Hostname: page-component-745bb68f8f-f46jp Total loading time: 0 Render date: 2025-01-11T06:27:25.542Z Has data issue: false hasContentIssue false
  • English
  • Français

Impact of exposure to combat during deployment to Iraq and Afghanistan on mental health by gender

Published online by Cambridge University Press:  11 January 2012

C. Woodhead ,
S. Wessely ,
N. Jones ,
N. T. Fear  and
S. L. Hatch
C. Woodhead*
Affiliation:
King's Centre for Military Health Research, King's College London, UK
S. Wessely
Affiliation:
King's Centre for Military Health Research, King's College London, UK
N. Jones
Affiliation:
Academic Centre for Defence Mental Health, King's College London, UK
N. T. Fear
Affiliation:
Academic Centre for Defence Mental Health, King's College London, UK
S. L. Hatch
Affiliation:
Department of Psychological Medicine, King's College London, Institute of Psychiatry, London, UK
*
*Address for correspondence: Miss C. Woodhead, King's Centre for Military Health Research, King's College London, Weston Education Centre, 10 Cutcombe Road, London SE5 9RJ, UK. (Email: charlotte.c.woodhead@kcl.ac.uk)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Interest in the mental health of women deployed to modern military campaigns is increasing, although research examining gender differences is limited. Little is known about experiences women have had on these deployments, or whether men and women respond differently to combat exposure.

Method

The current study used data from a representative sample of UK Armed Forces personnel to examine gender differences among those deployed to Iraq and Afghanistan (n=432 women, n=4554 men) in three measures of experience: ‘risk to self’, ‘trauma to others’ and ‘appraisal of deployment’. We examined the impact of such experiences on post-deployment symptoms of post-traumatic stress disorder (PTSD), symptoms of common mental disorder (CMD) and hazardous alcohol use.

Results

After adjustment, men reported more exposure to ‘risk to self’ and ‘trauma to others’ events and more negative appraisals of their deployment. Among both genders, all measures of combat experience were associated with symptoms of PTSD and CMD (except ‘risk to self’ events on symptoms of CMD among women) but not with alcohol misuse. Women reported higher scores on the PTSD Checklist – Civilian Version (PCL-C) among those exposed to lower levels of each experience type but this did not hold in the higher levels. Women reported greater symptoms of CMD and men reported greater hazardous alcohol use across both levels of each experience type. Examining men and women separately suggested similar responses to exposure to adverse combat experiences.

Conclusions

The current findings suggest that, although gender differences in mental health exist, the impact of deployment on mental health is similar among men and women.

Keywords

Combat exposuredeploymentgender differencesmental healthmilitary
Type
Original Articles
Information
Psychological Medicine , Volume 42 , Issue 9 , September 2012 , pp. 1985 - 1996
Copyright
Copyright © Cambridge University Press 2012

