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      Deployment-related trauma and post-traumatic stress disorder: does gender matter? Translated title: Trauma relacionado a despliegue militar y trastorno de estrés postraumático: ¿Importa el género? Translated title: 与部署有关的创伤和创伤后应激障碍:性别是否重要?

      a , b , c , d , b , a

      European Journal of Psychotraumatology

      Taylor & Francis

      Gender, post-traumatic stress disorder, PTSD, trauma, combat exposure, military, Género, Trastorno de Estrés Postraumático, TEPT, trauma, exposición a combate, militar, 性别, 创伤后应激障碍, PTSD, 创伤, 战斗暴露, 军事, • Women have higher odds of reporting PTSD compared to men.• Deployment-related trauma is positively linked with the odds of PTSD. Gender does not modify this link (i.e. no gender differences).• Interpersonal trauma is positively linked with the odds of reporting PTSD. Gender is a significant modifier of this association.• The interpersonal trauma–PTSD association is significantly stronger for women than for men.

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          ABSTRACT

          Objective: Military research has attempted to identify whether women have an increased vulnerability to mental health issues following deployment-related trauma, but findings have been mixed. Most studies have controlled for childhood abuse, but not other non-deployment trauma (e.g. life-threatening illness), which may partly explain previous mixed results. This study assessed gender differences in the association between deployment-related trauma and post-traumatic stress disorder (PTSD) while controlling for non-deployment trauma.

          Methods: Data came from the 2013 Canadian Forces Mental Health Survey. Regular or reserve personnel who had been deployed at least once were included in this study ( n = 5980). Logistic regression was used to examine the interaction between gender and deployment-related trauma in predicting lifetime PTSD.

          Results: After controlling for non-deployment trauma, the association of gender with PTSD went from being significant to being marginally significant. The interaction between gender and deployment-related trauma was not significant.

          Conclusion: Though controlling for non-deployment trauma did not completely dissipate gender differences in PTSD, such differences were greatly reduced, indicating that these may be partly related to traumatic experiences outside deployment. As gender did not moderate the link between deployment-related trauma and PTSD, the findings suggest that trauma experienced while on deployment does not disproportionately affect women compared to their male counterparts.

           

          Objetivo: La investigación militar ha intentado identificar si las mujeres tienen una mayor vulnerabilidad a los problemas de salud mental después del trauma relacionado con el despliegue militar, pero los hallazgos han sido mixtos. La mayoría de los estudios han controlado el abuso infantil, pero no otros traumas no relacionados con el despliegue (p. Ej., Enfermedad potencialmente mortal), lo cual puede explicar parcialmente los resultados mixtos anteriores. Este estudio evaluó las diferencias de género en la asociación entre el trauma relacionado con el despliegue militar y el trastorno de estrés postraumático, al mismo tiempo que se controlaba los traumas no relacionados con despliegue militar.

          Métodos: Los datos provienen de la Encuesta de Salud Mental de las Fuerzas Armadas Canadienses de 2013. El personal regular o de reserva que se había desplegado al menos una vez se incluyeron en este estudio (n = 5980). Se Utilizó regresión logística para examinar la interacción entre el género y el trauma relacionado con el despliegue en la predicción del TEPT a lo largo de la vida.

          Resultados: Después de controlar por trauma no relacionado con el despliegue, la asociación de género con TEPT paso de ser significativa a solo marginalmente significativa. La interacción entre el género y el trauma relacionado con el despliegue no fue significativa.

          Conclusión: Aunque el controlar por traumas no relacionados con el despliegue militar no disipó por completo las diferencias de género en el TEPT, tales diferencias se redujeron sustancialmente, lo que indica que pueden estar parcialmente relacionadas con experiencias traumáticas fuera del despliegue. Dado que el género no moderó la relación entre el trauma relacionado con el despliegue y el TEPT, los hallazgos sugieren que el trauma experimentado durante el despliegue no afecta en forma desproporcionada a las mujeres en comparación con sus pares masculinos.

           

          目标:军事研究试图识别妇女在入伍相关的创伤后是否更容易受到精神健康问题的影响,但研究结果不一。大部分研究都控制了儿童期虐待,但没有控制其他与入伍无关的创伤(如,威胁生命的疾病),这可能部分解释了混合结果。 本研究评估了与部署相关的创伤和PTSD之间的关联中的性别差异,同时控制了非入伍相关创伤。

          方法:数据来自2013年加拿大部队心理健康调查。 本研究纳入至少部署一次的定期或储备人员(n = 5980)。 Logistic回归用于检测性别和部署相关创伤之间在预测终身PTSD方面的相互作用。

          结果:控制非入伍相关创伤后,性别与创伤后应激障碍的关联从显著变为边缘显著。 性别与入伍相关的创伤之间的相互作用并不显著。

          结论:尽管控制非入伍相关创伤并未完全消除创伤后应激障碍中的性别差异,但这种差异大大减少,表明这可能与入伍以外的创伤性经历有部分关系。 由于性别并未降低部署相关创伤与创伤后应激障碍之间的联系,研究结果表明创伤的经历在入伍过程中不会影响女性比男性更为严重。

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          Most cited references 28

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          Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care.

