Paula P. Schnurr, Ph.D.
The ongoing conflicts in Iraq and Afghanistan are enabling researchers to learn more about a question that has plagued them for decades: Is there a difference between men and women who serve in the military when it comes to incidence of Post Traumatic Stress Disorder (PTSD)?
Unfortunately, the jury is still out, according to Paula P. Schnurr, PhD, research professor of psychiatry at Dartmouth Medical School, deputy executive director of the VA National Center for PTSD, and lead author of a ground-breaking study of women veterans and PTSD.1 “My study was done because women had not been included historically in studies of treatments for all conditions,” she says.
In terms of the general population, in samples of all types and studies outside of North America, women are more likely than men to have PTSD — in fact, a twofold increase, according to Schnurr. “One source of this difference is that men and women experience different types of traumatic events,” she explains. “For example, women are more likely than men to be victims of sexual violence, so they are more likely to have a PTSD-causing event. But, even when that is taken into account, women are more likely than men to have PTSD — although we do not have conclusive evidence of why.”
Is the military different?
This difference may not apply in the military, however. “One interesting finding in meta analyses, prior to the current conflicts, confirm that this doubled rate does not apply in military samples. But the fact is that men and women, up until the current conflicts, had such different experiences in war zones,” notes Schnurr. “Women had much less exposure to combat; they primarily had medical occupations.”
Incidence of PTSD, she adds, might have to do with type of duty, or even the type of people involved. “Women who experienced sexual assault and not PTSD, and who were able to go through military training may simply be more resilient,” she offers. “We did not have a good way to answer these questions until the current conflict, when women have more exposure to battle; it gives men and women comparable experiences in situations where they may be more likely to experience PTSD.”
So far, however, the evidence has gone both ways, according to Schnurr. “There was a Rand Corporation study a couple of years ago that, when statistics were adjusted for background characteristics, women had more incidences of PTSD than one might have expected, given those other factors,”2 However, she adds, a more recent study that was published this spring said that men and women were equally likely to develop PTSD; even when both have combat exposure, men still have more. But women are more likely to have trauma outside of the military.”
In fact, wrote the authors, “Though it was hypothesized that combat-related stressors would demonstrate stronger negative associations with post-deployment mental health for women, only one of 16 stressor × gender interactions achieved statistical significance, and an evaluation of the clinical significance of these interactions revealed that effects were trivial. Results suggest that female Operation Enduring Freedom/Operation Iraqi Freedom servicemembers may be as resilient to combat-related stress as men.”3
Another study supports that reviewing, showing that returning women veterans from OEF/OIF service had lower rates of PTSD than men.4 However, “the findings showed that women had more depression and men more alcohol abuse,” adds Shira Maguen, PhD, assistant professor, University of California San Francisco Medical School, staff psychologist for the San Francisco VA Medical Center PTSD Program, and lead author of the study.
“The research seems to have contradictory findings, but I’m confident that, after further research, we will have better indications,” notes Schnurr.
Maguen agrees. “Things will become clearer; as we move in time, there will be more studies,” she says. One of the things that have been interesting in some recent studies is that they show that when it comes to rates of combat exposure in men and women the gap is decreasing; it could be that women will have greater and greater exposure to a factor that can increase the rates of PTSD.”
She adds that the number of women’s’ clinics within VA is growing and has grown in the past few years. “It’s important if you work with women veterans that you be aware of these findings,” Maguen says. “There’s already a lot of good evidence-based treatment going on, and you have to be attuned to that.” >> Page 2