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.
A wealth of research has established clear gender differences in exposure to potentially traumatic events and in subsequent posttraumatic stress disorder (PTSD). One perspective that is missing from ...most conversations about gender differences in PTSD is a systematic discussion of gender role socialization, and relatedly, the social construction of gender within our society. The purpose of the present review is to provide exposure to these theories as they relate to gender differences in PTSD, including differences in trauma exposure, risk for the development and maintenance of PTSD symptoms, and PTSD treatment outcome. In this review we focus on characteristics and behaviors that arise from a way of being in the world that is largely influenced by assigned gender. These include gender differences in patterns of trauma exposure, chronic environmental strain, behavioral responses to distress, cognitive factors, and the experience and expression of emotion. We posit that these different sets of factors reciprocally influence each other and combine synergistically to influence observed gender differences.
The research reviewed here indicates that societal definitions of masculinity and femininity have psychological consequences in that they produce gender differences in major risk factors relevant to PTSD.
•Societal definitions of gender roles have an impact on risk factors for PTSD.•Basic biological differences may be increased by social and cultural experiences.•Understanding the impact of gender roles on PTSD can help us prevent and treat it.
Objective:
The authors conducted a meta-analysis of empirical studies investigating associations between indices of posttraumatic stress disorder (PTSD) and intimate relationship problems to ...empirically synthesize this literature.
Method:
A literature search using PsycINFO, Medline, Published International Literature on Traumatic Stress (PILOTS), and Dissertation Abstracts was performed. The authors identified 31 studies meeting inclusion criteria.
Results:
True score correlations (ρ) revealed medium-sized associations between PTSD and intimate relationship discord (ρ = .38,
N
= 7,973,
K
= 21), intimate relationship physical aggression perpetration (ρ = .42,
N
= 4,630,
K
= 19), and intimate relationship psychological aggression perpetration (ρ = .36,
N
= 1,501,
K
= 10). The strength of the association between PTSD and relationship discord was higher in military (vs. civilian) samples, and when the study was conducted in the United States (vs. other country), and the study represented a doctoral dissertation (vs. published article). The strength of the association between PTSD and physical aggression was higher in military (vs. civilian) samples, males (vs. females), community (vs. clinical) samples, studies examining PTSD symptom severity (vs. diagnosis), when the physical aggression measure focused exclusively on severe violence (vs. a more inclusive measure), and the study was published (vs. dissertation). For the PTSD-psychological aggression association, 98% of the variance was accounted for by methodological artifacts such as sampling and measurement error; consequently, no moderators were examined in this relationship.
Conclusions:
Findings highlight a need for the examination of models explaining the relationship difficulties associated with PTSD symptomatology and interventions designed to treat problems in both areas.
Suicide is a public health problem, with multiple causes that are poorly understood. The increased focus on combining health care data with machine-learning approaches in psychiatry may help advance ...the understanding of suicide risk.
To examine sex-specific risk profiles for death from suicide using machine-learning methods and data from the population of Denmark.
A case-cohort study nested within 8 national Danish health and social registries was conducted from January 1, 1995, through December 31, 2015. The source population was all persons born or residing in Denmark as of January 1, 1995. Data were analyzed from November 5, 2018, through May 13, 2019.
Exposures included 1339 variables spanning domains of suicide risk factors.
Death from suicide from the Danish cause of death registry.
A total of 14 103 individuals died by suicide between 1995 and 2015 (10 152 men 72.0%; mean SD age, 43.5 18.8 years and 3951 women 28.0%; age, 47.6 18.8 years). The comparison subcohort was a 5% random sample (n = 265 183) of living individuals in Denmark on January 1, 1995 (130 591 men 49.2%; age, 37.4 21.8 years and 134 592 women 50.8%; age, 39.9 23.4 years). With use of classification trees and random forests, sex-specific differences were noted in risk for suicide, with physical health more important to men's suicide risk than women's suicide risk. Psychiatric disorders and possibly associated medications were important to suicide risk, with specific results that may increase clarity in the literature. Generally, diagnoses and medications measured 48 months before suicide were more important indicators of suicide risk than when measured 6 months earlier. Individuals in the top 5% of predicted suicide risk appeared to account for 32.0% of all suicide cases in men and 53.4% of all cases in women.
