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Original Investigation |

Prevalence of Posttraumatic Stress Disorder in Vietnam-Era Women Veterans The Health of Vietnam-Era Women’s Study (HealthVIEWS)

Kathryn Magruder, PhD, MPH1,2; Tracey Serpi, PhD3; Rachel Kimerling, PhD4,5; Amy M. Kilbourne, PhD6,7; Joseph F. Collins, ScD3; Yasmin Cypel, PhD, MS8; Susan M. Frayne, MD, MPH5,9; Joan Furey, RN, MA10; Grant D. Huang, MPH, PhD11; Theresa Gleason, PhD12; Matthew J. Reinhard, PsyD13,14; Avron Spiro, PhD15,16,17; Han Kang, DrPH8
[+] Author Affiliations
1Mental Health Service, Ralph H. Johnson Veterans Affairs (VA) Medical Center, Charleston, South Carolina
2Department of Psychiatry, Medical University of South Carolina, Charleston
3Cooperative Studies Program Coordinating Center, VA Maryland Health Care System, Perry Point
4National Center for PTSD, VA Palo Alto Health Care System, Menlo Park, California
5Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California
6VA Ann Arbor Center for Clinical Management Research, Ann Arbor, Michigan
7Department of Psychiatry, University of Michigan Medical School, Ann Arbor
8US Department of Veterans Affairs, Office of Public Health, Post Deployment Strategic Healthcare Group, Washington, DC
9Division of General Medical Disciplines, Stanford University School of Medicine, Palo Alto, California
10Vietnam veteran, Sayville, New York
11Cooperative Studies Program Central Office, VA Office of Research and Development, Washington, DC
12Clinical Science Research and Development, VA Office of Research and Development, Washington, DC
13War Related Illness and Injury Center, Washington, DC
14Department of Psychiatry, Georgetown University Medical School, Washington, DC
15Massachusetts Veterans Epidemiology Research and Information Center, VA Boston Healthcare System, Boston, Massachusetts
16Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
17Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
JAMA Psychiatry. 2015;72(11):1127-1134. doi:10.1001/jamapsychiatry.2015.1786.
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Importance  Many Vietnam-era women veterans served in or near war zones and may have experienced stressful or traumatic events during their service. Although posttraumatic stress disorder (PTSD) is well studied among men who served in Vietnam, no major epidemiologic investigation of PTSD among women has been performed.

Objectives  To assess (1) the onset and prevalence of lifetime and current PTSD for women who served during the Vietnam era, stratified by wartime location (Vietnam, near Vietnam, or the United States), and (2) the extent to which wartime location was associated with PTSD, with adjustment for demographics, service characteristics, and wartime exposures.

Design, Setting, and Participants  Survey of 8742 women who were active-duty military personnel in the US Armed Forces at any time from July 4, 1965, through March 28, 1973, and alive as of survey receipt as part of Department of Veterans Affairs Cooperative Study 579, HealthVIEWS. Data were obtained from mailed and telephone surveys from May 16, 2011, through August 5, 2012, and analyzed from June 26, 2013, through July 30, 2015.

Main Outcomes and Measures  Lifetime and current PTSD as measured by the PTSD module of the Composite International Diagnostic Interview, version 3.0; onset of PTSD; and wartime experiences as measured by the Women’s Wartime Exposure Scale–Revised.

Results  Among the 4219 women (48.3%) who completed the survey and a telephone interview, the weighted prevalence (95% CI) of lifetime PTSD was 20.1% (18.3%-21.8%), 11.5% (9.1%-13.9%), and 14.1% (12.4%-15.8%) for the Vietnam, near-Vietnam, and US cohorts, respectively. The weighted prevalence (95% CI) of current PTSD was 15.9% (14.3%-17.5%), 8.1% (6.0%-10.2%), and 9.1% (7.7%-10.5%) for the 3 cohorts, respectively. Few cases of PTSD among the Vietnam or near-Vietnam cohorts were attributable to premilitary onset (weighted prevalence, 2.9% [95% CI, 2.2%-3.7%] and 2.9% [95% CI, 1.7%-4.2%], respectively). Unadjusted models for lifetime and current PTSD indicated that women who served in Vietnam were more likely to meet PTSD criteria than women who mainly served in the United States (odds ratio [OR] for lifetime PTSD, 1.53 [95% CI, 1.28-1.83]; OR for current PTSD, 1.89 [95% CI, 1.53-2.33]). When we adjusted for wartime exposures, serving in Vietnam or near Vietnam did not increase the odds of having current PTSD (adjusted ORs, 1.05 [95% CI, 0.75-1.46] and 0.77 [95% CI, 0.52-1.14], respectively).

Conclusions and Relevance  The prevalence of PTSD for the Vietnam cohort was higher than previously documented. Vietnam service significantly increased the odds of PTSD relative to US service; this effect appears to be associated with wartime exposures, especially sexual discrimination or harassment and job performance pressures. Results suggest long-lasting mental health effects of Vietnam-era service among women veterans.

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Figure.
Identification of Vietnam-Era Women Veteran Cohorts

CATI indicates computer-assisted telephone interview; HealthVIEWS, Health of Vietnam-Era Women’s Study.

aIdentified before mailed survey administration only.

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Submit a Comment
PTSD in Nurses
Posted on October 9, 2015
Bill Harmon
Retired Military ('60-'92)
Conflict of Interest: None Declared
My wife was a Nurse in the 8th Field Hospital in Nha Trang, Vietnam from Mar 62-Jan 63. It was the first field hospital in Vietnam and handled all combat casualties and evacuations. Those in Field Hospitals see more combat gore than some front line troops and it stays with them the rest of their lives. My wife took her life on 7 May 1983 after a series of flash-backs to Vietnam. It was too early in 1983 to diagnose PTSD even on a military installation, however, PTSD is what killer her. Thanks for the article!
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