Top

Social Psychiatry and Psychiatric Epidemiology

Published in:

01-09-2018 | Original Paper

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

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

Published in: Social Psychiatry and Psychiatric Epidemiology | Issue 9/2018

Abstract

Objectives

To examine factors that account for women veterans’ higher prevalence of past-year DSM-5 posttraumatic stress disorder (PTSD) compared to women civilians and men veterans.

Methods

Cross-sectional analyses of the 2012–2013 National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). Face-to-face interviews with 379 women veterans, 20,007 women civilians, and 2740 men veterans were conducted. Trauma type (child abuse, interpersonal violence, combat or war zone, and other), number of trauma types, past-year stressful life events, current social support, and DSM-5 PTSD were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-5. Generalized linear models were used that accounted for the complex survey design.

Results

Women veterans had a higher unadjusted prevalence of past-year PTSD (11.40%) compared to their civilian (5.96%) and male (5.19%) counterparts. Individual predictor models indicated that the difference between women veterans’ and civilians’ prevalence of PTSD was attenuated when adjusting for number of trauma types, whereas the difference between men and women veterans was attenuated when adjusting for child abuse, interpersonal violence, and stressful life events. Nonetheless, while full adjustment in a multiple predictor model accounted for the difference in PTSD between women veterans and civilians, gender differences between men and women veterans remained.

Conclusions

Number of trauma types, type of trauma, and social factors may together help explain women veterans’ higher PTSD prevalence compared to women civilians, but do not fully account for differences between men and women veterans. Results highlight a need to explore additional explanatory factors and evaluate associations with longitudinal data.

Available only for authorised users

Boscarino JA (2006) Posttraumatic stress disorder and mortality among U.S. army veterans 30 years after military service. Ann Epidemiol 16:248–256CrossRefPubMed

Hoge CW, Terhakopian A, Castro CA, Messer SC, Engel CC (2007) Association of posttraumatic stress disorder with somatic symptoms, health care visits, and absenteeism among Iraq war veterans. Am J Psychiatry 164:150–153CrossRefPubMed

Perkonigg A, Kessler RC, Storz S, Wittchen HU (2000) Traumatic events and post-traumatic stress disorder in the community: prevalence, risk factors and comorbidity. Acta Psychiatr Scand 101:46–59CrossRefPubMed

Schnurr PP, Friedman MJ, Senqupta A, Jankowski MK, Holmes T (2000) PTSD and utilization of medical treatment services among male Vietnam veterans. J Nerv Ment Dis 188:496–504CrossRefPubMed

Schnurr PP, Hayes AF, Lunney CA, McFall M, Uddo M (2006) Longitudinal analysis of the relationship between symptoms and quality of life in veterans treated for posttraumatic stress disorder. J Consult Clin Psychol 74:707–713CrossRefPubMed

Kessler RC, Sonnega A, Bromet E, Hughes M, Nelson CB (1995) Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry 52:1048–1060CrossRefPubMed

Resnick HS, Kilpatrick DG, Dansky BS, Saunders BE, Best CL (1993) Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women. J Consult Clin Psychol 61:984–991CrossRefPubMed

Goldstein RB, Smith SM, Chou SP, Saha TD, Jung J, Zhang H, Pickering RP, Ruan WJ, Huang B, Grant BF (2016) The epidemiology of DSM-5 posttraumatic stress disorder in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. Soc Psychiatr Psychiatr Epidemiol 51:1137–1148CrossRef

Pietrzak RH, Goldstein RB, Southwick SM, Grant BF (2011) Prevalence and Axis I comorbidity of full and partial posttraumatic stress disorder in the United States: results from Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. J Anxiety Disord 25:456–465CrossRefPubMed

10.

Kilpatrick DG, Resnick HS, Milanak ME, Miller MW, Keyes KM, Friedman MJ (2013) National estimates of exposure to traumatic events and PTSD prevalence using DSM-IV and DSM-5 criteria. J Trauma Stress 26:537–547CrossRefPubMedPubMedCentral

11.

Danan ER, Krebs EE, Ensrud K, Koeller E, MacDonald R, Velasquez T, Greer N, Wilt TJ (2017) An evidence map of the women veterans’ health research literature (2008–2015). J Gen Intern Med 32:1359–1376CrossRefPubMedPubMedCentral

12.

