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Gulf War and Health, Volume 6: Physiologic, Psychologic, and Psychosocial Effects of Deployment-Related Stress
Men and women appear to suffer equal degrees of impairment from PTSD, although women are more likely to seek medical help and take medication. In a study of PTSD in the general population, Breslau (2001b) found that when symptoms were most severe, about 25% of both men and women in a population of young adults felt that they were unable to work during the entire 30-day period during which they experienced the symptoms. When inability to work was added to reports of reduced activity, almost 39% of the 20 men and 44% of 44 women reported that they were unable to do their jobs or had to reduce their activities. When young people with a diagnosis of PTSD, other psychiatric diagnoses, or no psychiatric diagnosis were compared, the limitation of activities from PTSD was twice that from the other diagnoses and 4 times that associated with no diagnosis.
RISK AND PROTECTIVE FACTORS
Risk and protective factors influence responses to stressors or traumatic events. In the case of veterans, those factors might determine the extent of the response to a deployment-related stressor and whether PTSD will develop. The following discussion is not exhaustive and is meant to provide the reader with an overview of the types of risk and protective factors that may influence each veteran. Some of the risk and protective factors that have been noted in the development of PTSD are: sex; age; race and ethnicity; developmental history and early-life stressors; personal psychiatric history; hardiness, a sense of control, and coping strategies; socioeconomic status and military status; social support; exposure to combat; and physical injury. None of those factors occurs in isolation; they may interact with one another before, during, and after deployment (Benotsch et al. 2000; Stein et al. 2005). Although many of the studies discussed below focus on PTSD, other health effects, primarily other psychiatric disorders, are also discussed when the results are applicable to them.
As in the general population (Kessler et al. 1995), female veterans of both the Vietnam War and the Gulf War are more likely than their male counterparts to suffer from PTSD (Fiedler et al. 2006; Kang et al. 2003; Kulka et al. 1990; Wolfe 1996; Wolfe et al. 1993b, 1999; Zatzick et al. 1997b). After the Gulf War, Fiedler et al. (2006) found that deployed women were more likely than deployed men to experience PTSD (4.0% of women and 3.4% of men), other anxiety disorders (25.3% of women and 15.3% of men), and major depression (25.3% of women and 14.2% of men), but they were less likely than men to have drug or alcohol disorders; these findings are mirrored in the general population (Kessler et al. 1995, 2005a). In a study assessing the prevalence of PTSD and chronic fatigue syndrome (CFS) in Gulf War veterans, women made up 18.6% of the 11,441 veterans in the study; 24.3% of the women met the screening criteria for PTSD, and 16.7% had CFS symptoms (Kang et al. 2003). Female Gulf War veterans were more likely than men to have PTSD symptoms when assessed 5 days after their return from the gulf (8% vs 3%, respectively, OR 3.2, 95% CI 1.9-5.5) and after controlling for the effects of combat and other risk factors; 18-24 months later, the prevalence was still higher for women than men (16% vs 7%, respectively, OR 2.3, 95% CI 1.5-3.5) (Wolfe et al. 1999). However, Sutker et al. (1995a) found that female Gulf War veterans (14% of sample) reported similar levels of psychologic distress and had no more PTSD symptoms than their male counterparts.