Gender Differences Among Veterans Deployed in Support of the Wars in Afghanistan and Iraq
The changing scope of women’s roles in combat operations has led to growing interest in women’s deployment experiences and post-deployment adjustment.
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.
National mail survey of OEF/OIF Veterans randomly sampled within gender, with women oversampled.
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 %.
Deployment stressors (including combat and harassment stress), PTSD, depression, anxiety and alcohol use, all measured via self-report.
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.
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.
- Defense Manpower Data Center. Contingency Tracking System Profile of Service Members Ever Deployed (In Support of OEF/OIF from Sept. 2001-Oct. 2009), By Gender: Department of Defense; 2009.
- Street AE, Vogt D, Dutra L. A new generation of women veterans: stressors faced by women deployed to Iraq and Afghanistan. Clin Psychol Rev. 2009;29(8):685–694. CrossRef
- Vogt D, Pless AP, King LA, King DW. Deployment stressors, gender, and mental health outcomes among Gulf War I veterans. J Trauma Stress. 2005;18(3):272–284.
- Rosen LN, Martin L. Psychological effects of sexual harassment, appraisal of harassment, and organizational culture among U.S. Army soldiers. Mil Med. 1998;163(2):63–67.
- Street AE, Stafford J, Mahan CM, Hendricks A. Sexual harassment and assault experienced by reservists during military service: prevalence and health correlates. J Rehabil Res Dev. 2008;45(3):409–419. CrossRef
- Skinner KM, Kressin N, Frayne S, et al. The prevalence of military sexual assault among female Veterans’ administration outpatients. J Interpers Violence. 2000;15(3):291–310. CrossRef
- Kang H, Dalager N, Mahan C, Ishii E. The role of sexual assault on the risk of PTSD among Gulf War veterans. Ann Epidemiol. 2005;15(3):191–195. CrossRef
- Kimerling R, Gima K, Smith MW, Street A, Frayne S. The Veterans Health Administration and military sexual trauma. Am J Public Health. 2007;97(12):2160–2166. CrossRef
- Rosen LN, Wright K, Marlowe D, Bartone P, Gifford RK. Gender differences in subjective distress attributable to anticipation of combat among U.S. Army soldiers deployed to the Persian Gulf during operation desert storm. Mil Med. 1999;164(11):753–757.
- Vogt D, Vaughn R, Glickman ME, et al. 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. 2011;120(4):797–806.
- Maguen S, Luxton DD, Skopp NA, Madden E. Gender differences in traumatic experiences and mental health in active duty soldiers redeployed from Iraq and Afghanistan. J Psychiatr Res. 2012;46:311–316. CrossRef
- National Defense Authorization Act for Fiscal Year 1994, P.L. 103–160, SEC. 541–542, H.R. 2401–1131994.
- Hoge CW, Clark JC, Castro CA. Commentary: Women in combat and the risk of post-traumatic stress disorder and depression. Int J Epidemiol. 2007;36(2):327–329. CrossRef
- Haskell SG, Gordon KS, Mattocks KM, et al. Gender difference in rates of depression, PTSD, pain, obesity, and military sexual trauma among Connecticut war Veterans of Iraq and Afghanistan. J. Women’s Health. 2010;19(2):267–271. CrossRef
- Maguen S, Cohen B, Ren L, Bosch J, Kimerling R, Seal K. Gender differences in military sexual trauma and mental health diagnoses among Iraq and Afghanistan Veterans with posttraumatic stress disorder. Women’s Health Issues. 2012;22–1:e61–e66. CrossRef
- Kimerling R, Street AE, Pavao J, et al. Military-related sexual trauma among veterans health administration patients returning from Afghanistan and Iraq. Am J Public Health. 2010;100(8):1409–1412. CrossRef
- Katz LS, Bloor LE, Cojucar G, Draper T. Women who served in Iraq seeking mental health services: Relationships between military sexual trauma, symptoms, and readjustment. Psychol Serv. 2007;4(4):239–249. CrossRef
- Dutra L, Grubbs K, Greene C, et al. Women at war: Implications for mental health. J Trauma Dissociation. 2011;12(1):25–37. CrossRef
- Luxton DD, Skopp NA, Maguen S. Gender differences in depression and PTSD symptoms following combat exposure. Depress Anxiety. 2010;27(11):1027–1033. CrossRef
- Skopp NA, Reger MA, Reger GM, Mishkind MC, Raskind M, Gahm GA. The role of intimate relationships, appraisals of military service, and gender on the development of posttraumatic stress symptoms following Iraq deployment. J Trauma Stress. 2011;24(3):277–286. CrossRef
- Mental health advisory team (MHAT) IV Operation Iraqi Freedom 05–07 [news and media link]. 2006; http://www.armymedicine.army.mil/reports/mhat/mhat_iv/MHAT_IV_Report_17NOV06.pdf. Accessed December 14, 2012.
