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Prior research has demonstrated that intimate partner violence (IPV) is associated with employment instability among poor women. The current study assesses the broader relationship between IPV and women's workforce participation in a population-based sample of 6,698 California women. We examined past-year IPV by analyzing specific effects of physical violence, psychological violence, and posttraumatic stress disorder (PTSD) symptoms as predictors of unemployment. Results indicated substantial rates of unemployment among women who reported IPV, with rates of 20% among women who experienced psychological violence, 18% among women who experienced physical violence, and 19% among women with PTSD symptoms. When the relationship was adjusted for demographic characteristics and educational attainment, PTSD (adjusted odds ratio [AOR] = 1.60; 95% confidence interval [CI] = 1.22, 2.09) and psychological violence (AOR = 1.78; 95% CI = 1.36, 2.32), but not physical violence, were associated with unemployment. Implications for supported employment programs and workplace responses to IPV are discussed.
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PMID:Unemployment among women: examining the relationship of physical and psychological intimate partner violence and posttraumatic stress disorder. 1845 53

The proportion of women in militaries is growing; however, many studies in the area of military mental health have been conducted with majority male samples. The present study examined sex differences in trauma exposure, work stress, and mental disorders in the Canadian Community Health Survey - Canadian Forces Supplement, a representative sample of 5155 regular force personnel and 3286 reservists ages 16-54. Past-year DSM-IV mental disorders (depression, generalized anxiety disorder, panic disorder, social phobia, PTSD, and alcohol dependence), lifetime exposure to 28 traumatic events, and work stress were assessed. Regular and reserve female personnel were less likely than males to experience deployment-related traumas, accidents, and several events involving violence (adjusted odds ratio [AOR] range 0.10-0.62). Women were more likely to endorse sexual trauma, partner abuse, and being stalked (AOR range 3.60-13.63). For work stress, regular force women reported higher levels of job demand and stress around social support than men, whereas regular and reserve force women reported less physical exertion. After adjusting for a range of covariates, regular female personnel were more likely than males to have PTSD (AOR 1.88, 99% CI 1.01-3.50), while reservist women were more likely than men to have depression, panic disorder, and any mood or anxiety disorder (AOR range 1.87-6.98). Both regular and reservist women had lower rates of alcohol dependence (AOR range 0.30-0.34). Clinicians working with female personnel should screen for trauma/stressors and mental disorders that are particularly common in this population.
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PMID:Stress and mental disorders in female military personnel: comparisons between the sexes in a male dominated profession. 2202 87

Trauma and posttraumatic stress disorder disproportionally affect HIV-positive women. Studies increasingly demonstrate that both conditions may predict poor HIV-related health outcomes and transmission-risk behaviors. This study analyzed data from a prevention-with-positives program to understand if socio-economic, behavioral, and health-related factors are associated with antiretroviral failure and HIV transmission-risk behaviors among 113 HIV-positive biological and transgender women. An affirmative answer to a simple screening question for recent trauma was significantly associated with both outcomes. Compared to participants without recent trauma, participants reporting recent trauma had over four-times the odds of antiretroviral failure (AOR 4.3; 95% CI 1.1-16.6; p = 0.04), and over three-times the odds of reporting sex with an HIV-negative or unknown serostatus partner (AOR 3.9; 95% CI 1.3-11.9; p = 0.02) and <100% condom use with these partners (AOR 4.5; 95% CI 1.5-13.3; p = 0.007). Screening for recent trauma in HIV-positive biological and transgender women identifies patients at high risk for poor health outcomes and HIV transmission-risk behavior.
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PMID:Recent trauma is associated with antiretroviral failure and HIV transmission risk behavior among HIV-positive women and female-identified transgenders. 2242 97

We examined the relationship between posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and human immunodeficiency virus (HIV) risk behavior among the Ohio Army National Guard (OHARNG). We analyzed data collected from a sample of OHARNG enlisted between June 2008 and February 2009. Participants completed interviews assessing HIV risk activities defined by the Behavioral Risk Factor Surveillance System, and were screened for PTSD and MDD based on DSM-IV criteria according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV; American Psychiatric Association, 1994). Logistic regression was used to examine the independent and combined effects of PTSD and MDD on past-year HIV risk behavior. Of 2,259 participants, 142 (6.3%) reported at least 1 past-year HIV risk behavior. In adjusted models, relative to soldiers with neither disorder, screening positive for MDD only was associated with HIV risk behavior (adjusted odds ratio [AOR] = 2.33, 95% CI = [1.15, 4.71]), whereas PTSD was not significant (AOR = 1.60, 95% CI = [0.80, 3.20]). Participants with both PTSD and depression were most likely to report HIV risk behavior (AOR = 2.75, 95% CI = [1.06, 7.11]). Soldiers with PTSD and MDD may be at greater risk for HIV infection due to increased engagement in HIV risk behavior. Integrated interventions to address mental health problems and reduce HIV risk behavior are in need of development and evaluation.
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PMID:Posttraumatic stress disorder, depression, and HIV risk behavior among Ohio Army National Guard Soldiers. 2341 76