Marmar CR, Schlenger W, Henn-Hasse C, Qian M, Purchia E, Li M, Corry N, Williams CS, Ho CL, Horesh D, Karstoft KI, Shalev A, Kulka RA (2015) Course of posttraumatic stress disorder 40 years after the Vietnam war: findings from the National Vietnam Veterans Longitudinal Study. JAMA Psychiatry 72:875–881CrossRefPubMed

13.

Weiss DS, Marmar CR, Schlenger WE, Fairbank JA, Jordan KB, Hough RL, Kulka RA (1992) The prevalence of lifetime and partial post-traumatic stress disorder in Vietnam theater veterans. J Trauma Stress 5:365–376CrossRef

14.

Vogt D, Vaughn R, Glickman ME, Schultz M, Drainoni ML, Elwy R, Eisen S (2011) Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of U.S. OEF/OIF veterans. J Abnorm Psychol 120:797–806CrossRefPubMed

15.

Lehavot K, Katon JG, Chen JA, Fortney JC, Simpson TL (2018) Post-traumatic stress disorder by gender and veteran status. Am J Prev Med 54:e1–e9CrossRefPubMed

16.

Wisco BE, Marx BP, Wolf EJ, Miller MW, Southwick SM, Pietrzak RH (2014) Posttraumatic stress disorder in the US veteran population: results from the National Health and Resilience in Veterans Study. J Clin Psychiatry 75:1338–1346CrossRefPubMed

17.

American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders (DSM-5), 5th edn. Author, Washington, DCCrossRef

18.

Committee on the Assessment of Ongoing Efforts in the Treatment of Posttraumatic Stress Disorder, Board on the Health of Select Populations, Institute of Medicine (2014) Treatment for posttraumatic stress disorder in military and veteran populations: final assessment. The National Academies Press, Washington, DC

19.

Stein MB, Walker JR, Forde DR (2000) Gender differences in susceptibility to posttraumatic stress disorder. Behav Res Ther 38:619–628CrossRefPubMed

20.

Breslau N, Kessler RC, Chilcoat HD, Schultz LR, Davis GC, Andreski P (1998) Trauma and posttraumatic stress disorder in the community: the 1996 Detroit Area Survey of Trauma. Arch Gen Psychiatry 55:626–632CrossRefPubMed

21.

Bromet E, Sonnega A, Kessler RC (1998) Risk factors for DSM-III-R posttraumatic stress disorder: findings from the National Comorbidity Survey. Am J Epidemiol 147:353–361CrossRefPubMed

22.

Zinzow HM, Grubaugh AL, Monnier J, Suffoletta-Maierle S, Frueh BC (2007) Trauma among female veterans: a critical review. Trauma Violence Abuse 8:384–400CrossRefPubMed

23.

Lang AJ, Rodgers CS, Laffaye C, Satz LE, Dresselhaus TR, Stein MB (2003) Sexual trauma, posttraumatic stress disorder, and health behavior. Behav Med 28:150–158CrossRefPubMed

24.

Yaeger D, Himmelfarb N, Cammack A, Mintz J (2006) DSM-IV diagnosed posttraumatic stress disorder in women veterans with and without military sexual trauma. J Gen Intern Med 21:S65–S69CrossRefPubMedPubMedCentral

25.

Macmillan HL, Fleming JE, Trocme N, Boyle MH, Wong M, Racine YA, Beardslee WR, Offord DR (1997) Prevalence of child physical and sexual abuse in the community: results from the Ontario Health Supplement. JAMA 278:131–135CrossRefPubMed

26.

Stein MB, Walker JR, Hazen AL, Forde DR (1997) Full and partial posttraumatic stress disorder: findings from a community survey. Am J Psychiatry 154:1114–1119CrossRefPubMed

27.

Olff M, Langeland W, Draijer N, Gersons BPR (2007) Gender differences in posttraumatic stress disorder. Psychol Bull 133:183–204CrossRefPubMed

28.

Tolin DF, Foa EB (2006) Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Bull 132:959–992CrossRefPubMed

29.

Frayne SM, Parker VA, Christiansen CL, Loveland S, Seaver MR, Kazis LE, Skinner KM (2006) Health status among 28,000 women veterans. J Gen Intern Med 21:S40–S46CrossRefPubMedPubMedCentral

30.

Mota NP, Medved M, Wang J, Asmundson GJ, Whitney D, Sareen J (2011) Stress and mental disorders in female military personnel: comparisons between the sexes in a male dominated profession. J Psychiatr Res 46:159–167CrossRefPubMed

31.

