文章基本信息

标题：Gender Differences in Mental Health Diagnoses Among Iraq and Afghanistan Veterans Enrolled in Veterans Affairs Health Care
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作者：Shira Maguen ; Li Ren ; Jeane O. Bosch 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2010
卷号：100
期号：12
页码：2450-2456
DOI：10.2105/AJPH.2009.166165
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined gender differences in sociodemographic, military service, and mental health characteristics among Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) veterans. We evaluated associations between these sociodemographic and service characteristics and depression and posttraumatic stress disorder (PTSD) diagnoses. Methods. In a retrospective, cross-sectional study, we used univariate descriptive statistics and log binominal regression analyses of Department of Veterans Affairs (VA) administrative data on 329 049 OEF and OIF veterans seeking VA health care from April 1, 2002, through March 31, 2008. Results. Female veterans were younger and more likely to be Black and to receive depression diagnoses than were male veterans, who were more frequently diagnosed with PTSD and alcohol use disorders. Older age was associated with a higher prevalence of PTSD and depression diagnoses among women but not among men. Conclusions. Consideration of gender differences among OEF and OIF veterans seeking health care at the VA will facilitate more targeted prevention and treatment services for these newly returning veterans. The number of women in the US military has significantly increased in the past decade, 15% of active duty and 17% of National Guard and Reserve personnel are women.¹ Women also compose 12.65% of the total number of US military personnel who have served in Operation Enduring Freedom (OEF; principally in Afghanistan) and Operation Iraqi Freedom (OIF; principally in Iraq; Melnyk L, Defense Press Officer, Office of the Assistant Secretary of Defense for Public Affairs, The Pentagon, written communication, February 3, 2009). The number of female US veterans has doubled over the past 20 years.¹ Although ample research has examined female veterans who served in Vietnam, the first Gulf War, and female veterans of multiple eras seeking Department of Veterans Affairs (VA) health care,^{2 – 8} relatively little has been published on female OEF and OIF veterans. Although a growing literature focuses on the rapidly increasing prevalence and incidence of mental health disorders among OEF and OIF veterans,^{9 , 10} we know relatively little about gender differences among this new generation of veterans, especially among veterans seeking VA health care. One organizing theory that can help frame gender differences postulates that women and men vary in their expression of mental health symptoms, with women more often receiving internalizing diagnoses, such as depression, and men receiving more externalizing diagnoses, such as alcohol and substance use disorders.^{11 , 12} However, many of the studies on which these theories are based use population prevalence rates; consequently, the types of stressors to which individuals are exposed are not held constant. The current conflicts offer a unique opportunity to examine diagnostic differences among women and men exposed to war. Although the particular types of stressors to which individuals were exposed during their deployments may vary, the wars in Afghanistan and Iraq provide an opportunity to examine whether gender differences exist in how men and women respond to potentially traumatic stressors. The few OEF and OIF studies that have examined gender differences in mental health outcomes have produced mixed results.^{13 – 18} A longitudinal study of OEF and OIF service members found that in the postdeployment period, new-onset posttraumatic stress disorder (PTSD) symptoms were proportionately higher among women.¹⁴ Similarly, another large study of OEF and OIF veterans found that women were more likely than were men to screen positive for PTSD and depression.¹⁵ A third study of OEF and OIF veterans found that female OIF personnel were more likely than were their male counterparts to report depression; however, no gender difference was observed in the prevalence of PTSD.¹⁶ Two additional studies found no difference in PTSD symptoms between female and male personnel deployed to Iraq.^{17 , 18} One notable gap in the literature concerns rates of mental health disorders among OEF and OIF female veterans who seek VA health care after deployment. Few studies have examined associations between demographic and military service characteristics and adverse mental health outcomes among newly returning veterans. In a longitudinal study of OEF and OIF service members, new-onset PTSD was higher among those who were younger, never married or divorced, Black (non-Hispanic), enlisted, Reserve or National Guard members, or Army personnel.¹⁴ In another study of OEF and OIF military personnel, being separated or divorced (vs married) and being junior enlisted (vs officer status) were significantly associated with PTSD and depressive symptoms.¹⁶ A study of veterans seeking VA health care found that being younger was associated with mental health and PTSD diagnoses; younger men were at greater risk than were younger women.¹⁰ The rapid growth of the female military and veteran populations has led to interest at the Department of Defense and VA in identifying prevalent mental health diagnoses among female veterans, as well as associated demographic and military service characteristics, to appropriately evaluate, triage, and care for this new generation of returning female veterans. Among OEF and OIF veterans seeking VA health care nationwide, we identified (1) gender-specific demographic and military service characteristics, (2) gender-specific mental health diagnoses, and (3) independent correlates of PTSD and depression among female and male OEF and OIF veterans. Previous research findings led us to hypothesize that depression would be more prevalent among women, that alcohol and substance use disorders would be more prevalent among men, and that there would be little to no difference by gender in rates of PTSD. We also hypothesized that being younger, separated or divorced, and junior enlisted would be significantly associated with PTSD and depressive symptoms because of greater vulnerability and increased combat exposure.