Despite decades of research on suicide risk factors, understanding of suicide remains poor. In this study, the first to date to develop risk profiles for suicide based on data from a full population, apparent consistency with what is known about suicide risk was noted, as well as potentially important, understudied risk factors with evidence of unique suicide risk profiles among specific subpopulations.
Despite substantial efforts to counter sexual assault and harassment in the military, both remain persistent in the Armed Services. In February 2021, President Biden directed the U.S. Department of ...Defense to establish a 90-day Independent Review Commission on Sexual Assault in the Military (IRC) to assess the department’s efforts and make actionable recommendations. As servicemembers discharge from the military, effects of military sexual trauma (MST) are often seen in the Veterans Health Administration (VA). In response to an IRC inquiry about VA MST research, we organized an overview on prevalence, adverse consequences, and evidence-based treatments targeting the sequelae of MST. Women are significantly more likely to experience MST than their male counterparts. Other groups with low societal and institutional power (e.g., lower rank) are also at increased risk. Although not all MST survivors experience long-term adverse consequences, for many, they can be significant, chronic, and enduring and span mental and physical health outcomes, as well as cumulative impairments in functioning. Adverse consequences of MST come with commonalities shared with sexual trauma in other settings (e.g., interpersonal betrayal, victim-blaming) as well as unique aspects of the military context, where experiences of interpersonal betrayal may be compounded by perceptions of institutional betrayal (e.g., fear of reprisal or ostracism, having to work/live alongside a perpetrator). MST’s most common mental health impact is posttraumatic stress disorder, which rarely occurs in isolation, and may coincide with major depression, anxiety, eating disorders, substance use disorders, and increased suicidality. Physical health impacts include greater chronic disease burden (e.g., hypertension), and impaired reproductive health and sexual functioning. Advances in treatment include evidence-based psychotherapies and novel approaches relying on mind-body interventions and peer support. Nonetheless, much work is needed to enhance detection, access, care, and support or even the best interventions will not be effective.
ABSTRACT
BACKGROUND
The changing scope of women’s roles in combat operations has led to growing interest in women’s deployment experiences and post-deployment adjustment.
OBJECTIVES
To quantify the ...gender-specific frequency of deployment stressors, including sexual and non-sexual harassment, lack of social support and combat exposure. To quantify gender-specific post-deployment mental health conditions and associations between deployment stressors and posttraumatic stress disorder (PTSD), to inform the care of Veterans returning from the current conflicts.
DESIGN
National mail survey of OEF/OIF Veterans randomly sampled within gender, with women oversampled.
SETTING
The community.
PARTICIPANTS
In total, 1,207 female and 1,137 male Veterans from a roster of all Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) Veterans. Response rate was 48.6 %.
MAIN MEASURES
Deployment stressors (including combat and harassment stress), PTSD, depression, anxiety and alcohol use, all measured via self-report.
KEY RESULTS
Women were more likely to report sexual harassment (OR = 8.7, 95% CI: 6.9, 11) but less likely to report combat (OR = 0 .62, 95 % CI: 0.50, 0.76). Women and men were equally likely to report symptoms consistent with probable PTSD (OR = 0 .87, 95 % CI: 0.70, 1.1) and symptomatic anxiety (OR = 1.1, 9 5% CI: 0.86, 1.3). Women were more likely to report probable depression (OR = 1.3, 95 % CI: 1.1, 1.6) and less likely to report problematic alcohol use (OR = 0 .59, 9 5% CI: 0.47, 0.72). With a five-point change in harassment stress, adjusted odds ratios for PTSD were 1.36 (95 % CI: 1.23, 1.52) for women and 1.38 (95 % CI: 1.19, 1.61) for men. The analogous associations between combat stress and PTSD were 1.31 (95 % CI: 1.24, 1.39) and 1.31 (95 % CI: 1.26, 1.36), respectively.
CONCLUSIONS
Although there are important gender differences in deployment stressors—including women’s increased risk of interpersonal stressors—and post-deployment adjustment, there are also significant similarities. The post-deployment adjustment of our nation’s growing population of female Veterans seems comparable to that of our nation’s male Veterans.
