Female veterans who served in Vietnam during the Vietnam-war era developed post-traumatic stress disorder (PTSD) at a significantly higher rate than women who served at bases near Vietnam or in the United States, according to research published in JAMA Psychiatry. These findings appear to be associated with wartime exposures such as sexual discrimination, sexual harassment, and job performance pressures.
This research is crucial for understanding and implementing treatment for both Vietnam-era and recent veterans. “Vietnam-era women veterans are now at the precipice of their life span, when illness is likely to increase markedly. Understanding the late health effects of war among this earlier cohort will also benefit the rapidly growing population of women more recently returned from war and provide evidence for planning of clinical programs,” wrote Kathryn Magruder, PhD, MPH of the Ralph J. Johnson Veterans Affairs Medical Center in Charleston, S.C.
Researchers surveyed 8742 women who were active-duty military personnel in the U.S. Armed Forces at any time between July 4, 1965 and March 28, 1973 for at least 30 days, as part of the Department of Veterans Affairs Cooperative Study 579, also known as HealthVIEWS.
Data was obtained through mailed and telephone surveys from May 16, 2011 through August 5, 2012 and was analyzed from June 26, 2013 through July 30, 2015. Lifetime and current PTSD were measured according to the Composite International Diagnostic Interview version 3.0. Onset of PTSD and wartime experiences were measured by the Women’s Wartime Exposure Scale-Revised.
Researchers examined the onset and prevalence of lifetime and current PTSD in women veterans who served in the Vietnam wartime era by location: in Vietnam, near Vietnam at various bases (in Japan, the Philippines, Guam, Korea, and Thailand), and in the United States.
Among the 4219 women (48.3%) who completed both the mailed survey and the telephone interview, 20.1% of the Vietnam cohort had lifetime PTSD compared with 11.5% in the near-Vietnam cohort and 14.1% (95% CI, 12.4%-15.8%) in the US cohort. The prevalence of current PTSD was an average of 15.9% (14.3%-17.5%) for the Vietnam cohort, 8.1% (6.%-10.2%) for near-Vietnam, and 9.1% (7.7%-10.5%) for the U.S.
The odds of experiencing lifetime PTSD were 1.5 times greater for women who served in Vietnam compared with women who served in the U.S. This effect remained significant when researchers factored in the women’s military characteristics, such as their enlistment age, whether or not they were a nurse, whether they were white or non-white, and whether they served in the army, navy, air force, or marines.
However, when the researchers factored in wartime exposures such as sexual discrimination or harassment, casualty or environment related stress, performance pressure, triage or death, danger or threat, and overwork, the effect of PTSD by location was no longer significant. These wartime exposures increased the chances of PTSD. Greater exposure to sexual discrimination or harassment increased the chances of PTSD by 7%, higher performance pressure increased the odds by 3%, and an increase in exposure to triage or death increased the chances of PTSD by 1%.
Women stationed in Vietnam were also exposed directly to war zone experiences, compared with women stationed near Vietnam, who may have been exposed to casualties but who were not directly in a war zone. US-stationed veterans presumably had the least exposure to war zone exposures.
Limitations of the study include the possibility that nonrespondents and veterans who died before the survey’s beginning or completion may have had different PTSD prevalence, and those deployed to various war zones may have had unknown individual risk factors for PTSD. Also, due to the large study size, the CIDI PTSD module was used for PTSD assessment rather than CAPS, which is the criterion standard.
However, the study also has major strengths: the women identified for the study represent the most comprehensive cohort of women veterans who served during the Vietnam era. The study was also population-based, rather than relying on the limited subset of veterans who use VA health care services. Most notably, researchers used military personnel records to assess service data, thus reducing potential biases in recall.
“Given the long-term nature of many war-related disorders and their relationships with adverse mental health outcomes, understanding how wartime service can affect the mental health of aging veterans is important,” wrote Magruder. “Because current PTSD is still present in many of these women decades after their military service, clinicians who treat them should continue to screen for PTSD symptoms and be sensitive to their noncombat wartime experiences.”
The researchers noted that future studies should examine the effect of military service on psychiatric disorders other than PTSD and their influence on geriatric medical conditions, as well as the resilience and other positive aspects of military service for these women.
Magruder K, Serpi T, Kimerling R, Kilbourne AM, et al. Prevalence of Posttraumatic Stress Disorder in Vietnam-Era Women Veterans: The Health of Vietnam-Era Women’s Study (Health VIEWS). JAMA Psychiatry. 2015; doi:10.1001/jamapsychiatry.2015.1786.