Do trauma type, stressful life events, and social support explain women veterans’ high prevalence of PTSD?

Lehavot, Keren; Goldberg, Simon B.; Chen, Jessica; Katon, Jodie G.; Glass, Joseph E.; Fortney, John C.; Simpson, Tracy L.; Schnurr, Paula P.

doi:10.1007/s00127-018-1550-x

Cited by 51 publications

(43 citation statements)

References 56 publications

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“…With the exception of alcohol misuse, adverse post-deployment outcomes were typically associated with pre-trauma, within trauma, and post-trauma factors related to stressful life events, past trauma exposures, current social support, as well as other factors [ 1 ] and this was less so with rural residency. Consistent with a previous study [ 87 ], female sex was associated with PTSD. Our results suggest that rural residence is not a post-deployment risk factor for poor mental health outcomes, but rather protective.…”

Section: Discussionsupporting

confidence: 92%

Mental health status in veterans residing in rural versus non-rural areas: results from the veterans’ health study

et al. 2020

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Background The majority of Veterans Affair (VA) hospitals are in urban areas. We examined whether veterans residing in rural areas have lower mental health service use and poorer mental health status. Methods Veterans with at least 1 warzone deployment in central and northeastern Pennsylvania were randomly selected for an interview. Mental health status, including PTSD, major depression, alcohol abuse and mental health global severity, were assessed using structured interviews. Psychiatric service use was based on self-reported utilization in the past 12 months. Results were compared between veterans residing in rural and non-rural areas. Data were also analyzed using multivariate logistic regression to minimize the influence by confounding factors. Results A total of 1730 subjects (55% of the eligible veterans) responded to the survey and 1692 of them had complete geocode information. Those that did not have this information (n = 38), were excluded from some analyses. Veterans residing in rural areas were older, more often of the white race, married, and experienced fewer stressful events. In comparison to those residing in non-rural areas, veterans residing in rural areas had lower global mental health severity scores; they also had fewer mental health visits. In multivariate logistic regression, rural residence was associated with lower service use, but not with PTSD, major depression, alcohol abuse, and global mental health severity score after adjusting confounding factors (e.g., age, gender, marital status and education). Conclusions Rural residence is associated with lower mental health service use, but not with poor mental health in veterans with former warzone deployment, suggesting rural residence is possibly protective.

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Section: Discussionsupporting

confidence: 92%

Mental health status in veterans residing in rural versus non-rural areas: results from the veterans’ health study

et al. 2020

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“…Our study is consistent with earlier research which nds female veterans at greater risk for lifetime PTSD and other mental health problems, and higher users of psychological services, 9,38 even after controlling for several risk and protective factors. Our results also match results from non-US countries.…”

Section: Discussionsupporting

confidence: 92%

“…41 Many of these limitations are also found in other studies, especially for those of veterans who served in industrialized countries other than the US. [4][5][6][7][38][39][40] Future research examining sex differences needs to have much larger numbers of female veterans so that we can have more accurate estimates of their mental health problems and treatment needs.…”

Section: Discussionmentioning

confidence: 99%

Risk and Protective Factors Associated Mental Health among Female Military Veterans: Results from the Veterans’ Health Study

Adams

Figley

et al. 2020

Preprint

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Background: This study focuses on factors that may affect female veterans’ mental health, compared to men, and is part of a large study assessing the prevalence of mental health disorders and treatment seeking among formerly deployed US military service members.Methods: We surveyed a random sample of 1,730 veterans who were patients in a large non-VA hospital system in the US. Based on previous research, women were hypothesized to be at higher risk for psychological problems. We adjusted our models for confounding factors, including history of childhood abuse, combat exposure, stressful life events, alcohol misuse, psychological resources, and social support. Results: Among the veterans studied, 5% (N=85) were female, 96% were White, 22.9% were Iraq/Afghanistan veterans, and the mean age was 59 years old. Compared to males, female veterans were younger, unmarried, college graduates, have less combat exposure, but more likely to have lifetime PTSD (29% vs. 12%.), lifetime depression (46% vs. 21%), lifetime suicide ideation (27% vs. 11%), to have ever used psychological services (67 vs. 47%). Females were more likely to have low psychological resilience and use psychotropic medicines. Using multivariate logistic regression analyses that controlled for risk and protective factors, female veterans had greater risk for lifetime PTSD, lifetime depression, and lifetime suicidal thoughts, compared to males. Since 95% of the population in this study were male and these results may have been statistically biased, we reran our analyses using propensity score matching. The results were consistent.Conclusion: Using a sample of post-deployment veterans receiving services from a non-VA healthcare system, we find that female veterans are at greater risk for lifetime psychological problems, compared to male veterans. We discuss these findings and their implications for service providers.