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adler, A, Huffman, AH, Bliese, PD, Castro, CA (2005). The impact of deployment length and experience on the well-being of male and female soldiers. Journal of Occupational Health Psychology 10, 121–137.CrossRefGoogle ScholarPubMed
Babor, TF, Higgins-Biddle, JC, Saunders, JB, Monteiro, MG (2001). AUDIT: The Alcohol Use Disorders Identification Test, 2nd edn. World Health Organization: Geneva.Google Scholar
Bell, E, Roth, MA, Weed, G (1998). Wartime stressors and health outcomes: women in the Persian Gulf War. Journal of Psychosocial Nursing and Mental Health Services 36, 19–25.CrossRefGoogle ScholarPubMed
Carter-Visscher, R, Polusny, MA, Murdoch, M, Thuras, P, Erbes, CR, Kehle, SM (2010). Pre-deployment gender differences in stressors and mental health among U.S. National Guard troops poised for Operation Iraqi Freedom deployment. Journal of Traumatic Stress 23, 78–85.CrossRefGoogle Scholar
Cohen, B, Gima, K, Bertenthal, D, Kim, S, Marmar, CR, Seal, KH (2009). Mental health diagnoses and utilization of VA non-mental health medical services among returning Iraq and Afghanistan veterans. Journal of General Internal Medicine 25, 18–24.CrossRefGoogle ScholarPubMed
Engel, C, Engel, AL, Campbell, SJ, McFall, ME, Russo, J, Katon, W (1993). Posttraumatic stress disorder symptoms and pre-combat sexual and physical abuse in Desert Storm veterans. Journal of Nervous and Mental Disease 181, 683–688.CrossRefGoogle Scholar
Fear, NT, Iversen, A, Meltzer, H, Workman, L, Hull, L, Greenberg, N, Barker, C, Browne, T, Earnshaw, M, Horn, O, Jones, M, Murphy, D, Rona, RJ, Hotopf, M, Wessely, S (2007). Patterns of drinking in the UK Armed Forces. Addiction 11, 1749–1759.CrossRefGoogle Scholar
Fear, NT, Jones, M, Murphy, D, Hull, L, Iversen, A, Coker, B, Machell, L, Sundin, J, Woodhead, C, Jones, N, Greenberg, N, Landau, S, Dandeker, C, Rona, RJ, Hotopf, M, Wessely, S (2010). What are the consequences of deployment to Iraq and Afghanistan on the mental health of the UK Armed Forces? A cohort study. Lancet 375, 1783–1797.CrossRefGoogle ScholarPubMed
Fontana, A, Rosenheck, R, Desai, R (2010). Female veterans of Iraq and Afghanistan seeking care from VA specialized PTSD programs: comparison with male veterans and female war zone veterans of previous eras. Journal of Women's Health 19, 1–7.CrossRefGoogle ScholarPubMed
Freedy, J, Magruder, KM, Mainous, AG, Frueh, C, Geesey, ME, Carnemolla, M (2010). Gender differences in traumatic event exposure and mental health among veteran primary care patients. Military Medicine 175, 750–758.CrossRefGoogle ScholarPubMed
Goldberg, DP, Gater, R, Sartorius, N, Ustun, TB, Piccinelli, M, Gureje, O, Rutter, C (1997). The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine 27, 191–197.CrossRefGoogle ScholarPubMed
Haskell, S, Gordon, KS, Mattocks, K, Duggal, M, Erdos, J, Justice, A, Brandt, CA (2010). Gender differences in rates of depression, PTSD, pain, obesity, and military sexual trauma among Connecticut war veterans of Iraq and Afghanistan. Journal of Women's Health 19, 267–271.CrossRefGoogle ScholarPubMed
Hoge, C, Castro, CA, Messer, SC, McGurk, D, Cotting, DI, Koffman, RL (2004). Combat duty in Iraq and Afghanistan, mental health problems, and barriers to care. New England Journal of Medicine 351, 13–22.CrossRefGoogle ScholarPubMed
Hoge, C, Clark, JC, Castro, CA (2007). Commentary: women in combat and the risk of post-traumatic stress disorder and depression. International Journal of Epidemiology 36, 327–329.CrossRefGoogle ScholarPubMed
Hotopf, M, Hull, L, Fear, NT, Browne, T, Horn, O, Iversen, A, Jones, M, Murphy, D, Bland, D, Earnshaw, M, Greenberg, N, Hacker Hughes, J, Tate, AR, Dandeker, C, Rona, R, Wessely, S (2006). The health of UK military personnel who deployed to the 2003 Iraq war: a cohort study. Lancet 367, 1731–1741.CrossRefGoogle Scholar
Iversen, AC, Fear, NT, Ehlers, A, Hacker Hughes, J, Hull, L, Earnshaw, M, Greenberg, N, Rona, R, Wessely, S, Hotopf, M (2008). Risk factors for post-traumatic stress disorder among UK Armed Forces personnel. Psychological Medicine 38, 511–522.CrossRefGoogle ScholarPubMed
Jones, M, Fear, N, Greenberg, N, Jones, N, Hull, L, Hotopf, M, Wessely, S, Rona, R (2008). Do medical services personnel who deployed to the Iraq war have worse mental health than other deployed personnel? European Journal of Public Health 18, 422–427.CrossRefGoogle Scholar
Kessler, R, McGonagle, KA, Zhao, S, Nelson, CB, Hughes, M, Eshleman, S, Wittchen, HU, Kendler, KS (1994). Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Archives of General Psychiatry 51, 8–19.CrossRefGoogle ScholarPubMed
Kessler, RC, Sonnega, A, Bromet, E, Hughes, M, Nelson, CB (1995). Posttraumatic stress disorder in the National Comorbidity Survey. Archives of General Psychiatry 52, 1048–1060.CrossRefGoogle ScholarPubMed
King, D, King, LA, Foy, DW, Keane, TM, Fairbank, JA (1999). Posttraumatic stress disorder in a national sample of female and male Vietnam veterans: risk factors, war-zone stressors, and resilience-recovery variables. Journal of Abnormal Psychology 108, 164–170.CrossRefGoogle Scholar
