Kelber Marija Spanovic, Liu Xian, O'Gallagher Kevin, Stewart Lindsay Thonsen, Belsher Bradley E, Morgan Maria A, Workman Don E, Skopp Nancy A, McGraw Kate, Evatt Daniel P
Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA.
Psychological Health Center of Excellence, Defense Health Agency, Falls Church, VA, USA.
J Psychiatr Res. 2021 Jan;133:16-22. doi: 10.1016/j.jpsychires.2020.12.010. Epub 2020 Dec 3.
Recent expansions in the roles of women in combat have prompted increased interest in the psychological toll combat exposure may have on female service members as compared to males. This study examined the interactive effects of gender and combat exposure on transitions in posttraumatic stress disorder (PTSD) diagnostic status (presence or absence of PTSD diagnosis). We used administrative data of 20,000 U.S. Army soldiers whose combat exposure was assessed after return from deployment between January 1, 2008 and June 30, 2014; soldiers' PTSD diagnostic status was determined using International Classification of Diseases-9 diagnoses at four time points separated by 12 months. We used a mixed-effects logit transition model to examine the effects of combat and gender on incidence, persistence, and prevalence of PTSD diagnosis. Incidence and prevalence of PTSD diagnosis were higher among women, but persistence of PTSD diagnosis was higher in men. Higher rates of new PTSD diagnosis among women were not dependent on combat exposure, suggesting that other types of trauma may be responsible for increased rates among women. Gender differences in prevalence and persistence of PTSD diagnosis were greater among combat-exposed soldiers than among those not exposed to combat. Men maintained a PTSD diagnosis over longer periods of time than women suggesting greater PTSD persistence, and this pattern was particularly pronounced among soldiers exposed to combat. These results have implications for the recent policy changes and gender-based prevention strategies, and suggest that women in combat roles may be no more vulnerable to PTSD than are their male counterparts. Though the gender differences were small, they are indicative of healthcare utilization patterns that may be important for prevention and that warrant further exploration.
近年来，女性在战斗中角色的扩大引发了人们对战斗经历可能给女性军人带来的心理影响与男性军人相比有何不同的更多关注。本研究考察了性别和战斗经历对创伤后应激障碍（PTSD）诊断状态转变（是否被诊断为PTSD）的交互作用。我们使用了20000名美国陆军士兵的行政数据，这些士兵的战斗经历在2008年1月1日至2014年6月30日从部署地返回后进行了评估；士兵的PTSD诊断状态通过在相隔12个月的四个时间点使用国际疾病分类第9版诊断来确定。我们使用混合效应逻辑回归转变模型来考察战斗经历和性别对PTSD诊断的发病率、持续时间和患病率的影响。女性中PTSD诊断的发病率和患病率更高，但男性中PTSD诊断的持续时间更长。女性中新发PTSD诊断率较高并不依赖于战斗经历，这表明其他类型的创伤可能是女性发病率增加的原因。与未接触战斗的士兵相比，接触战斗的士兵中PTSD诊断患病率和持续时间的性别差异更大。男性比女性维持PTSD诊断的时间更长，这表明PTSD的持续性更强，这种模式在接触战斗的士兵中尤为明显。这些结果对最近的政策变化和基于性别的预防策略具有启示意义，并表明担任战斗角色的女性可能并不比男性更容易患PTSD。尽管性别差异很小，但它们表明了医疗利用模式，这可能对预防很重要，值得进一步探索。