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“…The fact that our sample is 95% male is also a potential limitation, since the differences in PTSD biology likely vary significantly by sex. 13,75 Our previous PTSD-genetic study was mostly female. 62 Also, the total number of currently diagnosed PTSD cases in our study was limited (n=75).…”

Section: Discussionmentioning

confidence: 98%

<p>Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics</p>

Hu¹,

Chu²,

Urosevich³

et al. 2020

NDT

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Background: Previously we reported a genetic risk score significantly improved PTSD prediction among a trauma-exposed civilian population. In the current study, we sought to assess this prediction among a trauma-exposed military population. Methods: We examined current PTSD diagnosis and PTSD symptom severity among a random sample of 1042 community-based US military veterans. Main effects and interaction effects were assessed for PTSD genetic risk by trauma exposure using cross-product terms for PTSD x trauma exposures, including combat, lifetime trauma, and adverse childhood exposures. The PTSD risk variants studied were within genetic loci previously associated with PTSD, including CRHR1, CHRNA5, RORA, and FKBP5 genetic variants, which were used to calculate a total PTSD genetic risk score (range=0-8, mean=3.6, SD=1.4). Results: Based on DSM-5 PTSD criteria, 7.1% of veterans (95% CI=5.6-8.8) met criteria for current PTSD. The PTSD genetic risk count was significantly higher among PTSD cases vs noncases (3.92 vs 3.55, p=0.027). Since the PTSD genetic risk score was not significant in the PTSD diagnosis model, we assessed this association using PTSD symptom severity. Because these symptom data were skewed (mean=9.54, SD=12.71, range=0-76), we used negative binomial regression to assess this outcome. This symptom model included a PTSD genetic risk score, demographic factors, trauma exposures, current insomnia, current depression, concussion history, and attention-deficit disorder, expressed as incident rate ratios (IRR), which is an estimate of oneunit increase in PTSD severity, given other variables are held constant. Variables in the final model included age and sex (both p<0.001), PTSD genetic risk (IRR=1.02, p=0.028), warzone tours (IRR=0.94, p=0.003), childhood abuse (IRR=1.50, p<0.0001), current depression (IRR=1.89, p<0.0001), current insomnia (IRR=2.58, p<0.0001), low social support (IRR=1.19, p<0.0001), attention-deficit disorder (IRR=1.51, p<0.0001), agreeable personality (IRR=0.77, p<0.0001), and concussion (IRR=1.38, p<0.0001). Significant interactions were detected for combat and lifetime trauma exposure by PTSD genetic risk (both p<0.0001), suggesting that the impact of trauma exposures on PTSD severity was lower when the PTSD genetic risk was higher. Conclusion: Both warzone and non-warzone factors predicted current PTSD symptoms among veterans, including a PTSD genetic risk score. Interaction effects were detected for combat exposure and lifetime trauma by genetic risk score for PTSD symptoms, suggesting that PTSD symptom manifestation was more dependent on PTSD risk variants than the level of trauma or combat exposure. This suggests that controlling for other factors, the absence of genetic risk variants may confer PTSD resilience. Further research is planned.

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Do trauma type, stressful life events, and social support explain women veterans’ high prevalence of PTSD?

Cited by 51 publications

References 56 publications

Mental health status in veterans residing in rural versus non-rural areas: results from the veterans’ health study

Mental health status in veterans residing in rural versus non-rural areas: results from the veterans’ health study

Risk and Protective Factors Associated Mental Health among Female Military Veterans: Results from the Veterans’ Health Study

<p>Predictors of Current DSM-5 PTSD Diagnosis and Symptom Severity Among Deployed Veterans: Significance of Predisposition, Stress Exposure, and Genetics</p>

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