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Women and war

What physicians should know

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Abstract

Most of today’s 1.7 million women veterans obtain all or most of their medical care outside the VA health care system, where their veteran status is rarely recognized or acknowledged. Several aspects of women’s military service have been associated with adverse psychologic and physical outcomes, and failure to assess women’s veteran status, their deployment status, and military trauma history could delay identifying or treating such conditions. Yet few clinicians know of women’s military history—or of military service’s impact on women’s subsequent health and well being. Because an individual’s military service may be best understood within the historical context in which it occurred, we provide a focused historical overview of women’s military contributions and their steady integration into the Armed Forces since the War for Independence. We then describe some of the medical and psychiatric conditions associated with military service.

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References

  1. CiviWarTalk.com. Women in the Civil War: Annie Etheridge Hooks. Women in the Civil War. 1999. Available at: http://civilwartalk.com/cwt_alt/resources/women/a_hooks.htm. Accessed October 17, 2005.

  2. Skelton WI, Skelton N. Women as prisoners of war. Mil Med. 1995;160:558–60.

    PubMed  Google Scholar 

  3. Skelton WP, III. The American Ex-Prisoner of War. 12th edn. Tampa, FL: James A. Haley Veterans Hospital; 1999.

    Google Scholar 

  4. Wilson B. Women Prisoners of War, 1996. Available at: http://userpages.aug.com/captbarb/prisoners.html. Accessed November 28, 2004.

  5. Wilson B. Women Were There: the Wars of 1812 and 1846 and the Spanish American War, 1996. Available at: http://userpages.aug.com/captbarb/femvets3.html. Accessed June 17, 2004.

  6. Bellafaire J. America’s Military Women—the Journey Continues: Women in Military Service for America Memorial Foundation Inc. Available at: http://womensmemorial.org/Education/WHM982.html#6. Accessed June 17, 2005.

  7. Christides M. The History of a Hello Girl: Trenches on the Web/Great War Society. Available at: http://www.worldwarl.com/dbc/hello.htm. Accessed June 17, 2005.

  8. Holm J. Women in the Military: an Unfinished Revolution. 1st edn. Novato, CA: Presidio Press; 1982.

    Google Scholar 

  9. Sheldon K. Brief History of Black Women in the Military: Women in Military Service for America Memorial Foundation. Available at: http://www.womensmemorial.org/Education/BBH1998.html#Top%20of%20-Page. Accessed November 28, 2004.

  10. Gendergap.com. World War II (1941–1945): nurses, 1998. Available at: http://www.gendergap.com/military/usmil6.htm. Accessed October 17, 2005.

  11. Kang H, Bullman T, MacFarlane G, Gray G. Mortality among US and UK veterans of the Persian Gulf War: a review. Occup Environ Med. 2002;59:794–9.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Carney C, Sampson T, Voelker MD, Woolson RF, Thorne P, Doebbeling B. Women in the Gulf War: combat experience, exposures, and subsequent health care use. Mil Med. 2003;168:654–61.

    PubMed  Google Scholar 

  13. Cornum R. She Went to War. Novato, CA: Presidio Press; 1993.

    Google Scholar 

  14. Women’s Research and Education Institute. Chronology of significant legal and policy changes affecting women in the military: 1947–2003: Women’s Research and Education Institute, 2003. Available at: http://www.wrei.org/projects/wiu/wim/wim_chron01.pdf. Accessed December 27, 2004.

  15. White J. Army to issue combat badge for soldiers not in infantry. Washington Post. Washington, DC. 2005: A23.

  16. Bellafaire J. Native American Women Veterans: Women in Military Service For America Memorial Foundation Inc. Available at: http://womensmemorial.org/Education/NAHM.html. Accessed November 28, 2004.

  17. Lewis V. Side-By-Side: a Photographic History of American Women in War. New York: Stewart, Tabori, & Chang; 1999.

    Google Scholar 

  18. Wilson B. Women Were There: the Civil War, 1996. Available at: http://userpages.aug.com/captbarb/femvets2.html. Accessed October 18, 2005.

  19. Blanton D. Cathay Williams: black woman soldier, 1866–1868. Minerva 1992:1–12. National Archives Record Groups 15:94.

    Google Scholar 

  20. Graf M. A Woman of Honor: Dr. Mary E. Walker and the Civil War. Gettysburg, PA: Thomas Publications; 2001.

    Google Scholar 

  21. Bacon G, Howland E, Hoisington D. My Heart Toward Home: Letters of a Family During the Civil War. 2000.

  22. Russell M. Jungle Angel: Bataan Remembered. Brainerd, MN: Bang Printing Co.; 1988.

    Google Scholar 

  23. Norman E. We Band of Angels: the Untold Story of American Nurses Trapped on Bataan by the Japanese. New York: Random House; 1992.

