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Prevalence of Post Traumatic

Stress Disorder in the Women


Veteran Population
Jennifer H. Stokes
Liberty University
Learning Outcomes
After reviewing this presentation, the reader
will be able to:
1. Describe characteristics of PTSD in women
veterans.
2. Identify barriers to care in this population.
3. Evaluate all aspects of care that must be
considered in caring for patients with PTSD.
4. Develop ways to apply current evidenced based
practice guidelines in their current area of practice.
Women Veterans
Women veterans (WV) have been identified as a
special population within the Department of Veteran
Affairs Healthcare System (VHA).
WV are one of the fastest growing groups of new
users in the VHA, with particularly high rates of
utilization among veterans of Operation Enduring
Freedom (OEF) and Operation Iraqi Freedom (OIF).
According to the National Center for Veteran
Analysis and Statistics (NCVAS), in 2010, the
number of WV was 2,204,790. In 2013, this
number increased to 2,271,222.
Women Veterans cont.
According to Bean-Mayberry et al. (2011), Women
are one of the fastest growing groups of new users
in the Department of Veterans Affairs (VA)
Healthcare System, with particularly high rates of
utilization among veterans of Operation Enduring
Freedom (OEF) and Operation Iraqi Freedom
(OIF), (p. 86).
WV and Post Traumatic Stress Disorder
In FY 2009 and FY 2010 PTSD, hypertension, and
depression were the top three diagnostic categories
for women Veterans treated by VHA.
Female veterans with PTSD have complex mental
health profiles.
PTSD can occur following the experience or
witnessing of a life-threatening events such as
military combat, natural disasters, terrorist
incidents, serious accidents, or physical or sexual
assault in adult or childhood.
Why so Important?
Within the Primary Care (PC) setting, providers are
more likely to identify at risk patients.
Studies have shown that co-morbid conditions can
be directly linked to the diagnoses of PTSD. For
example, WV identified to have chronic
gynecological problems may have undiagnosed
PTSD.
According to Cohen et al. (2013), there is a trend
of increasing prevalence of disease outcomes in
women with PTSD, depression, and comorbid
PTSD and depression, (p. 469).
Barriers to Care
Due to the specialty nature of womens health, WV
may be reluctant to engage services for the
treatment of PTSD.
Seeking care for the symptoms felt by those
suffering from PTSD can be seen as a weakness.
In the WV population, the fight for equality can deter
their willingness to admit to any coping deficits.
WV may not feel comfortable seeing care within the
VA system as it provides a constant reminder of
their military roots.
Care Considerations
Cultural and spiritual characteristics of patients are
essential to providing holistic care.
Tran, Kuhn, Walser, & Drescher (2012) in their
study found, A more negative concept of God was
associated with higher severity of PTSD and
depressive symptoms, whereas, a more positive
concept of God was associated with lower severity
of depressive symptoms and was not significantly
associated with PTSD symptoms, (p. 313).
Incorporating a patients spiritual well-being is
essential to successful outcomes.
Care Considerations
Social well-being should also be a key focus in
treating WV diagnosed with PTSD.
A sense of belonging or not belonging can be a
significant barrier to positive treatment outcomes.
The social stigmas that surround patients
diagnosed with PTSD can cause patients to be
noncompliant with treatment regiments.
Lehavot, Der-Martirosian, Shipherd, Simpson, &
Washington (2013) found, Screening positive for
PTSD was associated with poorer health and
increased VHA utilization whereas greater military
social support was associated with better health
and less frequent VHA utilization, (p. 774).
Cultural Considerations
The care delivered to a patient is only as good as
its applicability. Plans of care must be formulated
to the patient and their specific needs and goals.
Understanding the culture in which the patient lives
and breaths is as important as their living and
breathing.
Campinha-Bacote (2011) stated, At the core of
both patient centeredness and cultural competence
is the importance of seeing the patient as a unique
person, (para. 1).
Skills in cultural competence are as essential and
performing basic life support.
Trends in Treatment
Cognitive behavioral therapy has been identified as
successful in the treatment of PTSD in WV.
Group therapy allows for the WV to feel that she is
not alone and there are others like her. This allows
for effective sharing of her current health state.
Patients diagnosed with PTSD will need both
pharmacological and non-pharmacological
treatment to provide for the best possible outcomes.
Healthcare providers must foster therapeutic
relationships that will allow for open communication
with patients and their families
Education for patients and families is key to positive
outcomes.
Thoughts for Improvement
Incorporating a multidisciplinary approach in the
treatment of any disease has been found to be
beneficial towards patient outcomes. For example,
a shared medical appointment that incorporates
group therapy, nursing, and a pharmacists. This
would allow patients to have all needs met at this
one appointment.
Healthcare providers must ensure that all avenues
of care are incorporated in the treatment plan. This
includes cultural and spiritual.
This plan must also include the patient and any
support systems they may have at their disposal.
Patient buy-in is imperative to compliance with any
established treatment regiment.
References
Bean-Mayberry, B., Yano, E. M., Washington , D. L., Golzweig, C., Bautman, F., Huang, C., , & Shekelle,
P. G. (2011). Systematic review of women veterans health: update on successes and
gaps. Womens Health Issues, 21(4), 84-97. Retrieved from
http://dx.doi.org/10.1016/j.whi.2011.04.022
Bomyea, J., & Lang, A. J. (2012). Emerging interventions for PTSD: Future directions for clinical care and
research. Neuropharmacology, 62(2), 607-616. Retrieved from
http://dx.doi.org/10.1016/j.neuropharm.2011.05.028
Bonner, L. M., Lanto, A. B., Bolkan, C., Watson, G. S., Campbell, D. G., Chaney, E. F., , Rubenstein, L. V.
(2013). Help-seeking from clergy and spiritual counselors among veterans with depression
and PTSD in primary care. Journal of Religion and Health, 52(3), 707-718. Retrieved from
http://link.springer.com.ezproxy.liberty.edu:2048/article/10.1007%2Fs10943-012-9671-0
Campinha-Bacote, J. (2011). Delivering patient-centered care in the midst of a cultural conflict: the role of
cultural competence. Online Journal of Issues in Nursing, 16(2), 5.
DOI: 10.3912/OJIN.Vol16No02Man05
References
Lehvaot, K., Der-Martirosian, C., Simpson, T, L., Shipher, J. C., & Washington, D. L. (2013). The role of
military social support in understanding the relationship between PTSD, physical health, and
healthcare utilization in women veterans. Journal of Traumatic Stress, 26(6), 772-775. DOI:
10.1002/jts.21859
Mohr, S. (2011). Integration of spirituality and religion in the care of patients with severe mental disorders.
Religions, 2(1), 549-565. doi:10.3390/rel2040549
Tran, C. T., Kuhn, E., Walser, R. D., & Drescher, K. D. (2013). The relationship between religiosity, PTSD,
and depressive symptoms in veterans in PTSD residential treatment . The Journal of
Psychology and Theology, 40(4), 313. Retrieved from
http://go.galegroup.com.ezproxy.liberty.edu:2048/ps/i.do?action=interpret&id=GALE%7CA3145
65111&v=2.1&u=vic_liberty&it=r&p=AONE&sw=w&authCount=1
US Department of Veterans Affairs (2014). Facts and statistics about women veterans. Retrieved from
http://www.womenshealth.va.gov/WOMENSHEALTH/latestinformation/facts.asp#sthash.JBIaMI
Nr.dpuf

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