Researchers Identifying Gender Differences in Combat Trauma

by U.S. Medicine

January 22, 2011

BETHESDA, MD—Women comprise nearly 20-percent of the military. Many women, like their male counterparts, return from combat traumatized by the events they experienced. Researchers and healthcare providers are beginning to recognize that gender plays a large role in how veterans process the psychological trauma of war.

USM_01-11_gender-combat.jpgCurrently, the greatest hope for answers is the Women Veterans Cohort Study—a longitudinal study seeking to identify important factors of gender-associated disparities in healthcare utilization and outcomes among OEF/OIF veterans receiving care within the VA system.

Sally Haskell, MD, consultant to VA’s Women Veterans Health Strategic Health Care Group, spoke at the 3rd Annual Trauma Spectrum Conference at NIH, where she revealed that results from the study show significant differences in certain symptomatology. “We especially wanted to look at clinical diagnoses in this cohort. In the men and women coming back, are there differences in the clinical diagnoses after serving in combat?”

Female veterans utilize VA services more frequently (86%) compared to men (79%), with that increased frequency extending to mental health services.

The top complaints from women recently returning from combat are: back problems, joint disorders, PTSD, female genital disorders, mild depression, and musculoskeletal disorders. Significant differences are seen in mild depression, with women exhibiting it 80% more than male veterans, and in musculoskeletal disorders, with a 20% increase among women. Major depression is almost twice as common in women, and adjustment disorder and skin disorders are also higher in women.

Pain seems to differ between men and women veterans of OEF/OIF, Haskell said. “They are equally likely to be assessed for pain. But while men had more pain than women, women were more likely to have moderate-to-severe pain and men were more likely to have persistent pain. It’s not what you see in a lot of other studies, and we don’t know what to make of it.”

To date, there has been little research into gender differences in psychiatric diagnoses and neurobehavioral symptoms with deployment-related TBI. The data VA does have shows that, in each of the four types of cognitive symptoms—affective,
somatosensory, cognitive, and vestibular—women were more likely to have severe or very severe symptoms than men.

“Mild TBI is associated with significant psychiatric and neurobehavioral comorbidities, and women are more likely to have severe symptoms, with depression more common in women,” Haskell said.

Asked about polytrauma in women, Haskell explained that, because so few women have been seen in VA’s polytrauma clinics, there is little data. “We need to do more work to understand the gender-specific problems related to polytrauma.”

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