    Google Scholar 

  24. Wilson B. Women Were There: World War II, 1996. Available at: http://userpages.aug.com/captbarb/femvets5.html. Accessed October 17, 2005.

  25. Office of the Assistant Secretary of Defense (Force Management Policy). Table D-19. Female Active Component Enlisted Members by service with civilian Comparison Group, FYs 1964, 1970–2000, 2001.

  26. Harrell M, Miller L. New opportunities for military women: effects upon readiness, cohesion, and morale: RAND, MR-896-OSD, 1997.

  27. Scarborough R. Female Soldiers Eyed for Combat. Washington, DC: The Washington Times; 2004. Available at: http://www.washtimes.com/national/20041022-120846-1796r.htm. Accessed October 17, 2005.

  28. Miller L. Not Just weapons of the weak: gender harassment as a form of protest for Army men. Soc Psychol Quart. 1997;60:32–51.

    Article  Google Scholar 

  29. Frayne SM, Skinner KM, Sullivan LM, et al. Medical profile of women veterans administration outpatients who report a history of sexual assault occurring while in the military. J Womens Health Gend Based Med. 1999;8:835–45.

    Article  CAS  PubMed  Google Scholar 

  30. Sadler A, Booth B, Cook B, Torner J, Doebbeling B. The military environment: risk factors for women’s non-fatal assaults. J Occup Environ Med. 2001;43:325–34.

    Article  CAS  PubMed  Google Scholar 

  31. Sadler A, Booth B, Cook B, Doebbeling B. Factors associated with women’s risk of rape in the military environment. Am J Indust Med. 2003;43:262–73.

    Article  Google Scholar 

  32. Martin L, Rosen L, Durand D, Stretch R, Knudson K. Prevalence and timing of sexual assaults in a sample of male and female US Army soldiers. Mil Med. 1998;163:213–6.

    CAS  PubMed  Google Scholar 

  33. Bastian L, Lancaster A, Reyst H. Department of Defense 1995 Sexual Harassment Survey (Report No. 96-014). Arlington, VA: Defense Manpower Data Center; 1996.

    Google Scholar 

  34. Rosen L, Martin L. Childhood maltreatment history as a risk factor for sexual harassment among US Army soldiers. Violence Vict. 1998;13:269–86.

    CAS  PubMed  Google Scholar 

  35. Murdoch M, Polusny M, Hodges J, Cowper D. The association between in-service sexual harassment and posttraumatic stress disorder among compensation-seeking veterans. Mil Med, in press.

  36. Pryor J, Whalen N. A typology of sexual harassment: characteristics of harassers and the social circumstances under which sexual harassment occurs. In: O’Donohue W, ed. Sexual Harassment: Theory, Research, and Treatment. Needham Heights, MA: Allyn & Bacon; 1995.

    Google Scholar 

  37. De Vise D. Defense department surveys academy sex assaults. Washington Post. Washington, DC. 2005: A01.

  38. Fontana A, Schwartz L, Rosenheck R. Posttraumatic stress disorder among female Vietnam veterans: a causal model of etiology. Am J Public Health. 1997;87:169–75.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  39. Louis Harris and Associates. Survey of Female Veterans: A Study of the Needs, Attitudes, and Experiences of Women Veterans. Washington, DC: Veterans Administration; 1985.

    Google Scholar 

  40. Thomas T, Kang H, Dalager N. Mortality among women Vietnam veterans, 1973–1987. Am J Epidemiol. 1991;134:973–80.

    CAS  PubMed  Google Scholar 

  41. Dalager N, Kang H, Thomas T. Cancer mortality patterns among women who served in the military: the Vietnam experience. J Occup Environ Med. 1995;37:298–305.

    Article  CAS  PubMed  Google Scholar 

  42. Kang H, Bullman T. Mortality among U.S. Veterans of the Persian Gulf War. N Engl J Med. 1996;335:1498–504.

    Article  CAS  PubMed  Google Scholar 

  43. Stern A, Wolfe J, Daley J, Zaslavsky A, Folsom Roper S, Wilson K. Changing demographic characteristics of women veterans: results from a national sample. Mil Med. 2000;165:773–80.

    CAS  PubMed  Google Scholar 

  44. Davidson J, Hughes D, George L, Blazer D. The association of sexual assault and attempted suicide within the community. Arch Gen Psychiatry. 1996;53:550–5.

    Article  CAS  PubMed  Google Scholar 

  45. Kessler R, Sonnega A, Bromet E, Hughes M, Nelson C. Posttraumatic stress disorder in the National Comorbidity Survey. Arch Gen Psychiatry. 1995;52:1048–60.