Street AE, Gradus JL, Giasson HL, Vogt D, Resick PA (2013) Gender differences among veterans deployed in support of the wars in Afghanistan and Iraq. J Gen Intern Med 28:556–562CrossRefPubMedCentral

32.

Vogt DS, Pless AP, King LA, King DW (2005) Deployment stressors, gender, and mental health outcomes among Gulf War I veterans. J Trauma Stress 18:272–284CrossRefPubMed

33.

Hamilton A, Maisel N, Oishi S, Klap R, Balusubramanian V, Yano E, Frayne S (2014) Mental health needs and diagnoses among women veterans receiving veterans health administration health care. In: VA women’s health services research conference on enhancing partnerships for research and care for women veterans. Arlington, VA

34.

Possemato K, McKenzie S, McDevitt-Murphy ME, Williams JL, Ouimette P (2014) The relationship between postdeployment factors and PTSD severity in recent combat veterans. Mil Psychol 26:15–22CrossRefPubMedPubMedCentral

35.

Brewin CR, Andrews B, Valentine JD (2000) Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. J Consult Clin Psychol 68:748–766CrossRefPubMed

36.

Grant BF, Chu A, Sigman R, Amsbary M, Kali J, Sugawana Y, Jiao R, Ren W, Goldstein RB (2014) Source and accuracy statement: National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). National Institute on Alcohol Abuse and Alcoholism, Bethesda

37.

Bureau of the Census (2013) American Community Survey, 2012. Bureau of the Census, Suitland

38.

Substance Abuse and Mental Health Services Administration (2014) Results from the 2013 National Survey on Drug Use and Health-Detailed Tables. Substance Abuse and Mental Health Services Administration, Rockville

39.

Centers for Disease Control and Prevention (2014) Summary health statistics for US adults: National Health Interview Survey, 2012. National Center for Health Statistics, Hyattsville

40.

Grant BF, Chou GR SP, et al (2011) The Alcohol Use Disorder and Associated Disabilities Interview Schedule—diagnostic and statistical manual of mental disorders, fifth edition version (AUDADIS-5). National Institute on Alcohol Abuse and Alcoholism, Rockville

41.

Smith SM, Goldstein RB, Grant BF (2016) The association between post-traumatic stress disorder and lifetime DSM-5 psychiatric disorders among veterans: data from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III). J Psychiatr Res 82:16–22CrossRefPubMedPubMedCentral

42.

Grant BF, Goldstein RB, Smith SM, Jung J, Zhang H, Chou SP, Pickering RP, Ruan WJ, Huang B, Saha TD, Aivadyan C, Greenstein E, Hasin DS (2015) The Alcohol Use Disorder and Associated Disabilities Interview Schedule-5 (AUDADIS-5): reliability of substance use and psychiatric disorder modules in a general population sample. Drug Alcohol Depend 148:27–33CrossRefPubMed

43.

Hasin DS, Aivadyan C, Greenstein E, Grant BF (2011) Psychiatric research interview for substance use and mental disorders, diagnostic and statistical manual of mental disorders, fifth edition (PRISM-5) version. Columbia University, New York

44.

Hasin D, Samet S, Nunes E, Meydan J, Matseoane K, Waxman R (2006) Diagnosis of comorbid psychiatric disorders in substance users assessed with the psychiatric research interview for substance and mental disorders for DSM-IV. Am J Psychiatry 163:689–696CrossRefPubMed

45.

Hasin DS, Shmulewitz D, Stohl M, Greenstein E, Aivadyan C, Morita K, Saha T, Aharonovich E, Jung J, Zhang H, Nunes EV, Grant BF (2015) Procedural validity of the AUDADIS-5 depression, anxiety and post-traumatic stress disorder modules: substance abusers and others in the general population. Drug Alchol Depend 152:246–256CrossRef

46.

Dawson DA, Grant BF, Ruan WJ (2005) The association between stress and drinking: modifying effects of gender and vulnerability. Alcohol Alcohol 40:453–460CrossRefPubMed

47.

Ruan WJ, Goldstein RB, Chou SP, Smith SM, Saha TD, Pickering RP, Dawson DA, Huang B, Stinson FS, Grant BF (2008) The Alcohol Use Disorder and Associated Disabilities Interview Schedule-IV (AUDADIS-IV): reliability of new psychiatric diagnostic modules and risk factors in a general population sample. Drug Alcohol Depend 92:27–36CrossRefPubMed

48.

Cohen S, Mermelstein R, Kamarck T, Hoberman HM (1985) Measuring the functional components of social support. In: Sarason IG et al (eds) Social support: theory, research, and applications. Martinus Nijhoff Publishers, Holland, pp 73–94CrossRef

49.