          The current combat operations in Iraq and Afghanistan have involved U.S. military personnel in major ground combat and hazardous security duty. Studies are needed to systematically assess the mental health of members of the armed services who have participated in these operations and to inform policy with regard to the optimal delivery of mental health care to returning veterans. We studied members of four U.S. combat infantry units (three Army units and one Marine Corps unit) using an anonymous survey that was administered to the subjects either before their deployment to Iraq (n=2530) or three to four months after their return from combat duty in Iraq or Afghanistan (n=3671). The outcomes included major depression, generalized anxiety, and post-traumatic stress disorder (PTSD), which were evaluated on the basis of standardized, self-administered screening instruments. Exposure to combat was significantly greater among those who were deployed to Iraq than among those deployed to Afghanistan. The percentage of study subjects whose responses met the screening criteria for major depression, generalized anxiety, or PTSD was significantly higher after duty in Iraq (15.6 to 17.1 percent) than after duty in Afghanistan (11.2 percent) or before deployment to Iraq (9.3 percent); the largest difference was in the rate of PTSD. Of those whose responses were positive for a mental disorder, only 23 to 40 percent sought mental health care. Those whose responses were positive for a mental disorder were twice as likely as those whose responses were negative to report concern about possible stigmatization and other barriers to seeking mental health care. This study provides an initial look at the mental health of members of the Army and the Marine Corps who were involved in combat operations in Iraq and Afghanistan. Our findings indicate that among the study groups there was a significant risk of mental health problems and that the subjects reported important barriers to receiving mental health services, particularly the perception of stigma among those most in need of such care. Copyright 2004 Massachusetts Medical Society
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            The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI).

             R Kessler,  T Ustün (2003)
            This paper presents an overview of the World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) and a discussion of the methodological research on which the development of the instrument was based. The WMH-CIDI includes a screening module and 40 sections that focus on diagnoses (22 sections), functioning (four sections), treatment (two sections), risk factors (four sections), socio-demographic correlates (seven sections), and methodological factors (two sections). Innovations compared to earlier versions of the CIDI include expansion of the diagnostic sections, a focus on 12-month as well as lifetime disorders in the same interview, detailed assessment of clinical severity, and inclusion of information on treatment, risk factors, and consequences. A computer-assisted version of the interview is available along with a direct data entry software system that can be used to keypunch responses to the paper-and-pencil version of the interview. Computer programs that generate diagnoses are also available based on both ICD-10 and DSM-IV criteria. Elaborate CD-ROM-based training materials are available to teach interviewers how to administer the interview as well as to teach supervisors how to monitor the quality of data collection.
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              The psychological risks of Vietnam for U.S. veterans: a revisit with new data and methods.

              In 1988, the National Vietnam Veterans Readjustment Study (NVVRS) of a representative sample of 1200 veterans estimated that 30.9% had developed posttraumatic stress disorder (PTSD) during their lifetimes and that 15.2% were currently suffering from PTSD. The study also found a strong dose-response relationship: As retrospective reports of combat exposure increased, PTSD occurrence increased. Skeptics have argued that these results are inflated by recall bias and other flaws. We used military records to construct a new exposure measure and to cross-check exposure reports in diagnoses of 260 NVVRS veterans. We found little evidence of falsification, an even stronger dose-response relationship, and psychological costs that were lower than previously estimated but still substantial. According to our fully adjusted PTSD rates, 18.7% of the veterans had developed war-related PTSD during their lifetimes and 9.1% were currently suffering from PTSD 11 to 12 years after the war; current PTSD was typically associated with moderate impairment.
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                Author and article information

                Journal
                Eur J Psychotraumatol
                Eur J Psychotraumatol
                ZEPT
                zept20
                European Journal of Psychotraumatology
                Taylor & Francis
                2000-8066
                2018
                06 July 2018
                : 9
                : 1
                Affiliations
                [a ]School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa , Ottawa, ON, Canada
                [b ]Military Personnel Research and Analysis, Department of National Defence , Ottawa, ON, Canada
                [c ]Directorate of Mental Health, Canadian Forces Health Services Group , Ottawa, ON, Canada
                [d ]Department of Family Medicine, University of Ottawa , Ottawa, ON, Canada
                Author notes
                CONTACT Christine Frank christine.frank@ 123456forces.gc.ca DGMPRA, Department of National Defence , 285 Coventry Road, Ottawa, ONK1K 3X6, Canada
                Article
                1486123
                10.1080/20008198.2018.1486123
                6041783
                The work of Christine Frank, Mark A. Zamorski and Jennifer E. C. Lee is Copyright of the Crown in Canada 2018.Ian Colman hereby waives his right to assert copyright, but not his right to be named as co-author in the article.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                Page count
                Figures: 4, Tables: 3, References: 44, Pages: 11
                Product
                Funding
                Funded by: the Canadian Institute for Military & Veteran Health Research
                Award ID: W7714-145967
                This work was supported by the Canadian Institute for Military & Veteran Health Research [number W7714-145967]. This work was also supported, in part, by the Canada Research Chairs program for Dr Colman.
                Categories
                Basic Research Article

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