    Article  CAS  PubMed  Google Scholar 

  46. Norris F. Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. J Consult Clin Psychol. 1992;60:409–18.

    Article  CAS  PubMed  Google Scholar 

  47. Baker D, Boat B, Grinvalsky H, Geracioti TJ. Interpersonal trauma and animal-related experiences in female and male military veterans: implications for program development. Mil Med. 1998;163:20–5.

    CAS  PubMed  Google Scholar 

  48. Wolfe J, Sharkansky E, Read J, Dawson R, Martin J, Ouimette P. Sexual harassment and assault as predictors of PTSD symptomatology among US female Persian Gulf War military personnel. J Interpers Violence. 1998;13:40–57.

    Article  Google Scholar 

  49. Fontana A, Litz B, Rosenheck R. Impact of combat and sexual harassment on the severity of posttraumatic stress disorder among men and women peacekeepers in Somalia. J Nerv Ment Dis. 2000;188:163–9.

    Article  CAS  PubMed  Google Scholar 

  50. Fontana A, Rosenheck R. Duty-related and sexual stress in the etiology of PTSD among women veterans who seek treatment. Psychiatric Serv. 1998;49:658–62.

    CAS  Google Scholar 

  51. Burnam M, Stein J, Golding J, et al. Sexual assault and mental disorders in a community population. J Consult Clin Psychol. 1988;56:843–50.

    Article  CAS  PubMed  Google Scholar 

  52. Hankin C, Skinner K, Sullivan L, Miller D, Frayne S, Tripp T. Prevalence of depressive and alcohol abuse symptoms among women VA outpatients who report experiencing sexual assault while in the military. J Trauma Stress. 1999;12:601–14.

    Article  CAS  PubMed  Google Scholar 

  53. Schwartz I. Sexual violence against women: prevalence, consequences, societal factors, and prevention. Am J Prev Med. 1991;7:363–7.

    CAS  PubMed  Google Scholar 

  54. Becker J, Skinner L, Abel G, Cichon J. Level of postassault sexual functioning in rape and incest victims. Arch Sex Behav. 1986;15:37–49.

    Article  CAS  PubMed  Google Scholar 

  55. Norris J, Feldman-Summers S. Factors related to the psychological impacts of rape on the victim. J Abnorm Psychol. 1986;90:562–7.

    Article  Google Scholar 

  56. Letourneau E, Resnick H, Kilpatrick D, Saunders B, Best C. Comorbidity of sexual problems and posttraumatic stress disorder in female crime victims. Behav Therapy. 1996;27:321–36.

    Article  Google Scholar 

  57. van Berlo W, Ensink B. Problems with sexuality after sexual assault. Ann Rev Sex Res. 2000;11:235–57.

    Google Scholar 

  58. Sadler A, Booth B, Nielson D, Doebbeling B. Health-related consequences of physical and sexual violence: women in the military. Obstet Gynecol. 2000;96:473–80.

    Article  CAS  PubMed  Google Scholar 

  59. Murdoch M, Nichol K. Women veterans experiences with domestic violence and with sexual harassment while they were in the military. Arch Fam Med. 1995;4:411–8.

    Article  CAS  PubMed  Google Scholar 

  60. Stein M, Barrett-Connor E. Sexual assault and physical health: findings from a population-based study of older adults. Psychosom Med. 2000;62:838–43.

    Article  CAS  PubMed  Google Scholar 

  61. Dienstfrey S. Women veterans’ exposure to combat. Armed Forces Soc. 1988;14:549–58.

    Article  Google Scholar 

  62. Wolfe J, Brown P, Kelley J. Reassessing war stress: exposure and the Persian Gulf War. J Soc Issues. 1993;49:15–31.

    Article  Google Scholar 

  63. Unwin C, Hotopf M, Hull L, Ismail K, David A, Wessely S. Women in the Persian Gulf: lack of gender differences in long-term health effects of service in United Kingdom Armed Forces in the 1991 Persian Gulf War. Mil Med. 2002;167:406–13.

    PubMed  Google Scholar 

  64. Davidson JRT, Kudler H, Saunders W, Smith R. Symptom and comorbidity patterns in World War II and Vietnam veterans with posttraumatic stress disorder. Compr Psychiatr. 1990;31:162–70.

    Article  CAS  Google Scholar 

  65. Wolfe J, Schnurr P, Brown P, Furey J. Posttraumatic stress disorder and war-zone exposure as correlates of perceived health in female Vietnam War veterans. J Consult Clin Psychol. 1994;62:1235–40.

    Article  CAS  PubMed  Google Scholar 

  66. Elder G, Shanahan M, Clipp E. Linking combat and physical health: the legacy of World War II in men’s lives. Am J Psychiatry. 1997;154:330–6.

    PubMed  Google Scholar 

  67. Hyer L, Stanger E, Boudewyns P. The interaction of posttraumatic stress disorder and depression among older combat veterans. J Clin Psychol. 1999;55:1073–8.

