Military Sexual Trauma Interacts With Combat Exposure to Increase Risk for Posttraumatic Stress Symptomatology in Female Iraq and Afghanistan Veterans
ABSTRACT Objective: Sexual trauma during military service is increasingly recognized as a substantial public health problem and is associated with detrimental effects on veteran mental health. In this study, we examined associations between childhood trauma, military sexual trauma (MST), combat exposure, and military-related posttraumatic stress symptomatology (PTSS) in the Women Veterans Cohort Study (WVCS), a community-based sample of veterans who served in the recent conflicts in Iraq and Afghanistan. Method: From July 2008 to December 2011, 365 female veterans completed a survey that assessed combat exposure, military sexual trauma, military-related PTSS (assessed using the PTSD [posttraumatic stress disorder] Checklist-Military Version), and demographic, life history, and other psychopathology variables. Results: High rates of childhood trauma (59.7%) and MST (sexual assault = 14.7%; sexual harassment = 34.8%) were observed in this sample. A hierarchical regression revealed that active duty status, childhood trauma, combat exposure, and MST were independently associated with increased severity of military-related PTSS (Ps < .05). Moreover, a significant interaction emerged between MST and combat exposure in predicting military-related PTSS (P = .030), suggesting that the relationship between combat exposure and PTSS was altered by MST status. Specifically, under conditions of high combat exposure, female veterans with MST had significantly higher PTSS compared to female veterans without MST. Conclusions: Taken together, results suggest that exposure to multiple traumas during military service may have synergistic effects on posttraumatic stress symptoms in female veterans. Moreover, our findings highlight the importance of prevention efforts to protect female veterans from the detrimental effects of MST, particularly those who are exposed to high levels of combat. (C) Copyright 2014 Physicians Postgraduate Press, Inc.
SourceAvailable from: Marcello Gallucci[Show abstract] [Hide abstract]
ABSTRACT: Despite many articles reporting the problems of dichotomizing continuous measures, researchers still commonly use this practice. The authors' purpose in this article was to understand the reasons that people still dichotomize and to determine whether any of these reasons are valid. They contacted 66 researchers who had published articles using dichotomized variables and obtained their justifications for dichotomization. They also contacted 53 authors of articles published in Psychological Methods and asked them to identify any situations in which they believed dichotomized indicators could perform better. Justifications provided by these two groups fell into three broad categories, which the authors explored both logically and with Monte Carlo simulations. Continuous indicators were superior in the majority of circumstances and never performed substantially worse than the dichotomized indicators, but the simulations did reveal specific situations in which dichotomized indicators performed as well as or better than the original continuous indictors. The authors also considered several justifications for dichotomization that did not lend themselves to simulation, but in each case they found compelling arguments to address these situations using techniques other than dichotomization.Psychological Methods 12/2009; 14(4):349-66. DOI:10.1037/a0016956 · 4.45 Impact Factor
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ABSTRACT: In the present study we sought to identify factors associated with posttraumatic stress disorder (PTSD) following the World Trade Center Disaster (WTCD) and examine changes in PTSD status over time. Our data come from a two-wave, prospective cohort study of New York City adults who were living in the city on September 11, 2001. We conducted a baseline survey 1 year after the attacks (year 1), followed by a survey 1 year later (year 2). Overall, 2368 individuals completed the year 1 survey, and 1681 were interviewed at year 2. Analyses for year 1 indicated that being younger, being female, experiencing more WTCD events, reporting more traumatic events other than the WTCD, experiencing more negative life events, having low social support, and having low self-esteem increased the likelihood of PTSD. For year 2, being middle-aged, being Latino, experiencing more negative life events and traumas since the WTCD, and having low self-esteem increased the likelihood of PTSD. Exposure to WTCD events was not related to year 2 PTSD once other factors were controlled. Following previous research, we divided study respondents into four categories: resilient cases (no PTSD years 1 or 2), remitted cases (PTSD year 1 but not year 2), delayed cases (no PTSD year 1 but PTSD year 2), and acute cases (PTSD both years 1 and 2). Factors predicting changes in PTSD between year 1 and year 2 suggested that delayed PTSD cases were more likely to have been Latino, to have experienced more negative life events, and to have had a decline in self-esteem. In contrast, remitted cases experienced fewer negative life events and had an increase in self-esteem. We discuss these findings in light of the psychosocial context associated with community disasters and traumatic stress exposures.Journal of Nervous & Mental Disease 08/2006; 194(7):485-93. DOI:10.1097/01.nmd.0000228503.95503.e9 · 1.81 Impact Factor
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ABSTRACT: Military sexual trauma (MST) is a widespread problem associated with negative psychological and physical health problems. This article presents the current state of MST research and highlights specific areas in need of more focused study. Areas that have produced the greatest body of knowledge include MST prevalence and psychological and physical health correlates. We propose a research agenda based on gaps noted in our research review and empirical and theoretical evidence of issues relevant to but not studied directly in MST populations. We present evidence that MST is qualitatively distinct from other forms of sexual maltreatment in terms of its relational and vocational context as well as the severity of associated psychological distress, examine underexplored gender and sexual issues in MST, and discuss the lack of treatment and prevention studies specific to MST. Specific recommendations are made throughout in an attempt to guide and advance the field.Journal of Trauma & Dissociation 04/2011; 12(3):324-45. DOI:10.1080/15299732.2011.542609 · 1.72 Impact Factor