Stefanovics Elina A, Rosenheck Robert A
Department of Psychiatry, School of Medicine, Yale University, New Haven, Connecticut, USA.
Department of Veterans Affairs Connecticut Healthcare System, New England Mental Illness, Research, Education, and Clinical Center (MIRECC), West Haven, Connecticut, USA.
J Dual Diagn. 2020 Oct;16(4):382-391. doi: 10.1080/15504263.2020.1822569. Epub 2020 Oct 1.
Posttraumatic stress disorder (PTSD) is a problem of growing importance among female veterans, which is especially challenging when accompanied by comorbid substance use disorder (SUD). Since women are still a small minority of Veterans Health Administration (VHA) patients, there is concern that outcomes among dually diagnosed women may be worse than among men.
National program evaluation data were collected at admission and 4 months after discharge from 7,074 dually diagnosed veterans including 203 women (2.9%) treated at 57 specialized intensive VHA PTSD treatment programs between 1993 and 2011. Multiple regression was used to compare clinical change in women and men adjusting for baseline differences.
Women showed no significant differences from men in measures of substance use or total PTSD symptoms at admission although they were more likely to have experienced sexual trauma and less likely to report combat exposure. With adjustment for these differences, there were no significant gender differences in length of stay, satisfaction with treatment, or measures of change in substance use or total PTSD symptoms 4 months after discharge. Reductions in an index of days of substance use was associated with reduction in total PTSD symptoms among both women ( = 0.33; = .01) and men ( = 0.44, < .0001) with no significant gender difference.
No significant gender differences were observed in substance use or PTSD outcomes, despite the extreme minority status of women in VHA programs. Highly vulnerable women can benefit as much as men, even when treatment is not formally tailored to address gender-specific needs.
创伤后应激障碍（PTSD）在女性退伍军人中变得越来越重要，当伴有物质使用障碍（SUD）共病时，这一问题尤其具有挑战性。由于女性在退伍军人健康管理局（VHA）的患者中仍占少数，人们担心双重诊断女性的治疗结果可能比男性更差。
收集了1993年至2011年间在57个专门的VHA创伤后应激障碍强化治疗项目中接受治疗的7074名双重诊断退伍军人（包括203名女性，占2.9%）入院时和出院后4个月的全国项目评估数据。采用多元回归分析比较了女性和男性的临床变化，并对基线差异进行了调整。
女性在入院时的物质使用或PTSD总症状测量方面与男性没有显著差异，尽管她们更有可能经历过性创伤，而报告有战斗经历的可能性较小。在对这些差异进行调整后，出院后4个月的住院时间、对治疗的满意度或物质使用或PTSD总症状变化的测量方面，没有显著的性别差异。女性（r = 0.33；p = 0.01）和男性（r = 0.44，p < 0.0001）物质使用天数指数的降低与PTSD总症状的降低相关，且无显著性别差异。
尽管女性在VHA项目中占极少数，但在物质使用或PTSD治疗结果方面未观察到显著的性别差异。即使治疗没有正式针对满足特定性别的需求进行调整，高度脆弱的女性也能与男性一样受益。
