Studies Look at Combat Effects on Female Troops and Healthcare Providers

by U.S. Medicine

February 20, 2012

Several recently released studies conducted by a number of federal agencies examine the effects of combat on women, who now make up 15% of American military forces.

As military healthcare providers see more frontline action, increased attention is being given to the long-term health effects of their service. A study by the Uniformed Services University of the Health Sciences (USUHS) in Bethesda, MD, examined gender differences in response to deployment of providers to Afghanistan and Iraq. 1

The study used data from the 2005 DoD Survey of Health-Related Behaviors Among Active-Duty Military Personnel, focusing on healthcare personnel who had been deployed at least once to Operation Enduring Freedom (OEF) or Operation Iraqi Freedom (OIF). The goal was to see if gender had any impact on operational stress.

Enlisted female healthcare providers (HCP) were more likely to be African-American and single. They also were more likely to have significant psychological difficulties, indicated by serious psychological distress endorsement (11.3%) and positive screens for depression (32.2%).

Female HCPs also were more likely to exhibit harmful drinking patterns than their male counterparts (61%, compared with 41% for enlisted personnel; 76%, compared with 67% for officers).

Researchers concluded that this distress could adversely impact the subjects’ performance within the military and in their lives at home.

A separate study, conducted through VA’s Health Services Research and Development Service, interviewed 19 OEF/OIF female veterans. The veterans identified stressful military experiences and post-deployment reintegration problems as major stressors in their lives. Those military experiences included combat situations, military sexual trauma and separation from family. 2

A third study, conducted at Tripler Army Medical Center in Honolulu and VA’s National Center for Posttraumatic Stress Disorder in Washington, examined 54 active-duty female servicemembers for exposure to combat experiences and military sexual harassment. 3

Within three months of returning from deployment to Iraq, participants completed screenings for PTSD, sexual harassment and other combat-related experiences.

Approximately one-third of the participants showed clinical or subclinical levels of PTSD symptoms, with 11% screening positive for PTSD and between 9% and 14% showing symptoms of depression.

Military sexual harassment was found to be the strongest single predictor of PTSD symptoms, lending support to other research showing that military sexual trauma may be more associated with PTSD symptoms in female servicemembers than combat exposure.

1. Gibbons SW, Heckling EJ, Barnett SD, Herbig-Wall PL, Watts DD. Gender Differences in Response to Deployment Among Military Healthcare Providers in Afghanistan and Iraq. J Womens Health (Larchmt). 2012 Jan 6. [Epub ahead of print] PubMed PMID: 22224844.

2. Mattocks KM, Haskell SG, Krebs EE, Justice AC, Yano EM, Brandt C. Women at war: Understanding how women veterans cope with combat and military sexual trauma. Soc Sci Med. 2011 Dec 11. [Epub ahead of print] PubMed PMID: 22236641.

3. Dutra L, Grubbs K, Greene C, Trego LL, McCartin TL, Kloezeman K, Morland L. Women at war: implications for mental health. J Trauma Dissociation. 2011;12(1):25-37. PubMed PMID: 21240736.

Female Veterans’ Contraceptive Use Much Lower Than Civilians

Contraception use among female veterans is low, with use of women’s health clinics being the primary factor in higher contraceptive use.

A VA survey of 103,950 female veterans who made at least one primary-care clinic visit in 2008 found that only 22% of women veterans had a documented contraception method, and Hispanic and African-American women were significantly less likely to have a method, compared with whites.1

This is in contrast with 62% of overall American women who use a regular method of contraception.

Women who went to women’s health clinics (WHC) were more than twice as likely to have a contraception method, compared with women who went to traditional primary-care clinics.

WHCs include not only the range of primary care found at other clinics but also gender-specific healthcare, such as family planning, birth control and preconception counseling.

Previous studies have found a higher rate of contraceptive use in active-duty female servicemembers than this study found in the veteran population. A 2010 study found that 34% of female servicemembers used an oral contraceptive.

1. Borrero S, Mor MK, Zhao X, McNeil M, Ibrahim S, Hayes P. Contraceptive care in the VA health care system. Contraception. 2011 Dec 14. [Epub ahead of print] PubMed PMID: 22176794.

Studies Look at Combat Effects on Female Troops and Healthcare Providers Cont

Statins Linked To Diabetes in Postmenopausal Women

Postmenopausal women who take statin medication are more likely to develop diabetes, according to a recent study conducted through NIH’s Women’s Health Initiative (WHI). 1

The study looked at 153,840 postmenopausal women ages 50 to 79 at 40 clinical centers across the United States who received treatment between 1993 and 1998 with regular follow-up. The study’s analysis looked at data through 2005. At their enrollment, the women did not have diabetes mellitus (DM).

At baseline, 7% of the women reported taking statin medication. Over the course of about one million person-years of follow-up, 10,242 incident cases of self-reported DM were collected.

Statin use was associated with an increased risk of DM, with a hazard ratio of 1.71. The association remained after adjusting for other potential factors and was observed for all types of statin medications.

Researchers concluded that the risk may be a medication-class effect, but further study by statin type and dose is needed to determine varying risk levels for diabetes in this population.  

1. Culver AL, Ockene IS, Balasubramanian R, Olendzki BC, et. al. Statin Use and Risk of Diabetes Mellitus in Postmenopausal Women in the Women’s Health Initiative. Arch Intern Med. 2012 Jan 10. [Epub ahead of print] PubMed PMID: 22231607.

Analysis Cements Benefit of Progesterone in Preventing Preterm Births

An NIH meta-analysis of studies looking at progesterone has found that the naturally-occurring hormone is even more effective at reducing the rate of preterm birth among some high-risk women than previously thought. That high-risk category includes women who have a short cervix and are at an increased risk of early delivery. 1

Researchers looked at five previous studies with 775 total participants and found that progesterone treatment substantially reduced the risk of delivery between gestational weeks 27 and 34. Use of the hormone reduced preterm delivery before week 28 by half and before 30 weeks by 42%. The study shows the positive effects of treatment can be seen through 35 weeks.

The meta-analysis also concluded that, for full-term births, progesterone treatment can reduce the likelihood that a newborn will die (by 43%), have respiratory distress syndrome (by 52%), be severely underweight (by 45%), be admitted for intensive are (by 25%) or require mechanical ventilation (by 34%).

The researchers recommend that physicians who detect a short cervix during ultrasound begin treatment of 90mg per day of progesterone between weeks 20 and 37.

1.  Romero R, Nicolaides K Conde-Agudelo A, Tabor A, et al. Vaginal Progesterone In Women With An Asymptomatic Sonographic Short Cervix In The Midtrimester Decreases Preterm Delivery And Neonatal Morbidity: A Systematic Review And Meta-Analysis Of Individual Patient Data American journal of obstetrics and gynecology 12 December 2011 (Article in Press DOI: 10.1016/j.ajog.2011.12.003

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