Women's Mental Health in the U.S. Military - Where Are We Now? A Review of Recent Research.

PURPOSE OF REVIEW: The field of women's mental health has grown in the military healthcare system, which has begun to acknowledge and address the sex-specific differences in mental health for service women. The purpose of this review is to examine recent research in active duty populations addressing perinatal mental health, post-traumatic stress disorder (PTSD), depression, and gender isolation. RECENT FINDINGS: Within the examined literature focused on active duty populations, analyses by sex and gender continue to exist as notable gaps, and a majority of studies reviewed either do not aim to examine sex or gender-based differences, and/or do not analyze data with an eye towards these paradigms. Within perinatal mental health, the lack of studies led to an inability to make any notable conclusions. PTSD was the area with the most robust publications focused on active duty women, studies of major depression showed significant occupational impact, and the area of gender isolation continues to grow as a promising field with practical implications. We discuss current promising research and advance ideas for future research trajectories that will provide clinicians, policy makers, and scientists with more data to support improved mental healthcare for both military women and men.

Optimism predicts positive health in repatriated prisoners of war.

"Positive health," defined as a state beyond the mere absence of disease, was used as a model to examine factors for enhancing health despite extreme trauma. The study examined the United States' longest detained American prisoners of war, those held in Vietnam in the 1960s through early 1970s. Positive health was measured using a physical and a psychological composite score for each individual, based on 9 physical and 9 psychological variables. Physical and psychological health was correlated with optimism obtained postrepatriation (circa 1973). Linear regressions were employed to determine which variables contributed most to health ratings. Optimism was the strongest predictor of physical health (ß = -.33, t = -2.73, p = .008), followed by fewer sleep complaints (ß = -.29, t = -2.52, p = .01). This model accounted for 25% of the variance. Optimism was also the strongest predictor of psychological health (ß = -.41, t = -2.87, p = .006), followed by Minnesota Multiphasic Personality Inventory-Psychopathic Deviate (MMPI-PD; McKinley & Hathaway, 1944) scores (ß = -.23, t = -1.88, p = .07). This model strongly suggests that optimism is a significant predictor of positive physical and psychological health, and optimism also provides long-term protective benefits. These findings and the utility of this model suggest a promising area for future research and intervention.

Sleep and resilience: a longitudinal 37-year follow-up study of Vietnam repatriated prisoners of war.

This study examined sleep histories associated with resilience after trauma defined as a continuous lack of psychiatric illness across 37 years. Data were drawn from a 37-year follow-up examination of the effects of the Vietnam prisoner of war (POW) experience. The Robert E. Mitchell Center for POW Studies is a unique institution holding the only longitudinal study of the effects of the American POW experience in existence. The study used a sample of 440 Vietnam repatriated prisoners of war (RPWs). Psychiatric disorders were assessed at repatriation (1973) and were continued annually by a psychiatrist or clinical psychologist. Sleep issues before, during, and after captivity were assessed upon repatriation during medical examinations. Odds ratios examining presence of sleep symptoms show resilient RPWs reporting fewer symptoms compared to nonresilient RPWS before, during, and after captivity. Logistic regression comparing before, during, and after indicates fewer reported sleep disturbance symptoms after captivity was the strongest predictor of resilience (b = -0.82, Wald chi2 (1) = 16.70, p < 0.000). Reporting fewer sleep complaints, but not necessarily an absence of them before, during, and after the trauma predicts resilience across time.

Optimism predicts resilience in repatriated prisoners of war: a 37-year longitudinal study.

Resilience, exhibiting intact psychological functioning despite exposure to trauma, is one perspective as to why some people who are exposed to trauma do not develop symptoms. This study examines the prisoner of war experience to expand our understanding of this phenomenon in extreme cases of trauma such as prolonged captivity, malnourishment, and physical and psychological torture. The study examined the United States' longest detained American prisoners of war, those held in Vietnam in the 1960s through early 1970s. A logistic regression analysis using resilience, defined as never receiving any psychiatric diagnosis over a 37-year follow-up period, as the outcome was performed (n = 224 with complete data). Six variables showing at least small effects emerged: officer/enlisted status, age at time of capture, length of solitary confinement, low antisocial/psychopathic personality traits, low posttraumatic stress symptoms following repatriation, and optimism. Odds ratios (ORs) and confidence intervals (CIs) confirmed the significance and relative strength of these variables, with a range from OR = 0.54, 95% CI [0.13, 2.29] to OR = 1.11, 95% CI [1.04, 1.17]. When all variables were examined continuously and categorically, dispositional optimism was the strongest variable, accounting for 17%, continuously, and 14%, categorically. We discuss optimism as a protective factor for confronting trauma and the possibility of training to increase it.

Posttraumatic stress disorder and metabolic syndrome: retrospective study of repatriated prisoners of war.

OBJECTIVE: We conducted a retrospective study of metabolic data for Vietnam-era repatriated prisoners of war (RPWs) and a comparison group to determine if metabolic syndrome (MbS) was more common in those individuals with clinically diagnosed, current or lifetime posttraumatic stress disorder (PTSD) as suggested in a recent report. METHODS: The metabolic data of our patients nearest the time of psychiatric evaluation (1998-2004) for PTSD were analyzed using both an analysis of variance and logistic regression. RESULTS: Although we found elevated triglyceride levels (40 mg/dl higher) in RPWs with PTSD who met MbS criteria, overall the prevalence of MbS was the same in RPWs with and without PTSD and comparison group. Moreover, current PTSD symptom severity did not increase the likelihood of MbS. CONCLUSIONS: Our results from these repatriates who actively participate in a 37-year medical follow up program do not support the conclusion that MbS occurs more commonly in individuals with current PTSD.

Potential association of posttraumatic stress disorder and decreased bone mineral density in repatriated prisoners of war.

OBJECTIVE: We conducted a retrospective evaluation of bone mineral density data collected during routine medical follow-up evaluations of 241 Vietnam-era male repatriated prisoners of war, with and without the lifetime diagnosis of posttraumatic stress disorder (PTSD), and 79 subjects in a comparison group. METHODS: Dual-energy X-ray absorptiometry scans evaluated total hip and lumbar spine T-scores. A multivariate analysis of covariance was performed on the data using age, body mass index, ethnicity, and reported alcohol consumption as covariates. RESULTS: There was a significant effect of group on total hip, but not lumbar spine, T-scores. Pairwise comparisons revealed statistically lower total hip T-scores in repatriates with a lifetime history of PTSD in comparison to both the comparison group and repatriates without a lifetime history of PTSD. CONCLUSION: In this study of elderly repatriated prisoners of war, we noted an association between a lifelong history of PTSD and decreased bone mineral density at the hip.