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Gender Differences in VA Disability Status for PTSD Over Time
Nina A. Sayer, Ph.D.; Emily M. Hagel, M.S.; Siamak Noorbaloochi, Ph.D.; Michele R. Spoont, Ph.D.; Robert A. Rosenheck, M.D.; Joan M. Griffin, Ph.D.; Paul A. Arbisi, Ph.D.; Maureen Murdoch, M.D., M.P.H.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300017
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Dr. Sayer, Ms. Hagel, Dr. Noorbaloochi, Dr. Spoont, Dr. Griffin, and Dr. Murdoch are with the Center for Chronic Disease Outcomes Research, a U.S. Department of Veterans Affairs (VA) Health Services Research and Development Service Center of Excellence, Minneapolis VA Health Care System, Minneapolis, Minnesota (e-mail: nina.sayer@va.gov). Dr. Sayer, Dr. Noorbaloochi, Dr. Spoont, Dr. Griffin, and Dr. Murdoch are also with the Department of Medicine, University of Minnesota School of Medicine, Minneapolis. Dr. Rosenheck is with the VA New England Mental Illness Research, Education and Clinical Center, West Haven, Connecticut, and the Department of Psychiatry, Epidemiology and Public Health and the Child Study Center, Yale Medical School, West Haven. Dr. Arbisi is with the Department of Psychology, VA Health Care System, Minneapolis, and the Departments of Psychiatry and Psychology, University of Minnesota, Minneapolis.

Copyright © 2014 by the American Psychiatric Association

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Abstract

Objective  Posttraumatic stress disorder (PTSD) is the most prevalent psychiatric condition for which veterans receive service-connected disability benefits from the U.S. Department of Veterans Affairs (VA). Historically, women have been less likely than men to obtain PTSD disability benefits. The authors examined whether these gender disparities have been redressed over time and, if not, whether appropriate clinical factors account for persisting differences.

Methods  This longitudinal, observational study was based on a gender-stratified, nationally representative sample of 2,998 U.S. veterans who applied for VA disability benefits for PTSD between 1994 and 1998. The primary outcome was change in PTSD service connection over a ten-year period.

Results  Forty-two percent (95% confidence interval [CI]=38%–45%) of the women and 50% (CI=45%–55%) of the men originally denied service connection for PTSD eventually received such benefits. Only 8% (CI=7%–10%) of women and 5% (CI=4%–6%) of men lost PTSD disability status. Compared with men, women had lower unadjusted odds of gaining PTSD service connection (odds ratio [OR]=.70, CI=.55–.90) and greater unadjusted odds of losing PTSD service connection (OR=1.76, CI=1.21–2.57). Adjusting for clinical factors accounted for the gender difference in gaining PTSD service connection; adjusting for clinical factors and demographic characteristics eliminated the gender difference in loss of PTSD service connection.

Conclusions  Gender-based differences in receipt of PTSD service connection persisted in this cohort over a ten-year period but were explained by appropriate sources of variation. Further research on possible disparities in loss of PTSD disability benefits is warranted.

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