Abbreviations: AOR, adjusted odds ratio; CI, confidence interval; MST, military-related sexual trauma; OEF, Operation Enduring Freedom; OIF, Operation Iraqi Freedom; PCL-C, PTSD Checklist Civilian Version; PTSD, post-traumatic stress disorder; VA, Veterans Administration.
Epidemiol Rev. 2014;36:5-18. doi: 10.1093/epirev/mxt005. Epub 2013 Aug 29.
Despite the marked expansion of roles for women in the US military over the last decade, whether differences by gender exist in regard to the development of mental health conditions postdeployment is unclear. This comprehensive review of the literature (2001-2012) examined whether US servicewomen were more likely than men to experience post-traumatic stress disorder (PTSD) after returning from deployments to the Iraq and Afghanistan conflicts. Findings from 18 studies from 8 unique study populations were reviewed. Seven studies found that women had a higher risk for screening positive for PTSD compared with men, including prospectively designed studies that evaluated new-onset PTSD among members from all service branches. Although results from studies with Veterans Affairs samples found women at decreased risk in 4 analyses, these studies used the same source databases, were conducted in treatment-seeking populations, and were mostly unable to account for combat experience. Seven studies detected no differences by gender. In summary, women appeared to have a moderately higher risk for postdeployment PTSD, although there was a lack of consensus among the studies, and even those with the most rigorous methods were not designed specifically to evaluate potential gender differences. Given the limitations of the published literature, further research should use longitudinal study designs and comprehensive evaluations of deployment experiences while adjusting for predeployment factors to confirm that gender differences exist with regard to postdeployment PTSD.
尽管在过去十年中,美国军队中女性的角色明显扩大,但性别是否会影响部署后心理健康状况的发展尚不清楚。这项对文献的全面回顾(2001-2012 年)研究了美国女兵在从伊拉克和阿富汗冲突中部署返回后是否比男性更容易患创伤后应激障碍(PTSD)。审查了来自 8 个独特研究人群的 18 项研究的结果。有 7 项研究发现,与男性相比,女性筛查出患有 PTSD 的风险更高,其中包括评估所有军种成员新发 PTSD 的前瞻性设计研究。尽管退伍军人事务部样本研究的结果在 4 项分析中发现女性的风险降低,但这些研究使用了相同的数据源,在寻求治疗的人群中进行,并且大多无法说明战斗经历。有 7 项研究未发现性别差异。总的来说,女性似乎在部署后 PTSD 方面的风险略高,但这些研究之间缺乏共识,甚至那些方法最严格的研究也不是专门为评估潜在的性别差异而设计的。鉴于已发表文献的局限性,进一步的研究应使用纵向研究设计和对部署经历的全面评估,同时调整部署前的因素,以确认性别差异在部署后 PTSD 方面是否存在。