D'Aoust Rita F, Rossiter Alicia Gill, Elliott Amanda, Ji Ming, Lengacher Cecile, Groer Maureen
College of Nursing, University of South Florida, 12901 Bruce B. Downs Boulevard, Tampa, FL 33612.
Mil Med. 2017 Jul;182(7):e1828-e1835. doi: 10.7205/MILMED-D-15-00557.
The Institute of Federal Health Care recently published an executive summary from a round table discussion indicating that active duty and retired female military personnel are at high risk for adverse health outcomes unique to military service including complications related to post-traumatic stress disorder (PTSD), unreported sexual trauma, and musculoskeletal problems. In 2008, the Institute of Medicine began to review, evaluate, and summarize the literature on health outcomes in Gulf War-deployed and found sufficient evidence of a causal relationship with PTSD and suggestive evidence of an association with fibromyalgia (FM). This study examines the prevalence and impact of FM in women veterans and to explore the association between other comorbidities to improve risk differentiation for treatment and improve outcomes.
This study is designed as a nested, cross-sectional study within a larger project funded by the U.S. Army at the University of South Florida, College of Nursing entitled "Nursing Health Initiative for Empowering Women Veterans." A sample of 76 participants completed a battery of study instruments related to physical and psychological stressors.
Over half of the sample had a positive FM screening score (56.68%) although only 14.42% were deployed to the Middle East. More than 70% of participants reported harassment in life in the military and 32.9% reported sexual assault while in the military. Results of the 1-way analysis of variances find that there was a significant association of FM with the psychological symptoms of stress, depression, and PTSD. There was a significant association of FM with quality of life and sleep difficulty.
DISCUSSION, IMPACT, AND RECOMMENDATIONS: The results from this pilot study suggest there is a significant relationship between FM and the psychological symptoms of depression and PTSD. Nearly two-thirds of these women screened positive for depressive symptoms and just over one-quarter of participants had symptoms indicative of PTSD. Only a small proportion of women veterans in this study were deployed (14.42%) and this suggests that a trigger or risk factor other than deployment or combat may contribute to the development of FM and mental health symptomology. To focus on the complex interrelationships between pain, fatigue, sleep, and depression, a follow-up study with a larger sample powered for more complex statistical analyses is warranted. Additional analyses in this study reveal that over half of women veterans who reported military sexual trauma (MST) while in the military, screened positive for FM. Although our analyses did not reveal there to be a significant effect between FM and MST, it should be considered as a potential risk factor for FM as MST can be a precursor for PTSD. Women veterans who present with FM should be screened for MST as sexual trauma may not be disclosed. Understanding how many women veterans are affected with FM and the relationship with PTSD, MST, stress, depression, and sleep can improve screening and treatment to improve quality of life. This will also inform decision-making about how best to design and implement interventions, programs, and policies.
联邦医疗保健研究所最近发表了一份圆桌讨论的执行摘要，指出现役和退役女性军事人员面临着军事服务特有的不良健康后果的高风险，包括与创伤后应激障碍（PTSD）相关的并发症、未报告的性创伤和肌肉骨骼问题。2008年，医学研究所开始审查、评估和总结有关海湾战争部署人员健康结果的文献，并发现有充分证据证明与PTSD存在因果关系，并有暗示性证据表明与纤维肌痛（FM）有关联。本研究调查女性退伍军人中FM的患病率和影响，并探索其他合并症之间的关联，以改善治疗的风险区分并改善结果。
本研究设计为在美国南佛罗里达大学护理学院由美国陆军资助的一个更大项目中的嵌套横断面研究，该项目名为“增强女性退伍军人护理健康倡议”。76名参与者的样本完成了一系列与身体和心理应激源相关的研究工具。
超过一半的样本FM筛查得分呈阳性（56.68%），尽管只有14.42%被部署到中东地区。超过70%的参与者报告在军队生活中受到骚扰，32.9%报告在军队中遭受性侵犯。单因素方差分析结果发现，FM与压力、抑郁和PTSD的心理症状之间存在显著关联。FM与生活质量和睡眠困难之间存在显著关联。
讨论、影响和建议：这项初步研究的结果表明，FM与抑郁和PTSD的心理症状之间存在显著关系。这些女性中近三分之二抑郁症状筛查呈阳性，略多于四分之一的参与者有PTSD症状。本研究中只有一小部分女性退伍军人被部署（14.42%），这表明除了部署或战斗之外的其他触发因素或风险因素可能导致FM和心理健康症状的发展。为了关注疼痛、疲劳、睡眠和抑郁之间复杂的相互关系，有必要进行一项样本量更大、有能力进行更复杂统计分析的后续研究。本研究的其他分析表明，在军队中报告有军事性创伤（MST）的女性退伍军人中，超过一半FM筛查呈阳性。尽管我们的分析没有揭示FM和MST之间有显著影响，但应将其视为FM的潜在风险因素，因为MST可能是PTSD的先兆。出现FM的女性退伍军人应接受MST筛查，因为性创伤可能未被披露。了解有多少女性退伍军人受FM影响以及与PTSD、MST、压力、抑郁和睡眠的关系，可以改善筛查和治疗，以提高生活质量。这也将为如何最好地设计和实施干预措施、项目和政策的决策提供信息。
