharmila Chatterjee, Maria E. Rath, Avron Spiro, Susan Eisen, Kevin L. Sloan, Amy K. Rosen

Abstract:

PURPOSE: The objective of this study was to compare gender differences in mental health disease burden and outpatient mental health utilization among veterans utilizing Veterans Health Administration (VHA) mental health services in fiscal year 1999 (FY99), after the first Gulf War and significant restructuring of VHA services.

METHODS: We used logistic regression to examine the relationships among gender, age, diagnostic groups, and utilization of mental health and specialty mental health services in a national sample of veterans. The sample included 782,789 veterans with at least 1 outpatient visit in the VHA in FY99 associated with a mental health or substance abuse (SA) diagnosis. Subgroup analyses were performed for 4 diagnostic categories: 1) posttraumatic stress disorder (PTSD), 2) SA disorders, 3) bipolar and psychotic disorders, and 4) mood and anxiety disorders.

MAIN FINDINGS: Younger women veterans (<35 years old) were significantly less likely and older women (> or =35) more likely to use any mental health services in comparison with their male counterparts. Similar findings were observed for younger women diagnosed with SA or mood and anxiety disorders, but not among veterans with PTSD or bipolar and psychotic disorders, among whom no there were no gender or age differences. In the case of specialized services for SA or PTSD, women younger than 55 with SA or PTSD were significantly less likely to use services than men.

CONCLUSION: Women veterans underutilized specialty mental health services in relation to men but receipt of mental health care overall in FY99 varied by age and diagnosis. Examining gender differences alone, without taking other factors into account, may not provide an adequate picture of women veterans' current mental health service needs.

Topics: Combatants, Female Combatants, Gender, Health, Mental Health, Trauma

Year: 2009

A Painful Purgatory: Grief and the Nicaraguan Mothers of the Disappeared

Citation:

Tully, Sheila R. 1995. “A Painful Purgatory: Grief and the Nicaraguan Mothers of the Disappeared.” Social Science & Medicine 40 (12): 1597–1610.

Author: Sheila R. Tully

Abstract:

In Latin America the past two decades have been marked by low-intensity conflicts, state-sponsored violence, and the creations of 'cultures of terror'. This research, conducted in Managua, Nicaragua during 1991-1992 examines the impact of political violence on a small group of women whose relatives were 'disappeared' during the Contra War. I discuss the lack of discourse about the disappeared and suggest possible reasons for this silence in the body politic, the community and the family.

The historical routinization of violence against the Nicaraguan poor and the continuing socio-political instability within the country present specific challenges to the healing processes of the Nicaraguan Mothers of the Disappeared. This article discusses some of the ways that these mothers challenge the collective silence and confront the public amnesia about what happened during the decade of war.

Keywords: Mothers of the Disappeared, low intensity warfare, suffering, terror

Topics: Gender, Women, Health, Mental Health, Trauma, Households, Violence Regions: Americas, Central America Countries: Nicaragua

Year: 1995

Improving Nurse Practitioner Assessment of Woman Veterans

Citation:

Fitzgerald, Cynthia E. 2010. “Improving Nurse Practitioner Assessment of Woman Veterans.” Journal of the American Academy of Nurse Practitioners 22 (7): 339–45.

Author: Cynthia E. Fitzgerald

Abstract:

PURPOSE: To provide nurse practitioners (NPs) with brief screening tools that can be used to identify postmilitary healthcare concerns common among women veterans.

DATA SOURCES: Existing screening tools for posttraumatic stress disorder, traumatic brain injury, and military sexual trauma.

CONCLUSIONS: Women represent more than 10% of military veterans who have served in combat settings during the current wars in Afghanistan and Iraq. As a result of their military service, women veterans may present in community healthcare settings with one or more of a variety of functional health problems, posttraumatic stress disorder, depression, anxiety, or other evidence of significant physical or psychiatric stress. Their families may be temporarily or permanently unstable as a result of the disruption caused by their military service, deployment, or health status.

IMPLICATIONS FOR PRACTICE: NPs who are aware of the unique healthcare needs of women veterans returning from combat will be better prepared to assess and intervene when these patients present with symptoms or health consequences of military service. Simple, straightforward assessments can determine the extent to which women veteran patients require intervention during wartime and/or referral.

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

Year: 2010

Integrating Health Care for Mothers and Children in Refugee Camps and at District Level

Citation:

Hafeez, Assad, Rubina Riaz, Samin Ullah Shah, Javed Pervaiz, and David Southall. 2004. “Integrating Health Care for Mothers and Children in Refugee Camps and at District Level.” BMJ: British Medical Journal 328 (7443): 834–6.

Authors: Assad Hafeez, Rubina Riaz, Samin Ullah Shah, Javed Pervaiz, David Southall

Abstract:

Health care for mothers and children is inadequate in most refugee situations and in poorly resourced countries. The authors argue that, as well as providing primary (home based) care for basic health care, there is a need to integrate primary care with adequately functioning hospital based care for a healthcare system to succeed.

Topics: Displacement & Migration, Refugees, Refugee/IDP Camps, Gender, Women, Health, Mental Health, Reproductive Health, Trauma

Year: 2004

Refugee Women's Health: Collaborative Inquiry with Refugee Women in Rwanda

Citation:

Pavlish, Carol. 2005. “Refugee Women’s Health: Collaborative Inquiry with Refugee Women in Rwanda.” Health Care for Women International 26 (10): 880–96.

Author: Carol Pavlish

Abstract:

A collaborative capacity building experience in a Rwandan refugee camp with refugee women from the Democratic Republic of Congo (DRC) is described in this article. In service to the American Refugee Committee, I taught 13 refugee women how to plan and facilitate focus group sessions with the larger community of refugee women. The facilitators then conducted 18 focus group sessions gathering data from 100 refugee women. Thematic results included the health implications of poverty, the struggle to survive, the overburden of daily work, ambivalence about family planning, and the lack of freedom to express themselves.