    Article  CAS  PubMed  Google Scholar 

  68. Bollinger A, Riggs D, Blake D, Ruzek J. Prevalence of personality disorders among combat veterans with posttraumatic stress disorder. J Trauma Stress. 2000;13:255–70.

    Article  CAS  PubMed  Google Scholar 

  69. Wagner A, Wolfe J, Rotnitsky A, Proctor S, Erickson D. An investigation of the impact of posttraumatic stress disorder on physical health. J Trauma Stress. 2000;13:41–55.

    Article  CAS  PubMed  Google Scholar 

  70. Erickson D, Wolfe J, King D, King L, Sharkansky E. Posttraumatic stress disorder and depression symptomatology in a sample of Gulf War veterans: a prospective analysis. J Consult Clin Psychol. 2001;69:41–9.

    Article  CAS  PubMed  Google Scholar 

  71. Dlugosz L, Hocter W, Kaiser K, et al. Risk factors for mental disorder hospitalization after the Persian Gulf War: U.S. Armed Forces, June 1, 1991–September 30, 1993. J Clin Epidemiol. 1999;52:1267–78.

    Article  CAS  PubMed  Google Scholar 

  72. Kulka R, Schlenger W, Fairbank J, et al. Contractual Report of Findings from the National Vietnam Veterans Readjustment Study, Vol II: Tables of Findings. Research Triangle Park, NC: Research Triangle Institute; 1988.

    Google Scholar 

  73. Kulka R, Schlenger W, Fairbank J, et al. Contractual Report of Findings from the National Vietnam Veterans Readjustment Study, Vol. 1: Executive Summary, Description of Findings, and Technical Appendices. Research Triangle Park, NC: Research Triangle Institute; 1988.

    Google Scholar 

  74. Perconte S, Wilson A, Pontius E, Dietrick A, Spiro K. Psychological and war stress symptoms among deployed and nondeployed reservists following the Persian Gulf War. Mil Med. 1993;158:516–21.

    CAS  PubMed  Google Scholar 

  75. Kang H, Natelson B, Mahan C, Lee K, Murphy F. Post-traumatic stress disorder and chronic fatigue syndrome-like illness among Gulf War veterans: a population-based survey of 30,000 veterans. Am J Epidemiol. 2003;157:141–8.

    Article  PubMed  Google Scholar 

  76. Gray G, Reed R, Kaiser K, Smith T, Gastanaga V. Self-reported symptoms and medical conditions among 11,868 Gulf War-era veterans: the Seabee Health Study. Am J Epidemiol. 2002;155:1033–44.

    Article  PubMed  Google Scholar 

  77. Pierce P. Physical and emotional health of Gulf War veteran women. Aviat Space Environ Med. 1997;68:317–21.

    CAS  PubMed  Google Scholar 

  78. Cowan D, Lange J, Heller J, Kirkpatrick J, De Bakey S. A case-control study of asthma among US Army Gulf War veterans and modeled exposure to oil well fire smoke. Mil Med. 2002;167:777–82.

    PubMed  Google Scholar 

  79. Horner R, Kamins K, Feussner J, et al. Occurrence of amyotrophic lateral sclerosis among Gulf War veterans. Neurology. 2003;61:742–9.

    Article  CAS  PubMed  Google Scholar 

  80. Murdoch M, Bradley A. Sexual trauma in the military workplace. In: Liebschutz J, Frayne S, Saxe G, eds. Violence Against Women: A Physician’s Guide to Identification and Management. Philadelphia, PA: American College of Physicians; 2003:283–90.

    Google Scholar 

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Correspondence to Maureen Murdoch MD, MPH.

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Disclaimer: The views presented in this paper are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

There are no conflicts of interest to declare.

Dr. Murdoch is a core investigator for the Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center. Dr. Bradley is Director of Women’s Health at the VA Roseburg Healthcare System and Chair of the VISN 20 Women Veterans Health Advisory Committee. Ms. Turner is the Director of the Women Veterans Health Program, Veterans Health Administration. Dr. Mather is the former Chief Public Health & Environmental Hazards Officer, Office of Public Health and Environmental Hazards, Veterans Health Administration. Dr. Klein is a statistician in VA’s Office of the Actuary. Dr. Yano is Deputy Director and Senior Social Scientist for the Center for the Study of Healthcare Provider Behavior. The Center for Chronic Disease Outcomes Research and The Center for the Study of Healthcare Provider Behavior are VA Health Services Research and Development (HSR&D) Service Centers of Excellence.

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Murdoch, M., Bradley, A., Mather, S.H. et al. Women and war. J GEN INTERN MED 21 (Suppl 3), S5–S10 (2006). https://doi.org/10.1111/j.1525-1497.2006.00368.x

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