- National Comorbidity Survey Replication. Lifetime prevalence of DSM_IV/WMH-CIDI disorders by sex and cohort. In: NCS-R appendix table, ed. http://www.hcp.med.harvard.edu/ncs/ftpdir/NCSR_Lifetime_Prevalence_Estimates.pdf2007. Accessed December 14, 2012.
- Dillman DA. Mail and Internet Surveys: The Tailored Design, Second Edition—2007 Update. Hoboken: John Wiley; 2007.
- King DW, King LA, Vogt DS. Manual for the Deployment Risk and Resilience Inventory (DRRI): a collection of measures for studying deployment-related experiences of military veterans. Boston, MA: National Center for PTSD; 2003.
- King LA, King DW, Vogt D, Knight J, Samper RE. Deployment risk and resilience inventory: A collection of measures for studying deployment-related experiences of military personnel and Veterans. Mil Psychol. 2006;18(2):89–120. CrossRef
- Vogt D, Proctor SP, King DW, King LA, Vasterling JJ. Validation of scales from the Deployment Risk and Resilence Inventory in a sample of Iraq War Veterans. Assessment. 2008;15(4):391–403. CrossRef
- Weathers FW, Huska JA, Keane TM. PCL-M for DSM-IV. Boston: National Center for PTSD--Behavioral Science Division. 1991.
- Tanielian T, Jaycox LH, eds. Invisible wounds of war: Psychological and cognitive injuries, their consequences, and services to assist recovery. Santa Monica, CA: The RAND Corporation; 2008. RAND Corporation monograph series.
- Hotopf M, Hull L, Fear NT, et al. The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet. 2006;367(9524):1731–1741. CrossRef
- Weathers FW, Litz BT, Herman DS, Huska JA, Keane TM. The PTSD Checklist (PCL): Reliability, validity, and diagnostic utility. Paper presented at: 9th annual meeting of the International Society for Traumatic Stress Studies1993; San Antonio, Texas.
- Radloff LS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas. 1977;1:385–401. CrossRef
- Andresen EM, Malmgren JA, Carter WB, Patrick DL. Screening for depression in well older adults: evalutation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). Am J Prev Med. 1994;10(2):77–84.
- Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Therapy. 1995;33:335–343. CrossRef
- Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. Sydney: The Psychology Foundation of Australia; 1995.
- Ewing JA. Detecting alcoholism: The CAGE questionnaire. JAMA. 1984;252:1905–1907. CrossRef
- Buchsbaum DG, Buchanan RG, Centor RM, Schnoll SH, Lawton MJ. Screening for alcohol abuse using CAGE scores and likelihood ratios. Ann Intern Med. 1991;115(10):774–777. CrossRef
- Groves R, Dillman D, Eltinge J, Little R. Survey Nonresponse. New York: Wiley; 2002.
- Greenland S. Introduction to Regression Modeling. In: Rothman KJ, Greenland S, Lash TL, eds. Modern Epidemiology. 3rd ed. Philadelphia: Lippincott, Williams, & Wilkins; 2008:418–458.
- Brailey K, Vasterling JJ, Proctor SP, Constans JI, Friedman MJ. PTSD symptoms, life events, and unit cohesion in U.S. soldiers: baseline findings from the neurocognition deployment health study. J Trauma Stress. 2007;20(4):495–503. CrossRef
- Clemmitt M. Women in the military. Congressional Quarterly Researcher. 2009;19(40):957–980.
- Martin R. Panel to recommend allowing women in combat. NPR. January, 2011. http://www.npr.org/2011/01/13/132882277/Panel-To-Recommend-Allowing-Women-In-Combat. Accessed December 14, 2012.
- Maguen S, Ren L, Bosch JO, Marmar CR, Seal KH. Gender differences in mental health diagnoses among Iraq and Afghanistan Veterans enrolled in Veterans Affairs health care. Am J Public Health. 2010;100(12):2450–2456. CrossRef
- Tolin DF, Foa EB. Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research. Psychol Bull. 2006;132(6):959–992. CrossRef
- Smith B, Smith TC, Gray GC, Ryan MA. When epidemiology meets the Internet: Web-based surveys in the Millennium Cohort Study. Am J Epidemiol. 2007;166(11):1345–1354. CrossRef
- Gender Differences Among Veterans Deployed in Support of the Wars in Afghanistan and Iraq
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Journal of General Internal Medicine
Volume 28, Issue 2 Supplement, pp 556-562
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- 1. National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue (116B-3), Boston, MA, 02130, USA
- 2. Department of Psychiatry, Boston University School of Medicine, Boston, MA, USA
- 3. Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA