1 Gastroenterology Service, Central Texas Veterans Health Care System , Temple, Texas.
2 Division of Gastroenterology, Department of Medicine, Scott & White Memorial Hospital , Temple, Texas.
J Womens Health (Larchmt). 2018 Mar;27(3):305-310. doi: 10.1089/jwh.2016.6105. Epub 2017 Sep 7.
BACKGROUND/OBJECTIVE: Posttraumatic stress disorder (PTSD), the experience of military sexual trauma (MST) that may contribute to PTSD, and obesity are three issues that complicate care for our population of new veterans. Our aim was to analyze the association of MST and diagnosed PTSD with obesity among female veterans.
Women 20-103 years old using the Veterans Health Administration (VA) in fiscal year 2014 (October 2013-September 2014) with diagnosis and body-mass data were identified in administrative databases (213,985 of 404,183 women). MST was defined by use of an MST clinic or positive MST screen, PTSD by International Classification of Diseases, Ninth Revision (ICD-9) diagnosis code (309.81), and weight categories from body-mass index.
The unadjusted chi-square of MST by obesity showed a modest association: 52% MST-affected versus 46% non-MST women were obese. MST status was associated with PTSD (50% MST vs. 15% non-MST women). A multivariable model of obesity adjusting for clinical and demographic covariates estimated a 9% increased risk of obesity from MST (adjusted risk ratio [RR] = 1.09). Younger age, African American race, and chronic disease such as hypertension and dyslipidemia correlated with obesity. Adding PTSD to the model did not affect the association with MST: RR (MST) = 1.09, RR (PTSD) = 1.00 (not significant).
This study showed association of MST with obesity in female veterans, independent of PTSD. Weight-gain in patients with trauma may add psychological or medical risk to the burden of disease shouldered by female veterans with MST. Primary care clinicians may need to consider integrating mental health into care of patients with suspected history of trauma especially sexual trauma.
背景/目的：创伤后应激障碍（PTSD）、可能导致 PTSD 的军事性创伤经历（MST）和肥胖是困扰我们新退伍军人群体的三个问题。我们的目的是分析 MST 和诊断 PTSD 与女性退伍军人肥胖之间的关联。
在行政数据库中确定了 20-103 岁的在 2014 财年（2013 年 10 月至 2014 年 9 月）使用退伍军人健康管理局（VA）的女性退伍军人（404183 名女性中的 213985 名），使用 MST 诊所或 MST 阳性筛查来定义 MST，PTSD 通过国际疾病分类，第九版（ICD-9）诊断代码（309.81），以及体重指数的体重类别来定义。
肥胖的 MST 未调整的卡方显示出适度的关联：52%的 MST 受影响者与 46%的非 MST 女性肥胖。MST 状况与 PTSD 相关（50%的 MST 女性与 15%的非 MST 女性）。在调整临床和人口统计学协变量的肥胖多变量模型中，MST 导致肥胖的风险增加了 9%（调整后的风险比[RR] = 1.09）。年轻、非裔美国人种族以及高血压和血脂异常等慢性疾病与肥胖相关。在模型中加入 PTSD 并没有影响与 MST 的关联：RR（MST） = 1.09，RR（PTSD） = 1.00（不显著）。
本研究显示，MST 与女性退伍军人的肥胖相关，与 PTSD 无关。创伤后体重增加可能会增加患有创伤的患者的心理或医疗风险，从而增加患有 MST 的女性退伍军人的疾病负担。初级保健临床医生可能需要考虑将心理健康纳入有疑似创伤史（尤其是性创伤）的患者的护理中。