Alcohol use is common following traumatic military deployment experiences. What is less clear is why, and for whom, particular deployment experiences lead to alcohol use.
The current study explored ...associations between deployment stressors (Warfare, Military Sexual Trauma, and Concerns about Life and Family Disruptions—“Life Disruptions”), PTSD (PCL-5), and alcohol use (CAGE) post-deployment, stratified by gender among 2344 male and female veterans (1137 men; Mage = 35). Conditional process analyses examined the indirect effect of traumatic deployment experiences on alcohol use, via PTSD symptom severity, with Life Disruptions as a moderator.
More severe Warfare and military sexual trauma (MST) were associated with greater PTSD symptom severity, which was associated with higher problematic alcohol use. PTSD symptom severity accounted for the associations between trauma type (i.e., MST or Warfare) and alcohol use. Among women, but not men, Life Disruptions moderated the associations between trauma type (i.e., MST, Warfare) and PTSD symptom severity, such that elevated Life Disruptions amplified the associations between trauma type and PTSD symptom severity. Moderated mediation was significant for MST among women, indicating that the strength of the indirect effect (MST ➔ PTSD ➔ problematic alcohol use) was moderated by Life Disruptions; problematic alcohol use was highest for women with greater PTSD symptom severity following exposure to more severe Life Disruptions and MST (Est. = 0.0007, SE = 0.0001, CI = 0.0002 to 0.0013).
Taken together, alcohol use following potentially traumatic deployment experiences can be understood by considering PTSD symptom severity, gender, and Life Disruptions.
•Alcohol use is common following traumatic deployment experiences.•PTSD symptom severity explains post-deployment alcohol use among veterans.•Home life disruptions amplify the impact of trauma on PTSD among women.•These disruptions moderate relations between trauma, PTSD, and alcohol among women.
We examined military-related sexual trauma among deployed Operation Enduring Freedom and Operation Iraqi Freedom veterans. Of 125 729 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.
Little is known about predictors of military veterans' suicidal ideation as they transition from service to civilian life, a potentially high-risk period that represents a critical time for ...intervention. This study examined factors associated with veterans' suicidal ideation in the first year after military separation.
A national sample of U.S. veterans (N=7,383) from The Veterans Metrics Initiative Study reported on their mental health, psychosocial well-being, and demographic/military characteristics in an online survey at 3 and 9 months after separation. Cross-validated random forest models and mean decrease in accuracy values were used to identify key predictors of suicidal ideation. Bivariate ORs were calculated to examine the magnitude and direction of main effects associations between predictors and suicidal ideation. Data were collected in 2016/2017 and analyzed in 2021.
In the first year after separation, 15.1% of veterans reported suicidal ideation. Endorsing depression symptoms and, to a lesser extent, identifying oneself as experiencing depression, were most predictive of suicidal ideation. Other psychopathology predictors included higher anxiety and posttraumatic stress disorder symptoms. Psychosocial well-being predictors included higher health satisfaction and functioning, community satisfaction and functioning, and psychological resilience. Logistic models performed similarly to random forest models, suggesting that relationships between predictors and suicidal ideation were better represented as main effects than interactions.
Results highlight the potential value of bolstering key aspects of military veterans' mental health and psychosocial well-being to reduce their risk for suicidal ideation in the first year after separation. Findings can inform interventions aimed at helping veterans acclimate to civilian life.
Objective
This study explored possible mechanisms through which symptoms of posttraumatic stress disorder (PTSD) were reduced in a randomized controlled trial comparing the effect of a yoga ...intervention with an assessment control.
Method
We examined whether changes in psychological flexibility, mindfulness, and emotion regulation strategies (expressive suppression and reappraisal) were associated with posttreatment PTSD symptoms for 38 women with Diagnostic and Statistical Manual of Mental Disorders Fourth Edition full or subthreshold PTSD.
Results
Hierarchical linear regression models revealed that expressive suppression significantly decreased for the yoga group relative to the assessment control. Psychological flexibility increased significantly for the control but not yoga group. However, increases in psychological flexibility were associated with decreases in PTSD symptoms for the yoga but not control group.
Conclusion
Preliminary findings suggest that yoga may reduce expressive suppression and may improve PTSD symptoms by increasing psychological flexibility. More research is needed to replicate and extend these findings.
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