The authors sought to determine the prevalence and risk factors for major depressive disorder and posttraumatic stress disorder (PTSD) among survivors living in temporary accommodation in the Yongxing settlement in Mianyang city 1 year after the Sichuan earthquake for further interventions. They interviewed 182 residents, using the Structured Clinical Interview for DSM-IV Axis I Disorders and a self-report questionnaire. The 12-month prevalence of depressive disorder and PTSD were 48.9% and 39.6%, respectively. Multivariate analysis indicated that bereaved survivors were 5.51 times (adjusted odds ratio [AOR] = 5.51; 95% confidence interval [CI] =2.14-14.22) more likely to report PTSD and 2.42 times (AOR = 2.42; 95%CI =1.00-5.48) more likely to report depressive disorder than nonbereaved survivors. Older age and receipt of government financial support were significantly associated with 12-month PTSD. Depressive disorder 12 months after the earthquake was associated with receipt of government financial support, pre-earthquake physical illness, single marital status, being currently employed, and Han ethnicity.
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PMID:Depression and posttraumatic stress disorder in temporary settlement residents 1 year after the Sichuan earthquake. 2366 29

This study assessed the prevalence and interrelationships of posttraumatic stress disorder (PTSD), antecedent trauma, and psychosocial risk factors among pregnant women served at three urban Federally Qualified Health Care Centers. This analysis was part of a validation study of the prenatal risk overview, a structured psychosocial risk screening interview. The study sample included 745 prenatal patients at three clinics who also were administered the major depression, PTSD, alcohol, and drug use modules of the Structured Clinical Interview for DSM-IV (SCID). Most participants were women of color (89.1%), under the age of 25 years (67.8%), and unmarried (86.2%). The rate for a current PTSD diagnosis was 6.6% and for subthreshold PTSD 4.2%. More than half (54%) of participants reported a trauma that met PTSD criteria; 21% reported being a victim of or witness to violence or abuse, including 78 % of women with PTSD. Compared to those without PTSD, those with PTSD were 4 times more likely to be at risk for housing instability (AOR 4.15; 95% CI 1.76, 9.80) and depression (AOR3.91; 95% CI 2.05, 7.47) and 2 times as likely to be at risk for a drug use disorder (AOR 1.96, 95% CI 1.04, 3.71) and involvement with child protective services (AOR 2.27; 95% CI 1.06, 4.89). Women age 25 or older were twice as likely to meet PTSD diagnostic criteria as younger women (AOR2.27; 95%CI 1.21, 4.28). Trauma exposure and pervasive PTSD were common in this population. Systematic psychosocial risk screening may identify the population with PTSD even without questions specific to this disorder.
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PMID:Posttraumatic stress disorder among women receiving prenatal care at three federally qualified health care centers. 2391 14

Many U.S. military women are exposed to unwanted sexual contact during military service, which can have important implications for mental health. Using data from the 2008 Department of Defense Survey of Health Related Behaviors, we employed multiple logistic regression methods to examine whether unwanted sexual contact was associated with stress, screening positive for mental disorders, or substance use, among active duty service women. The sample included 7,415 female military personnel, of whom 13.4% reported unwanted sexual contact (including any touching of genitals) since entering the military. After adjusting for potentially confounding variables, factors independently associated with unwanted sexual contact included military-related stress (adjusted odds ratio [AOR] = 2.44), family/personal life-related stress (AOR = 1.78), and gender-related stress (AOR = 1.98) in the past 12 months. In addition, screening positive for depression, anxiety, posttraumatic stress disorder, or psychological distress, and suicidal ideation or attempt were associated with unwanted sexual contact (AOR = 1.57-2.11). For drug/alcohol use, only misuse of tranquilizers/muscle relaxers (past 12 months) was associated with report of unwanted sexual contact (AOR = 1.35). Given the prevalence of unwanted sexual contact and corresponding adverse health outcomes in this sample of active duty women, strategies to create military structural/cultural changes and reduce gender-related stress and sexism are needed.
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PMID:Mental Health and Substance Use Factors Associated With Unwanted Sexual Contact Among U.S. Active Duty Service Women. 2597 35