Topics: Displacement & Migration, Refugees, Gender, Women, Health, Mental Health, Reproductive Health, Trauma Regions: Africa, Central Africa, East Africa Countries: Democratic Republic of the Congo, Rwanda

Year: 2005

Factors Affecting Women's Health-Related Behaviors and Safe Motherhood: A Qualitative Study From a Refugee Camp in Eastern Sudan

Citation:

Furuta, Marie, and Rintaro Mori. 2008. “Factors Affecting Women’s Health-Related Behaviors and Safe Motherhood: A Qualitative Study From a Refugee Camp in Eastern Sudan.” Health Care for Women International 29 (8): 884–905.

Authors: Marie Furuta, Rintaro Mori

Abstract:

We aim to provide a deeper understanding of a broader range of potential factors affecting risk behaviors related to safe motherhood among refugee women in Eastern Sudan, thus creating a basis for further research in behavioral change. Risk behaviors chosen for this study follow (1) practice of female genital cutting, (2) adopting family planning (FP) practices, (3) usage of a skilled birth attendant, and (4) response to obstetric complications. Analyzing findings with the PRECEDE-PROCEED model, we found that factors frequently were uncontrollable for an individual woman, suggesting the importance of a supportive political, social, and educational environment for safe motherhood.

Topics: Displacement & Migration, Refugees, Refugee/IDP Camps, Gender, Women, Health, Mental Health, Reproductive Health, Trauma Regions: Africa, East Africa Countries: Sudan

Year: 2008

Prolonged Grief Disorder and Depression in Widows due to the Rwandan Genocide

Citation:

Schaal, Susanne, Thomas Elbert, and Frank Neuner. 2009. “Prolonged Grief Disorder and Depression in Widows due to the Rwandan Genocide.” Omega 59 (3): 203–19.

Authors: Susanne Schaal, Thomas Elbert, Frank Neuner

Abstract:

Should pathological grief be viewed as a nosological category, separate from other forms of mental diseases? Diagnostic criteria for "Prolonged Grief Disorder" (PGD) have recently been specified by Prigerson and her coworkers. We interviewed a total of 40 widows who had lost their husbands during the Rwandan genocide in 1994. We assessed Major Depression using the Mini-International Neuropsychiatric Interview (M.I.N.I.) and prolonged grief reactions with the PG-13. In order to examine the distinctiveness of the two syndromes we performed a multitrait correlational matrix analysis using modified versions of Generalized Proximity Functions (GPFs). 12.5% (n = 5) of the sample fulfilled the criteria for a diagnosis of PGD; 40% (n = 16) met criteria for Major Depressive Episode. The two syndromes were strongly associated. No discriminant validity was found between the two constructs suggesting that PGD may rather be an appearance of depression than a separate nosological entity.

Topics: Gender, Women, Genocide, Health, Mental Health, Trauma Regions: Africa, Central Africa, East Africa Countries: Rwanda

Year: 2009

A New Generation of Women Veterans: Stressors Faced by Women Deployed to Iraq and Afghanistan

Citation:

Street, Amy, Dawne Vogt, and Lissa Dutra. 2009. “A New Generation of Women Veterans: Stressors Faced by Women Deployed to Iraq and Afghanistan.” Clinical Psychological Review 29 (8): 685–94.

Authors: Amy Street, Dawne Vogt, Lissa Dutra

Abstract:

The extent of female service members' involvement in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF), in terms of both the number of women deployed and the scope of their involvement, is unprecedented. While many of the mental health readjustment issues of female service members are likely to mirror those of the majority male Veteran population, this newest generation of women Veterans may also face unique threats to their mental health. The goal of this review it to highlight emerging issues relevant to the development of posttraumatic stress disorder (PTSD) among women deployed to Iraq and Afghanistan by reviewing the existing literature on gender-relevant issues among this cohort, as well as raising theoretically important issues that are worthy of further empirical investigation. Topics addressed include gender differences in combat experiences and in PTSD following combat exposure; sexual assault, sexual harassment and other interpersonal stressors experienced during deployment; women Veterans' experiences of premilitary trauma exposure; and unique stressors faced by women Veterans during the homecoming readjustment period. Given that most models of the impact of war zone deployment on PTSD are predicated on the experiences of male service members, women's expanding role in combat operations presents both an opportunity and a challenge to adapt these models to more effectively capture the experiences of female service members.

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

Year: 2009

The Gendering of Human Rights: Women and the Latin American Terrorist State

Citation:

Hollander, Nancy Caro. 1996. “The Gendering of Human Rights: Women and the Latin American Terrorist State.” Feminist Studies 22 (1): 40–80.

Author: Nancy Caro Hollander

Topics: Gender, Women, Governance, Health, Trauma, Military Forces & Armed Groups, Militaries, Militarization, Rights, Human Rights, Sexual Violence, Rape, SV against Women, Terrorism Regions: Americas, Central America, South America Countries: Argentina, Chile, El Salvador, Guatemala

Year: 1996

Congo Ceasefire Brings Little Relief for Women

Citation:

Truscott, Amanda. 2008. “Congo Ceasefire Brings Little Relief for Women.” CMAJ: Canadian Medical Association Journal 179 (2): 133–4.

Author: Amanda Truscott

Topics: Gender, Women, Gender-Based Violence, Health, Reproductive Health, Trauma, Sexual Violence, Male Perpetrators, Rape, SV against Women Regions: Africa, Central Africa Countries: Congo-Brazzaville

Year: 2008

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