King, D, King, LA, Gudanowski, DM, Vreven, DL (1995). Alternative representations of war zone stressors: relationships to posttraumatic stress disorder in male and female Vietnam veterans. Journal of Abnormal Psychology 104, 184–196.CrossRefGoogle ScholarPubMed
Lapierre, C, Schwegler, AF, LaBauve, BJ (2007). Posttraumatic stress and depression symptoms in soldiers returning from combat operations in Iraq and Afghanistan. Journal of Traumatic Stress 20, 933–943.CrossRefGoogle ScholarPubMed
Luxton, DD, Skopp, NA, Maguen, S (2010). Gender differences in depression and PTSD symptoms following combat exposure. Depression and Anxiety 27, 1027–1033.CrossRefGoogle ScholarPubMed
Maguen, S, Ren, L, Bosch, JO, Marmar, CR, Seal, KH (2010). Gender differences in mental health diagnoses among Iraq and Afghanistan veterans enrolled in Veterans Affairs health care. American Journal of Public Health 100, 2450–2456.CrossRefGoogle ScholarPubMed
McManus, S, Meltzer, H, Brugha, T, Bebbington, P, Jenkins, R (2009). Adult Psychiatric Morbidity in England, 2007: Results of a Household Survey. The NHS Information Centre for Health and Social Care 2009 (www.ic.nhs.uk/pubs/psychiatricmorbidity07). Accessed 18 March 2009.Google Scholar
Nunnink, S, Goldwaser, G, Heppner, PS, Pittman, JOE, Nievergelt, CM, Baker, DG (2010). Female veterans of the OEF/OIF conflict: concordance of PTSD symptoms and substance misuse. Addictive Behaviors 35, 655–659.CrossRefGoogle ScholarPubMed
Rona, R, Fear, NT, Hull, L, Wessely, S (2007). Women in novel occupational roles: mental health trends in the UK Armed Forces. International Journal of Epidemiology 36, 319–326.CrossRefGoogle ScholarPubMed
Sareen, J, Belik, S, Stein, MB, Asmundson, GJG (2010). Correlates of perceived need for mental health care among active military personnel. Psychiatric Services 61, 50–57.CrossRefGoogle ScholarPubMed
Scott, W, McCone, D, Jackson, R, Sayegh, L, Don Looney, J (2011). The tip of the spear hypothesis revisited: evidence from recent deployments of U.S. National Guard troops to Iraq and Afghanistan. Unpublished paper presented at the American Sociological Association Annual Meeting, 20 August 2011, Las Vegas, Nevada.Google Scholar
Seal, K, Metzler, TJ, Gima, KS, Bertenthal, D, Maguen, S, Marmar, CR (2009). Trends and risk factors for mental health diagnoses among Iraq and Afghanistan veterans using Department of Veterans Affairs health care, 2002–2008. American Journal of Public Health 99, 1651–1658.CrossRefGoogle ScholarPubMed
Smith, T, Wingard, DL, Ryan, MAK, Kritz-Silverstein, D, Slymen, DJ, Sallis, JF (2008). Prior assault and posttraumatic stress disorder after combat deployment. Epidemiology 19, 505–512.CrossRefGoogle ScholarPubMed
Sternke, LM (2011). Measurement of military combat exposure among women: analysis and implications. Women's Health Issues 21, S160–S168.CrossRefGoogle ScholarPubMed
Street, A, Vogt, D, Dutra, L (2009). A new generation of women veterans: stressors faced by women deployed to Iraq and Afghanistan. Clinical Psychology Review 29, 685–694.CrossRefGoogle ScholarPubMed
Tolin, DF, Foa, EB (2006). Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychological Bulletin 132, 959–992.CrossRefGoogle ScholarPubMed
Unwin, C, Hotopf, M, Hull, L, Ismail, K, David, A, Wessely, S (2002). Women in the Persian Gulf: lack of gender differences in long-term health effects of service in the United Kingdom Armed Forces in the 1991 Persian Gulf War. Military Medicine 167, 406–413.CrossRefGoogle ScholarPubMed
Visco, R (2009). Postdeployment, self-reporting of mental health problems, and barriers to care. Perspectives in Psychiatric Care 45, 240–253.CrossRefGoogle ScholarPubMed
Vogt, D, Pless, AP, King, LA, King, DW (2005). Deployment stressors, gender, and mental health outcomes among Gulf War I veterans. Journal of Traumatic Stress 18, 115–127.CrossRefGoogle ScholarPubMed
Wang, PS, Michael, L, Olfson, M, Pincus, HA, Wells, KB, Kessler, RC (2005). Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Archives of General Psychiatry 62, 629–640.CrossRefGoogle ScholarPubMed
Weathers, F, Litz, B, Herman, D, Huska, J, Keane, T (1994). The PTSD Checklist – Civilian Version (PCL-C). National Centre for PTSD: Boston.Google Scholar
Wells, T, LeardMann, CA, Fortuna, SO, Smith, B, Smith, TC, Ryan, MAK, Boyko, EJ, Blazer, D (2010). A prospective study of depression following combat deployment in support of the wars in Iraq and Afghanistan. American Journal of Public Health 100, 90–99.CrossRefGoogle ScholarPubMed
Wolfe, J, Brown, PJ, Kelley, JM (1993). Reassessing war stress: exposure and the Persian Gulf War. Journal of Social Issues 49, 15–31.CrossRefGoogle Scholar
Zinzow, H, Grubaugh, AL, Frueh, BC, Magruder, KM (2008). Sexual assault, mental health, and service use among male and female veterans seen in Veterans Affairs primary care clinics: a multi-site study. Psychiatry Research 159, 226–236.CrossRefGoogle ScholarPubMed
Zinzow, H, Grubaugh, AL, Monnier, J, Suffoletta-Maierle, S, Frueh, BC (2007). Trauma among female veterans: a critical review. Trauma, Violence and Abuse 8, 384–400.CrossRefGoogle ScholarPubMed