Women who served in Vietnam have higher odds of posttraumatic stress disorder (PTSD) than women stationed during that era in the United States, and this effect appears to be associated with wartime exposures including sexual discrimination or harassment and job performance pressures, according to an article published online by JAMA Psychiatry.
During the Vietnam era, approximately 5,000 to 7,500 American women served in the U.S. military in Vietnam, at least 2,000 were stationed at nearby bases in Japan, the Philippines, Guam, Korea and Thailand, and 250,000 were in the United States. Most of the deployed women were nurses, although others filled clerical, medical and personnel positions. Although women were excluded from combat, women in Vietnam were still in a war theater and many of those stationed near Vietnam were exposed to casualties and other stressors.
Kathryn Magruder, Ph.D., M.P.H., of the Johnson Veterans Affairs Medical Center, Charleston, S.C., and coauthors report the main findings from the Department of Veterans Affairs (VA) Cooperative Study 579, the Health of Vietnam-Era Women’s Study (HealthVIEWS).
Among the 4,219 women (48.3 percent) who completed a survey and telephone interview, 1,956 served in Vietnam, 657 were near Vietnam and 1,606 served in the United States. Most of the women who served in Vietnam and in the United States were in the Army, while most of the women who served near Vietnam were in the Air Force. Women in Vietnam were more likely to be nurses.
The lifetime prevalence of PTSD was 20.1 percent for women in Vietnam, 11.5 percent for women near Vietnam and 14.1 percent for women in the United States. The prevalence for current PTSD active within the past year was 15.9 percent for women in Vietnam, 8.1 percent for women near Vietnam and 9.1 percent for women stationed in the U.S., the study reports.
Wartime exposure increased the odds of PTSD, especially exposure to sexual harassment and job performance pressure, according to the results. Sexual discrimination or harassment, which is not thought of as a unique war zone exposure, was higher among deployed women and related to PTSD in every model of analysis.
The authors acknowledge their findings differ from another national study of PTSD among Vietnam-era women veterans. They also note nonrespondents to the study, including those who have died, may have had a different PTSD prevalence. “Because current PTSD is still present in many of these women decades after their military service, clinicians who treat them should continue to screen for PTSD symptoms and be sensitive to their noncombat wartime experiences,” the study concludes.
Source: Heather Woolwine – JAMA Network
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Original Research: Abstract for “Prevalence of Posttraumatic Stress Disorder in Vietnam-Era Women Veterans: The Health of Vietnam-Era Women’s Study (HealthVIEWS)” by Kathryn Magruder, PhD, MPH; Tracey Serpi, PhD; Rachel Kimerling, PhD; Amy M. Kilbourne, PhD; Joseph F. Collins, ScD; Yasmin Cypel, PhD, MS; Susan M. Frayne, MD, MPH,; Joan Furey, RN, MA; Grant D. Huang, MPH, PhD; Theresa Gleason, PhD; Matthew J. Reinhard, PsyD; Avron Spiro, PhD; and Han Kang, DrPH in JAMA Psychiatry. Published online October 7 2015 doi:10.1001/jamapsychiatry.2015.1786
Prevalence of Posttraumatic Stress Disorder in Vietnam-Era Women Veterans: The Health of Vietnam-Era Women’s Study (HealthVIEWS)
Importance Many Vietnam-era women veterans served in or near war zones and may have experienced stressful or traumatic events during their service. Although posttraumatic stress disorder (PTSD) is well studied among men who served in Vietnam, no major epidemiologic investigation of PTSD among women has been performed.
Objectives To assess (1) the onset and prevalence of lifetime and current PTSD for women who served during the Vietnam era, stratified by wartime location (Vietnam, near Vietnam, or the United States), and (2) the extent to which wartime location was associated with PTSD, with adjustment for demographics, service characteristics, and wartime exposures.
Design, Setting, and Participants Survey of 8742 women who were active-duty military personnel in the US Armed Forces at any time from July 4, 1965, through March 28, 1973, and alive as of survey receipt as part of Department of Veterans Affairs Cooperative Study 579, HealthVIEWS. Data were obtained from mailed and telephone surveys from May 16, 2011, through August 5, 2012, and analyzed from June 26, 2013, through July 30, 2015.
Main Outcomes and Measures Lifetime and current PTSD as measured by the PTSD module of the Composite International Diagnostic Interview, version 3.0; onset of PTSD; and wartime experiences as measured by the Women’s Wartime Exposure Scale–Revised.
Results Among the 4219 women (48.3%) who completed the survey and a telephone interview, the weighted prevalence (95% CI) of lifetime PTSD was 20.1% (18.3%-21.8%), 11.5% (9.1%-13.9%), and 14.1% (12.4%-15.8%) for the Vietnam, near-Vietnam, and US cohorts, respectively. The weighted prevalence (95% CI) of current PTSD was 15.9% (14.3%-17.5%), 8.1% (6.0%-10.2%), and 9.1% (7.7%-10.5%) for the 3 cohorts, respectively. Few cases of PTSD among the Vietnam or near-Vietnam cohorts were attributable to premilitary onset (weighted prevalence, 2.9% [95% CI, 2.2%-3.7%] and 2.9% [95% CI, 1.7%-4.2%], respectively). Unadjusted models for lifetime and current PTSD indicated that women who served in Vietnam were more likely to meet PTSD criteria than women who mainly served in the United States (odds ratio [OR] for lifetime PTSD, 1.53 [95% CI, 1.28-1.83]; OR for current PTSD, 1.89 [95% CI, 1.53-2.33]). When we adjusted for wartime exposures, serving in Vietnam or near Vietnam did not increase the odds of having current PTSD (adjusted ORs, 1.05 [95% CI, 0.75-1.46] and 0.77 [95% CI, 0.52-1.14], respectively).
Conclusions and Relevance The prevalence of PTSD for the Vietnam cohort was higher than previously documented. Vietnam service significantly increased the odds of PTSD relative to US service; this effect appears to be associated with wartime exposures, especially sexual discrimination or harassment and job performance pressures. Results suggest long-lasting mental health effects of Vietnam-era service among women veterans.
“Prevalence of Posttraumatic Stress Disorder in Vietnam-Era Women Veterans: The Health of Vietnam-Era Women’s Study (HealthVIEWS)” by Kathryn Magruder, PhD, MPH; Tracey Serpi, PhD; Rachel Kimerling, PhD; Amy M. Kilbourne, PhD; Joseph F. Collins, ScD; Yasmin Cypel, PhD, MS; Susan M. Frayne, MD, MPH,; Joan Furey, RN, MA; Grant D. Huang, MPH, PhD; Theresa Gleason, PhD; Matthew J. Reinhard, PsyD; Avron Spiro, PhD; and Han Kang, DrPH in JAMA Psychiatry. Published online October 7 2015 doi:10.1001/jamapsychiatry.2015.1786