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Articles   |    
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
View Author and Article Information

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

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.

Abstract Teaser
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Table 1Characteristics of veterans who sought disability benefits for service-connected PTSD
Table Footer Note

a Chi square and t tests were used to compare characteristics between women and men.

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b Assessed with the Penn Inventory (17). Possible scores range from 0 to 78, with higher scores indicating greater PTSD symptom severity.

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c Assessed with the Social Adjustment Scale (20). Possible scores range from 1 to 5, with higher scores indicating poorer adjustment across all domains.

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d Assessed with the RAND Revised Physical Functioning Battery (21). Possible scores range from 12 to 36, with higher scores indicating less impairment.

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e Assessed with the Charlson Comorbidity Index (22), which assesses the number of and seriousness of comorbid diseases. Higher scores indicate greater risk of mortality from comorbid conditions.

Table Footer Note

f Assessed with the revised Life Stressor Checklist (23). Possible scores range from 0 to 11, with higher scores indicating exposure to more postservice life stressors and hardships.

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g Combat exposure was measured with a 22-item version of the Combat Exposure Index (25). Possible scores range from 0 to 22, with higher scores indicating exposure to heavier combat.

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Table 2Characteristics of veterans, by gain and loss of PTSD service-connected disability benefits
Table Footer Note

a Chi square and t tests were used to compare characteristics between women and men.

Table Footer Note

b Assessed with the Penn Inventory (17). Possible scores range from 0 to 78, with higher scores indicating greater PTSD symptom severity.

Table Footer Note

c Assessed with the Social Adjustment Scale (20). Possible scores range from 1 to 5, with higher scores indicating poorer adjustment across all domains.

Table Footer Note

d Assessed with the RAND Revised Physical Functioning Battery (21). Possible scores range from 12 to 36, with higher scores indicating less impairment.

Table Footer Note

e Assessed with the Charlson Comorbidity Index (22), which assesses the number of and seriousness of comorbid disease. Higher scores indicate greater risk of mortality from comorbid conditions.

Table Footer Note

f Assessed with the revised Life Stressor Checklist (23). Possible scores range from 0 to 11, with higher scores indicating exposure to more postservice life stressors and hardships.

Table Footer Note

g Combat exposure was measured with a 22-item version of the Combat Exposure Index (25). Possible scores range from 0 to 22, with higher scores indicating exposure to heavier combat.

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Table 3Sequential adjustment effects on odds of PTSD service connection gaina
Table Footer Note

a Stratified logistic regression models were used to compute odds ratios. All models included PTSD service connection at time 1, gender, and the gender × time 1 PTSD service connection interaction.

Table Footer Note

b Adjusted for time 1 PTSD symptom severity, overall role functioning, physical functioning, comorbidity, postservice trauma and hardship, time 2 employment, and the change from time 1 to time 2 in PTSD symptom severity, overall role functioning, physical functioning, and postservice trauma and hardship

Table Footer Note

c Adjusted for variables in model 2 plus age, race (white), marital status, education, military service era, military branch, region in which claim was filed, and time since claim was initiated

Table Footer Note

d Adjusted for all variables in model 3 plus in-service sexual assault

Table Footer Note

e Adjusted for all variables in model 3 plus level of combat exposure

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Table 4Sequential adjustment effects on odds of PTSD service connection lossa
Table Footer Note

a Stratified logistic regression models were used to compute odds ratios. All models included PTSD service connection at time 1, gender, and the gender × time 1 PTSD service connection interaction.

Table Footer Note

b Adjusted for time 1 PTSD symptom severity, overall role functioning, physical functioning, comorbidity, postservice trauma and hardship, time 2 employment, and the change from time 1 to time 2 in PTSD symptom severity, overall role functioning, physical functioning, and postservice trauma and hardship

Table Footer Note

c Adjusted for variables in model 2 plus age, race (white), marital status, education, military service era, military branch, region in which claim was filed, and time since claim was initiated

Table Footer Note

d Adjusted for all variables in model 3 plus in-service sexual assault

Table Footer Note

e Adjusted for all variables in model 3 plus level of combat exposure

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