Associations between posttraumatic stress disorder (PTSD) and perpetration of intimate partner violence (IPV) have not been extensively studied in nonveteran samples. Secondary analysis was conducted using a nationally representative U.S. sample and limited to those who reported being in a relationship in the past year (N = 25,652). This sample was mostly White (72.0%), the majority had completed high school/ general educational development (GED; 87.8%), about half were female (49.2%), and the mean age was 46.44 years (SD = 15.92). We hypothesized that a diagnosis of PTSD in the past year would be associated with greater perpetration of IPV and that the arousal/reactivity and intrusion symptom clusters would evidence the strongest associations with IPV. Consistent with expectations, a PTSD diagnosis in the past year was associated with greater perpetration of IPV, OR = 2.07, 95% CI [1.89, 2.26]. Among those with a PTSD diagnosis in the past year (n = 1,742), arousal/reactivity symptom cluster scores were associated with greater perpetration of IPV for both men and women, AOR = 1.27, 95% CI [1.11, 1.44]; intrusion symptom cluster scores were associated with perpetration of IPV for men only, AOR = 1.56, 95% CI [1.20, 2.04]; whereas negative cognitions/mood symptom cluster scores were only significant among women, AOR = 1.12, 95% CI [1.01, 1.24]. Results suggested that theoretical and empirical work linking PTSD and perpetration of IPV in military samples extends to the general population.
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PMID:Posttraumatic Stress Disorder Symptom Clusters and Perpetration of Intimate Partner Violence: Findings From a U.S. Nationally Representative Sample. 2646 29

Posttraumatic stress disorder (PTSD) has symptoms that exist along a spectrum that includes depression and the 2 disorders may coexist. Collaborative care management (CCM) has been successfully used in outpatient mental health management (especially depression and anxiety) with favorable outcomes. Despite this, there exist limited data on clinical impact of a diagnosis of PTSD on depression outcomes in CCM. The present study used a retrospective cohort design to examine the association of PTSD with depression outcomes among 2121 adult patients involved in CCM in a primary care setting. Using standardized self-report measures, baseline depression scores and 6-month outcome scores were evaluated. Seventy-six patients had a diagnosis of PTSD documented in their electronic medical record. Patients with PTSD reported more severe depressive symptoms at baseline (Patient Health Questionnaire-9 score of 17.9 vs 15.4, P < .001) than those without PTSD. Controlling for sociodemographic and clinical characteristics, a clinical diagnosis of PTSD was associated with lower odds (AOR = 0.457, CI = 0.274-0.760, P = .003) of remission at 6 months and was also associated with higher odds (AOR = 3.112, CI = 1.921-5.041, P < .001) of persistent depressive symptoms at 6 months after CCM. When coexisting with depression, a diagnosis of PTSD was associated with worse depression outcomes, when managed with CCM in primary care. Opportunities still exist for more aggressive management of depression in these patients to help improve remission as well as reduce persistent depressive symptoms.
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PMID:The Impact of Posttraumatic Stress Disorder on the 6-Month Outcomes in Collaborative Care Management for Depression. 2699 60

Although absolute counts of U.S. service men who experience sexual trauma are comparable to service women, little is known about the impact of sexual trauma on men. The association of recent sexual trauma (last 3 years) with health and occupational outcomes was investigated using longitudinal data (2004-2013) from the Millennium Cohort Study. Of 37,711 service men, 391 (1.0%) reported recent sexual harassment and 76 (0.2%) sexual assault. In multivariable models, sexual harassment or assault, respectively, was associated with poorer mental health: AOR = 1.60, 95% CI [1.22, 2.12], AOR = 4.39, 95% CI [2.40, 8.05]; posttraumatic stress disorder: AOR = 2.50, 95% CI [1.87, 3.33], AOR = 6.63, 95% CI [3.65, 12.06]; depression: AOR = 2.37, 95% CI [1.69, 3.33], AOR = 5.60, 95% CI [2.83, 11.09]; and multiple physical symptoms: AOR = 2.22, 95% CI [1.69, 2.92]; AOR = 3.57, 95% CI [1.98, 6.42], after adjustment for relevant covariates. Sexual harassment was also associated with poorer physical health: AOR = 1.68, 95% CI [1.27, 2.22]. Men who reported sexual trauma were more likely to have left military service: AOR = 1.60, 95% CI [1.14, 2.24], and be disabled/unemployed postservice: AOR = 1.76, 95% CI [1.02, 3.02]. Results suggest that sexual trauma was significantly associated with adverse health and functionality extending to postmilitary life. Findings support the need for developing better prevention strategies and services to reduce the burden of sexual trauma on service men.
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PMID:Sexual Trauma and Adverse Health and Occupational Outcomes Among Men Serving in the U.S. Military. 2707 93


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