Merz EL, Roesch SC, Malcarne VL et al (2014) Validation of Interpersonal Support Evaluation List-12 (ISEL-12) scores among English- and Spanish-speaking Hispanics/Latinos from the HCHS/SOL sociocultural ancillary study. Psychol Assess 26:384–394CrossRefPubMed

50.

R Development Core Team (2017) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

51.

Aquino J (2016) descr: descriptive statistics. R package version 1.1.3

52.

Lumley T (2017) survey: analysis of complex survey samples. R package version 3.32

53.

Lumley T (2004) Analysis of complex survey samples. J Stat Softw 9:1–19CrossRef

54.

Muthén BO, Satorra A (1995) Complex sample data in structural equation modeling. Sociol Methodol 25:267–316CrossRef

55.

Katon JG, Lehavot K, Simpson TL, Williams EC, Barnet SB, Grossbard JR, Schure MB, Gray KE, Reiber GE (2015) Adverse childhood experiences, military service, and adult health. Am J Prev Med 49:573–582CrossRefPubMed

56.

Steenkamp MM, Schlenger WE, Corry N, Henn-Haase C, Qian M, Li M, Horesh D, Karstoft KI, Williams C, Ho CL, Shalev A, Kulka R, Marmar C (2017) Predictors of PTSD 40 years after combat: findings from the National Vietnam Veterans longitudinal study. Depress Anxiety 34:711–722CrossRefPubMed

57.

Kaniasty K, Norris KF (2008) Longitudinal linkages between perceived social support and posttraumatic stress symptoms: sequential roles of social causation and social selection. J Trauma Stress 21:274–281CrossRefPubMed

58.

Washington DL, Farmer MM, Mor SS, Canning M, Yano EM (2015) Assessment of the healthcare needs and barriers to VA use experienced by women veterans: findings from the National Survey of Women Veterans. Med Care 53(4 Suppl 1):S23–S31CrossRefPubMed

59.

National Center for Veterans Analysis and Statistics. Population Tables September (2015) https://www.va.gov/vetdata/veteran_population.asp. Accessed 31 May 2018

60.

Regier DA, Narrow WE, Clarke DE, Kraemer HC, Kuramoto SJ, Kuhl EA, Kupfer DJ (2013) DSM-5 field trials in the United States and Canada, part II: test-retest reliability of selected categorical diagnoses. Am J Psychiatry 170:59–70CrossRefPubMed

61.

Close RJ, Sachs CJ, Dyne PL (2001) Reliability of bimanual pelvic examinations performed in emergency departments. West J Med 175:240–244CrossRefPubMedPubMedCentral

62.

Marin JR, Bilker W, Lautenbach E, Alpern ER (2010) Reliability of clinical examinations for pediatric skin and soft-tissue infections. Pediatrics 126:925–930CrossRefPubMedPubMedCentral

63.

Wallace DE, McGreal GT, O’Toole G, Holloway P, Wallace M, McDermott EW, Blake J (2000) The influence of experience and specialisation on the reliability of a common clinical sign. Ann R Coll Surg Eng 82:336–338

Title: Do trauma type, stressful life events, and social support explain women veterans’ high prevalence of PTSD?
Authors: Keren Lehavot
Simon B. Goldberg
Jessica A. Chen
Jodie G. Katon
Joseph E. Glass
John C. Fortney
Tracy L. Simpson
Paula P. Schnurr
Publication date: 01-09-2018
Publisher: Springer Berlin Heidelberg
Published in: Social Psychiatry and Psychiatric Epidemiology / Issue 9/2018
Print ISSN: 0933-7954
Electronic ISSN: 1433-9285
DOI: https://doi.org/10.1007/s00127-018-1550-x

ACC 2024 Congress

Springer Medicine

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

Abstract

Objectives

Methods

Results

Conclusions

ACC 2024 Congress

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2018

Commentary on: Mendelson T & Eaton WW. Recent advances in the prevention of mental disorders. SPPE (2018)

Traumatic exposure, acculturative stress and cultural orientation: the influence on PTSD, depressive and anxiety symptoms among refugees

The association of depression and posttraumatic stress disorder with the metabolic syndrome in a multi-ethnic cohort: the HELIUS study

School poverty and the risk of attempted suicide among adolescents

Towards personalised positive psychiatry?

The impact of economic recessions on depression and individual and social well-being: the case of Spain (2006–2013)